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

Ann Goldberg. Sex, Religion, and the Making of Modern Madness: The Eberbach Asylum and German Society, 1815-1849. New York: Oxford University Press, 1999. x + 236 pp. Ill. $35.00 (0-19-512581-9).

This microhistory of the Eberbach asylum in Nassau, Germany, mines a rich assortment of patient records, notable not only for their medical opinions, but also for a wealth of material written by community members and local political and legal authorities. Together, these sources shed a great deal of light on the social history of madness in the Vormärz period. Ann Goldberg's categories of analysis are class, religion, and gender, through which she illustrates the "making of modern madness": the recoding of mental distress in the social lives of the underclass German population as psychiatric diagnoses. She has convincingly demonstrated the ways in which individual patients became subject to the larger historical forces of modernization; the rise of medical professionalization was accompanied by an increase in state power, and by the promotion of rationalist religion.

Chapters are dedicated to the refashioning of religious experience into the diagnosis of religious madness, the translation of the promiscuous behavior of women into nymphomania, and the assessment of socially withdrawn, passive men as suffering from masturbatory insanity. The final chapter, however, on the plight of the Jewish patient, indicates that the drive to medicalization was not ubiquitous: rather than an illness category, "Jewishness" remained the sign for criminality, maliciousness, and deception until later in the nineteenth century. The strength of Goldberg's approach lies in its melding of the methods of anthropology and social history; the exploration of individual case histories illuminates the clash of bourgeois institutions with lower-class rural life.

Goldberg wisely sidesteps the heated historical debates on moral management that have characterized the establishment of the modern psychiatric asylum as either a triumph of modern mental medicine, or as simply a new institution for the disciplining and control of deviants. Instead, she presents a complicated account of a number of different treatment practices at Eberbach: alongside brutal disciplinary interventions adopted from military models stood more "enlightened" practices of influence and pedagogy that were intended to induce the patient to achieve a measure of the ideal bourgeois self by the internalization of restraint and the cultivation of self-awareness.

That said, however, Goldberg's monograph focuses less on asylum practices than on patient experience. She compares and contrasts "the social patterns and cultural logic" (p. 10) that were present in village life with those of the medical experts to reveal both points of agreement and large gaps. For instance, the medical diagnosis of nymphomania was loosely linked to the community identification of one of its female members as man-crazy (Manntollheit). More often than not, community members acted in concert with medical authorities to remove from their milieu women who engaged in increased sexual activity, which often produced illegitimate children--a heavy economic burden on an already impoverished community. However, community and medical accounts of cause differed: villagers recounted lengthy progressive histories of the disorder, giving ample credit to traumatic experiences, whereas the physician located the root of the pathology in timeless, internal sexual urges.

In focusing on the meanings of patient experience, Goldberg reimagines the "symptoms" of sexual and scatological behavior in the asylum context according to a social logic of patient resistance, or strategic, communicative acts to garner power. A woman who lifted her skirt in the presence of physicians was, in their eyes, simply demonstrating another symptom of nymphomania, whereas Goldberg attributes such behavior to the medieval practice of shaming the viewer. Likewise, mental distress in the community setting is explained by Goldberg according to an economic cultural logic: it emerged from the strains of failed marriage prospects and the loss of economic security for poor women, the inability to pay...