Therapeutics and the history of psychiatry.

Abstract

Over the last couple of decades, historians of medicine and psychiatry increasingly have probed the messy and complicated world of clinical medicine. In so doing, they have asked fundamental questions regarding the nature of everyday medical practices. These questions have included, for example, why do physicians do what they do when treating and caring for their patients? How does a practitioner decide when to deploy a particular intervention and then judge whether or not it has worked? How do institutional, social, cultural, and scientific milieus shape these judgments? The recent publication of Jack Pressman's book, Last Resort: Psychosurgery and the Limits of Medicine, represents a further development of this historiographic trend and provides us with an opportunity to reflect on this growing body of scholarship within the historiography of psychiatry. 1 To this end, I will first outline the early phase of this shift that focused, for the most part, on nineteenth-century asylum practices. I then will turn to more recent work on the twentieth century, where specific therapeutic interventions have taken center stage. In particular, historians increasingly have been focusing on somatic or biological remedies, such as lobotomy, the shock therapies, and psychotropic drugs--an emphasis that reflects, in part, the current dominance of biological psychiatry. I will conclude with some thoughts about how this new historiographic trend, as exemplified by Last Resort, does more than simply [End Page 794] chart the course of psychiatric science and practice: it also makes significant insights into the nature of present-day clinical science and what it means to be a physician.