Maio de 2025 – Vol. 31 – Nº 5
Visitando meus arquivos encontrei algumas entrevistas com historiadores
famosos na História da Psiquiatria publicado por H-Madness um Blog
destinado a difundir a Psiquiatria.
O H-Madness foi criado como um recurso para acadêmicos interessados na
história da loucura, da doença mental e seu tratamento (incluindo a história da
psiquiatria, psicoterapia, psicologia clínica e serviço social). O objetivo principal é
fornecer um fórum para pesquisadores nas áreas de humanidades e ciências
sociais trocarem ideias e informações sobre o estudo histórico da saúde mental e
da doença mental. O blog, portanto, atende principalmente professores
universitários e de faculdades, estudantes e pesquisadores independentes. Os
assinantes são incentivados a compartilhar informações sobre ensino e pesquisa,
bem como notícias sobre atividades e eventos profissionais, como ofertas de
emprego, conferências, bolsas de estudo e auxílios. Embora a maioria das
postagens seja em inglês, postagens em outros idiomas são bem-vindas. Para
entrar em contato conosco: [email protected]ça historiadores da
psiquiatria através de depoimentos pessoais.
How I became a historian of psychiatry: Edward Shorter
For the second installment of the “How I became a
historian of psychiatry” series, Edward Shorter, Hannah Professor in the
History of Medicine and Professor of Psychiatry at the University of Toronto,
author among others of A History of Psychiatry from the Era of the Asylum to
the Age of Prozac (1997) and From Paralysis to Fatigue: A History of
Psychosomatic Illness in the Modern Era (1992), kindly shares his intellectual
biography with the H-Madness community:
This story began in 1967 when, a fresh young
history PhD graduate, I came to the University of
Toronto. I had been trained as a social historian
and after several projects far away from the
history of medicine, in 1975 I wrote a general
history of the family, not that it was such a
medical contribution – but it called my attention to
a number of medical issues in the lives of women
historically: infected abortion, weariness from
overwork, and iron-deficiency anemia. This led to
a history of women’s health care (Women’s
Bodies) in 1982. This was full-blast medical
history, but researching it made me aware that I
knew almost nothing of medicine. So I went to
medical school for two years, taking all the basic
medical sciences.
I now felt better equipped to take on a big
problem: the history of psychosomatic illness,
especially “hysteria,” mainly in women, over the
centuries. Knowing something about medicine
was helpful here because of the difficulty in
sorting out symptoms that are psychogenic
(“hysteria”) from those that are organic-medical,
such as endometriosis, often dubbed “hysterical”
in the past. This research resulted in From
Paralysis to Fatigue (1992).
I was now thoroughly enmeshed in psychiatry,
and went on to write a general history of the
discipline, which appeared in 1997 and was read
by a number of psychiatrists. I became friendly
with several whose work I greatly admired, and
who subsequently influenced the direction of my
own studies, in particular David Healy, Max Fink,
Bernard Carroll, Tom Ban, Tom Bolwig, and
Gordon Parker. Animated email exchanges with
this group produced a sharp research interest on
my part in two themes: the history of diagnosis
(nosology), and the history of psychiatric
medications (psychopharmacology). This led to a
string of publications: A History of Shock Therapy,
with David Healy (2007), Before Prozac (2009),
and Endocrine Psychiatry; Solving the Riddle of
Melancholia (with Max Fink) in 2010. My latest
book, The Rise and Fall of the Nervous
Breakdown – And How Everyone Became
Depressed, will be published by Oxford early in
2013. I should say that among contemporary
historians of psychiatry there are also several
whose work I have learned from, in particular
Patrizia Guarnieri and Ian Dowbiggin. Everyone
in our field learned from Roy Porter.
There are two points of more general interest in
this cascade of self-esteem: (1) Historians of
psychiatry have a real contribution to make to
clinical psychiatric diagnosis, subject as it is to the
buffeting of fashion and fad; that contribution lies
in surveying the enormous historical experience
of psychiatry to see which diagnoses seem to
correspond most closely to natural disease
entities. (2) Psychiatric historians also have a
contribution to make to therapeutics, because
many past therapies have been discarded not
because they were unsafe or ineffective, but
because the patents expired! Or because (as in
the case of electroconvulsive therapy) society
turned against them for non-scientific reasons. Or
because, as in the case of the barbiturates,
makers of newer drug classes scorned them in
advertising as old-fashioned and risky.
