The December 2017 issue of History of Psychiatry is now online. Articles in this issue explore connections between psychology, psychiatry, and philosophy, nineteenth century insane acquittal policy, LSD experiments in the United States Army, the use of ECT for mass killing by the Nazis, and much more. Full details below.
“Con Drury: philosopher and psychiatrist,” by John Hayes. Abstract:
Maurice O’Connor Drury (1907–76), an Irish psychiatrist, is best known for his accounts of his close friendship with the eminent twentieth-century philosopher, Ludwig Wittgenstein. His only book, The Danger of Words (1973), was well received by those who had an interest in the relationship between psychiatry, psychology and philosophy. This article concentrates on Drury’s experiences, studies and writings in these fields.
“Insane acquittees and insane convicts: the rationalization of policy in nineteenth-century Connecticut,” by Lawrence B Goodheart. Abstract:
A current situation in Connecticut of whether a violent insane acquittee should be held in a state prison or psychiatric facility raises difficult issues in jurisprudence and medical ethics. Overlooked is that the present case of Francis Anderson reiterates much of the debate over rationalization of policy during the formative nineteenth century. Contrary to theories of social control and state absolutism, governance in Connecticut was largely episodic, indecisive and dilatory over much of the century. The extraordinary urban and industrial transformation at the end of the Gilded Age finally forced a coherent response in keeping with longstanding legal and medical perspectives.
The Saskatchewan Mental Hospital at Weyburn has played a significant role in the history of psychiatric services, mental health research, and community care in Canada. Its history provides a window to the changing nature of mental health services over the twentieth century.
Built in 1921, the Saskatchewan Mental Hospital was billed as the last asylum in North America and the largest facility of its kind in the British Commonwealth. A decade later, the Canadian Committee for Mental Hygiene cited it as one of the worst institutions in the country, largely due to extreme overcrowding. In the 1950s, the Saskatchewan Mental Hospital again attracted international attention for engaging in controversial therapeutic interventions, including treatments using LSD.
In the 1960s, sweeping health care reforms took hold in the province and mental health institutions underwent dramatic changes as they began moving patients into communities. As the patient and staff population shrank, the once palatial building fell into disrepair, the asylum’s expansive farmland fell out of cultivation, and mental health services folded into a complicated web of social and correctional services.
Managing Madness examines the Weyburn mental hospital, the people it housed, struggled to understand, help, or even tried to change, and the ever-shifting understanding of mental health.
Revisiting the history of postwar LSD (lysergic acid diethylamide) research illuminates how the work of a chemist at the Rockefeller Institute contributed to the development of a biochemical paradigm for mental functioning. Dilworth Wayne Woolley proposed one of the first theories of the biochemistry of mental illness based on empirical evidence. His research with LSD and serotonin had wide-ranging repercussions for pharmacology and fit neatly into the emerging medicalization of mental illness. Reevaluating Woolley’s ideas and the fruits of psychopharmacology leads to possible new approaches toward mental health and illness when considered alongside lessons learned from past research with psychedelic substances, and exemplifies a broader paradigm shift in cultural studies toward a biopsychosocial model that acknowledges the intersections between biology and culture.
The June 2016 issue of History of Psychiatry is now online. Articles in this issue explore psychiatric semiology, the German Research Institute of Psychiatry in Munich, madness in novelist Muriel Spark’s work, LSD as treatment in Denmark, the DSM and learning disabilities, Joseph Mason’s madhouse, and the work of Max Scheler. Full titles, authors, and abstracts follow below.
“The emergence of psychiatric semiology during the Age of Revolution: evolving concepts of ‘normal’ and ‘pathological’,” by Diego Enrique Londoño and Professor Tom Dening. The abstract reads,
This article addresses some important questions in psychiatric semiology. The concept of a sign is crucial in psychiatry. How do signs emerge, and what gives them validity and legitimacy? What are the boundaries of ‘normal’ and ‘pathological’ behaviour and mental experiences? To address these issues, we analyse the characteristics and rules that govern semiological signs and clinical elements. We examine ‘normality’ from the perspective of Georges Canguilehm and compare the differences of ‘normal’ in physiology and psychiatry. We then examine the history and the philosophical, linguistic and medical-psychiatric origins of semiology during the eighteenth and nineteenth centuries (the Age of Revolution). The field of rhetoric and oratory has emphasized the importance of passions, emotions and language as applied to signs of madness. Another perspective on semiology, provided by Michel Foucault, lays stress on the concept of ‘instinct’ and the axis of voluntary-involuntary behaviour. Finally, we analyse how statistics and eugenics have played an important role in our current conceptualization of the norm and therefore the scientific discourse behind the established clinical signs.
