Scottish 18th-century physician and philosopher.

George Cheyne (1672-1743) practised for many years as a doctor in the English spa town of Bath. He is considered a pioneer of vegetarianism and of modern concepts of “nervousness” and hypochondria.

Life

Cheyne was born into a wealthy family in Methlick, Aberdeenshire. He grew up in a privileged environment and enjoyed a liberal education. He studied medicine in Edinburgh and Aberdeen. In Edinburgh, he was strongly influenced by one of his teachers, the physician and poet Archibald Pitcairne (1652–1713). He graduated from the University of Aberdeen in 1701 and moved to London where he opened his own private practice in 1702. He became a member of the Royal Society and was acquainted with Isaac Newton and his circle. His debaucherous lifestyle eventually led to obesity; he weighed over “32 stones” (200 kg), was short of breath and became lethargic (Cheyne 1733: 342). In 1705, he experienced convulsive symptoms (“vertiginous paroxysms”), possibly signs of an impending stroke or heart attack. On a colleague’s advice, he consulted the physician Dr Taylor in Croydon, who recommended an austere diet (no meat, no alcohol, vegetarian food and dairy products; cf. Richardson 2013). Cheyne radically changed his lifestyle and dietary habits, and his weight and health normalised. In 1719, he transferred his practice to the spa town of Bath where he treated numerous prominent patients (e.g., David Hume, Alexander Pope). He suffered several severe relapses, particularly between 1723 and 1725, with attacks of fever and gout, ulcers, erysipelas and depressive moods. Yet, George Cheyne died without any serious bodily impediment at the age of 71 in Bath.

Dietary treatment and the cultural conditions of mental suffering

In 1725, Cheyne published his most successful and influential work, An Essay on Health and Long Life, in which he propagated the benefits of vegetarianism, the abstinence from alcohol, and physical exercise. His medical colleagues, particularly those in the Royal Society, were of divided opinion about the book. The critics accused Cheyne, who had been given the nickname “Dr Diet”, of putting medical matters that were the responsibility of doctors into the hands of patients.

His other famous work is The English Malady: or, A Treatise of Nervous Diseases of all Kinds, as Spleen, Vapours, Lowness of Spirits, Hypochondriacal and Hysterical Distempers, published in 1733. Cheyne claimed that the English people were particularly susceptible to nervous disorders, which he defined as follows: “Diseases are chiefly and properly called nervous whose symptoms imply that the system of the nerves and their fibres are evidently relax’d and broken” (1733: 14). According to him, the nervous system was made up from “hollow fibres packed into nerve tracts”, and the nervous symptoms resulted from blockages and plaques in these tracts, impairing their vigour and vibrancy and ultimately leading to lethargy, convulsions and disease. In order to revitalise the nerves, he recommended medication (e.g., bitter drinks, quicksilver, oils), a light diet and regular physical exercise (cf. Cheyne 1742: 57–133). He described the positive effect of this cure in the third part of The English Malady by presenting his own experiences on forty pages titled The Case of the Author (325–364).

George Cheyne theorised on diseases of affluence, attributing them to the increasing wealth and the idle life of the English bourgeoisie. His concepts on nerve physiology and the effects of milieu and lifestyle, including the recommended naturopathy cures, replaced the previous theological and humorism-based ideas regarding the nature and treatment of melancholia and hypochondria.

Literature

Cheyne, G. (1702): A New Theory of Acute and Slow Continu'd Fevers. 2nd Edition. Cornhill: Strahan.

Cheyne, G. (1705): Philosophical Principles of Natural Religion. Cornhill: Strahan.

Cheyne, G. (1715): Philosophical Principles of Religion. Natural and Revealed. In Two Parts. Cornhill: Strahan.

Cheyne, G. (1724): An Essay of Health and Long Life. Cornhill: Strahan.

Cheyne, G. (1733): The English Malady: or, A Treatise of Nervous Diseases of all Kinds, as Spleen, Vapours, Lowness of Spirits, Hypochondriacal and Hysterical Distempers. Cornhill, Bath: Strahan, Leake.