Among my current interests are pediatric
catatonia and self-injury behavior in autism, and
the extent to which they have been relieved in the
past with ECT; the early “tranquilizers” and
sedatives, discarded as effective treatments
largely because of psychiatric urban myths of
various kinds; and melancholia as a distinctive
illness in its own right with characteristic biological
markers. I find this research tremendously
exciting, and hope that historian colleagues will
become involved.
How I Became a Historian of Psychiatry:
Gerald Grob
To continue our intellectual biography series, Gerald Grob, the
Henry E. Sigerist Professor of the History of Medicine (Emeritus) at Rutgers
University and author of various books including The State and the Mentally
Ill (1965), From Asylum to Community: Mental Health Policy in Modern
America (1991) and The Deadly Truth: A History of Disease in America (2002),
has kindly agreed to share with us his own trajectory:
Like many American historians, I shared the social democratic ethos that dominated the
discipline in the post-World War II decades. I was born in 1931 at the beginning of the Great
Depression. My parents were Jews who had migrated from Poland to the United States in
order to escape from an environment in which anti-Semitism was endemic and virulent.
Married in 1929, they lacked formal education and struggled economically for most of their
lives. Yet they instilled in my sister and me an almost naive faith in the redemptive authority
of education quite apart from its role in enhancing career opportunities. Their Judaism,
poverty, and liberal outlook made then staunch supporters of Franklin Delano Roosevelt’s
New Deal.
My commitment to the social democratic left was further strengthened during my years at the
City College of New York, a bastion of liberal if not radical thinking. The student body
included many committed to Marxian ideals, which in their eyes provided an alternative to
what appeared to be a rapacious capitalism. Although I was not unsympathetic to campus
Marxists, their single-mindedness and hostility to alternative ideas proved unacceptable, and
my allegiance remained with the liberal and social democratic left.
My faith in a liberal political ideology and its promise of progress, nevertheless, was always
tempered by a recognition that human beings were neither completely rational nor moral.
Too young to serve in World War II, I was increasingly aware of the horrors of Nazism and the
Holocaust. With but a single exception, all of the members of our family who had remained
behind in Poland–including my grandfather–were murdered by the Germans. The Holocaust
left me with an abiding sense of tragedy and a recognition of human frailty. My approach to
history, therefore, reflected contradictory tendencies: a commitment to social democratic
principles; a belief in the fallibility of human nature; a faith in the ability of individuals to
make genuine choices independent of the forces operating upon them; and hostility to any
overarching historical explanations bordering on determinism. Nor was I persuaded that all
phenomena were linked or that it was possible to apply all-encompassing theories to human
behavior and society.
After graduating from City College in 1951, I briefly attended Columbia University, where I
received my M.A. in 1952. Through a circuitous route I ended up at Northwestern University
and received my Ph.D. in 1958 (interrupted by two years of military service in the army). My
dissertation (published in 1961 and entitled Workers and Utopia) dealt with the late
nineteenth-century American labor movement, a subject that had interested since my
undergraduate days.
In 1957 I accepted a teaching position at Clark University in Worcester, Massachusetts. At
that time Clark was a small institution but one with a rich intellectual tradition. With a total
faculty of no more than about seventy, friendships transcended disciplinary lines. In 1959 a
colleague in psychology with extraordinarily broad interests suggested that I set a graduate
student to work on a history of an old state mental hospital in Worcester. Upon familiarizing
myself with the hospital, I found that it had played a significant role in the history of the care
and treatment of persons with severe mental illnesses. I also found that a large mass of
manuscript material had survived, including every single patient case history since its
opening in 1833 (which by the 1960s exceeded 70,000). By this time I had decided not to
pursue my research in labor history, and therefore undertook the task of writing a history of
Worcester State Hospital since its opening in 1833.
In retrospect, my decision to pursue research on the history of psychiatry and institutional
care was somewhat presumptuous. My knowledge of psychiatry was nonexistent. At the
outset I pursued two strategies. The first was to begin a systematic reading of psychiatric
works. Secondly, I attended basic training sessions offered to interns at the hospital in order
to familiarize myself with clinical practice and institutional life. My book The State and the
Mentally Ill: A History of Worcester State Hospital in Massachusetts 1830-1920 was published
in 1966. I found that the project presented formidable problems. I was determined not to write
a purely local history, but to place the evolution of the hospital within the framework of
public policy. My overarching concern, therefore, was with historical context and the ways in
which seemingly disparate elements interacted.
