'The poetry of psychiatry': existential analysis and the politics of psychopathology in Franco's Spain.

This article examines the presence and influence of the work of Swiss psychiatrist Ludwig Binswanger and existential analysis (Daseinsanalyse) in Spanish psychiatry in the central decades of the 20th century. First, and drawing on various printed and archival sources, it reconstructs the important personal and professional ties that Binswanger maintained with numerous Spanish colleagues and describes the notable dissemination of his work in Spain through bibliographical reviews, scientific events, academic reports, university lectures and translations. Next, it reviews the incorporation of the postulates of existential analysis into the discourse of Spanish psychiatrists and assesses their most elaborate and original contributions to the foundations of 'anthropological-existential' psychiatry or the 'existential-analytical' interpretation of certain disorders or clinical conditions. And, finally, it tries to clarify the assessment according to which the (inevitable) instrumentalisation of existential analysis in the context of Franco's Spain first compromised the critical recognition of its true possibilities (and limits) and later contributed to the discrediting of psychopathological research among Spanish psychiatrists.

From mental hygiene to mental health: ideology, discourses and practices in Franco's Spain (1939-75).

Based on an analysis of the discourses, the ideological appropriation and the practical influence of mental hygiene in Spanish psychiatry during the early years of the Francoist regime, this article examines its decline and subsequent replacement by the new concept of mental health promoted by the World Health Organization and other international bodies from the mid-twentieth century. The old approach, essentially focused on the prophylaxis of insanity within the framework of a set of interventionist policies of social defence, was thus transformed from the beginning of the 1960s into a much more ambitious and comprehensive project which sought to promote the psychosocial balance and performance of individuals in the context of increasingly socialized health-related discourses and networks of care.

Travel and professional networks in the origins of Spanish psychiatry. / Viajes y redes profesionales en los orígenes del alienismo español.

This article examines the importance of travel and professional networks in the origins of Spanish psychiatry. After reviewing the early alienists' Enlightenment predecessors and their therapeutic and professional trajectories, it describes the trips to foreign psychiatric institutions made during the second third of the nineteenth century by a group of exiled Spanish doctors, commissioners and pioneers. Later, as they became more socially, institutionally and professionally established, some figures of Spanish psychological medicine cultivated their connections and international profile by organizing or attending conferences and other scientific events. This case illustrates the important role of international relations and scientific and professional networks in the spread of psychiatric discourses and practices.

Viajes y redes profesionales en los orígenes del alienismo español / Travel and professional networks in the origins of Spanish psychiatry

Resumen Este artículo examina la importancia de los viajes y las redes profesionales en los orígenes de la psiquiatría en España. Tras una revisión de los antecedentes ilustrados y los periplos terapéuticos y profesionales en el primer alienismo, se describen los desplazamientos a instituciones psiquiátricas extranjeras, durante el segundo tercio del siglo XIX, de un grupo de médicos exiliados, comisionados y pioneros españoles. Posteriormente, con su afianzamiento social, institucional y profesional, algunas figuras de la medicina mental española estrecharon sus vínculos y su proyección internacional organizando o asistiendo a congresos y otros eventos científicos. Su caso ilustra así el importante papel desempeñado por las relaciones internacionales y las redes científicas y profesionales en la difusión de los discursos y prácticas psiquiátricas.

Abstract This article examines the importance of travel and professional networks in the origins of Spanish psychiatry. After reviewing the early alienists’ Enlightenment predecessors and their therapeutic and professional trajectories, it describes the trips to foreign psychiatric institutions made during the second third of the nineteenth century by a group of exiled Spanish doctors, commissioners and pioneers. Later, as they became more socially, institutionally and professionally established, some figures of Spanish psychological medicine cultivated their connections and international profile by organizing or attending conferences and other scientific events. This case illustrates the important role of international relations and scientific and professional networks in the spread of psychiatric discourses and practices.

[The clinics of subjectivity]. / La clínica de la subjetividad.

