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

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

Two approaches are evident in the literature dealing with the history of madness and psychiatry. The first is associated with Foucault. His seminal works in the 1960s and 1970s provided a dramatic reinterpretation of the evolution of modern European society that emphasized ideology and power and offered a novel explanation of institutional development and madness.¹ Historians of medicine, by contrast, deal with insanity in different ways. They concede that each generation constructs categories that describe and explain mental illnesses, but they also insist that mental illnesses are more than mere social constructs. They possess a reality that transcends human interpretations.

Goldberg's study of a single institution--the Eberbach Asylum, located in the western German territory of Nassau--is clearly in the tradition of Foucault, even while modifying many of his grandiose interpretations. Nevertheless, there are striking differences between the two authors' approaches. Foucault (to paraphrase Carl Becker) wrote without fear and with little or nonexistent data. Goldberg, by contrast, has relied on a close examination of the 463 surviving patient files of the Eberbach Asylum (out of a total of 758), as well as numerous other primary and secondary sources in a micro-study of a single institution. Her analysis is also informed by findings from other disciplines, including anthropology and feminist studies. Like Foucault, however, she provides global conclusions about madness, psychiatry, popular and elite perceptions, and the growth of state authority, as well as the role of class, gender, and ethnicity.

Goldberg's primary goal is to illuminate the encounter of educated physicians and officials with rural lower-class persons incarcerated in the Eberbach Asylum. In this encounter are embedded two distinct stories. The first constitutes the medical categories applied to patients by the emerging specialty of psychiatry, including religious madness, nymphomania, and masturbatory insanity. To these she has added "Jewishness"--a designation that shared many of the characteristics of these diagnoses. The medical interpretation of madness, Goldberg insists, reveals little about patients, but much about doctors. The second story revolves around the lives of patients and their "everyday struggles" with doctors "over a range of issues far beyond the purely medical--over definitions of identity, truth, self, God, the supernatural, and sexuality (6)."

Goldberg's narrative reflects many of the contemporary trends in social history. She is concerned with locating the behavior and language of patients within a cultural and social matrix. The evolution of the nineteenth-century public asylum, she argues, was intimately tied in with the rise of the modern state and the creation of a bourgeois society identified with capitalism, liberalism, and Victorian morality. The role of psychiatry (a specialty that she describes as having "enormous influence . . . in the twentieth century") was therefore to act "as a kind of cultural colonizer of peasant communities (185)."

Yet, a curious ambivalence is evident in Goldberg's book. She occasionally offers her own explanation of the etiology of mental disorders that rests upon a psychodynamic foundation (an approach of which she is highly critical). Mental disturbance among poor peasant women, she writes, did not arise from poverty per se or a generalized feeling of hopelessness; it occurred when "hopes and fantasies collapsed (145)." The evidence to support such a claim, however, is at best dubious. Moreover, her efforts to link psychiatry, institutions, diagnostic categories, and patient behavior to state authority and a market-oriented society are not always persuasive, largely because of the absence of causal links. Similarly, her claims about the "enormous influence" of modern psychiatry are questionable, given its marginal character within twentieth-century medicine.

Sex, Religion, and the Making of Modern Madness will undoubtedly have wide appeal among scholars from a variety of...