The State and the Mentally Ill, though a narrow study, shaped virtually all of my subsequent
thinking about the history of institutions and psychiatry. Having learned much from the
research on the Worcester hospital, I decided to undertake a national history. Originally I had
intended to write a one volume study. Given the sources, this proved impossible, and I ended
up by writing a multi-volume study. The first volume (Mental Institutions in America: Social
Policy to 1875) appeared in 1973; the second (Mental Illness and American Society 1875-
1940) in 1983; the third (From Asylum to Community: Mental Health Policy in Modern
America) in 1991. I published a summary volume (The Mad in America: A History of Their
Care and Treatment) in 1994. Subsequently I collaborated with Howard H. Goldman in
publishing in 2006 The Dilemma of Federal Mental Health Policy: Radical Reform or
Incremental Change? a volume that brought much of history to the present.
My emphasis has always been on those elements that shaped and modified mental health
policy: the changing composition of the population with severe mental; concepts of the
etiology and nature of mental illnesses; the organization and ideology of psychiatry; funding
mechanisms; and existing popular, political, social, and professional attitudes and values.
Equally significant, I have tried to show how the structure of the American political system
shaped the mental health system.
After working on the history of psychiatry for nearly four decades, my interest began to shift
to the history of changing disease patterns. For many years I taught a course on the
changing epidemiology of disease. I decided therefore to shift my focus to write about this
subject. The result was the publication in 2002 of The Deadly Truth: A History of Disease in
America, and in 2010 (with the collaboration of Allan V. Horowitz) Diagnosis, Therapy and
Evidence: Conundrums in Modern American Medicine. In these books I hoped to illuminate
changing patterns of morbidity and mortality and to reveal the folly of those who suggest
that the elimination of disease should be the primary goal of medical science.
In closing I must concede that a series of personal beliefs have clearly shaped my scholarly
work. I have never held to the modern belief that human beings mold and control their world
in predetermined and predictable ways. This is not in any way to suggest that we are totally
powerless to control our destiny. It is only to insist upon both our fallibility and our inability
to predict all of the consequences that follow our actions. Nor do I believe that human
behavior can be reduced to a set of deterministic or quasi-deterministic laws or
generalizations, or that solutions are readily available for all our problems. Tragedy is a
recurring theme in human history and defines the parameters of our existence. I have always
tried, therefore, to deal sympathetically with our predecessors who grappled–so often in
partial and unsuccessful ways as we still do ourselves–with their own distinct problem.
How I Became a Historian of Psychiatry: George Makari
We are delighted to present an interview with George Makari, M.D.,
as part of our “How I Became a Historian of Psychiatry” series. Dr. Makari is a historian,
psychiatrist and psychoanalyst, serves as Director of The DeWitt Wallace Institute of
Psychiatry and the Oskar Diethelm Library at Weill Cornell Medical College, where he is also
a Professor, and is the author of Revolution in Mind: The Creation of Psychoanalysis (NY:
Harper Collins, 2008). He has kindly agreed to share with us his intellectual trajectory.
How did your interest in the history of psychiatry develop?
I would say fortuitously. The origins of something like that, for me at least, started out in a much
more general kind of interest. I came from a family of doctors, and it was always assumed that I
would become a doctor too; I got into medical school out of high school, so there was a road paved
in front of me. However, when I was doing my undergraduate studies, I became very interested in
history, literary studies and writing. Part of the challenge then was to integrate these two interests.
After my undergraduate education, I spent a year as a newspaper book reviewer and did some
volunteer work in a child psychiatry department. I was trying to discover how I might combine these
things that I felt very committed to, which were writing and helping others, trying to be someone who
had that kind of direct impact on people. It was also a time when Foucault was extremely influential,
and Janet Malcolm wrote In the Freud Archives. It became increasingly exciting for me to imagine
that I could integrate my interests by writing and being a psychiatrist. That writing eventually took the
form of history.
The second thing I should mention is the importance of my intellectual community. You can have all
these ideas about what you might be or do, but it’s very important to have a community that in some
ways supports those inklings and helps them develop. As a medical student, I came to Payne
Whitney (Cornell), where there was this extraordinary division that studied the history of psychiatry
and was interdisciplinary – there were a lot of doctors and there were a lot of historians, and these
people were doing very exciting work. So that made it all seem very natural that I could do those
things too.
At which point did you think, “I’m going to write a book”?