Cheyne, G. (1740): An Essay on Regimen, Together with Five Discourses, Medical, Moral, and Philosophical: Serving to Illustrate the Principles and Theory of Philosophical Medicine, And Point out Some of its Moral Consequences. Cornhill: Strahan.

Cheyne, G. (1742): The Natural Method of Cureing the Diseases of the Body and the Disorders of the Mind Depending on the Body. Cornhill: Strahan, Knapton.

Gerabek, W. E., B. D. Haage, G. Keil, W. Wegner (2004): Enzyklopädie Medizingeschichte. Berlin: de Gruyter.

Guerrini, A. (2000): Obesity and Depression in the Enlightenment. The Life and Times of George Cheyne. Norman: University of Oklahoma.

Ingram, A. (1998): Patterns of Madness in the Eighteenth Century. A Reader. Liverpool: Liverpool University Press, pp. 83–92.

Porter, R. (1995): Medicine in the Enlightenment. Amsterdam: Rodopi.

Richardson, S. (2013): Correspondence with Edward Cheyne and Thomas Edwards. Cambridge: Cambridge University Press.

Shuttleton, D. E. (1992): “My Own Crazy Carcase”. The Life and Works of Dr George Cheyne (1672–1743). Doctoral Thesis. University of Edinburgh.

Catharina Bonnemann, Burkhart Brückner

Picture: John Faber, Jr., 1732 / Source: Wikimedia / public domain.

British army officer, asylum inmate, pioneer of the user movement in psychiatry

John Thomas Perceval (1803–1876) was the tenth child of Spencer Perceval (1762–1812) and his wife, Jane (née Wilson). His father served as prime minister under King George III from 1809 and was shot dead in the lobby of the House of Commons by John Bellingham, a failed merchant, in 1812 (Treherne 1909: 193 ff.; cf. Gillen 1972). Two years after this event, Perceval’s mother married the army officer Sir Henry Carr. Born into the ruling elite of the United Kingdom, Perceval was, as he put it, “nursed in the lap of ease and scrupulous morality”. At the age of 18, he joined the military. He ended his military career nine years later, after deployments in Portugal and Ireland, in the rank of a captain: he no longer wished to be “a blind instrument of power” (cf. Bateson 1961: 10). He initially thought of entering politics but then enrolled at Magdalen College, Oxford, in 1830 to study theology (Hamilton 2004: 89).

Crisis and hospitalisation

After his first term in Oxford, Perceval went to see friends and family in the north of England and then embarked on a spiritual journey to Scotland to visit a controversial religious community in Port Row (today Rhu). This group, led by John McLeod Campbell (1800–1872), was said to speak in tongues (“Row Heresy”; cf. Perceval 1961: 16 ff.; Hervey 1986: 251; MacGregor 1950). Perceval allegedly started experiencing visions and hearing imaginary voices around that time; in Port Row, his behaviour became so unpredictable that he was eventually asked to leave the community (Hamilton 2004: 89). He left Scotland to visit friends in Dublin where he developed acute symptoms (ibid.; Podvoll 1990: 110). His friends had him restrained and alerted his eldest brother, Spencer Perceval (1795–1859), who came to take John Perceval back to England in December 1830 and put him in a private asylum near Bristol. This institution, Brislington House, was known for its wealthy clientele and its regime of comparatively few restrictions. Its director at that time was Edward Long Fox (1761–1835) (Smith 2008). In February 1832, Perceval was transferred to the equally well-equipped and expensive Ticehurst House in Sussex, then directed by Charles Newington (1781–1852). He was released from Ticehurst in December 1834 after having convinced his family to arrange for private care (MacKenzie 1992: 92).

Shortly after his release, Perceval married Anna Lesley Gardner. The couple went to live in Paris for some years. They had four daughters: Jane Beatrice (1835–1893), Alice Frederica (1836–1941), Selina Maria (1838–1925) and Fanny Louisa Charlotta (1845–1862). 

