Essay Review: The Historiography of the History of Psychiatry

The History of Psychiatry and the History of Madness

There is an interesting although varying relationship between the history and historiography of psychiatry and the history of madness. The history can be as narrow or as broad in content as one wishes. At one end of the spectrum, it consists of an examination of medical texts, both premodern and modern, for descriptions and therapeutic regimens of mental illnesses. Surveys of such texts provide a sense of what "conditions" were considered to be within the domain of psychiatry and how they were described; what were the theories of their etiologies; what systems of classification were used by practitioners; what methods of treatment were conceivable, acceptable, and preferable; and what underlying theories of human nature, health, and disease gave coherence and form to the medical perception of mental illness and the role of psychiatry in various times. At the middle of the spectrum, the history of psychiatry consists of examinations of the actual diagnoses, care, and treatment by psychiatry and psychiatric institutions of persons considered mentally ill. Toward the far end of the spectrum (probably the leftward end) are those studies by sociologists, social historians, and others who look at the relationships and influences between the profession of psychiatry, "its" patients, and the many levels of the greater society. History at this end of the spectrum views psychiatry and medicine as social institutions and specialty guilds with vested interests and territories to protect—as enterprises that can only be understood in terms of their embeddedness in culture and society. Such a viewpoint insists that the very concept of disease—and often even the presence of disease—is a social phenomenon that does not exist outside of social context and social construction. A medical model would disagree with this thesis, of course: a case of measles, it would insist, is a disease no matter what social construction is attached to it. The disease-model defense (utilizing an infectious condition) makes medicine's strongest case for this argument. Many other conditions, however, do not have such unequivocal and compelling physical evidence or social agreement. This is especially, but not exclusively, true for many psychiatrically defined conditions; for example, the personality disorders and the so-called volitional disorders (such as bulimia and pathological gambling).

The historiography of psychiatry, on the other hand, consists of those writings (almost exclusively from the nineteenth and twentieth centuries) that examine, not the actual historical events that comprise the subject of the history of psychiatry, but what, how, and why scholars and others have written about the events that comprise the history of psychiatry. At its best, historiography examines the underlying philosophy of history—the assumptions that are made about rules of evidence and proper use of documents; what constitutes relevant documents, valid sampling techniques, or uses of statistics; what is the valid use of individual case narratives, what is the role of biography in history, what is the role and importance of "little people" in history (history from the bottom up)—and the ways in which social, economic, and cultural values shape how historians have viewed history (Breisach 1983; Krieger 1989). Historiography also examines the ways in which histories of particular fields or disciplines that are written by their own practitioners (or by detractors) embody the values of that field, and the manner in which a particular field may then use its history to further its own aims. In the historiographical view, then, there is no such thing as a neutral history; each work of history incorporates the limitations of the prevalent worldview and reconstructs the past in a way that will sustain and advance its author's special interests and theses.

It hardly needs to be said that historiographers consider themselves to be extremely astute at discerning the biases, limitations, and self-interests of those who write history; however, they are rather dense at discerning their own biases and guild interests. Special vocabularies, or perhaps just special pejorative and laudatory terms, betray the particular values of each school of historiography. Thus, to call a piece...