Well, that I’m afraid is a long story too! I started a project that was much narrower and much more
defined, which was a history of transference theory and its relationship to German philosophy and
medicine. I saw the potential for something interesting about how this theory came from interesting
currents in European philosophy and culture. And the pre-existing literature claimed the theory was
de novo, came from Freud’s originality alone. So, I took that project one step at a time and first
researched the earliest use of transference as a notion in Freud. And then I moved on to the next
one: I wrote a series of papers. Eventually, I thought, at the end of the day I’ll string all these papers
together and I’ll have a monograph on the history of transference theory.
But a funny thing happened on the way. I had gotten a grant from the International Psychoanalytical
Association and that really helped me do a lot more archival work in Europe. I ended up coming
home with tons of new information from archives, all sorts of things that seemed important. So, I
tried sticking these newer discoveries into that smaller project. I stuffed all this good material into a
book proposal that I prepared for transference. If anyone reading this interview is in the process of
writing a book proposal, I suggest that you get the smartest person you can find to rake you over the
goals before you write the book. That’s what I did, and again this has to do with having a generative
community here at the Institute.
This discussion about my book proposal went badly, and it ended up being about how there were
really two books in my proposal: one about transference and another about much broader issues in
the history of the field. Feeling defensive, I argued that if someone else had written a book on the
origins and development of psychoanalysis as a field in Europe, I wouldn’t have to put all that stuff in
there, I could just refer to that work. But I blurted out, in fact no one had written such a book. When I
said that—when I heard myself say that—I was a bit taken aback. It seemed like that couldn’t
possibly be true. But the more I thought about it, I was dismayed to recognize that it was true. No
serious book had been written about the creation, consolidation, crisis and reworking of
psychoanalysis before the collapse of Europe. And at that moment—actually it wasn’t a moment, it
was a couple of very uncomfortable weeks, I transformed the book I had long planned into the one I
now would write.
It was an organic process that involved knowing exactly where one wants to go, getting lost in
archives and research, and then rediscovering a way that is more dictated by the materials and the
opportunities they offered.
Once the book came out, did you find that its reception differed amongst the two
communities (physicians and historians)?
They have different approaches to it. I’m a bit spoiled because the reception has been extremely
positive on both sides. But different people were interested in different aspects of the book. I think
historians of medicine and historians of modern European culture responded to the way that
intellectual history was integrated into social and political history; to the way I employed notions of
discursive communities to link those two things and not have theories and concepts kind of floating
out in space. Since much of historical discipline tends toward social history, they appreciate that
integration.
I think the physicians, the psychiatrists, and especially the psychoanalysts who care so deeply about
their history, appreciated how rich this restored tapestry was; in a way, they knew a very threadbare
version of their own past. And I think they responded to the book in relationship to the contemporary
struggles within psychoanalysis. Some at least felt that this account held important lessons about
how truth claims are made, how they’re verified, how they’re not verified in psychoanalysis; they saw
this – as opposed to standard great man biographies – as an attempt to understand the
psychoanalytic community—what led to schisms, what’s led to the orthodoxy, the kinds of struggles
and turbulence that community has had and still has.
On your side, how has this awareness of the history of psychiatry influenced the way in
which you treat patients, and vice versa, how does being a psychiatrist affect the way in
which you practice history?
It’s complicated because on the one hand, the obvious answer would be that studying history
relativizes your view of any particular truth claim from the present. And that’s in fact partially so.
Historical mindedness does make me think differently about diagnostic categories, about claims for
different novel advances. Right now, for example, it makes you turn a cold eye toward a lot of the
claims that are coming from neuroscience and the psychopharmaceutical industry. It allows you to
at times adopt an Olympian view, which can be very helpful. But the problem with that is that
patients are coming to me for help. So I have to be committed to something; I have to be engaged in
a way that will be helpful. You can’t sit there and philosophize about what this category error means
about our culture. So in a way it forces you to take a stand, even in a situation where you have only
a limited level of certainty, about how to benefit and console patients of different sorts. In that sense
I think it’s been a really interesting process, but not an obvious one at all.
In terms of how being a psychiatrist affects my being an historian, that’s a touchy question, because
what I’m very much not is a psycho-historian. Given the excesses of psychoanalyzing the history of
psychoanalysis, I took great pains to not speculate about the inner states and inner motivations of
the players in the book [Revolution in Mind]. At the same time, I would be a liar if I didn’t say that my
experience studying character and human behavior isn’t all over that book. When anyone tries to
deeply understand a historical character, reading letters or diaries, going through their choices, you
need to somehow pull together a sense of who they were. For example, sometimes there’ll be these
telling moments, ones that literature uses to great effect. Flaubert was a genius at this. I think about
those kinds of things every day, for seven or eight hours a day. So I am sure that process does not
stop when I think about historical characters and how they negotiate their internal and external
worlds.