The Canadian Broadcasting Corporation (CBC) has just aired a piece on the controversial history of Oak Ridge, the forensic mental health division of the Waypoint Centre for Mental Health Care in Penetanguishene, Ontario. (The Oak Ridge building officially closed in 2014, but Waypoint continues to house Ontario’s only maximum security forensic hospital.) “The Secrets of Oak Ridge” aired March 1st, 2016 as part of the CBC’s national news program The National and is described simply as: “Allegations of treatment with LSD, sleep deprivation, torture. The painful legacy of an Ontario psychiatric facility. Reg Sherren reports.”
The 15-minute piece, driven by the narrative of one man’s experiences in the institution in the 1970s, describes some of the treatment practices at the institution at this time and questions the ethics of those involved. A provocative indictment of the institution and its doctors, the segment unfortunately lacks any counterpoint regarding the ethics of the therapeutic practices employed at the hospital. Absent any discussion of the greater context of psychiatry at this time, the treatment of patients at Oak Ridge is presented as unequivocally cruel, unusual, and unethical. This is certainly the experience of the former patient featured in “The Secrets of Oak Ridge.”
And from our present-day vantage point we may well feel similarly. Taking the context of 1960s and 70s psychiatry into account, however, the ethics, or lack thereof, of the program are less clearcut. At the time, Oak Ridge’s use of LSD and other psychopharmaceuticals – alongside other therapies – was seen as a positive form of treatment and a promising advance in the field. Where the CBC segment is most successful is in presenting the patient’s voice, as he recounts his experiences at the hospital. Respecting this patient’s experience, while putting that experience into historical context is a fine balancing act, one, unfortunately, “The Secrets of Oak Ridge” does not attempt. Contextualizing these treatment practices does not mean invalidating the experiences of this or any other patient, but it is necessary for a more complete understanding of what transpired at this hospital in this moment in time.
As we’ve reported previously on AHP, the recently launched Remembering Oak Ridge Digital Archive and Exhibit produced by former AHP contributor Jennifer Bazar, is an excellent and under-utilized source for this much needed information. Details and fuller context for the social therapy program discussed in the CBC segment can be found on this page of the site. (It should also be noted that a class action lawsuit against the hospital and the program’s doctors, on behalf several patients, is as yet undecided.)
The November 2015 issue of Social History of Medicine includes several pieces of interest to AHP readers. Articles in this issue include ones that explore the modern construction of human subjects, madness during voyages to New Zealand during the Victorian and Edwardian eras, and the use of case records of early 20th century Eastern European emigrants as sources. Full titles, authors, and abstracts follow below.
“Migration and Madness at Sea: The Nineteenth- and Early Twentieth-century Voyage to New Zealand,” by Angela McCarthy.
This article draws on a range of sources—including surgeon superintendents’ reports as well as asylum records—to examine the mental health of migrants and crew on the voyage to New Zealand during the Victorian and Edwardian eras. It examines key themes such as relations between crew and passengers, the emotional dimensions of insanity, attempts to export the insane, and collaboration between doctors and relatives in adhering to mental health legislation in order to repatriate the insane, all of which facilitate assessment of wider debates about medical authority. While surgeon superintendents documented actions rather than causes for unusual behaviour, asylum doctors and family members were more likely to attempt to explain mental disturbance at sea. Additionally, this article examines the beliefs of medical officials who paradoxically argued that the voyage was beneficial, rather than detrimental, to health.
“Making up ‘Vulnerable’ People: Human Subjects and the Subjective Experience of Medical Experiment,” by Nancy D. Campbell and Laura Stark.
