Medizin, Gesellschaft, und Geschichte : Jahrbuch des Instituts fur Geschichte der Medizin der Robert Bosch Stiftung最新文献

In 1894 Gottlieb Hägi, a former guard at the mental institution Burghölzli in Zurich, published a brochure in which he heavily critizised the conditions in the asylum, its management, the board of supervision and the responsible authorities. This report attracted great public notice and led to an extended investigation. With the example of the "case Hägi", the present work analyzes the position of critics and defendors of mental institutions and studies the roles played by the government and the authorities in this area of conflict. Beyond this particular debate, the reaction of government and authorities at critics of the psychiatry of mental institutions after the "case Hägi" is investigated by an analysis of the complaints procedures against the psychiatric institutions of the canton Zurich which were initiated between 1870 and 1970. It is concluded that in complaint procedures a tight connection existed between authorities and psychiatry. In case of conflicts, the mental institutions could count on the support of the government and this played an important role for legitimating psychiatry.

In the early 1950s psychiatry in West-Germany was criticized by the public for a short period. The so-called "crisis of psychiatry" concerned two subjects, the professionals' behaviour towards the patients and the legal procedure of hospitalisation. The most important events were the Hollywood-film The Snake Pit, several reports about asylums in the media and especially the trial against Martin-Heinrich Corten. The debates and the solutions developed at that time focused on legal aspects; the deeper reasons for the bad state of the asylums were not discussed. Besides psychiatrists refused the criticism, so that the "crisis of psychiatry" did not induce any structural changes.

In the present article the Southern German states of Baden and Bavaria are analyzed to exemplify the ways in which during the first half of the 19th century clinical psychiatrists advanced to experts and how they gained within and outside the institutional sphere a psychiatric sovereignty of interpretation ("psychiatrische Deutungsmacht"). One aspect in this development are strategies with which their position as physician was legitimized and ensured. Another aspect analyzed are the conditions under which physicians were able to act. It is to be noted that the rise of the psychiatric profession took place in two phases: Up until the 1820s, during the so called establishing phase of institutional psychiatry, the physician's active horizont was limited to the clinical sphere. Then, a process of "professional self-discovery" set in. Only with the institutional differentiation from the 1830s onwards, clinical psychiatrists also began to appear outside the clinics as experts and critical councellors. However, the fact that there was a gradual gain in autonomy and the establishment of a psychiatric sovereignty of interpretation also within state bureaucracy cannot be explained solely by tendencies toward professionalization. It was rather a multilayered process involving different participants and vested interests. The role of the state is of special importance: Motivated by its interest in solving the problem of deviance through medicalization, the state not only helped to bring institutional psychiatry into being, but also paved the way for the rise of clinical psychiatry.

Between 1940 and 1945, some 250.000 institutionalized patients were murdered in Germany. This aspect of Nazi extermination policy involved a specific segment of the population in a special way: the victims' families. Only to a limited extent can their reactions can be historically analyzed in regard to the political question of assent, acquiescence, or resistance: although the families of institutional patients acted in a highly politicized context, this does not necessarily imply that they acted out of political motives. Family members' positions were mostly determined by their personal relationship to the patient and the situations in their own lives. The most important available source--the correspondence between family members and institutions--shows that situations in the family members' everyday lives were a crucial factor in actions that were potentially decisive for the life or death of a patient. Moral stances or critical estimations of Nazi mental health policy are rare, and still more rarely determined a course of action. Following this assessment, the article analyzes exemplary cases to offer a look at the range of family members' reactions.

In the last decade of the 19th century dozens of "mad" people from the respectable bourgoisie went public with most stigmatizing details of their private lives. The authors told about healthy people branded as insane, and incarcerated in insane asylums. They took their cases to the "court of public opinion". These stories became the stuff of public scandals and also the basis of an organized "lunatics' rights" movement, which was a protest movement against the power and competency of psychiatric expertise. Inspired by this movement some authors and playwriters took up the criticism towards psychiatry and wrote novels and stage plays in which they told frightening and desparate stories of restrained people who had to suffer from arbitrary decisions of psychiatrists. The paper deals with three novels and stage plays written between 1908 and 1917 by Heinrich Mann, Frederik van Eeden, and Waldemar Müller-Eberhart. It analyses the gloomy picture of the asylum and the practice and attitudes of the asylum doctors painted by the three authors. I argue that the narratives had an impact on the public as well as the professional discourse on the problem of psychiatric arbitrariness, and that the authors not only conveyed citicism but also pointed out a concept of a humaine interaction between "normal" and "abnormal" people.

Against a background of public criticism of institutional psychiatry, which had been growing since around 1900, the director of the institute in Erlangen, Gustav Kolb, devised and set up what was known as "open care", with the intention of reforming clinical psychiatric care. This led to the creation of a new type of outpatient care clinic, which became a defining characteristic of public mental health care during the time of the Weimar Republic. A closer examination of it as a concept and in practice shows, however, that Kolb was primarily pursuing aims related to the politics of the profession, for with "open care", he considerably extended the area of competence of institutional psychiatry. He also sought to improve the professional situation of institutional psychiatrists, which was constantly being complained about by members of the profession at the time, by creating the position of "care doctor" and with it a new career perspective for doctors at institutions. Kolb's model of "open care" can thus be interpreted as being the professionalisation strategy of a member of the psychiatric profession during the Weimar Republic.

Around 1900 a psychiatric reform movement propagated the foundation of sanatoriums for the lower middle class in Germany. These sanatoriums were supposed to cure patients suffering from neurasthenia and associated disorders. Many private sanatoriums existed for curing neurasthenia. Visiting them was a luxury beyond most of the patients' means. Therefore, the so called "Volksnervenheilstätten"-movement aimed at providing sanatorium care for free or at very low costs. One of the first sanatoriums that arose from this movement was the "Rasemühle" close to Goettingen. It was founded in 1903. As a governmentally funded institution for the less wealthy the "Rasemühle" constantly moved between legitimation and critique. Areas of conflict included on the one hand the need to operate economically (as requested by the sponsor) and on the other hand the demands of neurasthenic patients for optimal care and cure. Patients' complaints about the sanatorium addressed to the financiers or governmental institutions and the reactions of the sanatorium's director serve as a valuable tool for reconstructing these areas of conflict. An analysis of the complaint files of the "Rasemühle" between 1903 and 1932 reveals that complaints usually included food, accommodation and the doctors' behaviour. Before the First World War the sanatorium's reaction usually aimed at pathologising patients who put forward complaints. Complaining was described as a symptom of the treated disorder. After financiers and insurance companies had reduced their engagement for neurasthenics during the late 1920s financing the sanatorium became more difficult. With the vanishing neurasthenia discourse the "Rasemühle" had to enter the market of private patients to survive. Now the reaction to complaints shifted to understanding. The responsible government agency was asked to invest into the sanatorium to make it competitive on the market. Patients were not seen anymore as unwilling petitioners but as customers whose needs and demands should be fullfilled.