The 'social' in psychiatry and mental health: quantification, mental illness and society in international scientific networks (1920s-1950s).

The post-World War II international mental health movement placed significant emphasis on the concept of the 'social environment', a true paradigm shift in thinking about the causes of mental illness. Rather than focusing on individual risk factors, experts and policy-makers began to consider the interplay between social context and mental health and illness. Also, during this period, quantification gained prominence within the expanding field of Western psychiatry. Eventually, the concept of the 'social' became fragmented into quantifiable social determinants that could be correlated with mental illness and subjected to systematic neutralization. This trajectory paved the way for the prevailing biomedical psychiatric epidemiology. This broader inquiry challenges us to redefine our understanding of the 'social' in the context of mental health research and practice.

Workhouse or asylum? Accommodating pauper lunatics in nineteenth-century England.

The late eighteenth and early nineteenth century witnessed a dramatic increase in the number of pauper lunatics being admitted to institutions and many mentally-ill paupers found their way into workhouses. The range of options existing for the admission of paupers, who at the time were described as lunatics or insane, included private madhouses, charitable asylums, public asylums as well as workhouses. Legislation relating to transfer from a workhouse to a one of these other institutions was ambiguous and depended on the concept of dangerousness and whether a workhouse inmate was manageable, rather than the nature of their illness. Because demand exceeded the space available because of overcrowding, workhouses and public asylums continually needed to increase provision by means of converting existing facilities or erecting new buildings. Nevertheless, the transfer of patients between asylums was commonplace and extensive. This article will explore the interface between two urban workhouses in the West Midlands of England and their local asylums from the late eighteenth until the end of the nineteenth century. It will demonstrate that, although local circumstances at any one time may have contributed to decisions on transfer, the overriding difficulty in the correct placement of pauper lunatics throughout the time period was institutional overcrowding, mainly driven by the increasing numbers of pauper lunatics.

'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.

'Picture imperfect': the motives and uses of patient photography in the asylum.

In the nineteenth century, photography became common in psychiatric asylums. Although patient photographs were produced in large numbers, their original purpose and use are unclear. Journals, newspaper archives and Medical Superintendents' notes from the period 1845-1920 were analysed to understand the reasons behind the practice. This revealed: (1) empathic motivation: using photography to understand the mental condition and aid treatment; (2) therapeutic focus on biological processes: using photography to detect biological pathologies or phenotypes; and (3) eugenics: using photography to recognise hereditary insanity, aimed at preventing transmission to future generations. This reveals a conceptual move from empathic intentions and psychosocial understandings to largely biological and genetic explanations, providing context for contemporary psychiatry and the study of heredity.

Mortality among those certified under lunacy legislation in Scotland during World War I.

Mortality in asylum populations increased during World War I. This paper seeks to analyse the mortality data from Scotland, where governmental statistics allow comparison between different lunacy institutions, poorhouses and prisons, as well as people certified under lunacy legislation but living in the community. Detailed study is made of two Lothian asylums, the Royal Edinburgh Asylum and the Midlothian and Peebles District Asylum, and the 1918 influenza pandemic is considered in the asylum context. Similarities and differences between the situation in Scotland and that in England and Wales are discussed, and parallels are drawn with the Covid-19 pandemic in Scotland.

George Stephen Penny (1885-1964): his life and medical encounters before, during and after admission to Broadmoor Criminal Lunatic Asylum.

Amid extensive press coverage, George Stephen Penny (1885-1964) was tried for murder in 1923. He was found 'guilty but insane' due to 'confusional insanity' associated with malaria which he suffered during World War I. Penny was admitted to Broadmoor Criminal Lunatic Asylum at a time of great public concern about inadequate and cruel care in mental institutions, but he was treated with humanity and respect. Penny's story also reveals much about challenges of psychiatric diagnosis and the relationships between crime, insanity, the public, lawyers and the medical profession. Following discharge from Broadmoor, Penny built himself a life in the community. His pseudonymous memoir, with masterly concealment of his identity and crime, tells his story up to 1925.