Perceval’s Narrative

Perceval had already begun to note down his treatment experiences while at Brislington House. Now in Paris, he started writing an autobiographical book, the first volume of which he published anonymously in 1843; the second volume followed in 1840 under his own name. The work, totalling over 700 pages, was titled A Narrative of the Treatment Experienced by a Gentleman, During a State of Mental Derangement. The first volume described Perceval’s childhood and youth and explained the events leading up to his committal, with the main part recounting his asylum experiences. The second volume described his recovery and included numerous letters. In a contemporary review for the journal British and Foreign Medical Review (Forbes 1841: 106), the reviewer recommended the book to all psychiatric practitioners, emphasising the instructive value of Perceval’s meticulous descriptions of “imaginary”, delusional reasons for action and his response to treatment. In 1961, Gregory Bateson republished the volumes together with a new introduction.

Subjective theory of illness

Perceval believed his mental crisis to have resulted from his persistent problems of religious identity. In Dublin, he assumed, he had suppressed his nagging doubt in faith at the threshold of consciousness – however, the more he rejected this doubt, the stronger became the religious certainties: “I perished from an habitual error of mind, common to many believers, and particularly to our brethren the Roman Catholics, that of fearing to doubt, and of taking the guilt of doubt upon my conscience; the consequence of this is, want of candour and of real sincerity; because we force ourselves to say believe what we do not believe, because we think doubt sinful” (Perceval 1961: 36; emphasis added).

Treatment experiences

The treatment Perceval was given at Brislington House and Ticehurst obviously did not meet his expectations of how a member of the upper class would be treated, as he was temporarily put into a straitjacket and tied to his bed. In hindsight, he conceded to having been an unruly patient who posed a danger to himself and others. He admitted that he had planned to kill himself, developed his own private language, made up a fake biography and hallucinated incessantly. At Brislington House, for example, he mistook the asylum for his parental home. He described the staff’s actions and attitudes as follows:

“The first symptoms of my derangement were, that I gazed silently on the medical men who came to me, and resolutely persisted in acts apparently dangerous. No doubt there were also symptoms of bodily fever. But from that moment to the end of my confinement, men acted as though my body, soul and spirit were fairly given up to their control, to work their mischief and folly upon. I mean, that I was never told, such and such things we are going to do; we think it advisable to administer such and such medicine, in this or that manner; I was never asked, Do you want anything? Do you whish for, prefer any things? Have you any objection to this or to that? I was fastened down to bed; a meagre diet was ordered for me; this and medicine forced down my throat, or in the contrary direction; my will, my wishes, my repugnancies, my habits, my delicacy, my inclinations, my necessities, where not once consulted, I may say, thought of. [...] The persons round me consulted, directed, chose, ordered, and force was the unica and ultima ratio applied to me” (Perceval 1961: 120 f.).

Analysing the therapeutic milieu of Brislington House, Leonard Smith (2008: 181) concluded that Perceval acknowledged its high standards of treatment, while conceding that these standards could not always be maintained when dealing with a difficult patient like himself (hence the isolation room, cold baths and restraints). Perceval’s hospitalisation at Ticehurst House and the “moral treatment” practised there have been reconstructed by Charles McKenzie (1992: 62 ff.). According to him, Perceval’s account offers a good picture of the material and social situation at this institution but does not help in assessing whether he was accurate in his criticism of the treatment.

Recovery

The second volume of Perceval’s Narrative includes a detailed description of his recovery. Claiming that “many persons confined as lunatics are so only because they are not understood, and continue so because they do not understand themselves” (Perceval 1961: 220), he argued that therapeutic understanding required adequate circumstances: “A lunatic appears insensible, but his is, perhaps, the most alive of any mind to ridicule, and the contemptibleness of his state. But he is, as I may say, unconsciously alive to it. He does not acknowledge his own feelings, because his mind is deeply engrossed in painful and excruciating conflicts; he is already troubled by a thousand horrible and fanciful ideas of danger; the victim of inward  and preternatural sarcasm, contumely, and derision. But he acts strangely, from what he suffers unacknowledged and not understood by himself. If indeed, he were in quiet, peaceful circumstances, if he were secure he might find his mind reflect to his conscience perfectly, what the trouble occasioned by internal and external alarm prevents him noting” (Perceval 1961: 141).