Many thanks to Dr. Makari for this fascinating interview!
“How I became a historian of psychiatry”:
Hans Pols
In the spirit of reminding ourselves and others why our field is so
fascinating, H-Madness is launching a new series entitled “How I became a historian of
psychiatry “. Since this is such a unique and inter-disciplinary field, we thought it would be
fun to find out how various scholars (often accidentally) landed on this career path.
To launch the series, Hans Pols, Associate Professor in the Unit for the History and
Philosophy of Science at the University of Sydney and H-Madness editor, shares with us his
own intellectual biography:
I was born in a small village in the Netherlands in the 1960s. At the time, several relatively large
mental hospitals operated in the Netherlands, and I grew up next to one. During my childhood, I
quickly became aware of several advantages of this situation. The woods around the hospital were
deserted—hardly anyone went there for recreational walking. It thereby became an ideal territory for
me and my friends to build huts, blaze new trails, hide treasures, and make new discoveries. Of
course, we often bumped into patients who were working in the hospital gardens, and later I realized
I had been observing the many side-effects of the medications that were then used to treat mental
illness (or, at least, diminish the symptoms). This did not always work and at times the screaming of
patients in isolation cells could be heard. Even though I have been very close to the many pavilions
of the mental hospital, its inner workings remained mysterious to me. I probably did not want to
imagine what took place there.
Occupational therapy was implemented widely in this mental hospital, as patients worked in the
gardens and built all kinds of things in the many workshops. My family bought many pieces of
furniture there. I noticed a change in approach when we could no longer just order pieces of
furniture but had to wait and see whether a patient wanted to take the project on. Democracy in the
workshop probably benefited the patients working there, even if it inconvenienced an impatient
teenager.
The annual fête was of course the highlight of the year. There were lots of fun activities, games, and
competitions, the highlight of which was the soccer match between the physicians and the other
employees of the mental hospital (the physicians always lost). Stuffed animals, toys, artworks, and
other things made by patients were offered for sale. At times even well-known Dutch pop groups
(naturally unknown anywhere else in the world) would perform.
Next to the mental hospital was an institution for children with mental retardation. Initially I did not
notice them very much. One day, a new treatment method was implemented in our neighborhood:
three residential units were built there, with the aim of bringing inhabitants closer to the community.
Our chickens benefited enormously, as inhabitants came by quite regularly with leftover food for
them. This residential project has now been phased out, as treatment fashions have changed once
again.
My connection with the mental hospital was quite close, because my father worked in the out-patient
clinic there. Naturally, I was quite proud that my father did not lock people up but made them better
so they could stay at home. My interest grew even stronger when I overheard many discussions
between my father and my aunt, who was a psychoanalyst. She thought my father’s eclectic and
Rogerian approach would do no good because it ignored the fundamental insights of Sigmund
Freud. The high point of her life was when she attended a play when Jeanne Lampl-de Groot (who
had been analyzed by Freud himself) was in the audience as well. The many endless discussions
between my father and my aunt allowed me to develop, at an early age, the skill to bring up topics of
conversation (such as new girlfriends, accomplishments at school, or family scandals) that would
focus their attention on more appetizing topics.
Entering university brought me in contact with the theories of Michel Foucault, which I read with my
fellow students. Our resolve to understand his work fully was reinforced by our perception that our
philosophy teachers had discouraged us from reading his work—there are, naturally, distinctive
rewards for being subversive. I also read some theories about the psychologization of Western
society—theories which state that psychiatrists had taken the place of priests and ministers in
exerting social control. Such theories shed a whole new light on my father’s work—rather than
merely helping patients, he was part of a vast and powerful conspiracy that determined the
innermost aspects of human subjectivity. At that point, I knew what I wanted to do: I planned to
unearth the origins of that vast conspiracy and reveal its inner workings. To finish up my studies in
the Netherlands I wrote a thesis on how the power of the catholic church in the Netherlands was
reduced through their reliance on psychotherapists (who promised to clear up a general level of
immaturity among wayward Catholics, which would make these people more appreciative of the
church once again; unfortunately when they matured, they ran from the church in droves). After that
I moved to North America to investigate the history of the mental hygiene movement. After all, the
psy-complex came from the United States and its most powerful embodiment was this movement.
