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  • On the Heels of Ignorance: Psychiatry and the Politics of Not Knowing by Owen Whooley
  • Mical Raz

Psychiatry, American Medicine, Institutional History, Psychobiology

Owen Whooley, On the Heels of Ignorance: Psychiatry and the Politics of Not Knowing. Chicago: University of Chicago Press, 2019. 304 pp.

Sociologist Owen Whooley's new book is a synthetic study of the development of American psychiatry over the past century and a half. Relying on a conceptual framework Whooley describes as managing ignorance, the book reexamines major chapters in the psychiatric profession's history. Deftly argued, Whooley describes a profession "propelled less by the accumulation of its knowledge and more by the stubbornness of its ignorance" (p.5). Whooley frames these historical episodes as tensions between what is known and what is not; what is knowable and what is beyond the grasp of the profession's knowledge. Ignorance, Whooley writes, is the "consistent driving force behind the history of American psychiatry" (p.9). The politics of not knowing, and the response to ignorance, he argues, lead to the persistent reinvention of the profession. Whooley maintains that at each point of crisis and criticism, psychiatry responds with a complete reinvention and transformation, so that comprehensive change is the only constant in the history of the profession's development. This is an intriguing and ambitious reading of the development of psychiatry, and Whooley's approach offers some new insights and interpretations.

Chapter one focuses on asylums and the role of superintendents in the rise of the modern psychiatric profession. Whooley argues that a mismatch between the promise of cure in asylums in the overcrowded, cloistered reality of the mentally ill was a form by which superintendents "obscured their own ignorance" (p.53). Chapter two examines the rise of psychobiology as a comprehensive system in American psychiatric thought. Counterintuitively, Whooley describes Adolf Meyer's broad, inclusive conceptualization of psychobiology as a response to psychiatric ignorance. Chapter three focuses on the rise of psychoanalysis and the development of ego psychology. The rise of the psychoanalytic episteme as a response to psychiatric ignorance is novel, and his discussion of lay analysis sheds new light on a much-discussed topic. Chapter four addresses debates on deinstitutionalization and the rise of community psychiatry, framed again as a response to the ignorance of institutional psychiatry. By "ignorance," Whooley seems to be referring to the many contemporary critiques of psychiatry in the sixties and seventies. Chapter five is a study of the Diagnostic and [End Page 229] Statistical Manual (DSM), the rise of a diagnostic focus in psychiatry, and the promised paradigm shift of DSM-5, which never materialized. The tension between the promise of a psychiatric revolution versus a commitment to incrementalism are analyzed through the lens of addressing psychiatric ignorance, adding depth to this meticulous analysis. The conclusion is ambitious, asking sweeping questions on the development of psychiatry. Ultimately, it is an indictment of society's treatment to the mentally ill, asking whether "we get the psychiatry we deserve." In closing, Whooley assigns blame both to the psychiatric profession, and presumably to society at large, as his last sentence baldly states "we are all complicit."

Whooley's main contribution is his analytic framework; his historical work is synthetic, drawing from published materials on well researched episodes. However, his analysis of ignorance and knowledge seems ahistorical, and is not necessarily reflective of historical actors' views of their profession. A comparison of the state of knowledge in the psychiatric profession vis-a-vis other medical disciplines in the nineteenth century may be different from current views. What may be seen by the contemporary reader as ignorance may in fact be a coherent system of knowledge well accepted by historical actors. The historiography also appears somewhat dated; most of the books cited were published prior to 2010, and Whooley's historiographic arguments are often overstated. For instance, in arguing that historians have not been kind to psychobiology (p.91), Whooley cites only one source: Edward Shorter's, A History of Psychiatry (John Wiley & Sons, 1997). In describing Henry Cotton's focal infection theory and the surgeries he performed, Whooley uses the term psychosurgery (p.77–78). This term is generally reserved for...


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