Perceval suggested that just like the derangement had resulted from loosing the ability to doubt, regaining this ability was the key to his recovery: “shocked” by the experience that some of the prophecies of his hallucinated voices failed to materialise, he was increasingly able to distance himself from them and interpret them as dictates of conscience having taken on a life of their own. Becoming aware of the situational context of his delusions had reduced their presence and enabled a systematic examination of evidence (like, for example, his baptism certificate), as “many delusions that I laboured under, and which other insane persons labour under, consist in their mistaking a figurative or a poetic speech for a literal one; and this observation may be of importance to those who attend to their cure. […] During the progress of my recovery there, I kept watching minutely all my experiences and my conduct, and that of other patients, comparing their cases with my own, drawing such conclusions as in those painful circumstances I was” (Perceval 1961: 271 ff.). He concluded by explaining that, at Ticehurst House, he gradually calmed down and managed to address his family entanglements.

Criticism of treatment

Perceval demanded the legal protection of asylum inmates from (unnecessary) physical violence, arbitrary observation and shaming, an end to postal censorship, the right to choose one’s attending doctor, access to legal representation, the right to receive visits from friends and adequate medical treatment: “My mind was not destroyed, without the ruin of my body. My delusions, though they often made ridiculous, did not derange my understanding unaided by the poisonous medicines and unnatural treatment of my physicians” (Perceval 1961: 69).

Following the tradition of earlier testimonials presented by asylum inmates from Britain (for example, by Alexander Cruden or Samuel Bruckshaw), Perceval thus referred to the concept of inalienable civil liberties (Hunter & Macalpine 1962: 392; Podvoll 1990: 11; Wise 2012) – which were, however, suspended for asylum inmates: “I open my mouth for the dumb [...] I intreat you to replace yourselves in the position of those whose sufferings I describe, before you attempt to discuss what is to be pursued towards them. Feel for them: try to defend them. Be their friends – and argue not hostilely” (Perceval 1961: 4).

Alleged Lunatics’ Friend Society

In 1845, Perceval joined forces with other former patients to found the Alleged Lunatics’ Friend Society (ALFS) in London. He became the organisation’s chairman. Other prominent members were Richard Paternoster, Luke James Hansard, Richard Saumarez, Gilbert Bolden and John Parkin (Wise 2012; Scull 2015: 45; Paternoster 1841). The ALFS called for more adequate forms of asylum treatment and more effective protection from arbitrary compulsory hospitalisation. Despite accusations of selfish motives (as raised in The Times in 1858; cf. Hervey 1986), the Society achieved the release of several asylum patients, for example, in the forensic case of Arthur Legent Pearce. Perceval also published Pearce’s poetry in 1851. In 1854, he published a further book about the case of Eduard Peithmann (1803–1866), which had also been commented on by Karl Marx (1854) in the New York Daily Tribune (cf. Wise 2012; Meier-Peithmann 2011; Podvoll 1990: 111; Perceval 1854). The ALFS’s campaign strategy included sending letters to the government, politicians and the press. The organisation published reports in 1851 and 1858, which presented proposals for reform but were hardly noticed by the general public (Hunter & Macalpine 1962: 393 f.). The public impact remained rather limited; the ALFS probably never had more than a maximum of 60 people involved and ceased its activities around 1860. Its basic demand – that compulsory psychiatric admission be preceded by a court hearing – was fulfilled in 1890, fourteen years after John Perceval’s death. After obviously again suffering from mental problems, Perceval died at Munster House Asylum in the London borough of Fulham in 1876, at the age of 73. He is buried in Kensal Green Cemetery in London.

John Perceval called for consistent reforms of the asylum system at a very early point and is thus considered a pioneer of the user movement in psychiatry. His Narrative is a classic on the situation of the asylum system in 19th-century Britain (Shumway 2016) and one of the most significant first-person accounts of the experience od madness “from within” (Wise 2012; Gault 2008; Brückner 2007: 216–229; Hunter & Macalpine 1962: 392). The 1961 re-edition by Bateson has then also inspired the more recent recovery movement and alternative concepts of treatment in psychiatry (cf. Schlimme & Brückner 2017: 36 ff.; Podvoll 1990; Mosher, Hendrix & Fort 1994; Runte 2000).

