Private clinics in Central Europe 1850-1933.

Abstract

After the middle of the nineteenth century in Germany and Austria, private clinics provided most of the health care of the middle and upper classes. This study looks solely at those clinics on the ‘psychiatric-neurological-organic-medicine spectrum’, clinics specializing in the treatment of psychiatric and ‘functional’ organic symptoms. The study divides these private hospitals into four groups private insane asylums, ‘nervous’ clinics admitting patients on a voluntary basis, ‘organic-medical’ clinics that made no claim to treat psychiatric disorders but in fact did so, and water-therapy clinics, or Wasserheilanstalten, which chronologically were a forerunner of the ‘nervous’ and the ‘organic-medical’ clinics. The paper finds a tendency among soma-tizing patients to seek out ‘organic’ diagnoses and to enlist non-psychiatrists for care, in the belief that their subjective complaints were caused by ‘real’ physical disease of the body and not by a psychiatric disorder. Part of the need of these middle-class Central Europeans to organicize their complaints was the association they made between psychiatry and ‘madness’, given that major psychiatric disorders in those days were believed to be determined strongly by heredity Physicians in these competitive, profit-making clinics were happy to comply with the patients' desire for face-saving organic diagnoses, and made great use of such expressions for functional nervous illness as hysteria, chronic fatigue, and neurasthenia. The paper suggests that this tendency to organicize one's own distress seems to have increased during the period covered, an irony in view of the growing use of psychotherapy by clinic doctors over the same period