Nineteenth-century Psychiatry Research Articles

Book Review: From Melancholia to Depression: Disordered Mood in Nineteenth-Century Psychiatry

Book Review: From Melancholia to Depression: Disordered Mood in Nineteenth-Century Psychiatry

Humane Animals: Moral Treatment and the Non-Human at York Retreat.

This article sheds new light on the human-animal binary in eighteenth- and early nineteenth-century psychiatry by considering the therapeutic uses of non-human animals during the early years of the York Retreat (1796-1813). By considering both figurative and "real" uses of non-human animals at the Retreat, I demonstrate how the figure of the animal in institutional discourse shifted towards primarily representing the patient's docility rather than unreason. The essay proceeds to show how shifts in the conceptualization of animality affected how medical practitioners and theorists engaged with the language of mental patients. Through a close reading of a patient's poem, I demonstrate how the patient's capacity for self-expression challenges the institutional hierarchies which were maintained through the human-animal division, as the poem ironizes the institutional desire to reproduce patients as "humane animals" which could be safely resocialized and reintroduced into society.

From Melancholia to Depression: Disordered Mood in Nineteenth-Century Psychiatry.

My book From Melancholia to Depression: Disordered Mood in Nineteenth-Century Psychiatry charts how melancholia was reconceptualized in the nineteenth century as a modern mood disorder and a precursor to clinical depression. The book shows how this occurred chiefly in two ways. First, the idea of disordered mood as a medical concept was created through the appropriation of language from experimental physiology into the realm of psychopathology. Second, the interplay of statistical and diagnostic practices formed the basis for modern psychiatric classification and facilitated the standardization of melancholia as a psychiatric diagnosis. These developments were key to the reconceptualization of melancholia and the subsequent emergence of clinical depression, and were foundational to modern psychiatric theory and practice.

Freud, Griesinger and Foville: the influence of the nineteenth-century psychiatric tradition in the Freudian concept of delusion as an 'attempt at recovery'.

This article aims to situate the Freudian concept of delusion in psychosis as an 'attempt at recovery', within the context of the classical psychiatric theories prevalent in the nineteenth century. Freud's theoretical thinking on the psychopathology of psychosis presents elements of continuity with, and divergence from, the psychiatric theories of his time. We will thus demonstrate the singularity of Freud's own theory. We will discuss the possible influence that the theory proposed by Griesinger, with its description of a temporal evolution in the psychotic process, may have had on Freud's thinking, and consider the theory of 'deductive logic' prevalent in nineteenth-century French psychiatry. Finally, we will discuss the vehement critique Freud made of both these theories.

Coprophagy in nineteenth-century psychiatry

ABSTRACTThis paper shows how Austrian psychiatrists of the 1870s developed the first pathological accounts of institutional coprophagia, examining how they related the behaviour to mental illness and dementia. These ideas about coprophagia contrasted dramatically to the long European pharmacological tradition of using excrement for the treatment of a wide range of health conditions. Recent medical scholarship on institutional coprophagia is also reviewed here, with a novel hypothesis proposed about why some patients in long-term care resort to the behaviour in institutions where there is little opportunity for healthy human–microbe interactions.

The Home and the Asylum. Antebellum Representations of True Womanhood in Nathaniel Hawthorne’s The House of Seven Gables

This paper presents an analysis of Nathaniel Hawthorne’s novels The Scarlet Letter and The House of Seven Gables regarding his depiction of the nineteenth-century ideals of femininity: the cult of true womanhood and domesticity. Drawing primarily on original material, it will be shown that emerging nineteenth-century psychiatry – asylum medicine – has strongly corroborated American ideals of femininity and their presumably restorative influence in cases of mental derangement. Hawthorne’s portrayals of women and madmen negotiate antebellum concepts of femininity and psychiatry, juxtapose the asylum against the home, and emphasize the author’s embeddedness in nineteenth-century medico-psychological theories.