Literature

Alleged Lunatics’ Friend Society (1846, ed.): First report; shewing the origin, progress and expenditure of the Society, & c. / with its laws and regulations: 7th July, 1845, to 7th January. London: W. M’Dowall.

Alleged Lunatics’ Friend Society (1851, ed.): Report of the Alleged Lunatics’ Friend Society. London: The Society.

Alleged Lunatics’ Friend Society (1858, ed.): The Alleged Lunatics’ Friend Society – Report – 1858. London: The Society.

Bateson, G. (1961): Introduction. In: J. T. Perceval: Perceval’s Narrative. A Patient’s Account of His Psychosis 1830–1832. Stanford: Stanford University Press, pp. V–XXII.

Böker, W., A. Schaub (1997): Bewältigungsversuche Schizophrener. In: W. Böker, H. D. Brenner (eds.): Behandlung schizophrener Psychosen. Klinische Psychologie und Psychopathologie 64, pp. 163–185.

Brückner, B. (2007): Delirium und Wahn. Geschichte, Selbstzeugnisse und Theorien von der Antike bis 1900, Vol. 2. Das 19. Jahrhundert. Hürtgenwald: Pressler.

Forbes, J. (1841) [ed.]: [Review] J. Perceval, A Narrative of the Treatment Experienced by a Gentleman. In: The British and Foreign Medical Review 11 (January – April 1841), pp. 104–128.

Gault, H. (2008): An Expert by Experience. In: The Psychologist 21 (5), pp. 462–463.

Gillen. M. (1972): Assassination of the Prime Minister. The Shocking Death of Spencer Perceval. London: Sidgwick & Jackson.

Hamilton, J. W. (2004): Perceval’s Psychosis Revisited. In: Free Associations 11, pp. 89–103.

Hervey, N. (1986): Advocacy or Folly: The Alleged Lunatics’ Friend Society, 1845–63. In: Medical History 30, pp. 245–275.

Hunter, R., I. Macalpine (1962): John Thomas Perceval (1803–1876). Patient and Reformer. In: Medical History 6, pp. 391–395.

MacKenzie, C. (1992): Psychiatry for the Rich: A History of Ticehurst Private Asylum, 1792–1917. London: Routledge.

Kelly, B. D. (2016): Searching for the Patient’s Voice in the Irish Asylums. In: Medical Humanities 42 (2), pp. 87–91.

Marx, K. (1854): Die Erregung in Italien – Die Ereignisse in Spanien – Die Haltung der deutschen Staaten – Englische Richter [New-York Daily Tribune, No. 4142, 28 July 1854]. In: Marx, K., F. Engels (1961): Werke. Vol. 10. Berlin: Dietz, pp. 332–341.

McCandless, P. (1981): Liberty and Lunacy: The Victorians and Wrongful Confinement. In: A. Scull (ed.): Madhouses, Mad-Doctors and Madmen. The Social History of Psychiatry in the Victorian Era. Philadelphia: University of Pennsylvania Press.

MacGregor, G. (1950): The Row Heresy. In: The Harvard Theological Review 43 (4), pp. 281–301.

Mosher, L., V. Hendrix, D. Fort (1994): Dabeisein. Das Manual zur Praxis in der Soteria. Bonn: Psychiatrie-Verlag.

Paternoster R. (1841): The Madhouse System. London: Richard Paternoster.

Meier-Peithmann, W. (2011): Kulturgeschichte einer deutschen Familie. Vorträge zur Familiengeschichte Peit(h)mann 1990–2010. Hille-Südhemmern: Familienverb. Peit(h)mann, pp. 347–370.

Pearce, A. L. (1851): Poems by a Prisoner in Bethlehem. Edited by J. Perceval. London: Effingham Wilson.

Perceval, J. T. (1961): Perceval’s Narrative. A Patient’s Account of His Psychosis 1830–1832. Edited by G. Bateson. Stanford: Stanford University Press.

