Trübsinn und Raserei. Die Anfänge der Psychiatrie in Deutschland by Dietrich Geyer (review)

Science and especially medicine play a significant role in the formation of modern states and national identities. It was only in the 1970s and 1980s, however, that social historians began to use the history of science and medicine to explore topics that are not traditionally related to the history of medicine, such as class, ethnicity, and migration. In the last decades new themes of exploration highlight the richness of the field: migration, colonialism, and postcolonialism as well as global movements of people. Nevertheless, most historians do not consider the full relevance of the history of medicine to their work. Dietrich Geyer’s book follows the emergence, establishment, institutionalization, and academicization of psychiatry, the new medical discipline in Germany, from the turn of the eighteenth century until 1848.

As with political concepts prevalent in that period, ideas and perceptions about mental diseases and the treatment of the mentally ill also came to Germany from France and England. Geyer describes the local adaptation of these ideas within the German social and national context, German Enlightenment, and romanticism. He presents the central figures who were active in the field of mental health at the turn of the eighteenth century, such as Johann Christian Reil in Halle/Berlin, who coined the term Psychiatrie; Friedrich Schleiermacher and Ferdinand Autenrieth in Tübingen; Johann Christian August Heinroth in Leipzig; Alexander Haindorf, who was active in Heidelberg and Münster; and Friedrich Nasse in Bonn, who founded the Zeitschrift für Psychische Ärtze. As hinted in the title of the book, psychiatry in Germany did not emerge in one center but rather in various centers around different figures. They acted simultaneously, but mostly independent of one another, receiving support for opening asylums, or sometimes also for professorships at local universities, from states, churches, communities, and local foundations. For example, many of the asylums in Germany were built by “enlightened” monarchs and states based on the rationale that taking care of mentally ill people and maintaining public order are parts of the ruler’s responsibilities toward his people. In some cities, the building of an asylum was triggered by the existence of a medical school; and in Prussian cities we witness the adoption of a legal definition of insanity. Thus, in each region, the emergence of a mental health system varied.

Geyer offers details about the specific conditions of the development of mental health by focusing on three figures, the way they understood mental diseases, and how they ran asylums: Maximilian Jacobi in Siebring, Albert Zeller in Winnerthal, and Christian Rolle in Illenau. Each of these so-called “soul doctors,” as they were called (Thomas Szasz, A Lexicon of Lunacy, 2003), came from different backgrounds and held different perceptions regarding the mentally ill and how they should be treated. Jacobi admitted only curable patients to his asylum, whereas Zeller’s aim was the correction of both the soul and body. Seeing the establishment of his facility in Winnerthal as a patriotic mission, he also accepted incurable cases. Roller’s asylum in Illenau was the first in Germany, built in a spacious manner and adopting new nonrestraint ideas. These developments show that in the period under discussion, there was no standardization of the mental health system; its German founders were searching—mostly abroad—for the “right” way to deal with the problem of the mentally ill.

This book goes beyond the history of medicine: for the history of mental health reflects the emergence of modern German nationalism, the impact of romanticism, and the vision of Naturphilosophie. The book also teaches about the tensions between the state, public health, and experts within the nation-building project. In general, the reader gains from the fact that Geyer is not a historian of medicine because he makes the topic accessible to the layman. In the final chapter, however, he tries to squeeze in much of the twentieth century: the periods before and after World...