'They accused me of strangling her': epilepsy and violence debate in Croatia at the end of the nineteenth and the beginning of the twentieth centuries.

Nineteenth-century psychiatry shifted its focus to the brain as the seat of mental disorders. With a new understanding of mental disorders arose the need to consult forensic psychiatrists in cases of criminal acts committed by persons with mental illness. This article focuses on three murders committed by 'epileptics' at the end of the nineteenth and the beginning of the twentieth centuries in Croatia. An analysis of these cases will help to situate forensic psychiatry at the turn of the century within the Austro-Hungarian Empire, and reveal the authority that forensic experts wielded in the courts. We will argue that Cesare Lombroso's biological theory of crime, as well as the influence of eugenicists and pharmaceutical companies, shaped the long-standing relationship between epilepsy and violent behaviour.

The Man Who Thought He Was Napoleon: Toward a Political History of Madness, by Laure Murat

The Man Who Thought He Was Napoleon: Toward a Political History of Madness, by Laure Murat, translated by Deke Dusinberre. Chicago, The University of Chicago Press, 2014. xiii, 288 pp. $45.00 US (cloth). First published in French in 2011, Laure Murat's highly acclaimed work has been translated and published for an English readership. The Man Who Thought He Was Napoleon is a story of the manifestations and interpretations of madness amidst the political turmoil of France between 1789 and 1871. As she states, revolution provided not only a screen for the projection of delusion but also a space for its translation (p. 158). On the surface, this might seem like a simple truth; nineteenth-century psychiatry was notoriously subjective at best, and moralistic at worst. And yet the text quickly reveals itself as an impressive attempt to uncover the political history of madness. Taking a middle ground between the extremes of anti-psychiatry and Whiggish apologists, Murat's text outlines how both psychiatrists and their patients were deeply implicated in the dramatic political events of their age. After a brief and useful Foreword by David A. Bell, the work begins with a Preamble that functions both as a love letter to the archives and as an explanation of methodology. A cultural historian, Murat is comfortable with the limitations of the psychiatric archives, including its gaps, its coded language, and inconsistencies. Instead of crunching the numbers, she explores a personalized selection method that follows the more detailed and original cases of delusions (p. 15). The first chapter begins with how the spectre of the Terror and its ultimate symbol, the guillotine, plagued the nightmares of the mad. Murat details the many inmates of the asylum haunted by images of the guillotine, and notes that modern psychiatry in France was born at the same moment as the guillotine (pp. 33-34). Vivid depictions of victims' balls and images of guillotine earrings help situate the asylum within its social and cultural context (pp. 26-27). Asylum or Political Prison interrogates the relationship between these two institutions, and explores the politics of how people were institutionalized by the revolutionary state. While Murat does not follow a simple Foucauldian interpretation in her work, it is clear that despite the elimination of the infamous lettres de cachet, asylums were still used to incarcerate society's more problematic citizens. Yet for many of those citizens, freedom was already forfeit. The infamous Marquis de Sade, for example, entered the Charenton asylum only after a series of prisons (pp. …

"The Glamour of Arabic Numbers": Pliny Earle's Challenge to Nineteenth-Century Psychiatry.

A well-established interpretation associates the nineteenth-century psychiatrist Pliny Earle's deflation of high cure rates for insanity with the onset of a persistent malaise in patient treatment and public health policy during the Gilded Age. This essay comes not to praise Earle but to correct and clarify interpretations, however well intentioned, that are incomplete and inaccurate. Several points are made: the overwhelming influence of antebellum enthusiasm on astonishing therapeutic claims; the interrogation of high "recovery" rates begun decades before Earle's ultimate provocation; and, however disruptive, the heuristically essential contribution of Earle's challenge to furthering a meaningful model of mental disorder. In spite of the impression created by existing historiography, Earle, a principled Quaker, remained committed to "moral treatment."

Introduction to the Special Section on DSM-5: Classifying Sex.

