Krankheit und Kulturkritik: Psychiatrische Gesellschaftsdeutungen im bürgerlichen Zeitalter (1790-1914) (review)

Volker Roelcke. Krankheit und Kulturkritik: Psychiatrische Gesellschaftsdeutungen im bürgerlichen Zeitalter (1790-1914). Frankfurt am Main: Campus Verlag, 1999. 252 pp. DM 58.00; Sw. Fr. 55.00; öS 423.00 (paperbound).

Civilization makes me sick! This claim is one that is both very old and very new. Hippocrates (if not Plato and Aristotle) certainly thought that the pressures of living in a city could deform the individual and even cause illness. But it was in the Enlightenment that the very notion of civilization (or culture) came to signify a major cause for specific illnesses. This idea is often associated with Jean-Jacques Rousseau, but it was generally shared among the French Enlighteners, especially in the various essays on illness (and illnesses) in the great Encyclopédie.

Volker Roelcke provides a fascinating German subset of views on the theme of the illnesses of civilization. Roelcke's structure is quite sophisticated, as he looks for a model in which mental illness and the pressures of "modern life" are directly related. He finds this in the claim that the eighteenth-century intellectual suffered from specific forms of mental illness and links this view to the rapid importance that madness (and its treatment) assumes in the late eighteenth century. He then looks at the moment around 1800 when neurophysiology and madness are linked, and the catalyst of "culture" is seen as a leading cause of mental illness. The turn-of-the-century struggle between the German schools of somatic and "Romantic" (psychological) psychiatry for a definition of mental illness is exemplified in how each used the very idea of culture as a triggering mechanism for mental illness. Was it a disease of the nerves caused by modern times, or a disease of the will?

By the middle of the nineteenth century the importation of the French notion of degeneration framed the idea of diseases of civilization in thinkers as diverse as Wilhelm Griesinger and Richard Krafft-Ebing--but they lacked proof of a causal chain. By the end of the century the work of Volta had come to provide a physiological explanation. The electricity model for the nervous system was linked with the view, following the reception of George M. Beard's work, that neurasthenia was the "disease of civilization." In Imperial Germany the professionalization of psychiatry under Emil Kraepelin provided a further political model for the concept of a disease of culture. For Kraepelin, the very idea of radical political change came to be a significant sign of mental illness, one caused by the ravages of modern society on the nervous system. Roelcke concludes with a most interesting look at Sigmund Freud and his criticism of the idea of neurasthenia as the disease of culture.

The major gap in Roelcke's study is the rather undifferentiated notion of the category of the patient. It is clear that in all of these links between culture and illness the psychiatrists classified patients as more or less at risk. The Jews were certainly seen as at greater risk for the ravages of culture; while the Germans of a certain class were viewed as less at risk. This type of differentiation would have made the categories that run from the year 1800 to World War I even more complicated. Roelcke's book is a solid and informative first attempt to look at the German notion of diseases of culture. It would be helpful to have a comparative reading in the future among "Germans," and between "Germans" and other "national groups."

Sander L. Gilman
University of Chicago

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