Rafael Huertas, El siglo de la clínica: para una teoría de práctica psiquiátrica, Historia y crítica de la psiquiatría series, Madrid, Frenia, 2005, pp. 297, €15.00 (paperback 84-609-4361-5).

Abstract

The history of psychiatry has been approached from a myriad of perspectives and intellectual settings. Social history, conceptual history, intellectual history or history of ideas have all played an important role in defining historiographical trends. From the history of institutions to the history of illnesses, from the perspective of patients to the constitution of concepts and theories, they all have shed light on one of the most thought-provoking issues of modern times. Accepting the value of history of science as an epistemic tool, El siglo de la clinica rests on a complex middle ground between historical knowledge and psychiatric practice. The historiographical framework chosen by Rafael Huertas provides what he calls, a “theory of practice”, an expression indebted to the sociology of Pierre Bordieu that Huertas uses to link the production of theoretical discourses with diagnostic and therapeutic needs. Since the emphasis of the book lies on those conceptual tools that played an important role in clinical activity, the reader will find here neither a purely conceptual history of psychiatry, nor a history of diagnosis or therapeutic practices, but rather a history of conceptually relevant tools used by clinicians during the nineteenth century, from the beginning of the alienist discourses at the end of the eighteenth century to the description of schizophrenia in 1911. The book, focused mainly on the French psychiatric tradition, contains four sections: ‘The medicalization of madness’; ‘The somatization of the soul’; ‘At the borders of alienist orthodoxy’ and ‘Therapeutic dilemmas’. In all four, Huertas pays attention to the social conditions behind the contents of psychiatric production and to what he considers the two most recurrent issues in the conceptualization of psychiatry: the multiple versus the singular conceptualization of mental illness, and the natural versus the moral sciences regarding its understanding. Though most of the authors studied in this book are already very well known by historians, from Pinel to Chiarugi, Esquirol, Georget, Bayle, Tardieu, and Morel, among many others, Huertas does not attempt to provide a lengthy and complete account of their work. He concentrates, rather, on those neglected aspects whose study serves the purpose of the book. When writing on degeneration, for example, Huertas explains how, despite the emphasis placed on a somatic conception of mental diseases, based mainly on biologically determined causes and physical stigmata, delirium still played a preponderant role as a diagnostic category. In the same vein, the discussion of Joseph Guislain rests on his classification of mental disorders and the use of a new psychiatric terminology. While Guislain claimed that all mental disorders had a common origin, named phrenalgia, he was also forced to accept an enormous variety of symptoms and manifestations. El siglo de la clinica provides a picture of the medicalization of madness, where the shortage of therapeutic resources was balanced by the richness of conceptual tools regarding nosological and nosographic approaches. The author takes a middle ground between the social construction of mental illness and the history of therapeutic practices. He claims “that any objective interpretation of reality has always been given by the dominant culture and that systematic classifications [of mental illnesses], though very useful as intellectual tools, are but artificial abstractions with their (diagnostic) categories made up in given historical moments” (p. 259). From this point of view, nothing, except a misunderstanding of history and an irresponsible fear of change, prevents the arrival of new developments. These combined statements turn the history of psychiatry into both a critical rejection of stagnation and a heuristic tool for new practices. From an epistemological viewpoint, Huertas draws a necessarily schematic picture of the development of psychiatric discourses between social and cultural history, between the formation of concepts and their interaction with psychiatric practice. This gives important insights into the study of a highly elusive and culturally mediated object. However, the emphasis on practices could have gone a step further to include the conditions under which a given therapy or nosology was thought to be sound or adequate. After all, though many of us may very well accept that hysteria, for example, was constructed as a diagnostic category, as the author explains at length in one of the chapters of the book, the questions still remain as to whether or not that category had a diagnostic value within a given epistemological culture. Written with clarity and gusto, and relying heavily on Spanish historiography of psychiatry, this book will be very useful not only for the historian of psychiatry, but also for the scholar interested in an up-to-date bibliography of Spanish secondary sources on the history of psychiatry.