Tag Archives: 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.

British Society History of Science Conference Swansea 2015

This time last week saw the end of the BSHS annual conference. My talk seemed to be received well.

I’d never been to a history conference before and found myself pleasantly surprised. Everyone was very friendly and there was very little confrontational arguments. Typical questions were along the lines of asking speakers to expand upon their argument, what else was going on during these particular events, what theories were dominate, how did this relate to what came before and afterwards, how did this relate to activity in a wider setting (other counties, other sciences). Questions allowed the speaker another opportunity to discuss their research. This felt quite different to philosophy conferences (which I am more used to) where quite a few questions, though by no means a majority, focus upon criticizing the speaker’s argument: what about this counter example, surely you are making this particular assumption, maybe you should consider whoever’s view points. The history approach certainly makes for a more relaxing conference but which one is best? Generally, the history questions gave opportunities to present more empirical evidence rather than specifically defend a particular argument. Philosophy is typically more about defending the argument. To varying degrees (and with many exceptions) both history and philosophy need an empirical basis and a strong argument. The historian seems to build up from lots of empirical evidence to an argument whereas philosophy focuses more on the argument but then often need make their argument compatible with empirical evidence, i.e. fit available evidence as so avoid counter arguments. Personally, I prefer philosophy when it starts with a lot of empirical evidence and tries to analyse that evidence, systematise it and see how it relates to wider bodies of knowledge. I do not know how far it could be taken but I think philosophy could benefit from some approaches adopted by historians.

The other difference is how specific many history papers were, totally unrelated to my field, whereas most philosophy of science is relevant to most other philosophy of science. With exceptions, I think a philosopher of physics could still benefit from seeing, say, a philosopher of biology speak. Both cases may use notions in similar or different ways, i.e. cause, explain, predict, inductive, law, model, etc. You can learn from both the similarities and the differences. The benefits of attending many presentations at history conferences are less obvious but still there. History of 1800s paleontology is no use to the history of autism but you see a historian try to create a historical narrative or create explanations from a particular type of evidence, often using very different type of evidence than I’m used to. For instance, that presentation on paleontology had to appeal to a very limited number of paintings to understand 1800s views of woolly mammoths whereas I primarily deal with journal articles. Someone else deals with diaries, another with hospital records, another with medical equipment. Observing how a historian employs a particular type of evidence, with associated limitations that evidence brings, makes one reflect upon how I go about using evidence, how reliable is it, how representative is it, what is it missing, etc. A useful experience, but, again, useful in a different way to the benefits of seeing philosophers of science dealing with other sciences speak.