Perceval, J. T. (1838; anonymous publication): A Narrative of the Treatment Experienced by an Gentleman, During a State of Mental Derangement; Designed to Explain the Causes and the Nature of Insanity, and to Expose the Injudicious Conduct Pursued Towards Many Unfortunate under that Calamity. Vol. 1. London: Effingham Wilson.

Perceval, J. T. (1840): A Narrative of the Treatment Experienced by an Gentleman, During a State of Mental Derangement; Designed to Explain the Causes and the Nature of Insanity, and to Expose the Injudicious Conduct Pursued Towards Many Unfortunate under that Calamity. Vol. 2. London: London: Effingham Wilson.

Perceval, J. T. (1854): Case of Dr. Peithman, LL. D. The Petition of Dr. Peithman. London: Clayton.

Peterson, D. (1982): A Mad People’s History of Madness. Pittsburgh: University of Pittsburgh Press.

Podvoll, E. M. (1990): Recovering Sanity. The Seduction of Madness. New York: HarperCollins.

Porter, R. (1987): A Social History of Madness. The World Through the Eyes of the Insane. New York: Weidenfeld & Nicolson.

Porter, R. (1987a): Mind-Forg’d Manacles. A History of Madness in England from the Restoration to the Regency. London: Athlone Press.

Porter, R., H. Nicholson, B. Benett (2003): Women, Madness and Spiritualism. 2 Vols. London: Routledge

Runte, I. (2000): Begleitung höchst persönlich. Innovative milieu-therapeutische Projekte für akut psychotische Menschen. Bonn: Psychiatrie-Verlag.

Schlimme, J. E., B. Brückner (2017): Die abklingende Psychose. Verständigung finden, Genesung begleiten. Cologne: Psychiatrie-Verlag.

Scull, A. (2015): A Culture of Complaint: Psychiatry and its Critics. In: J. Reinarz, R. Wynter (eds.): Complaints, Controversies and Grievances in Medicine. Historical and Social Science Perspectives. London: Routledge, pp. 37–56.

Shumway, S. R. (2016): Perceval’s Narrative. Fifty Years Later. In: I. Natali, A. Volpone: Symptoms of Disorder: Reading Madness in British Literature, 1744–1845. New York: Cambria, pp. 119–139.

Smith, L. (2008): A Gentleman’s Mad-Doctor in Georgian England. Edward Long Fox and Brislington House. In: History of Psychiatry 19 (2), pp.163–184.

Treherne, P. (1909): The Right Honourable Spencer Perceval. London: T. Fisher Unwin.

Wise, S. (2012): Inconvenient People. Lunacy, Liberty and the Mad-Doctors in Victorian England. London: Bodley Head.

Burkhart Brückner, Annette Baum

German physician, proponent of Romantic medicine, coined the term "psychiatry"

Johann Christian Reil (1759-1813) was born in Rhaude (East Frisia, Kingdom of Prussia) as the son of a pastor. He was a professor of medicine in Halle and Berlin and also served as a medical officer for the Prussian state (e.g., in improving field hospitals). He represented a Romantic medicine informed by the Enlightenment and was the first to use the term "psychiatry" in an essay published in 1808. Reil ist considered the most influential German-speaking physician of the founding era of psychiatry (the "German Pinel").

Life and career

Having studied medicine in Göttingen (1779) and Halle (1780–82), Reil went to Berlin to work as an intern under Markus Herz, at whose house he also lived, to obtain his license to practice medicine and then spent some years as a general practitioner in Norden (East Frisia). In 1787, he was appointed to associate professor in Halle, which was to become his adopted home. When his mentor Johann Friedrich Gottlieb Goldhagen died in 1788, Reil became a full professor of medicine and was appointed to city physician (municipal medical officer). He was, for example, instrumental in the establishment of a medicinal spa where he also practised as a spa doctor. In the same year, he married Johanna Wilhelmine Leveaux, the daughter of a wealthy local family. Reil was a member of the Halle freemason lodge “Zu den drei Degen” (Three Swords).