After several years of research, I realized that the rhetoric of the mental hygienists I investigated
surely matched my wildest dreams—but their accomplishments were far more modest than their
rhetoric. I also became aware that several other forces (be they modern capitalism, a culture of
consumption, the mass media, or narcissism) could be responsible for the social changes for which I
had blamed psychiatry. In addition, I realized that Western society was far less psychologized than I
once thought—Manhattan and parts of Los Angeles and San Francisco, where every self-respecting
individual would occupy a couch for at least a few years, had surely been taken over by the psy-
complex, but many other places in America (i.e. the mid-West) and the rest of the so-called civilized
world had proven to be far more resilient. And how could it have been any different? Mental
hygienists, after all, were a small minority among psychiatrists, and a minority that received hardly
any respect to boot. In addition, psychiatrists have long been one of the least respected medical
specialties. How could a minority within one of the least respected medical specialties muster the
power to reshape western culture? Naturally, more bizarre things have happened, but they would
need to be explained by arguments coming from outside the historical profession. I now became
utterly fascinated by the interest psychiatrists had in the work of some of the followers of Foucault. If
they could not be saviors of humankind, they could at least be its villains?
Even though my early hunches about psychiatry and the psy-complex had proven to be mostly
unfounded, the discipline continued to pique my intellectual interests by challenging earlier ideas
and assumptions. Ironically, I became interested in the psychologization of Western society when
psychiatry was increasingly becoming biological in orientation (and, predictably, many
commentators have started discussing the psychopharmacologization of Western society). In a
relatively short period of time, an interest in the mind and a focus on psychotherapy lost its
dominance, to be overcome by an interest in the inner workings of the brain and the
pharmacological treatment of its aberrations (leading to today’s almost religious interest in the brain
as the organ that can explain the full range of human behavior). Mental hygienists had at least
emphasized social and cultural factors—and the few radicals among them had focused on political
and economic variables. Somehow psychiatry seemed to respond rather quickly to such
changes—or was it that social commentator with great interest in psychiatry had changed their
opinions? Everyday psychiatry probably changed less rapidly than psychiatry as it was presented in
the media. And every day psychiatrists are probably baffled about all the claims made in the media
about their profession.
Marrying a psychiatrist provided me with new insights on the profession. When my future wife first
visited my office, she was completely shell-shocked after browsing through several books detailing
the evils of psychiatry. A few weeks later, when she was on call, I overheard her having several
conversations in which her sole aim was to keep people out of the psychiatric ward of the hospital
(which was already filled). Instead of revealing an impulse related to the great confinement, she
deftly and strategically made decisions on how the resources of the hospital could best be made
available. This also opened my eyes to the fact that many individuals wish to be admitted—for a
variety of reasons, most of which are not related to the actual benefits admission could provide.
Today, it appears that the demand for psychiatric services (psychiatric medications) far outstrips
what can realistically be expected of them. Similarly, the popularity of brain-based explanations of
behavior far outstrips what scientific research has proven. In other words, there is a not entirely
wholesome public fascination with psychiatry which does not correspond to the ways psychiatrists
view what they are able to deliver.
As is apparent from these statements, I have been fascinated by psychiatry and psychiatrists for
most of my life, although the reasons for my interests have changed over time. I can certainly see
myself retaining this interest for the foreseeable future. Hans Pols
How I Became a Historian of Psychiatry: Andrew Scull
We are delighted to
have Andrew Scull participate in our H-Madness series “How I Became a
Historian of Psychiatry”. Scull, Distinguished Professor of Sociology at UC
San Diego, has authored numerous books including Museums of
Madness; Decarceration; The Most Solitary of Afflictions: Madness and
Society in Britain, 1700-1900; Masters of Bedlam and, most
recently, Madness in Civilization: A Cultural History of Insanity, from the
Bible to Freud, and from the Madhouse to Modern Medicine (2015). In 2015,
he received the Roy Porter Medal for lifetime contributions to the history of
medicine, and in 2016, he will receive the Eric T. Carlson award for lifetime
contributions to the history of psychiatry.
It is fair to say that I first became a historian of psychiatry by accident. I
have remained one by choice, and continue to be fascinated by the
subject, and by the rich array of scholarships it has generated over the
past four decades, a period where I think the subject has grown to
intellectual maturity.
