War Imprisonment and Clinical Narratives of Psychiatric Illness, Psychiatric Hospital Charité, Berlin, 1948-1956.

While the historical analysis of psychological trauma from warfare has been extensive, traumatic illness in East German psychiatric practice after the Second World War has drawn little attention. The dominant literature uses West German political and medical discourses as sources to investigate the relationship between traumatic experience and psychiatric illness. This paper instead draws from East German patient files from 1948 until 1956 to examine efforts at the Charité Hospital in Berlin to interpret the psychiatric illness of former prisoners of war (POWs). By examining Socialist Party discourse at the time, the paper argues that psychiatric explanations created parallels with political debates by foregrounding social readjustment difficulties as the cause of postwar illness. Against this background, the final section explores the way in which war imprisonment could constitute a challenge to the clinical restructuring of former POWs' patient histories. Using strategies of confabulation, POWs confronted the documentary negotiation between bodies and meaning, provoking ambivalence.

The neurological manifestations of trauma: lessons from World War I.

Changes in the clinical presentation of functional disorders and the influence of social and cultural factors can be investigated through the historical case notes from mental hospitals. World War I (WWI) was a potent trigger of functional disorders with neurological or psychiatric symptoms. We analysed 100 randomly selected case files of German servicemen admitted to the Department of Psychiatry of the Charité Medical School of Berlin University during WWI and classified them according to contemporaneous and retrospective modern diagnoses. We compared the clinical presentations with accounts in the German and British medical literature of the time. Most patients obtained the contemporaneous diagnosis of 'psychopathic constitution' or hysteria reflecting the general view of German psychiatrists that not the war but an individual predisposition was the basis for the development of symptoms. The clinical picture was dominated by pseudoneurological motor or sensory symptoms as well as pseudoseizures. Some soldiers relived combat experiences in dream-like dissociative states that partly resemble modern-day post-traumatic stress disorder. Most servicemen were classified as unfit for military service but very few of them were granted compensation. Severe functional disorders of a neurological character could develop even without traumatic exposure in combat, which is of interest for the current debate on triggers of stress disorders. The high incidence of pseudoseizures accords with the psychiatric literature of the time and contrasts with accounts of war-related disorders in Britain. The tendency of German psychiatrists not to send traumatised servicemen back to active duty also distinguished between German and British practice. Our data contribute to the debate on the changing patterns of human responses to traumatic experience and their historical and social context.

Writing the history of psychiatry in the 20th century.

As editors of the special issue, we try to summarize here the historiographic trends of the field.We argue that the field of research is accommodating the diversity of the institutional, social and political developments. But there is no narrative in sight which can explain the psychiatry of the 20th century, comparable to the authoritative coherence achieved for the 19th century. In contrast, the efforts to extend these narratives to the 20th century are largely missing the most impressive transformation of psychiatric treatment--and self-definition.

[Formalizing observation: The emergence of the modern patient record exemplified by Berlin and Paris medicine, 1725-1830]. / Formalisierte Beobachtung. Die Genese der modernen Krankenakte am Beispiel der Berliner und Pariser Medizin (1725-1830).

The paper focuses on the material basis of the development of modern clinical documentation. With the examples of Berlin and Paris medicine, it analyzes the various ways of recording clinical data in the 18th century, from where they came, and how they were introduced into bedside observations. Particular interest is given to the interrelation between administrative techniques (registration, book-keeping etc.) and the practices of medical recording developed within the hospitals. Comparing Berlin and Paris makes it possible to work out the differences in writing cultures and to consider the local interdependencies. With this approach it can be demonstrated that the "patient record" was already established as a patient related recording system in the form of loose files in the early 19th century.

[The suspicion of simulation. A psychiatric case history between appropriation and disciplinary action at the end of the 19th century]. / Der Verdacht der Simulation. Eine psychiatrische Fallgeschichte zwischen Aneignung und Disziplinierung am Ende des 19. Jahrhunderts.

This case history explores how the question of agency was dealt with historically in two developing, normative orders of deviant behaviour. Examining the institutional career of the supposed adulterer, marriage swindler, and craft baker, we can trace the different observation regimes and systems of knowledge acquisition in the prison and in psychiatry, in both institutions there was talk of simulated madness; the explanations, however, were different. For the prison doctors and civil servants, the baker was a criminal; his deviant behaviour was a matter of consciously planned-out deception. For the examining psychiatrist, on the other hand, he was mentally ill and could not be held responsible for his own behaviour. The case also shows how the suspicion of simulated madness stabilized an intermediate space between the two regimes that can be seen in the incoherence of the historical sources. This conflict was never resolved; the very indecisiveness marked the defiance and agency of the historical actor that could not be clearly decided within the institutional observation regimes and their methods of recording.

[Psychochemicals crossing the wall. The introduction of psychoactive pharmaceuticals in the German Democratic Republic--a perspective from the new historiography of drugs]. / Psychochemicals crossing the wall. Die Einführung der Psychopharmaka in der DDR aus der Perspektive der neueren Arzneimittelgeschichte.

