Würdig einer liebevollen Pflege: Die württembergische Anstaltspsychiatrie im 19. Jahrhundert (review)

Angela Roth. Würdig einer liebevollen Pflege: Die württembergische Anstaltspsychiatrie im 19. Jahrhundert. Zwiefalten, Germany: Verlag Psychiatrie und Geschichte, 1999. 151 pp. Ill. DM 29.80.

In this comprehensive study of institutions for mental patients in nineteenth-century Württemberg, Angela Roth argues that the institutional psychiatry of the time was not characterized by a single, monolithic set of principles and practices. Despite some important continuities, the history of a psychiatric institution, she declares, is often the history of its directors and their often-different convictions. The director was supposed to be a majestic figure, a stern but fair father-surrogate for the patients, and this stress on a larger-than-life personality no doubt encouraged directors to tailor their practices in individualized, even idiosyncratic ways. Roth illustrates her thesis by detailed examinations of the three asylums Zwiefalten, Winnenthal, and Schussenried and their many directors. Although she devotes much attention to the differences, one comes away from this book with a stronger sense of the broader continuities of asylum management and ideas about the nature of insanity.

These continuities, moreover, do not simply involve the three Württemberg institutions, but characterize others in lands as distant as England. As Roth herself acknowledges, psychiatry in Württemberg was neither revolutionary nor particularly original. Although each director might emphasize different aspects, they all drew upon a common fund of knowledge and beliefs: treatment, for instance, stressed general management rather than the use of drugs. Many had visited other asylums in German-speaking lands as well as abroad and were well acquainted with the specialist literature published in journals. Moreover, although many nineteenth-century mad-doctors came up with innovative or spectacular/coercive treatment methods (such as, for instance, immobilizing apparatus; or, to move to the other extreme, the ideal of total nonrestraint), the directors of the Württemberg asylums showed little interest in adopting these methods for regular use. For historians of asylum psychiatry in the English-speaking lands the stress on religious worship might seem a trifle unusual, but, in general, the story of psychiatry in nineteenth-century Württemberg is really rather predictable.

Where Roth's book scores something of a hit, however, is in its exploration of the patients' experience, a perspective that is distinctly uncommon in histories of institutional psychiatry. The raw material Roth has to work with, however, is not particularly extensive: patients' letters confiscated by directors, letters from relatives of patients to the director and medical staff, the few extant diaries of patients, the poetry of patients (recovered from an 1893 medical paper of an assistant physician investigating the links between lunacy and creativity), and scattered retrospective accounts by former inmates. Although few of these letters are truly informative, their analysis represents the most original section of the book and its most significant contribution to the history of psychiatry. Other historians of asylums should be inspired by Roth's approach, although they are hardly likely to find it easy to locate similar sources.

Chandak Sengoopta
Wellcome Unit for the History of Medicine
University of Manchester

...