The publication of the 5th revision of theDiagnostic and StatisticalManualofMentalDisordersinMay2013occurredwithin a radically different social and political context from that of the firstDSMin1952. Inhindsight, the1950swere the lastdecadeof anerawhenpsychiatricpracticeswererelatively littlecontested. Incontrast, theDSM-5 isverymuchaproductof the twenty-first century: while the DSM still constitutes an authoritative source of psychiatric classifications formedical practitioners in theUS andmanyothercountries,patientsandadvocacygroupsnowadays talk back andvoice criticismof the labels that are being applied to them.Indeed,suchviewsweresolicitedaspartoftheprocessthat led to the DSM-5, something which would have been unthinkable in the 1950s. The articles collected in this special section were initially presented at the interdisciplinary conference‘‘Classifying Sex: Debating theDSM-5organizedby sociologistsRobbieDuschinskyandVeroniqueMottier,whichtookplaceshortlyafterthepublicationofDSM-5,on4and5July2013attheCentreforResearch in theArts, Social Sciences andHumanities (CRASSH)of the University ofCambridge. Speakers at the conferencemostly came fromthesocial sciences, but also included twomembers oftheDSM-5SexualandGenderIdentityDisordersWorkGroup: KennethJ.ZuckerandCynthiaGraham.Theconferencepapers presented by the latter (and several others) appear in a special issue ofPsychology& Sexuality titled‘‘TheDSM-5 as Political Battleground:Gender Identities, SexualNorms, andFemale Desire,’’guest-edited byRobbieDuschinsky andVeronique Mottier. Other papers, specifically on the theme of sexual classifications,formthecontentsofthisspecialsectionoftheArchives. Sexual classifications have been a source of particularly vehement debatewithin the history of theDSM.They are not only tools ofpsychiatricpractice, but alsodeployedwithin social and politicalarenas,aswellaseverydaylife.Against thisbackdrop, the seven contributors to this special section—prominent feminist,queer,andtransscholars, socialandpolitical scientists, and historians of sexuality—focus on thewider social and political implications of the sexual classifications producedby theDSM5, and of sexual classification systemsmore generally. The articles in this special section thusmoveaway frompsychiatricor sexological discussion of sexual categories. Instead, they all highlight in different ways the personal, political, and social consequences of sexual classifications and classification systems. Thespecialsectionopenswithanarticlebyoneofthepioneers of critical histories of sexuality, theBritish sociologist Jeffrey Weeks, entitled‘‘Beyond the Categories.’’Weeks retraces the birth of sexual classifications within late nineteenth and early twentieth century psychiatry and sexology, thereby placing contemporarydebates on successive editions of theDSMwithin a wider timeframe. He shows how early sexologists introduced the psychiatrization of sexual practices and preferences, by

The soother of evil pains: Asclepius and Freud

Freud’s rejection of nineteenth century psychiatry and neurology encouraged him to look for new models of diagnosis and healing. While Western medical discourse was founded upon the Hippocratic corpus, this paper argues that psychoanalysis contains many elements that can be traced to the healing cult of Asclepius. A close reading of Freud’s texts reveals that he was aware of the practice of incubation at sites of healing such as Epidaurus and Pergamum and that this knowledge was incorporated into his theory and practice of dream interpretation.

Pedigrees of madness: the study of heredity in nineteenth and early twentieth century psychiatry.

This article discusses the development of the statistical methods employed by psychiatrists to study heredity as a causative factor of mental diseases. It argues that psychiatric asylums and clinics were the first institutions in which human heredity became the object of systematic research. It also highlights the different concepts of heredity prevalent in the psychiatric community. The first of four parts traces how heredity became a central category of asylum statistics in the first half of the nineteenth century. The second part deals with attempts to introduce new methods of surveying in order to generate more precise data about psychopathological inheritance in the 1860s and 1870s. The third part discusses how, by the end of the nineteenth century, a widespread discontent with the results of asylum statistics led to an increasing interest in the use of family studies. Finally, the fourth part examines the impact of Mendelian theory on psychiatric statistics in the early twentieth century.

