Psychiatry and Its Origins Jack D. Pressman Elizabeth Lunbeck. The Psychiatric Persuasion: Knowledge, Gender, and Power in Modern America. Princeton: Princeton University Press, 1994. xiv + 431 pp. Ill. $29.95; £25.00. The author of this ambitious, extensively researched and documented monograph aims to examine “the process by which psychiatrists in the early twentieth-century effected [a] momentous shift in their discipline’s foundations and fortunes”—namely, that of creating “a new psychiatry, . . . a discipline that deals as much with everyday problems as with established mental diseases” (pp. 3–4). By the 1930s and 1940s, the new scientific unit of analysis in psychiatry was neither “the symptom [n]or even the disease,” but “the whole person and his or her fit to the environment” (p. 306). It is this psychiatry, “not the psychiatry of serious mental maladies,” that is the “predecessor of the discipline that today enjoys a measure of cultural authority” (p. 46). In Lunbeck’s estimation, the true origins of psychiatry in America thus have yet to be explored, in spite of the enormous mass of historical literature on the subject that has already accumulated. The existing historiography, she explains, generally sorts out into three camps, each severely limited. Stories written by friends of the discipline tend to focus on the scientific or medical developments, ignoring the all-important turn to the normal. Ironically, this same defect is exhibited in the second kind of accounts, those written by psychiatry’s critics who have been preoccupied with the matter of social control as perpetrated within the [End Page 129] large asylums. A third kind of story, the evolution of psychoanalysis—with its elaboration of the “psychopathology of everyday life”—seems more on target, but Lunbeck dismisses this approach as well, indicting it as anachronistic. In her assessment, the new psychiatry emerged in the beginning of the second decade of this century; yet Freud did not substantially influence the American profession until after World War I. Lunbeck draws our attention instead to the emergence of a novel institutional form in this period, the urban psychopathic hospital, and to the dramatic transformations it engendered in the way psychiatrists viewed both their profession and their discipline. One of the most visible or important of these institutions was the Boston Psychopathic Hospital (BPH), which opened its doors in 1912. The bulk of this monograph is thus a richly textured reconstruction of what happened within the walls of the BPH—and outside, through the reaches of its innovative program of psychiatric social work. In Lunbeck’s version of the events, the bold new extensions of psychiatry did not follow a consciously planned or well-articulated professional agenda. Rather, the unusual mandate of the psychopathic hospitals set in motion a series of unintended consequences that had a profound effect. Unlike their aging cousins, the large state hospitals (in which the severely insane were warehoused into underfunded, cramped facilities far removed from contact with society or even the general medical community), the psychopathic hospitals were envisioned as state-of-the-art medical sites that would combine teaching, diagnostic, and research functions with a commitment to serving the myriad problems of the rising metropolises. Here, staff psychiatrists faced the expected mix of psychoses, dementias, and nervous ills that filled up the wards of the state hospitals. But they also encountered a very different type of patient as referrals began to stream in from a growing list of civic agencies that included juvenile courts, habit clinics, social welfare foundations, and the police. Some clients even voluntarily walked through the clinic doors, seeking advice. Consequently, many of the patients were clearly not insane but simply troubled or troubling. In grappling with such cases, the psychiatrists discovered a new world of disorder ripe for colonization. The lessons they learned would eventually allow them to speak to the problems that surfaced in the home, the school, the workplace, and everywhere else; in pursuing these issues, the psychiatrists would radically move the center of their profession away from the asylums and into private practice—and would establish a new basis for their cultural authority. Lunbeck’s story is explicitly Foucauldian, both in its overall narrative form and in the methodology brought to...
Read full abstract
Mar 14, 2022
Christophe Clesse + 2
Open Access