Category Archives: Secondary History

Reviewing Madness A History


Petteri Pietikainen’s 2015 Madness: A History intends to provide a general history of psychiatry, the author intending it the first general history since Shorter’s 1997 A History of Psychiatry (presumably Pietikainen started this book before Scull’s recent book came out). The scholarly quality appears to be first rate, a well researched analysis with lots of well thought out arguments. It also covered some ground which I’d not seen discussed elsewhere. On this basis the book is recommended. I do wonder if some of the material is too specific for a general history, such as the chapter on cold war psychiatry which included a section on various attempts at mind control, or the 1960s research into sensory deprivation. To my mind, these are not so crucial as an in depth discussion of the origin and evolution of the DSM, which is present just not as long as I’d like (though that is my specific interest so I might be biased). Basically, providing one reads the book without the assumption that the book will provide THE full history of psychiatry then it is recommended.

The part I found most interesting was Pietikainen’s remarks at the end of the book. He is broadly critical of two relatively recent trends. Firstly, modern focus upon what he calls the “worried well”, which are roughly people with relatively minor psychological issues. This he considers problematic because it can make people with relatively minor issues believe they have serious problems, “influence the person’s self-understanding and potentially cultivate a culture of vulnerability, no matter if it is done with a benevolent purpose”. Meanwhile, this distracts from helping people with more serious issues. Secondly, and relatedly, insufficient care for the more seriously mentally ill, especially after the 1980s “dismantle [of] the Keynesian welfare state”. Since then, “a solid infrastructure of mental health services is still missing in most if not all western countries. As a consequence of deinstitutionalization, homelessness skyrocketed, for example in the UK and the United States, and a growing number of mental patients ended up on the streets, in jails or in shelters for the homeless”. In contrast to some recent histories of psychiatry (especially recent histories of autism), this history suggests that in some important reguards things have actually got worse for the severely mentally ill. Recognising the good intentions behind community care, Pietkainen suggests this ultimately can result in simply not really doing anything to help the mentally ill. “If the mentally ill do not have a safe place to go and receive treatment – other than pills – then how does ‘community care’ differ from systematic negligence?… We have gone around full circle and are back in a world that has uncanny resemblances with the ‘pre-confinement’ era, with the exception of psychiatric pills, patient organizations and the individual ethos of self-management”.

Being a 1930s onward historian and primarily dealing with psychiatric classifications rather than psychiatric care, I’m not really in a position to judge the accuracy of these claims. I do, however, find them fascinating: the idea that without realising it through dressing up our modern situation up as community care and user led care we have returned to situation which most people would be deeply upset about if we realised it had happened. It makes one think about the power of concepts to shape perception, that by portraying (presumably in good faith) many modern innovations in a positive light modern psychiatry has only concealed how badly they are not working. Ultimately, I cannot judge if Pietkainen is exaggerating these claims, so I treat them with caution, but I cannot rule out the possibility they are partially or even wholly true. If so, his message is important and deserves a wider audience.

The History of Secondary Histories of Autism

Over the next few months I’ll be reviewing some secondary history texts, so firstly I’ll outline a brief history of the secondary history. I’m only counting work written from 1980 onwards, since this is when the major steps towards our modern autism started (for earlier histories see some of Kanner’s and Eisenberg’s texts). All texts I refer to below are listed here:

The earliest histories were written by medical practitioners. Sanua (1983) has other agendas than strictly writing a history but he gives an excellent account of the relationship between autism and childhood schizophrenia. Lorna Wing (1997) describes the basics but focuses too much on Kanner and Asperger, though I think her understanding of Kanner is more nuanced that some historians claim. Wolff (2004) is brief and also focuses too heavily on Kanner and Asperger, though she does give a good account of her own work.

The watershed came with Nadesan (2005). This was the first book length history of autism, additionally, it was written by someone who was not a medical practitioner, by someone who is not an important historical figure, unlike Wing and Wolff. Nadesan discusses of concepts of child development prior to autism and discuss how concepts of autism change over time due to changing theories in psychology, also giving wider cultural context to why those theories in psychology changed. Whilst not perfect the book was a massive step forward.

Except for Grinker (2007) (who is worth reading but is not primarily intending to write history), there was a major gap of four years between Nadesan’s book until what I call the first golden age started. 2010 saw books by Feinstein (2010) and Eyal et al (2010). Feinstein interviewed many historical figures whilst Eyal et al described in great detail the wider socio-medical changes and how this impacted concepts and classifications. 2010 also saw Jacobsen’s (2010) article which compared Kanner with Bettelheim and relates their work to modern autism. The next major publication was Silverman’s (2012) book. I believe her book is the least ground breaking of the four history of autism books, covering less new material than the others, but I believe it the most well developed and factually accurate. 2013 saw ground breaking articles by Verheoff (2013) and Evans (2013), both describing how wider theoretical changes in psychiatry influenced the changes to the classification. 2014 saw Evans (2014) provide background to 1950s and 1960s British psychiatry whilst Hollin (2014) and Verhoeff (2014) are the first history papers to cover beyond the 1980s in detail. I’ve missed out Neumärker (2003), Silverman (2010), Blacher & Christensen (2011) and Raz (2014) because they are very specific in their focus, though they are all still worth reading.

So far, to my knowledge, at time of writing (July), there has only been one secondary history publication in 2015 (my own, Fellowes (2015)). Perhaps the first golden age has ended. Alternatively, perhaps the second half of 2015 will see many publications; another of my articles will be submitted soon and Bonnie Evans’ book is due out in 2015. The history of autism has come far, especially since 2010, and I personally can identify many areas not yet covered. From where I sit, a continued stream of publications seems more likely than the field dying at this point – existing texts have raised many questions and it will be historians who read those secondary histories published during this first golden age who will produce the next wave of research.