The Painted Bridge

Back to table of contents Previous article Next article Book ReviewsFull AccessThe Painted BridgeJeffrey L. Geller, M.D., M.P.H., , and Jeffrey L. Geller, M.D., M.P.H.Jeffrey L. GellerSearch for more papers by this author, M.D., M.P.H., Editor, and Jeffrey L. GellerSearch for more papers by this author, M.D., M.P.H.Published Online:1 Mar 2014https://doi.org/10.1176/appi.ps.650309AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail by WallaceWendy; New York, Scribner, 2012, 304 pagesWendy Wallace creates a picture in words of a 19th century English madhouse (Lake House) and of the women confined within. The portrait is accurate (1) and the women’s plights true to the 19th century (2).It is 1859, and 24-year-old Anna Palmer, newly married (or so she thinks) to the supercilious, sanctimonious, hypocritical Reverend Palmer (20 years her senior), is unjustly deposited into the private madhouse of Querios Abse. He runs the facility tyrannically but unwillingly; he inherited the place from his father. The main plot line is Anna’s plight and her escape to freedoms of all sorts—from the asylum, from the reverend, from the preconceptions of women’s roles in the 19th century. And she literally and symbolically makes her escape by crossing a bridge that is actually no more than a bridge façade.There are, of course, subplots galore—the dysfunctional family of Mr. Abse, the love interest between Mrs. Palmer and a well-meaning young alienist, Lucas St. Clair. Dr. St. Clair’s efforts to expand the diagnostic tools available to him by making diagnoses through the use of photographic images is in fact one of many failed innovations of psychiatry over the past 200 years. Other subplots concern the visions that guide Mrs. Palmer, the inspection of Lake House by officials with the power to close the place, the power of husbands over their wives, and the abuse of the female patients, including the use of the infamous whirling chair.Wallace portrays much of this in stark yet poetic language. Mrs. Palmer is diagnosed as having “suppressed catamenia,” “uterine disturbance,” and “hysteria,” the last being something most women of the period suffered from “at some time in their lives.”St. Clair, on the other hand, opines that “half the female patients in his care had been driven to the edge of reason by their limited lives.” Mrs. Palmer describes herself as “being pulled apart like a piece of knitting” and as a “prisoner here, a prisoner who has committed no crime.” Perhaps the best use of language is the description of the laceration of a woman who killed herself at Lake House by cutting her own throat: “Below it, framed by the lace trim of the chemise, that throat was open from one side to the other in a violent smile, the severed windpipe like an end of macaroni.”Nineteenth century psychiatry as portrayed in this novel reminds us that, while quite different from contemporary psychiatry, some things have changed very little. St. Clair wonders, for example, “Where’s the merit in discharging people when they’re still ill or saying they’re well when they’re not? It’s pointless. It’s dangerous.” That sounds very much like yesterday’s conversation between the psychiatrist on the psychiatric unit at General Hospital Everywhere and the ABC managed care company.The Painted Bridge is longer than it should be. The passages describing Mrs. Palmer’s repeated visions are frequent enough to be annoying. But all told, this is a fascinating historical novel, a good read for both those familiar with and those who want to learn more about 19th century alienists in the world of for-profit inpatient treatment. It’s enough to make us think that maybe we shouldn’t have for-profit inpatient treatment in the 21st century.Dr. Geller, who is the book review editor, is facility medical director, Worcester Recovery Center and Hospital, and professor, Department of Psychiatry, University of Massachusetts Medical School, Worcester.References1 Parry-Jones WL: The Trade in Lunacy: A Study of Private Madhouses in England in the Eighteenth and Nineteenth Centuries. London, Routledge, 1971Google Scholar2 Geller JL, Harris M: Women of the Asylum: Voices From Behind the Walls, 1840–1945. New York, Doubleday, 1994Google Scholar FiguresReferencesCited byDetailsCited byNone Volume 65Issue 3 March 2014Pages e13-e13 Metrics PDF download History Published online 1 March 2014 Published in print 1 March 2014