This paper explores how ‘the human subject’ was figured historically and expands the interpretive range available to historians for understanding the subjective experiences of people who have served in medical experiments in the past. We compare LSD studies on healthy ‘volunteers’ conducted in two experimental settings in the 1950s: the US National Institutes of Mental Health’s (NIMH) Addiction Research Center (ARC) Lexington, Kentucky and the NIH Clinical Center (NIHCC) in Bethesda, Maryland. Sources consist of oral history interviews, transcripts and archival documents including photographs and records. Political priorities and historical contingencies relevant for crystalising the expert domain of modern bioethics, especially the 1960s US Civil Rights movement, were central for producing the ‘vulnerability’ attributed to the modern figure of the ‘human subject’. Using Ian Hacking’s historical ontology approach, we suggest how this figure of the ‘vulnerable human subject’ affected historical actors’ self-understandings while foreclosing paths of historical inquiry and interpretation.
In a recent piece on the Somatosphere blog, historian Laura Stark describes the making of “vulnerable populations” in medical experimentation. Currently writing a book on the emergence of “normal control” subjects in medical research, Stark uses her research on LSD experimentation at the US National Institutes of Health post-WWII to discuss the idea of “vulnerable populations.” The above video features excerpts from some of Stark’s oral history interviews with research subjects used as “normal controls” in this research.
As she describes in “How to make a “vulnerable population”,”
The category of the “vulnerable population” is itself a product of modern (American) bioethics, which invented the concept in its recent vintage and gave it specific meaning in public parlance. The field of modern bioethics emerged in the 1960s and 1970s, and in the post civil-rights period, the bioethical concept of the “vulnerable population” was coded with contemporary rights-based concerns: about minorities, about prisoners, and more. The specific meanings and people associated with “vulnerable populations” were embedded in 1970s human-subjects regulation, as well as in popular discourse….
The concepts of modern bioethics operate at another level, too. Ian Hacking coined the term “moral kinds” to tag what he called meta-ethical issues that people—including scholars—come to embody. We are working to develop Ian Hacking’s framework to show how law (especially U.S. human-subjects regulations) shapes both the memory practices of historical actors and the interpretive practices of present-day scholars. In sum, we are interested in how the concepts of bioethics, such as “vulnerable populations” codified in 1974 and later extended beyond the United States, have narrowed the range of possibilities available to scholars for interpreting empirical evidence. We like Hacking’s approach because it offers a way to investigate how the governing moral sensibilities of a specific time and place both constrain and liberate scholars themselves. The secular, North American, rights-revolution ethos of modern bioethics, we suggest, limits how questions about research practices in the human sciences are conceptualized, and can deflect questions about the historicity of the discipline of bioethics as a knowledge-making enterprise in its own right. We aim to explore medical knowledge-making alongside the ontology of modern bioethics—to ask how, when, where, and with what effects the terms and priorities of this expert domain developed. In doing so, we hope to capture a fuller repertoire of institutions, sensibilities, and activities that eventually came to constitute modern science and biomedicine.
the revival of psychedelic science since the “Decade of the Brain.” After the breakdown of this previously prospering area of psychopharmacology, and in the wake of clashes between counterculture and establishment in the late 1960s, a new generation of hallucinogen researchers used the hype around the neurosciences in the 1990s to bring psychedelics back into the mainstream of science and society. This book is based on anthropological fieldwork and philosophical reflections on life and work in two laboratories that have played key roles in this development: a human lab in Switzerland and an animal lab in California. It sheds light on the central transnational axis of the resurgence connecting American psychedelic culture with the home country of LSD. In the borderland of science and religion, Neuropsychedelia explores the tensions between the use of hallucinogens to model psychoses and to evoke spiritual experiences in laboratory settings. Its protagonists, including the anthropologist himself, struggle to find a place for the mystical under conditions of late-modern materialism.
“Efficacy and Enlightenment: LSD Psychotherapy and the Drug Amendments of 1962,” by Matthew Oram. The abstract reads,
The decline in therapeutic research with lysergic acid diethylamide (LSD) in the United States over the course of the 1960s has commonly been attributed to the growing controversy surrounding its recreational use. However, research difficulties played an equal role in LSD psychotherapy’s demise, as they frustrated researchers’ efforts to clearly establish the efficacy of treatment. Once the Kefauver Harris Drug Amendments of 1962 introduced the requirement that proof of efficacy be established through controlled clinical trials before a drug could be approved to market, the value of clinical research became increasingly dependent on the scientific rigor of the trial’s design. LSD psychotherapy’s complex method of utilizing drug effects to catalyze a psychological treatment clashed with the controlled trial methodology on both theoretical and practical levels, making proof of efficacy difficult to obtain. Through a close examination of clinical trials performed after 1962, this article explores how the new emphasis on controlled clinical trials frustrated the progress of LSD psychotherapy research by focusing researchers’ attention on trial design to the detriment of their therapeutic method. This analysis provides a new perspective on the death of LSD psychotherapy and explores the implications of the Drug Amendments of 1962.