This article reviews the project of capturing, describing and cataloging subjective experiences as the constitutive and founding event of psychiatric knowledge. To substantiate this view, it provides first a look at the origins (and problems) of psychiatric semiology in the pioneering work of Philippe Pinel. Afterwards, it describes some of the resources used by his successors in order to gain access to the madman's inner world, expose the folds of his intimacy and enhance the scope of the psychopathological gaze and the semiological repertoire of psychological medicine. And finally it discusses the contraposition between the practice of the gaze and the practice of listening carried out by psychiatrists as a significant correlate of an epistemic culture obsessed with gaze, but whose very eagerness to take the human being as an object of inquiry in its double physical and moral condition doomed it to cultivate listening.

[Suicide and cultural criticism in 19th century Spanish medicine]. / Suicidio y crítica cultural en la medicina española del siglo XIX.

This paper explores the major role of suicide in the cultural criticism deployed by 19th century Spanish doctors by analysing the most important theoretical models that inspired their contributions to its aetiology. In the first half of the century, the most commonly debated causal factor was the passions, which were thought to stand in a permanent tension with a free, reflexive and conscious self, in accordance with the spiritualist doctrine that was then dominant. In the context of a growing somatisation of moral and intellectual phenomena, the notion of suicide as an act of free will was later modified, and it became considered the consequence of certain organic disturbances. However, this process did not alter the central role of suicidal behaviour within 19th-century cultural criticism, because the advent of degeneration theory meant that doctors finally had a doctrine that allowed them to combine biological determinism with the extended perception of a moral and social crisis threatening the stability and achievements of bourgeois society.

Identidades inestables: el síndrome borderline y la condición postmoderna / Identidades instáveis: a síndrome borderline e a condição pós-moderna / Unstable identities: borderline syndrome and the postmodern condition / Identités instables: le sydrome borderline et la condition postmoderne

Partiendo de un análisis de las profundas transformaciones sociales y culturales que justifican lo que se describe como la nueva subjetividad expresiva propia de la modernidad tardía, el presente ensayo trata de mostrar su afinidad constitutiva con la patología de la identidad que numerosos autores consideran central no solo en el síndrome borderline o narcisista, sino también en buena parte de los trastornos mentales más frecuentes y representativos de nuestro tiempo.(AU)

A partir de uma análise das profundas mudanças sociais e culturais que fundamentam o que veio a ser descrito como a nova subjetividade expressiva da modernidade tardia, este ensaio tenta mostrar sua afinidade constitutiva com a patologia da identidade que muitos autores consideram central não só na síndrome de borderline ou narcisista, mas em muitos dos transtornos mentais mais comuns e representativos do nosso tempo.(AU)

Based on an analysis of the profound social and cultural changes that underlie what has been described as the new expressive subjectivity of late modernity, this essay tries to show its constitutive affinity with the pathology of identity that many authors consider as a central feature not only of the borderline or narcissistic syndrome, but also of many of the most common and representative mental disorders of our time.(AU)

À partir de l’analyse des changements sociaux et culturels profonds qui sous-tendent ce qu'on appelle la nouvelle subjectivité expressive de la modernité tardive, cet essai montre son affinité constitutive avec la pathologie de l’identité que de nombreux auteurs considèrent centrale non seulement dans le syndrome borderline ou narcissique, mais aussi dans les troubles mentaux plus communs et représentatifs de notre époque.(AU)

Identidades inestables: el síndrome borderline y la condición postmoderna / Identidades instáveis: a síndrome borderline e a condição pós-moderna / Unstable identities: borderline syndrome and the postmodern condition / Identités instables: le sydrome borderline et la condition postmoderne

Partiendo de un análisis de las profundas transformaciones sociales y culturales que justifican lo que se describe como la nueva subjetividad expresiva propia de la modernidad tardía, el presente ensayo trata de mostrar su afinidad constitutiva con la patología de la identidad que numerosos autores consideran central no solo en el síndrome borderline o narcisista, sino también en buena parte de los trastornos mentales más frecuentes y representativos de nuestro tiempo.

A partir de uma análise das profundas mudanças sociais e culturais que fundamentam o que veio a ser descrito como a nova subjetividade expressiva da modernidade tardia, este ensaio tenta mostrar sua afinidade constitutiva com a patologia da identidade que muitos autores consideram central não só na síndrome de borderline ou narcisista, mas em muitos dos transtornos mentais mais comuns e representativos do nosso tempo.