Perspectivity in Psychiatric Research: The Psychopathology of Schizophrenia in Postwar Germany (1955–1961)

The reorganization of psychiatric knowledge at the turn of the twentieth century derived from Emil Kraepelin’s clinical classification of psychoses. Surprisingly, within just few years, Kraepelin’s simple dichotomy between dementia praecox (schizophrenias) and manic-depressive psychosis (bipolar disorders) succeeded in giving psychiatry a new framework that is still used until the present day. Unexpectedly, Kraepelin’s simple clinical scheme based on the dichotomy replaced the significantly more differentiated nosography that dominated psychiatric research in the last three decades of the nineteenth century (Janzarik in Themen und Tendenzen der deutschsprachigen Psychiatrie. Springer, Berlin, 1974). Moreover, although all the components of the future development were already available shortly after 1868, the real course, which led to Kraepelin’s dichotomy, was unpredictable then. This paper explores the ways in which the unpredictability of psychiatric knowledge and the postulate of a rationality underlying psychopathological phenomena interacted in the debates regarding the classification of psychoses. It examines the “natural antagonism” between the practical aspirations of an increasingly specialized medical nosology and unitary conceptions, which, in a psychopathological countermovement, emphasized that no somatic criteria can be specified for the majority of psychic abnormalities and that all nosological distinctions are not binding (Janzarik 1974, 20). In this context, this paper investigates the revival of unitary theories of psychosis in postwar German psychiatry and seeks to understand why the forms of thinking that dominated nineteenth-century psychiatry have proved to be very lasting. Furthermore, this paper emphasizes the perspectivity underlying psychiatric research on psychoses and explores the ways in which writing the history of the schizophrenia concept involves inevitably writing the history of the entire psychiatry.

Bibliotherapy: tracing the roots of a moral therapy movement in the United States from the early nineteenth century to the present.

Bibliotherapy: tracing the roots of a moral therapy movement in the United States from the early nineteenth century to the present.

Anaesthetic Bodies and the Absence of Feeling: Pain and Self-Mutilation in Later Nineteenth-Century Psychiatry

This paper addresses the overlapping ways in which self-inflicted injury was understood in relation to an absence of pain during the long nineteenth century, arguing that a clear distinction between bodily and mental suffering cannot be made in this period. The medical view that self-infliction of injury must necessarily be pathological is shown to have emerged from earlier philosophical approaches to pain. This was cemented by the formation of a somatic model of self-mutilation, based on the concept of cutaneous anaesthesia, particularly in the work of Wilhelm Griesinger in Germany. In contrast, the words of asylum patients provide a much broader spectrum of ways in which injuries might have been understood. Nonetheless, the meanings attributed generally emphasize self-mutilation as a response to physical, rather than emotional, pain, indicating the widespread nature of physical aetiologies of insanity. Such a somatic approach also permeated psychological models of self-inflicted injury in the late nineteenth and early twentieth centuries, as shown through examination of Richard von Krafft-Ebing’s concept of ‘sexual anaesthesia’, William James’s association of anaesthesia with the absence of emotion, and self-mutilation and fixed ideas in the work of Pierre Janet. The study of self-mutilation thus provides an interesting angle from which to explore the complexity of notions of body and mind, in relation to concepts of pain.

‘Occasionally heard to be answering voices’: aural culture and the ritual of psychiatric audition, 1877–1911

This essay argues that historians will gain a deeper understanding of the nosological ritual and the professionals who enacted it by placing internal developments of late nineteenth-century psychiatry alongside the synchronic rise of the linguistic sciences. Doing so demonstrates that, contrary to historical consensus, what fell out of favour were traditional methods of observation rather than the practice of classification itself. Through an analysis of the aural culture at St Elizabeths Hospital (Washington, DC) between 1877 and 1911 as evidenced by patient case files and diagnostic training manuals, I focus on shifting methods of psychiatric audition as primary sites of professional claims to legitimacy at a time when the specialty was under attack from critics both external and internal.