Let me explain the first sentence a bit. My father was demobilized after
the Second World War having learned to be a land surveyor in the Royal
Engineers. He then joined the Ordnance Survey, an outfit that maps the
British Isles. That meant a peripatetic existence that lasted for nearly a
decade. I was born in Edinburgh in Scotland because that was where my
parents happened to be at the time, but we soon moved south, and then,
in the mid-fifties, moved much further afield to colonial Africa, Northern
Rhodesia (now Zambia) to be a bit more precise. I spent three years
there before we moved back to England when I was eleven and I began
attending a local grammar school, from which I graduated seven years
later. I read omnivorously as a child, and though my father had left formal
education at 14, ours was luckily a house full of books and newspapers.
From an early age, I was fascinated with history. At age thirteen, I faced
a choice that reflected the defects of attending a small rural school: I
either had to opt for the sciences or the arts. Given my emerging love of
history, I chose the latter, and the choice has worked out well for me, but
as I look back on things, it was a crazy choice (forgive me) to force on an
adolescent.
At school, I won an open scholarship to Balliol College, Oxford,
becoming the first in my family to attend university. The history tripos at
Oxford in those days were very old fashioned, and I chose instead a
degree in PPE (Politics, Philosophy, and Economics), a course of study
that also included some 19 th century history and a smattering of
sociology. Most British students spend their undergraduate years
studying a single subject. My choice of degrees meant I had a much
broader grounding in philosophy and the social sciences, and Oxford
was a time of exciting intellectual challenges and growth. As it was also
the time of the Vietnam War and the events of the sixties, it was also a
time that reinforced my existing left wing political sympathies, though
unlike some of the privileged people I now mingled with, I was never
attracted to the sectarian politics of the various Trotskyite and Maoist
sorts that then infected the place.
The first (happy) accident that took place during these years was
meeting the person who would become my wife – a young American who
was spending a sophomore year abroad studying at Oxford. It was that
romantic entanglement that persuaded me to move to the United States
for doctoral work. Given the hard times that would soon befall the British
academic scene, that too was fortunate for my career prospects, though
our initial intent was to move eventually back to Britain. In those days,
even Oxford academics rarely travelled to North America, and they
snobbishly looked down their noses at American universities, about
which they knew very little. I confined my choices of graduate schools to
the East Coast, because that was where my girlfriend was in college, and
when I was fortunate to be admitted to Harvard, Yale, and Princeton, my
advisors told me that it really didn’t matter which I chose – they were all
much of a muchness.
I chose Princeton, and in many ways that was a mistake, though a lucky
one, as it turned out. I had chosen to do graduate work in sociology,
which in those days was briefly more open to historical work than much
of it now is, and the subject struck me as sufficiently amorphous as to
allow me to pursue my intellectual interests wherever they led. But by
now I had a considerable interest in post-war French politics, acquired in
my Oxford years, and I expected to pursue that interest in my doctoral
work. At Princeton, however, I found no-one in either the sociology or
the political science departments with whom I wanted to work on the
subject. Indeed, the Princeton Sociology Department was in those days
in a pretty parlous state, unless one wanted to become a demography,
which was certainly not something that interested me.
The graduate students in the years above me recommended a particular
young associate professor named Robert Scott, who taught on deviance
and social control, and with some misgivings, I enrolled in his seminar
and read an array of work I would never have otherwise encountered. I
read Erving Goffman on asylums, and Thomas Scheff’s work on labelling
and mental illness (a perspective I immediately found wanting). But
pursuing my long-standing interests in history, I also read Michel
Foucault’s Madness and Civilization (the truncated translation by Richard
Howard and a book that was not yet famous in North America) and a
new book by an American historian, David Rothman, The Discovery of
the Asylum, that was making quite a splash. I also read a more focused
and less fashionable history of the Worcester State Hospital by Gerald
Grob. By accident, then, I discovered a topic I found fascinating.
Furthermore, when I investigated the historiography of developments in
England in the nineteenth century, I found it was rather thin. I had found
a dissertation topic – and, though I did not then know it, a lifetime
obsession.
Deciding to work on Victorian lunacy reform was perhaps an odd choice
for a sociology PhD, but it had one great advantage for my wife and me:
it provided an excuse to return to England for months of primary research
in local archive offices and in mental hospital basements – perhaps not
the most romantic of settings to work side-by-side (and I could not
possibly now afford the labor of the highly successful attorney my wife
has now become), but in a perverse way we enjoyed it, and I fell in love
with playing a historical detective.