When art therapy went chemical: Alfred Bader, pharmacology, and art brut, c.1950-1970s.

This article analyzes how psychopharmacology transformed the relationship between art and psychiatry. It outlines a novel genealogy of art therapy, repositioning its origins in the context of evolving clinical practices and discourses on mind-altering drugs. Evaluating the use of psychotropic drugs in connection with psychopathology of art in the first half of the twentieth century, the article then focuses on two post-Second World War experiments involving psilocybin conducted by psychiatrist Alfred Bader and pharmacologist Roland Fischer. Illustrating how consciousness was foregrounded in discussions about mental health and illness, the examples showcase how psychotherapists increasingly sought to articulate art brut and modernist aesthetics in a neurobiological fashion to define madness as a social disease.

Lunatic Asylums and Indigenous Australians during the Nineteenth Century.

Lunatic asylums formed part of the civic infrastructure that was constructed out of British colonists invading and subsequently colonising unceded, Indigenous Australian lands during the eighteenth and nineteenth century. This historical narrative examined nineteenth century primary and secondary sources including, patient lists, medical files, and government correspondence, to provide insight into the experiences of Indigenous Australians admitted to Australia's earliest lunatic asylums. Awareness that lunatic asylums formed part of the structure imposed during colonisation, provides nurses and other health professionals with greater historical literacy regarding the impact of colonial lunatic asylums on Indigenous Australians. Such impacts continue to be experienced through transgenerational trauma and emphasise the importance of culturally safe mental health services.

Wilhelm Mayer's follow-up study of Kraepelin's cases of paraphrenia: diagnostic validity in 1921.

As part of his lifelong effort to develop optimal nosologic categories for the non-affective delusional syndromes, in the 1913 8th edition of his textbook, Kraepelin proposed a new diagnosis of paraphrenia presenting with extensive bizarre delusions and auditory hallucinations but no prominent negative symptoms or personality deterioration. He tentatively suggested it was distinct from dementia praecox (DP). His proposal was met with controversy. In an attempt to resolve this matter, Wilhelm Mayer, working with Kraepelin in Munich, published in 1921 the result of a follow-up study of the 78 cases of paraphrenia on the basis of which Kraepelin had developed his new diagnosis. In the 74 cases with adequate follow-up, Mayer's final diagnoses were 43% DP, 38% paraphrenia, and 18% other. He also presented limited family data, suggesting co-aggregation of DP and paraphrenia. On the basis of these results, Mayer argued that paraphrenia was likely better considered to represent a form of DP and not an independent disorder. His opinion was accepted by nearly all subsequent authors. Mayer's work appeared nearly a half-century before the proposal of Robin and Guze for the validation of psychiatric disorders by follow-up and family studies. The idea of deciding psychiatric questions on empirical grounds-rather than on the prestige of debating parties-is not a recent discovery but can be traced to the roots of our current diagnostic system in the work of Emil Kraepelin and his associates.

The History of Psychiatric Epidemiology in Finland: From National Needs to International Arenas, 1900s-1990s.

Psychiatric epidemiology has significantly influenced public health policies all around the world. This article discusses how Finnish epidemiologists reacted to local needs, which were born in specific circumstances and were controlled by science policy and funding opportunities. The development between the 1900s and 1990s is divided into three stages. The first Finnish studies in the field focused on the prevalence of mental illnesses in the country. The focus was to gain information for service planning, most of all to estimate the need for new hospitals and to set up the national social insurance system. After the Second World War, structural changes and social engineering fueled epidemiological interest. From the 1960s until the late 1980s, psychiatric epidemiology was interconnected with social psychiatry, which held a strong position in Finland. Since the 1990s, Finnish psychiatric epidemiology has been integrated with international epidemiology by using shared methodologies and through participation in transnational studies.

Disputing Darwin: On Piloerection and Mental Illness.