Victor Kandinsky (1849–89): a pioneer of modern Russian forensic psychiatry

The paper describes Victor Kandinsky's professional achievements within nineteenth-century Russian forensic psychiatry. A thorough review of nineteenth-century Russian psychiatry is presented, followed by a short biographical account of Kandinsky's personal life. Within the backdrop of Russian forensic psychiatry toward the end of nineteenth century, Kandinsky's pioneer innovations in psychopathology and classification as well as his contributions to Russian forensic psychiatry are reviewed. These are exemplified by two of his forensic case studies relating to forensic responsibility and malingering, which are included in his famous book 'On Irresponsibility'.

Ian Marsh, Suicide: Foucault, History and Truth (Cambridge: Cambridge University Press, 2010), pp. xii + 251, £19.99/$34.99, paperback, ISBN: 978-0-531-13001-1.

The linkage of mental illness and suicide is, for the most part, accepted uncritically within medicine and psychiatry, by healthcare agencies and the media. Ian Marsh’s Suicide: Foucault, History and Truth attempts to understand how suicide came to be read as the consequence of some form of internal pathology, and has thus been absorbed into the domain of psychiatry. The book draws on the work of Michel Foucault, applying the ‘analytics of truth’ as a strategy for critically examining the pathologisation of suicide. The author examines how authoritative knowledge is established, objects and subjects are defined, and truths disseminated in professional accounts of suicide. Marsh begins with mapping a contemporary ‘regime of truth’ that constitutes suicide as pathological in nature, examining how a link between pathology and suicide is constructed and positioned as self-evident. The extent to which suicide has become primarily an issue of psychiatric care is illustrated by reference to psychiatrists’ clinical practices and their roles as advisors on government policy, and as editors of medical journals and authors of books. Marsh highlights how psychiatrists have developed ‘knowledge communities’ by means of certain ‘rhetorical strategies’, which allow them to achieve authority and construct the concepts and objects that make a link between pathology and suicide. The dissemination of professional truths through non-professional channels is also considered. Drawing on the World Health Organization’s guidelines on media reporting of suicide, Marsh argues that, a narrow picture of suicide is constructed based on the notion that suicide is an issue of individual mental health. In the next section of the book, Marsh delves into the ‘history of the present’ and draws on historical accounts ‘to call into question the presumed naturalness or inevitability of contemporary truths of suicide’ (p. 78). He first cites evidence from ancient Greece and Rome to illustrate that, at other times and places, suicide was not always interpreted as pathological in origin. The emergence and eventual dominance of medical theories in relation to suicide occurred much later, in the early decades of the nineteenth century. Suicide was initially conceived as a morbid action of the body, later as an internal impulse, and eventually as a symptom of degeneracy (p. 116). The asylum provided the emerging psychiatric profession with the opportunity to observe and treat suicidal patients, and therefore produce new truths (p. 117). In this discussion, Foucault’s historicist approach is employed to analyse specific historical medical texts and practices that relate to suicide; an analytic strategy absent in histories of the medicalisation of madness (p. 8). It is this close examination of medical explanations, in order to understand the cultural and historical forces involved in the construction of suicide, that makes Marsh’s study a refreshing contribution to histories of suicide and the asylum. The ‘psy’ discourses and practices of the early twentieth century acted to extend the notion of pathology as the primary cause of suicide, as well as to challenge the authority of psychiatry. Marsh examines how the emergence of psychoanalysis introduced new theories of suicidal behaviours and new practices that were based on a pathologised ‘psyche’. During the twentieth century, a variety of distinct professional groups emerged (social workers, counsellors, psychologists and psychiatric nurses), each offering their own form of ‘pastoral’ care. Importantly, though, psychiatrists’ position of authority is not fully eroded, as ultimately the psychiatrist intervenes when suicide seemed likely. ‘Psy’ disciplines, such as psychoanalysis, offers an alternative means that extended the possibilities of conceiving suicide in terms of individual pathology, rather than mounting a serious challenge to the doctrine produced by nineteenth-century psychiatry. Suicide: Foucault, History and Truth is a successful application of an historicist, Foucauldian, analytical approach to the subject of suicide. By emphasising the many possibilities for thought, action and experience that exist with respect to suicide, Marsh’s provocative study encourages us to ‘think against the present’ (p. 230), to critique existing truths and ask new questions. This is a highly engaging book that can be recommended to researchers and professionals interested in history, psychology, psychiatry and sociology.

