De l'asile au centre psychosocial: Esquisse d'une histoire de la psychiatrie suisse (review)

Historians of European medicine are in the habit of focusing on England, France, and Germany, with a polite bow to Italy, Spain, and perhaps Russia; they do not habitually pay much heed to small countries. And yet the theme of medicine in Switzerland immediately conjures up stars like Paracelsus, Albrecht von Haller, or Auguste Tissot; a martyr, Michael Servetus; or modern pharmaceutical firms such as Ciba-Geigy. Switzerland has several flourishing institutes of the history of medicine and a fine journal, Gesnerus. So it is with pleasure that one turns to a “sketch of Swiss psychiatry,” particularly since that specialty evokes names such as Carl Gustav Jung, Eugen Bleuler, Adolf Meyer, and Oskar Pfitzer, and a famous psychiatric hospital in Zürich, the Bürghölzli.

Christian Müller here interweaves the history of psychiatry in Switzerland and in the Western world, and he provides periodic glimpses of the small private asylum that became Lausanne’s psychiatric teaching hospital, Céry, where he served as director for twenty-five years. Being equally fluent in English, French, and German, he has easy access to a rich bibliography; moreover, he makes a practice of presenting the findings of recent theses as well as some unpublished documents. He is a collector and a bibliophile, and he includes some hitherto unknown texts. Müller lists numerous articles from learned journals by himself or his father, also a prominent psychiatrist: the book thus acquires an autobiographical tinge. It affords access to a wide variety of source material for further exploration.

Müller has his own historical method, which he calls “anecdotal.” Rather than attempting to cover the subject, he offers a chronologic sequence, in packages of thirty to fifty years, of brief, appropriate, and meaningful biographical sketches, case histories, travelers’ reports, incidents, vignettes, and anecdotes, sprinkled with his own well-informed reminiscences, perceptions, and judgments. This method permits him to raise relevant questions of general interest and to record his own opinions; for example, he comments on the Protestant churches’ initiatives on behalf of the hospitalization of epileptics, and on a controversy between Auguste Forel and Cesare Lombroso about criminal insanity. He recounts opening a cinematographic workshop at Céry and turning to a neighbor, Charlie Chaplin, for funding; only years later did he find out why Chaplin refused: the actor recalled having had to hospitalize a schizophrenic mother when he was eleven years old. Müller’s book is lively, informative, and fast-paced (each section is only a few pages long).

There emerges a picture of Switzerland as attuned to European developments in two parallel ways: French-speaking regions, like the Vaud canton with Geneva and Lausanne, produced leaders such as S. A. Tissot, who trained in Montpellier, or Abraham Joly, who, under the influence of French Revolutionary developments, replaced chains with straitjackets; while Lausanne built the first insane asylum in Switzerland, Champ-de-l’Air, the forerunner of Müller’s own Céry. On the other hand, the burgeoning centers of psychiatric training and research in Zürich, Basel, and Bern turned toward Heidelberg, Tübingen, or Vienna, and to famous German-speaking leaders—the best-known example being the close relationship of Eugen Bleuler with Sigmund Freud at the turn of the twentieth century. In Müller’s judgment, the psychoanalytic method was modified rather than wholeheartedly adopted in Switzerland.

Müller touches all-too-briefly on Hermann Rorschach, on the path-breaking work of Eugen Bleuler in replacing Kraepelin’s concept of dementia praecox with that of schizophrenia, and on Manfred Bleuler’s long-term follow-up of schizophrenic patients. In 1910–20, he says, the Bürghölzli turned into a “veritable beehive of activity” (pp. 168–69). He proudly proffers Swiss firsts in therapy, even with substances that had not been thoroughly tested or procedures that seem risky: thus he records the work of Gottlieb...