Console and Classify: The French Psychiatric Profession in the Nineteenth Century (review)

When it was originally published in 1987, Jan Goldstein's Console and Classify: The French Psychiatric Profession in the Nineteenth Century was hailed as a triumph. Justifiably so: it was the first book by an Anglophone author about the history of French psychiatry, it set new scholarly standards in that same field, and, like Andrew Scull's work in the history of British psychiatry, it felicitously combined historical research and the use of pioneering conceptual models drawn from sociology about the relations between professionalization and the production of expert knowledge. Goldstein showed persuasively how French psychiatry rose as a medical specialty in the first half of the nineteenth century, acquiring administrative and political power over rival occupational groups in the national asylum system, principally the Catholic religious orders. It was able to do so, she maintains, by convincing French society of its ability to diagnose ("classify") and treat ("console") the mentally ill. For French psychiatrists professional success was inseparable from their resourcefulness in claiming expertise in the identification and management of madness.

Goldstein's book is particularly strong in its finely researched analysis of the origins and establishment of the French asylum system. Codified in an 1838 law, this network of mental hospitals made possible an unprecedented institutionalization of mentally ill citizens, a confinement that lasted until the 1960s and the so-called decarceration movement. Goldstein is also adept at explaining how patronage played such a large role in the advancement of psychiatric careers, and how the specialty took shape thanks to the influence of "circles" of physicians led by charismatic, brilliant, and well-placed doctors such as J.E.D. Esquirol. Their genius lay in their talent to define diseases that seemed to enjoy immense social, political, and cultural appeal. A prime example was monomania, a disorder characterized by a pathologically obsessive fixation on a specific subject, and frequently cited by observers of French society in the first half of the nineteenth century as a valuable tool for interpreting various kinds of social and political behavior.

In her new afterword, written especially for this paperback edition, Goldstein argues that thinking about Console and Classify over the years has led her to believe it has relevance for both contemporary American psychiatry and current interpretations of Michel Foucault's theories. She draws telling comparisons between the diagnoses of monomania and Attention Deficit Disorder (ADD), a condition that afflicts nearly five million Americans today. ADD and monomania are alike, Goldstein insists, in that each has enjoyed support within medical circles and in society at large at specific historical junctures, and she contends that both lay and medical approval must exist before a psychiatric diagnosis can succeed historically.

Goldstein's second reason for re-publishing Console and Classify is what it has to say about the relationship between law and the Foucauldian notion of "discipline." Asserting that Foucault himself was never comfortable about thinking about legal systems as merely other forms of disciplinary power, Goldstein explains that her book demonstrates the friction that has existed historically between the law and discipline, as well as "the fragility of law in the face of discipline." "Bio-power," in other words, tends to win out over the law, confirming that in the long run it is far more hostile to human freedom than the customary institutions of justice.

Console and Classify is still worth reading, something that cannot be said of many academic works. However, to those who learned a great deal from it originally, the new edition of Console and Classify is a disappointment. When it appeared in 1987, the field of the history of psychiatry was just taking off, and in the meantime excellent books on the topic have been published. Goldstein acknowledges this, but says in her afterword that she would prefer not to "inventory authors and titles." Fair enough; except that some of the scholarship that followed her book (and, most alarmingly, some that actually pre-dated...