Somewhat surprisingly, perhaps, when I had nearly completed my thesis,
I managed to secure a number of jobs offers in sociology departments. I
had two members of the Princeton history department on my thesis
committee, but did not seek a job in that discipline, which proved a good
decision in some ways, since the market for historians of Britain was
already drying up, and because historians are hired to plough down a
narrower furrow than I would ever be comfortable with, sticking for the
most part to a particular period and a particular national historiography.
By contrast, the two sociology departments I have made my career in (I
also, ironically, spent a year back in Princeton in its very fine history
department), were open to having on their faculty someone who
increasingly spent much of his time researching the distant past, and
imposed no limits on my scholarship.
When I made the rounds of the job market, and underwent the ritual of
presenting my work, I was met on more than one occasion by questions
about the present-day mental health scene. Occasionally, my
interrogator, more knowledgeable than I (for I had been buried in
nineteenth century materials) would suggest that, as a critic of the
trajectory of Victorian museums of madness, I must be glad that we were
now abandoning them. Where we, I pondere, and if so, Why?
Settled in my first job at the University of Pennsylvania, I confronted a
task I found distinctly unappetizing: transforming my sprawling
dissertation into a publishable book. I baulked at the task, needing more
distance from the text than I then had. So, I took up the question of
deinstitutionalization, and in relatively short order, wrote Decarceration.
The book has its faults, as many first books do, but as I look back on it
now (laying aside my youthful infatuation with neo-Marxist ideas like the
fiscal crisis of the state), I think it got a surprising number of things right.
“Community care” was the slogan of the moment, and it was all a grand
reform that would usher the mad back into our welcoming midst, or so
the ideologues of the movement would have it. It was the drugs that
made it all possible, so the psychiatrists assured us, on the basis on no
more than temporal coincidence and their own overweening confidence
in chemical cures. It was in part the product of the critical “anti-
psychiatry” of people like Goffman and Szasz, claimed their followers. My
book rejected or was sharply critical of all these claims, pointing to the
limits of anti-psychotics and their many adverse effects, the non-
existence of community care and the hostility and neglect that were the
fate of discharged patients. It argued that what happened was driven in
great measure by fiscal concerns, and in the United States by the ability
to transfer costs between levels of government. And it suggested that the
rhetoric of reform masked what was an emerging policy of malign
neglect. I think those criticisms have all held up rather well.
Completing Decarceration early in 1976, I had become convinced I
needed more training in medical history than I had received in graduate
school, where, truth to tell, I had perforce been largely self-taught, and I
was now fortunate enough to win an ACLS post-doctoral fellowship that
allowed me a year in the Sub-Department of the History of Medicine at
University College London, a small but vibrant collection of scholars led
by Bill Bynum, who would go on to become the most distinguished and
successful director for a decade and a half of the late, much lamented
Welcome Institute for the History of Medicine – a setting I would spend a
very happy year at five years later on a Guggenheim Fellowship, and
would visit for shorter periods again and again for more than two
decades. The year in London also allowed me to finish
revising Museums of Madness, which Penguin Books then published.
My return to Penn in the fall of 1977 was a difficult one. In my absence,
the department had had an external review of its graduate program, and
the various factions among the senior faculty had aired a variety of
grievances and dirty laundry in public. The atmosphere was poisonous,
and to make matters worse, during the year, my closest friends in the
department had come up for tenure and been denied. They were all
frantically scouring the job market. Though it was still some two years
before I might face the same fate, I decided not to wait: I love my work,
but I found myself hating to go to the University, and that told me it was
time to go. The Princeton History Department offered me the temporary
lifeline of a year in its Shelby Cullom Davis Center for Historical Studies,
and soon after that, the University of California at San Diego offered me
a tenured position. Here I have been left free to follow my intellectual
interests wherever they have taken me: to studies of the emergence of
psychiatry as a profession; work on the mad trade in eighteenth century
England, and on the complex relations between doctors, patients and
families in eighteenth century London; the history of psychiatric
therapeutics, and of experimentation on vulnerable mental patients;
hysteria; the impact of World War II on American psychiatry, and much
else besides, including, most recently, the ultimate scholarly chutzpah of
producing a book on Madness in Civilization: A Cultural History of
Insanity, from the Bible to Freud, and from the Madhouse to Modern
Medicine. I shall be off to the Rockefeller Archives in a month, for I am
already in the midst of my next project. The history of psychiatry
continues to hold me in its thrall, and I bless the accidents that led me to
this life-long obsession. More detective work beckons, more discoveries
to make, more reflection on what I find, and the enormous pleasure of
trying to render those discoveries into texts others may (I hope) find
some pleasure and profit in reading.