Based on an analysis of the profound social and cultural changes that underlie what has been described as the new expressive subjectivity of late modernity, this essay tries to show its constitutive affinity with the pathology of identity that many authors consider as a central feature not only of the borderline or narcissistic syndrome, but also of many of the most common and representative mental disorders of our time.

À partir de l’analyse des changements sociaux et culturels profonds qui sous-tendent ce qu'on appelle la nouvelle subjectivité expressive de la modernité tardive, cet essai montre son affinité constitutive avec la pathologie de l’identité que de nombreux auteurs considèrent centrale non seulement dans le syndrome borderline ou narcissique, mais aussi dans les troubles mentaux plus communs et représentatifs de notre époque.

Suicidio y crítica cultural en la medicina española del siglo XIX / Suicide and cultural criticism in 19th century Spanish medicine

El presente trabajo explora el destacado papel del suicidio en la crítica cultural desplegada por los médicos españoles del siglo XIX a través de un análisis de los principales modelos teóricos que inspiraron sus aportaciones en torno a la causación del mismo. En la primera mitad del siglo, el factor etiológico más discutido fueron las pasiones, las cuales, de acuerdo con el espiritualismo dominante, actuaban en tensión permanente con un yo reflexivo, consciente y dueño de su libre albedrío. Posteriormente, y en el contexto de una progresiva somatización de los fenómenos morales e intelectuales, la concepción del suicidio como un acto libre del individuo fue modificándose hasta considerarlo como una consecuencia más o menos directa de ciertas alteraciones orgánicas. Pero este proceso no anuló el lugar central de las conductas suicidas en el marco de la crítica cultural decimonónica, pues, con la introducción de la teoría de la degeneración, los médicos dispusieron de una doctrina que les permitía conciliar el determinismo biológico con la muy extendida percepción de una crisis moral y social que amenazaba la estabilidad y los logros de la sociedad burguesa (AU)

This paper explores the major role of suicide in the cultural criticism deployed by 19th century Spanish doctors by analysing the most important theoretical models that inspired their contributions to its aetiology. In the first half of the century, the most commonly debated causal factor was the passions, which were thought to stand in a permanent tension with a free, reflexive and conscious self, in accordance with the spiritualist doctrine that was then dominant. In the context of a growing somatisation of moral and intellectual phenomena, the notion of suicide as an act of free will was later modified, and it became considered the consequence of certain organic disturbances. However, this process did not alter the central role of suicidal behaviour within 19th-century cultural criticism, because the advent of degeneration theory meant that doctors finally had a doctrine that allowed them to combine biological determinism with the extended perception of a moral and social crisis threatening the stability and achievements of bourgeois society (AU)

Cinco variaciones y una coda sobre la historia cultural de la psiquiatría / Five variations and a coda on the cultural history of psychiatry

Este artículo ofrece un breve recorrido por las principales coordenadas en las que cabe situar la azarosa invención de la psiquiatría en el tránsito del siglo XVIII al XIX. La síntesis presentada permite apreciar hasta qué punto la medicina mental constituye un producto característico y distintivo de lo que la modernidad y su ciencia han hecho de la locura, y, más concretamente, la estrecha relación de su desenvolvimiento con una serie de procesos que la emplazan en al menos cinco escenarios o contextos historiográficos más amplios: las historias respectivas de la alteridad, la subjetividad, la ciencia moderna, la biopolítica y la crítica cultural. Vista en perspectiva, pues, la historia de la psiquiatría se revela como la cristalización de una vasta mutación por la que la figura tradicional del loco ha devenido un referente especular pero inmediato y omnipresente de nosotros mismos, a saber, un sujeto a la vez psicologizado, cerebralizado, medicalizado y escindido (AU)