In recent years, the development, certification, and marketing of drugs has become an important field of research in the Science Studies. Attempting to analyse the growing complexity of the modern health care market, researchers have focused on the close links between pharmaceutical industry, clinical research, and drug regulation in Western Europe and North America. However, corresponding developments behind the Iron Curtain have received little attention. This article outlines a research project that analyses the history of psychoactive pharmaceuticals in East Germany from the perspective of the new historiography of drugs. The paper summarizes the central themes of recent research, provides an overview of the development of the major pharmaceutical substances, and surveys the history of these substances in the GDR in relation to drug legislation and state control of the pharmaceutical market.

"History, Theory and Ethics of Medicine": The Last Ten Years. A Survey of Course Content, Methods and Structural Preconditions at Twenty-nine German Medical Faculties.

Objective: "History, Theory, Ethics of Medicine" (German: "Geschichte, Theorie, Ethik der Medizin", abbreviation: GTE) forms part of the obligatory curriculum for medical students in Germany since the winter semester 2003/2004. This paper presents the results of a national survey on the contents, methods and framework of GTE teaching. Methods: Semi-structured questionnaire dispatched in July 2014 to 38 institutions responsible for GTE teaching. Descriptive analysis of quantitative data and content analysis of free-text answers. Results: It was possible to collect data from 29 institutes responsible for GTE teaching (response: 76%). There is at least one professorial chair for GTE in 19 faculties; two professorial chairs or professorships remained vacant at the time of the survey. The number of students taught per academic year ranges from <100 to >350. Teaching in GTE comprises an average of 2.18 hours per week per semester (min: 1, max: 6). Teaching in GTE is proportionally distributed according to an arithmetic average as follows: history: 35.4%, theory 14.7% and ethics 49.9%. Written learning objectives were formulated for GTE in 24 faculties. The preferred themes of teaching in history, theory or ethics which according to respondents should be taught comprise a broad spectrum and vary. Teaching in ethics (79 from a max. of 81 possible points) is, when compared to history (61/81) and theory (53/81), attributed the most significance for the training of medical doctors. Conclusion: 10 years after the introduction of GTE the number of students and the personnel resources available at the institutions vary considerably. In light of the differences regarding the content elicited in this study the pros and cons of heterogeneity in GTE should be discussed.

["Treating mankind honestly": medical innovation between market, public and science around 1800]. / "Treu und redlich an der Menschheit handeln": Medizinische Innovation zwischen Markt, Offentlichkeit und Wissenschaft um 1800.

This contribution is based on a case study of Professor Gottfried Christian Reich (1769-1848) of Erlangen, who in 1799 published what he considered to be an infallible method of curing any illness associated with a fever. This paper shows how in the course of a published debate the focus shifted from a medico-scientific issue to a moral one. Furthermore, the experiments carried out at Berlin's Charité hospital by order of the Prussian Medical Authority illustrate how the public debate had an effect on the assessment of the empirical evidence produced. Overall, this case study demonstrates that we can use the history of a medical innovation as a means to highlight the interconnections between medical science, the public, and the market.

Sauvages' paperwork: how disease classification arose from scholarly note-taking.

What was classification as it first took modern form in the eighteenth century, and how did it relate to earlier ways of describing and ordering? We offer new answers to these questions by examining medicine rather than botany and by reconstructing practice on paper. First among disease classifications was the 'nosology' of the Montpellier physician François Boissier de Sauvages de Lacroix. Analysis of his hitherto unstudied notebooks and of the nosology's many editions (1731-1772) shows that Boissier de Sauvages broke with earlier physicians' humanistic ordering of disease while sustaining the paper practices they had used. Scientific method was scholarly method. Classification arose through an incomplete break with, and intensified practice of, a past library-based way of ordering the described world. A new empiricism of generalizations (species) arose out of an older one of particulars (observationes). This happened through the rewriting--not the replacement--of the canon of disease knowledge since antiquity and its reordering on the printed page.

The administrative stabilization of vaccines: Regulating the diphtheria antitoxin in France and Germany, 1894-1900.

It is well known that the development of a diphtheria anti-toxin serum evolved in a competitive race between two groups of researchers, one affiliated with Emil Behring in Berlin and Marburg, and another affiliated with Emile Roux in Paris. Proceeding on the basis of different theoretical assumptions and experimental practices, the two groups developed a therapeutic serum almost simultaneously. But the standardized substance they developed took on very different forms in the two countries. In Germany the new serum was marketed in the private sphere and subjected to state regulations, becoming a kind ofprototype of industrial medications. In France, however, the same substance was marketed as a gift of science to humanity and distributed through the communal health care system. This article demonstrates how a new medication emerged from the efforts to produce, market, regulate, distribute, and apply it in the two respective countries. It attributes the difference to the negotiations between the respective actors (scientists, industrialists, politicians, officers, and the public) and institutions (firms, academies, private and public institutes, legislative bodies, professional corporations). I develop this argument on three different levels: First, I stress the importance of the institutional foundations of serum production; second, I illustrate the decisive role played by existing "ways of regulating" in the rapid development of new legal statutes; and third, I describe the consequences that flowed from the respective administrative organization of marketing and dissemination. In sum, I explore how an experimental object was transformed into an object of the public health system and stabilized by administrative means.