Most of Charles Darwin's ideas have withstood the test of time, but some of them turned out to be dead ends. This article focuses on one such dead end: Darwin's ideas about the connection between piloerection and mental illness. Piloerection is a medical umbrella term to refer to a number of phenomena in which our hair tends to stand on end. Darwin was one of the first scientists to study it systematically. In The Expression of the Emotions in Man and Animals (1872), he discusses piloerection in the context of his analysis of the expressions involved in fear and anger, relying heavily on the evidence provided by one of his correspondents, the British psychiatrist James Crichton Browne. This essay reveals how Darwin's initial doubts about the similarity between piloerection in animals and psychiatric patients were eased when studying photographic portraits of female psychiatric patients sent to him by Crichton Browne. It considers arguments against Darwin's reading of these portraits and the apparent contrast between this reading and his own skepticism, in later years, about the value of documentary photography. The article concludes with some notes regarding the reception of Darwin's ideas about psychopathology.

In the Tradition of William Osler: A New Biohumanistic Model of Psychiatry.

William Osler (1849-1919) is often considered the most influential physician in the emergence of science-based medicine. However, his approach to clinical medicine tends to be misunderstood, and its relevance to psychiatry has not been explored systematically. Osler's approach to the patient had four components: biological reductionism about disease, a scientific approach to clinical diagnosis, therapeutic conservatism, and a humanistic approach to the person. These concepts conflict with the pragmatic, eclectic, anti-reductionistic assumptions of contemporary psychiatry, as codified in its interpretation of a "biopsychosocial" model. This model leads to unscientific practice, with excessive use of medications given for symptoms, and inattention to identifying and treating diseases. This article suggests that implementing Osler's philosophy of medicine in psychiatry would greatly benefit the latter. It would inaugurate a new "biohumanistic" approach to psychiatry.

Prairie Madness: Mental Illness and Norwegian Immigration to North America in the Late Nineteenth and Early Twentieth Centuries.

In the late nineteenth and twentieth centuries, there was widespread concern about the fate of immigrants to the United States. One area of particular concern was mentally ill immigrants, as illustrated in contemporaneous screening procedures, asylum reports, government commissions, popular media, fiction, and scientific studies. This article examines the depiction of one mentally ill immigrant in O. E. Rølvaag's novel Giants in the Earth within the context of these discussions. The novel, published originally in two parts in 1924 and 1925 in Norwegian, was translated in collaboration with the author into English in 1927. While many explanations were posited for rates of mental illness among immigrants to North America in the late nineteenth and early twentieth centuries, Rølvaag presents a more nuanced view which accounts for mental responses to change of climate, environment, and cultural loss.

Psychiatric treatment of female mental patients in the Federated Malay States (FMS) of British-Malaya, 1930-57.

The British government in Malaya conducted treatment for women suffering mental illness in an effort to deal with the increasing number of cases in the Federated Malay States in 1930-57. This paper explores the role of mental asylums and society in contributing to methods of treatment during the twentieth century.

Electroshock Therapy

Registro de época (cerca de 1940) sobre os Tratamentos Físicos de Saúde Mental. Mostra como a eletroconvulsoterapia (ECT), anteriormente conhecida como terapia de eletrochoque e muitas vezes referida como tratamento de choque, tratamento psiquiátrico padrão no qual as convulsões são induzidas eletricamente em pacientes para proporcionar alívio de doenças psiquiátricas.

Henri Legrand du Saulle's 1873 book: "La Folie Héréditaire" (hereditary madness).

In his 1873 monograph "La Folie Héréditaire," the French Alienist Legrand du Saulle (LdS) first outlined his understanding of hereditary factors in insanity and then described in detail the theory of Hereditary Madness (HM) that emerged from the writings of his mentor Bénédict Morel. This form of insanity was thought to arise only in families with neuropathic traits. Degeneration theory, proposed by Morel, postulated a within-family "evolution" of increasingly severe psychopathology, typically beginning with mild neuropathic traits and associated idiosyncrasies, and progressing over generations to hereditary madness, mental retardation, epilepsy, and eventual sterility. LdS took strong positions in favor of (i) the heterogeneous transmission of mental illness within families, (ii) consideration of both direct and collateral relatives, and (iii) the inheritance of a predisposition to illness, not the illness itself. He carefully examined the wide range of psychopathology and physical stigmata that occurred in what he called "inheritors" of the neuropathic trait. A unique feature of his work was the use of familial patterns of psychopathology to define a psychiatric disorder. While the theory of HM did not gain wide popularity outside of 19th century France, the concept of neuropathic traits was used extensively in early 20th century psychiatric genetics.