This article provides a brief overview of the main coordinates framing the invention of psychiatry in the transition from the eighteenth to the nineteenth century. The presented synthesis allows to appreciate to what extent psychological medicine is a distinctive and characteristic product of what modernity and its science have made of madness, and, more specifically, the close relationship of its development with a series of processes that emplace it in at least five broader historiographical contexts: the respective histories of alterity, subjectivity, modern science, biopolitics and cultural criticism. Seen from this perspective, then, the history of psychiatry appears as the crystallization of a vast mutation whereby the traditional figure of the madman has become an immediate and ubiquitous mirror figure of ourselves, namely, a subject simultaneously psychologized, cerebralized, medicalized and split (AU)

Introducción: las ciencias de la mente y la historia de la subjetividad / Introduction: the mind sciences and the history of subjectivity

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El discurso del yo: el espiritualismo psicológico en la cultura española de mediados del siglo XIX / The discourse of the self: psychological spiritualism in mid nineteenth-century spanish culture

Este artículo ofrece un análisis de la amplia proyección del espiritualismo psicológico en la cultura española de las décadas centrales del siglo XIX. Tras revisar su profundo impacto en el pensamiento filosófico de la época, en la teoría de la medicina y en los discursos en torno a la locura y la responsabilidad criminal, su difusión se interpreta no solo como un intento de reforzar los dogmas tradicionales en torno a la espiritualidad del alma, la unidad de la conciencia o la libertad moral, sino también como la expresión de una cultura que, en líneas generales, todavía no había escindido hechos y valores ni asumido plenamente los presupuestos y las implicaciones más conspicuas de la nueva ciencia positiva y experimental (AU)

This paper offers an analysis of the wide projection of psychological spiritualism in Spanish culture during the central decades of the 19th century. After a detailed examination of its profound impact on philosophical thought, medical theory and the prevalent discourses on madness and criminal responsibility, its diffusion is interpreted not only as an attempt to reinforce traditional dogmas concerning the spirituality of the soul, the unity of consciousness or moral freedom, but also as the expression of a culture that, in general terms, had not yet split facts and values nor taken for granted some of the most conspicuous postulates and implications of the new positivist and experimental science (AU)

Alexandre Brierre de Boismont and the origins of the Spanish psychiatric profession.

This article examines the influence of the French alienist Alexandre Brierre de Boismont in the first development of the Spanish psychiatric profession during the third quarter of the 19th century. As an outstanding figure of French psychological medicine, Brierre enjoyed great scientific prestige among Spanish doctors, but he also took an active part in promoting and legitimizing the cause of alienism in Spain. For instance, he was involved in projects for the reform or creation of new mental hospitals, supported the admission of some Spanish colleagues into the Société Médico-Psychologique and made a decisive contribution to the social recognition of the professional and medico-legal expertise of alienists in Spain. His case is thus an excellent example of the important role played by international relations and the scientific and professional networks of European alienism in spreading the discourses and practices of the emerging psychological medicine.

La política del yo: Ciencia psicológica y subjetividad burguesa en la España del siglo XIX / The politics of the self: Psychological science and bourgueois subjetivity in 19TH century Spain

En este artículo se ofrece un análisis del proceso de institucionalización del conocimiento psicológico en España por obra de las reformas educativas implementadas durante el segundo tercio del siglo XIX, que prescribieron su inclusión en el programa curricular de la nueva educación secundaria. Tras un examen detenido de la orientación doctrinal, los supuestos ideológicos y la filiación sociopolítica de los contenidos transmitidos a los alumnos durante la mayor parte de la centuria, se interpreta su espiritualismo militante como un intento muy significativo por parte de las élites liberales de articular una pedagogía de la subjetividad destinada a contrarrestar las tendencias de reducción, naturalización y fragmentación del psiquismo alentadas por el desarrollo de la ciencia moderna (AU)

This paper offers an analysis of the process of institutionalization of psychological knowledge in Spain following the educative reforms implemented during the second third of the 19th century,which prescribed its inclusion in the curricular program of the new secondary education. After a detailed examination of the theoretical orientation, the ideological assumptions and the sociopolitical connections of the contents transmitted to the students throughout the century, its militant spiritualism is interpreted as a highly significant attempt on the part of the liberal elites to articulate a pedagogy of subjectivity intended to counteract the trends toward reduction, naturalization and fragmentation of psychic life inherent to the development of modern science (AU)