“Neuro Psychiatry 1943: The Role of Documentary Film in the Dissemination of Medical Knowledge and Promotion of the U.K. Psychiatric Profession,” by Edgar Jones. The abstract reads,
In 1943, Basil Wright produced a documentary film about the treatment of servicemen and civilians with psychological disorders at Mill Hill Emergency Medical Service Hospital. Funded by the Ministry of Information, Neuro Psychiatry was shot to convince influential clinicians and policy makers in North America that the British had developed expertise in the management of psychiatric casualties. By emphasizing novel and apparently effective interventions and excluding severe or intractable cases from the film, Wright encouraged an optimistic sense of achievement. Filmed at a time when victory was considered an eventual outcome, the picture presented a health service to which all had access without charge. Children and unemployed women, two groups excluded under the 1911 National Insurance Act, had been required to pay for healthcare in the prewar period and were shown receiving free treatment from the Emergency Medical Service. However, the therapeutic optimism presented in the film proved premature. Most U.K. battle casualties arose in the latter half of the conflict and follow-up studies failed to confirm the positive outcome statistics reported in the film. Aubrey Lewis, clinical director of the hospital, criticized research projects conducted at Mill Hill for a lack of rigor. The cinematographic skills of Wright and director Michael Hankinson, together with their reformist agenda, created a clinical presentation that emphasized achievements without acknowledging the limitations not only of the therapies offered by doctors but also the resources available to a nation at war.
“The Cost of War—Then and Now: Commentary on ‘Neuro Psychiatry 1943’,” by Heiner Fangerau. The abstract reads,
In his essay “Neuro Psychiatry 1943: The Role of Documentary Film in the Dissemination of Medical Knowledge and Promotion of the U.K. Psychiatric Profession” Edgar Jones provides a detailed case study of a single movie that was made under unusual wartime conditions. From this case, he builds a general analysis of the interpretation and portrayal of scientific expertise that shaped the production, distribution, and reception of this genre of documentary. The paper provides a fresh perspective for the historical analysis of film documentaries, while remaining highly topical and germane to present-day issues in medicine and health care.
The film that Jones studied was produced in a British hospital where war victims (mostly soldiers) were treated for war neuroses. The filmmakers documented the therapies employed and the apparently successful posttreatment reintroduction of patients into military service and civilian work. They hoped to convince informed audiences, especially those outside Britain in the United States and Canada, about the effectiveness of the British Health Care Service in …
AHP readers may be interested in a recent piece in the New Yorker titled “Operation Delirium.” The article explores experiments with psycho-chemicals within the United States military during the Cold War. This included the administration of nerve gas, LSD, and other chemicals to soldiers to assess their effects. At present, a class action suit on behalf of the soldiers who were subject to this chemical testing is underway.
As described in the article’s opening paragraph,
Colonel James S. Ketchum dreamed of war without killing. He joined the Army in 1956 and left it in 1976, and in that time he did not fight in Vietnam; he did not invade the Bay of Pigs; he did not guard Western Europe with tanks, or help build nuclear launch sites beneath the Arctic ice. Instead, he became the military’s leading expert in a secret Cold War experiment: to fight enemies with clouds of psychochemicals that temporarily incapacitate the mind—causing, in the words of one ranking officer, a “selective malfunctioning of the human machine.” For nearly a decade, Ketchum, a psychiatrist, went about his work in the belief that chemicals are more humane instruments of warfare than bullets and shrapnel—or, at least, he told himself such things. To achieve his dream, he worked tirelessly at a secluded Army research facility, testing chemical weapons on hundreds of healthy soldiers, and thinking all along that he was doing good.
Journalist Raffi Khatchadourian, the author of the New Yorker article, was also interviewed by NPR about the story. That interview can be heard on the NPR website here.