What faces reveal: Hugh Diamond's photographic representations of mental illness.

Hugh Diamond was a psychiatrist, antiquarian, and photographer, who was the first person to take photographs of female asylum patients. These photographs, using the newly invented technology of the camera, were intended to be objective and accurate visual indicators of mental illness. Considering Diamond's overlapping interests, his project must be understood within the larger cultural and historical context and the tensions inherent in medical photography and portraiture. Despite the goal of capturing "objective, scientific data," the photographs instead relied on traditional iconography dating back to the Greeks and Middle Ages and can be analyzed from an art historical perspective. As an antiquarian, Diamond collected portraits of his patients just as he collected various other objects. As such, while Diamond may be considered a humanistic leader of the moral treatment movement, his work in capturing these "specimens," the female patients, reflects a perpetuation of the stigmatization of mental illness to be put on display for the Victorian audience.

The Emergence of Psychiatry: 1650-1850.

Western psychiatry emerged as a medical specialty caring for the mentally ill over the course of the late 18th and early 19th centuries. This emergence was a contingent process, dependent on the co-occurrence of three historical developments that together shaped the young discipline. The first was the rise of the mind as an entity with numerous active faculties in the conceptual space between the body and the Christian soul. Only by the latter half of the 18th century was it common to conceptualize conditions like mania or melancholy as mental illnesses. The second advance critical to psychiatry's proto-specialty status, with its increasing focus on a mechanistic understanding of disease, was the rejection of humoral theories of insanity in favor of the brain and nerves as the seat of madness. The third development was the rise of the asylum. Only in dedicated institutions could mad-doctors be exposed to large numbers of the insane, permitting the development of a specialized clinical vocabulary grounded in faculties of mind, which led to new nosologic systems. The decline of humoral medicine, with its purges, bleeding, and emetics, and the urgent clinical need for care produced, in early asylums, the first novel treatment from the young specialty: moral therapy. We tell this story focusing mainly on the work of five philosophers and physicians: Descartes, Willis, Locke, Boerhaave, de Sauvages, and Cullen. Throughout its history, psychiatry has struggled with its sometimes disconjugate goals of understanding both mind and brain, with alternating efforts to expel one of these tasks from the profession. A historical perspective demonstrates that psychiatry is a profession inextricably linked to these two contrasting projects-and, indeed, jointly constituted by them.

Diagnosing the "master mechanism of the universe" in interwar and war-era America.

Drawing on personal testimonials and questions addressed to psychiatric hospital officials, this article explores how patients and their loved ones engaged with the idea of diagnosis in interwar and war-era America. I argue that diagnosis had synergies with intellectual sensibilities of American modernity, among them an enthusiasm for science and newness, a modernist sense of time that could be both forward- and backward-looking, and a knowable, interpreted self. While self-understanding and the creation of life narratives were more often considered the bailiwick of psychoanalysis in this period, understanding subjectivity and self-interpretation were not solely expressed in its conceptual vocabulary. Patient and family dialogs with diagnosis and psychiatric authorities allow for an illumination of the interaction between domestic intuitions, common sense, and folk wisdom, on the one hand, and institutional taxonomy, categorization, and scientific terminology on the other, or more broadly, between dispositions that are ostensibly antimodern and more modern ideas. I suggest that the protean and wide-ranging intellectual origins of the discipline of psychiatry, along with the inherent ambiguity of psychiatric diagnosis during the early 20th century, allowed patients to participate in their own medicalization in the most capacious way possible: by combining biology with diagnostic narrative capacities, as well as broader perceptions of morality and character. In the concluding reflection, I speculate about why it is that late 20th-century American critics and activists have tended to view diagnosis and medicalization as coercive and threatening, in contrast to earlier 20th-century patients and their intimate observers.