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.

[Historical comments on ethics in psychiatry : Challenges in the 19th century]. / Historische Anmerkungen zur Ethik in der Psychiatrie : Herausforderungen im 19. Jahrhundert.

With the emergence of an early psychiatry around 1800, a number of questions arose on dealing with a group of persons whose "alien", irritating and disruptive behavior was considered to be a phenomenon of being sick. In the context of the growing importance of human rights, the term humanitarianism attained a high relevance as the reference for early psychiatrists. Based on historical sources it is shown that despite a multitude of psychiatric beliefs on humanitarianism the established psychiatric practice was dominated by patriarchal order regimes up to the first decade of the twentieth century, later superimposed by the challenges of somatophysiological and experimental research as well as perceptions of biological racism. The associated new ethical questions were partially addressed within psychiatry but did not prevent an increase in the assessment of the mentally ill as "inferior".

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.

De lunatico inquirendo: managing family inheritance across madness in eighteenth-century London.

An 'inquisition' (or inquiry) held before a Justice of the Peace was the primary instrument for management of lunacy in eighteenth-century England. Yet its purpose was to protect wealth rather than the individual. The 1766 case book of Dr John Monro, London's leading doctor for madness, unexpectedly records a consultation that links two siblings who both had inquisitions. Nicholas Jeffreys' only son was attested lunatic in 1744: to circumvent inheritance through primogeniture, Jeffreys directed the family wealth to his last living child. One of his three daughters married Lord Camden, a former Lord Chancellor: after her and her second sister's deaths, the last-surviving sister was also placed under inquisition in 1780, to ensure the inheritance for his own family.

Deinstitutionalisation and the move to community care: comparing the changing dimensions of mental healthcare after 1922 in the Republic of Ireland and England.

The advent of deinstitutionalisation and the introduction of community care in the latter part of the twentieth century have revolutionised mental-health service provision across Europe, although implementation, timing and services have varied widely in different countries. This article compares the changing dimensions of mental-health provision in post-independence Ireland with that in England, and will shed light on the current state of mental healthcare in both countries. The article calls for more research into the impact of deinstitutionalisation, such as the challenges faced in the community for those in need of continuing care.

The Basaglia Law. Returning dignity to psychiatric patients: the historical, political and social factors that led to the closure of psychiatric hospitals in Italy in 1978.

Law no. 180 of 1978, which led to the closure of psychiatric hospitals in Italy, has often been erroneously associated with one man, Franco Basaglia, but the reality is much more complex. Not only were countless people involved in the movement that led to the approval of this law, but we should also take into account the historical, social, and political factors that came into play. The 1970s in Italy were a time of change and political ferment which made this psychiatric revolution possible there and nowhere else in the world.

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.

The Broken Promise of Institutional Psychiatry: Sexuality, Women and Mental Illness in 1950s Lebanon.

This article traces the case of Hala, a woman chronic patient of the Lebanon Hospital for Mental and Nervous Disorders (LHMND) in late 1950s Lebanon. Her story reveals a conglomeration of actors, expertise and technologies that regulated both her sexuality and mental illness, as she was moved, returned, then moved again, from the care of the family to the care of the psychiatric institution. By reconstructing an ethnographic case of the story of Hala, the article tackles an under-investigated area of research at the intersection of subjectivity, sexuality, psychiatry and family life. The case of Hala illustrates an on-going tension in defining and diagnosing mental illness for women between two forms of care: institutional psychiatry on one hand-promising a quick return of patients to society-and the family on the other, with its own understandings of what constitutes abnormality for women. Having lived at the hospital for more than twenty years, Hala's voice and experience provide a powerful contribution to the ethnographic history of psychiatry in Lebanon. The article tackles questions on competing psychiatric and social authorities and the formation of psychiatric subjectivities. It also provides methodological and ethical reflections on the use of archives when conducting ethnographic research on psychiatry from the global peripheries. The case of Hala illustrates the patient's own experience of LHMND's policies of social rehabilitation in the late 1950s. It adds to a broader understanding of the processes that have led to the pathologizing of sexuality in under-studied societies such as Lebanon and the Middle East.

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.

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.

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.

'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.

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.

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.

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.

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.

'Pruning a genius': marginalia by Richard Dadd.

After falling into mental illness as a young man, the British artist Richard Dadd (1817-86) spent some 20 years as a patient at Bethlem Hospital in London. A rare example of his writings from these years survives in the form of marginalia in a copy of Lectures on Painting and Design by Benjamin Robert Haydon, held in the Morgan Library & Museum in New York. This article presents a transcription of the notes, along with an introduction setting them in the contexts of Dadd's career and his relationship with the senior staff at Bethlem.

Public mental health care in colonial Lesotho: themes emerging from archival material, 1918-35.

This paper identifies some of the themes that emerge from a study of official archival records from 1918 to 1934 on the subject of mental health in colonial Lesotho. They include: difficulties experienced by colonial medical doctors in diagnosing and treating mental illnesses, given the state of medical knowledge in the nineteenth and early twentieth centuries; impact of shortage of financial and other resources on the establishment and operation of medical services, especially mental health care; convergence of social order, financial and medical concerns as influences on colonial approaches to mental health care; and the question of whether Basotho colonial society saw institutionalization of their relatives as 'hospitalization' or 'imprisonment'. Two case studies are presented as preliminary explorations of some of the themes.