“Aesthetic Disclosure”: An Educator Reimagines Confession

By now Michel Foucault's formulations about sexuality--the discursive constructions of sex--are well known. Yet, despite the fact that confession figures prominently in his genealogy about the manufacture and normalization of natural sexual identities, his theory of confession has received far less rigorous study. It generally is conceded that Foucault's problematization of confession has offered valuable insights as to the inherent dangers arising from the power relationships that imbue confessional institutions and techniques, an assessment with which I concur. Certainly, his analyses have challenged Western society's unexamined assumptions about the curative and liberatory properties of confession. However, in this article I argue that Foucault's apparent oblivion about the effects of gender in confessional discourse hides flaws in his confessional theory. When gender is taken into account, several of his conclusions warrant skepticism. I contend that Foucault's confessional theory begs attention since it serves as the cornice piece of his panoptic vision of domination that implicates not only religion, psychiatry, medicine, and jurisprudence, but also education. The need to reexamine his claims, charges, and conclusions is not solely a philosophical concern, but a practical issue facing teachers in schools and universities, community centers and religious institutions. Therefore, in this article I suggest that educators must think about confession in ways that avoid both the pitfalls uncovered by Foucault's deconstructive analysis and the gendered consequences that his patriarchal perspective failed to reveal. To that end, I will conceptualize aesthetic disclosure, a gender-sensitive approach for dealing with students' self-revelations that subverts the power relations exposed in Foucault's confessional theory and offers opportunities for rhetorical agency and artistic self-fashioning. Foucault's Confessional Dilemma Foucault argued that Western society is thoroughly saturated with confession: religious, legal, medical, and psychiatric. Social scientists and psychotherapists have maintained that secrets in themselves are discreditable, that what people conceal is what they regard as shameful or undesirable (See Jung, 2008, pp. 31-35; Bok, 1989, pp. 8-10). Foucault concluded: We have become a singularly confessing society.... one goes about telling, with the greatest precision, whatever is most difficult to tell. One confesses in public and in private, to one's parents, one's educators, one's doctor, to those one loves ... (Foucault, 1990, p. 59) Foucault charges that individuals' felt need to confess, as well as the felt benefits from having done so, have been ingrained in us as members of Western societies beginning with the Christian confessional, continuing through the rise of nineteenth and twentieth century psychiatry, and emerging in today's media-centered culture. We Westerners, according to Foucault, have come to believe that truth is lodged in our most secret nature and that articulating those secrets produces freedom. And, of course, since sex has been a privileged theme of both the Christian and psychiatric confessional, revealing sexual matters has come to be seen as that which will most completely allow one's true self to surface (Foucault, 1990, pp. 60-63). Foucault further contends that we no longer perceive the obligation to confess as a power that constrains us. Rather, it seems to us that disclosing our secrets produces a kind of liberation. Foucault insists, however, that we are mistaken if we are taken in by the ruse that all these voices urging confession are speaking of freedom, for confession is a ritual of discourse that unfolds within a power relationship. One does not confess without the presence (or virtual presence) of a listener who is not simply the interlocutor, but also the authority who requires, prescribes, or appreciates the confession and intervenes in order to judge, punish, forgive, console, or reconcile (Foucault, 1990, p. …