Sex, Religion, and the Making of Modern Madness: The Eberbach Asylum and German Society, 1815-1849 (review)

In the rapidly growing field of psychiatric history, the study of asylum records and patient charts has established itself as perhaps the most promising new departure. The work is highly demanding, going over hundreds of patient records for clues to deeper themes, then putting one’s particular microstudy in larger context with the aid of psychiatry textbooks, administrative records, and information about the careers of the asylum staff. Yet the technique is able to bring the power of Annales-school type scholarship to the conventional history of medicine. Ann Goldberg has examined 463 patient records (out of a total of 758) from the Eberbach Asylum in the small German state of Nassau from 1815, when the hospital was founded, until 1849. She comes to the work informed by the opinions of Michel Foucault and full of questions about the social shaping of insanity, offering us “a social history of insanity that explores how ...madness and personal distress were shaped by social experience.” (5) Indeed, the material cries out for social analysis, for the patients’ charts are filled with such diagnoses as “masturbatory insanity,” “nymphomania,” and “religious madness.” The main chapters of the book march through the chief illness-labels and social groups that Goldberg is interested in: the extent to which the diagnosis of religious madness gave asylum physicians an excuse (she argues) for extending their power and prestige; how “nymphomania,” meaning public displays of “raving” sexuality, represented a means of righting the balance in marital strife; and the extent to which deeper undercurrents of anti-Semitism are visible in the physicians’ stereotyping of the behavior of their Jewish patients.

Goldberg’s analyses of sexual relations in particular produce some interesting new insights from this material which takes us into the deepest recesses of the personality: what patients cry out in the grips of psychotic illness. Goldberg argues that, “These women used sex—their own and their husband’s—as a public language of accusation, demand, and punishment. We see women intentionally making a public spectacle of sex at the time of extreme marital tensions.” (130)

How curious, she comments, that men in the grips of masturbatory insanity were encouraged by the doctors to free-up energy and strength; women by contrast in nymphomania are ordered to heighten self- control and repression. All of this is attributable, Goldberg says, to capitalism’s need for “a new normative ideal of gender based on separate spheres.” (95)

But the analysis itself has a kind of archaic quality, as though we were still back in the 1970s, our ears ringing with earnest indictments of male society and “the bourgeoisie.” For Goldberg, capitalism and the middle classes are ultimately responsible for just about everything nasty that happens to these rural patients. The middle-class physicians are unrelentingly demonized by the author. And when the evidence doesn’t suffice for a shattering indictment of capitalism, Goldberg has no reluctance to import material from far-distant sites. Thus the book begins with a blood-curdling review of the inhumane and authoritarian physical therapies sometimes used in asylums, despite the absence of evidence that any of these were actually employed in Eberbach. And the visual material on wheels supposedly designed to break the resistance of patients and fiendish devices for restraint comes from the Wellcome Institute for the History of Medicine in London and the archives of the American Psychiatric Association in Washington.

This reviewer’s disappointment with the monograph concerns more what Goldberg chose not to do rather than what she did. In using patient records, one really has a choice: one can employ them to illumine the attitudes of the treating physicians and “society,” or to study the patients and their actual illnesses. Now, Goldberg’s work is very much in the former tradition, and she gratefully acknowledges such specialists in this as Jan Goldstein and Elizabeth Lunbeck as her predecessors. She...