European Psychiatry from 1800 to 2004 : Institutions, Concepts and Policies

CONCEPTS OF MENTAL DISORDERS IN THE 19TH AND 20TH CENTURY : WHY DO THEY MATTER FOR PRESENT-DAY PSYCHIATRY ?

P. Hoff

Department of Psychiatry, University of Zurich, Switzerland

The concept which is applied by the individual psychiatrist in the treatment of his or her individual patient is not only a theoretical issue. It has a lot to do with practical questions like doctor-patient relationship, patient’s autonomy and long-term therapy planning. This paper discusses three major approaches to the concept of mental disorders since the late 18th century : the realistic, nominalistic and biographical approach. This framework is still in use nowadays. The implications of each concept for practical issues in psychiatric therapy and research are discussed.

MADNESS IN THE HOME. FAMILY CARE, PSYCHIATRY AND WELFARE POLICIES FOR THE MENTALLY ILL IN THE 19TH AND 20TH CENTURIES IN FLORENCE

P Guarnieri

University of Florence, Italy

The view that the asylum is the only place for the care of the mentally ill is a prejudice. And it is necessary to promote family care. This represented the main advice that well-known psychiatrists such as Lombroso and Tamburini offered at the time that the first Italian law on insanity was being drafted. Why did this 1904 law, which insisted on the dangerousness of patients in psychiatric hospitals, brush aside the original advice of the experts ? The model that they intended to extend to the national level was clearly in force in Florence, where family care began early (in 1866) and assumed important and lasting dimensions. In some cases the psychiatric patients were sent to a farm family on contract (according to a similar model for looking after abandoned children). But most often the patients were officially assigned in custody to their own families and subsidized by the government (contrary to the idea that it was the poor who wished to disembarrass themselves of their mentally ill relatives). The study of this experience, on the basis of archival sources of the asylum and the provincial government, permits an understanding, more scholarly than activistic, of a law that lasted too long, from 1904 to 1978, until the so-called Basaglia law. And the confrontation of evidence and self-interest – on the part of the municipality doctors, the psychiatrists, the police, the neighbors and in addition a lady who was a militant advocate of « aiding the working class »- gives us a rich group narrative of attitudes and behaviors concerning the mentally ill, important for the history of psychiatry as well as for the history of the family and of society.

JURISDICTIONS OF PSYCHIATRIC PRACTICE : ON THE EMERGENCE OF UNIVERSITY CLINICS IN GERMANY

E. Engstrom

Max-Planck-Institute for Psychiatry, Munich, Germany

The paper explores the emergence of university psychiatric clinics and their impact on professional development in late-nineteenth century Germany. It argues that these clinics represented a fundamental redistribution of expert labor insofar as academic practitioners acquired jurisdiction over the work of laboratory and bedside research, professional training, and hygienic prophylaxis. Focusing mainly on Wilhelm Griesinger’s reform project at the Charite hospital in Berlin, it explores the professional politics of competing jurisdictional claims to control psychiatric practice – claims that pitted academicians, alienists, and representatives of other medical specialties against one another. The paper situates these jurisdictional disputes within the context of institutional priorities, administrative strictures, regional systems of psychiatric care, and growing public scrutiny of the profession in Imperial Germany. It illustrates how the organization of contemporary psychiatric practice is prefigured in debates that are nearly 150 years old.