El síndrome de Kraepelin-Bleuler-Schneider y la conciencia moderna: Una aproximación a la historia de la esquizofrenia / Kraepelin-Bleuler-Schneider Syndrome from a Modern Perspective: An Assessment of the History of Schizophrenia

El presente artículo propone un recorrido por la historia de la esquizofrenia en el que se describe, en primer lugar, el proceso de fijación del concepto clínico convencional en las obras de Emil Kraepelin, Eugen Bleuler y Kurt Schneider. Posteriormente, y como contrapunto a su caracterización externa u objetiva, se exponen algunas líneas maestras de la reconstrucción de la experiencia esquizofrénica acometida por la psicopatología de inspiración fenomenológica. Y, por último, se discuten los principales factores y ámbitos implicados en la constitución de la esquizofrenia como un trastorno característicamente moderno de la subjetividad que destaca por aunar anomalías de la conciencia, la vivencia del cuerpo y la vida social (AU)

This article offers a panoramic assessment of the history of schizophrenia. It describes first the foundations of the conventional clinical concept as in the classic works of Emil Kraepelin, Eugen Bleuler and Kurt Schneider. Afterwards, and as a counterpoint to its external or objective characterization, the article presents some of the most notable aspects of the schizophrenic experiential world as reconstructed by phenomenological psychopathology. Finally, it provides a discussion of the major factors and areas involved in the constitution of schizophrenia as a typically modern disorder of subjectivity that combines disturbances of self-consciousness, abnormal bodily experiences and a severe impairment of social life (AU)

Mental health care and the politics of inclusion: a social systems account of psychiatric deinstitutionalization.

This paper provides an interpretation, based on the social systems theory of German sociologist Niklas Luhmann, of the recent paradigmatic shift of mental health care from an asylum-based model to a community-oriented network of services. The observed shift is described as the development of psychiatry as a function system of modern society and whose operative goal has moved from the medical and social management of a lower and marginalized group to the specialized medical and psychological care of the whole population. From this theoretical viewpoint, the wider deployment of the modern social order as a functionally differentiated system may be considered to be a consistent driving force for this process; it has made asylum psychiatry overly incompatible with prevailing social values (particularly with the normative and regulative principle of inclusion of all individuals in the different functional spheres of society and with the common patterns of participation in modern function systems) and has, in turn, required the availability of psychiatric care for a growing number of individuals. After presenting this account, some major challenges for the future of mental health care provision, such as the overburdening of services or the overt exclusion of a significant group of potential users, are identified and briefly discussed.

Mental health care in the aftermath of deinstitutionalization: a retrospective and prospective view.

This paper offers a panoramic assessment of the significant changes experienced by psychiatric care in Western Europe and North America in the course of the last decades of deinstitutionalization and reform. Drawing on different comparative studies and an own review of relevant data and reports, the main transformations in the mental health field are analyzed around seven major topics: the expanding scope of psychiatry; the decline and metamorphosis of the asylum; the introduction of alternative and diversified forms of care; the new challenges posed by chronic mental illness; the emergence of modern psychopharmacology; the deployment of subspecialization; and the new forms of coercion implemented with community mental health practices. Following a renewed diagnosis on the essential features of the reformed mental health systems based on the pattern of social inclusion inherent to the new devices and philosophies of care, some major challenges for the future such as the overburdening of services or the overt exclusion of a significant part of potential users are also identified and briefly discussed.

[The politics of the self: psychological science and bourgeois subjectivity in 19th century Spain.]. / La política del yo: ciencia psicológica y subjetividad burguesa en la Expaña del siglo XIX.

This paper offers an analysis of the process of institutionalization of psychological knowledge in Spain following the educative reforms implemented during the second third of the 19th century, which prescribed its inclusion in the curricular program of the new secondary education. After a detailed examination of the theoretical orientation, the ideological assumptions and the socio-political connections of the contents transmitted to the students throughout the century, its militant spiritualism is interpreted as a highly significant attempt on the part of the liberal elites to articulate a pedagogy of subjectivity intended to counteract the trends toward reduction, naturalization and fragmentation of psychic life inherent to the development of modern science.