Reil was in contact with important physicians of his time (Johann Christian Ferdinand von Authenrieth, Christoph Wilhelm Hufeland), treated well-known personalities at the Halle spa (e.g., Johann Wolfgang von Goethe) and was a highly respected physician and professor in the state of Prussia. After he had turned down several offers form universities outside Prussia, King Frederick William III rewarded him in 1803 with the “Schafsberg”, a hill near Halle, on which Reil built a villa and a park. When Wilhelm von Humboldt initiated the founding of a university in Berlin in 1809, Reil was one of his advisors and became a full professor of medicine at the newly established university in 1810. Yet, he retained his position as a spa doctor in Halle and as director of the field hospitals in Leipzig and Halle. It was in the latter function that he inspected the battlefields of the Battle of the Nations in October 1813 and wrote about the wounded and the dying. Reil contracted typhoid fever on this trip and died on 22 November 1813 in Halle (Kaiser & Mocek 1979; Schrenk 1973: 61 ff.; Dörner 1969/1975: 227–273).

“Life-power” and theory of disorders

In his 1795 work Von der Lebenskraft [On Life-Power], strongly influenced by Schelling’s Naturphilosophie, Reil conceptualised this life-power as an overarching principle of life, an immaterial force that animates the organism as a whole. Drawing on the then-popular stimulation theory, developed by the Scotish physician John Brown, and Markus Herz’s concept of “material ideas” (cf. Hansen 1998: 399), Reil assumed that every organ and organ system had its own “life-power” and thus a specific irritability and specific responses to stimulation (Reil 1795/1910; Kokorschke 2004; Tsouyopoulos 2008: 36 ff.). This also applied to the “soul’s organ”, processing feelings and emotions of all kinds (sensory impressions, imagination, emotional drives; cf. Hagner 1997: 157–170). If this “synthesising function” of the soul’s organ was impaired due to internal or external causes, the “un-synthesised” and thus “disordered” organ functions would come to light and gain the upper hand (Reil 1795/1910: 46 ff.). This concept shows that Reil seized on bourgeois discourses of his time, which saw madness as being the result of excessive sentiment or the unbridled “night side” of the soul (Kaufmann 1995: 56 ff.) but also on Schelling’s philosophy as well as on Ernst Platner’s model of a “dualistic soul organ”, according to which human beings possessed a spiritual and an animal soul (cf. Marneros & Pillmann 2005: 50 ff.; Sonntag 2001). Reil conceptualised the scholarly problem of irrationality as the “un-synthesised”, inner night side of humans, tried to explain the regularities of this inner world and thus opened up to the medicine of his time a conceptual and practical access to understanding insanity.

“Psychiatry” as the art of healing the soul

Reil coined the term "psychiatry“ (in German: "Psychiaterie") in his 1808 essay Ueber den Begriff der Medicin und ihre Verzweigungen [On the Term of Medicine and Its Branches] to approach the unity of “speculation and empirical evidence” as well as of mental and bodily phenomena from a psychological perspective: “So there only remains psychiatry [Psychiaterie] or the method of curing diseases by means that address man’s ideational principle, to begin with. ... The problem that psychiatry [Psychiaterie] has to solve is how changes in the organism can be achieved by primary impressions on its ideational side for the purpose of curing?” (Reil 1808: 238; translated from German). 

“Psychical method of treatment”

Reil answered this question in his main work, published in 1803 under the title Rhapsodien über die Anwendung der psychischen Curmethode auf Geisteszerrüttungen [Rhapsodies on the Application of the Psychical Method of Treatment to Mental Breakdowns]. There he called for the establishment of state-supervised mental institutions in rural environments, which should differ from previous madhouses in terms of better staffing and adequate architecture and should provide pharmaceutical, surgical and psychological means of treatment. Restoring the self-consciousness of the disturbed would require not only doctors who take care of body and soul and but also the involvement of psychologists who take care of the soul (Reil 1808: 237; 1803: 68, 477 f.). The method centred around exposing the patient to the synthetic consciousness of the attending doctor, who would have to “drive them up to the full use of reason” in three steps: 1. strong stimuli like drum beats or branding irons; 2. specific stimuli like gymnastics or exercises; 3. talking as a stimulus affecting the synthetic consciousness (cf. Brückner 2007: 35 ff.; Schlimme & Gonther 2010: 68).

The work of Reil had a lasting influence on the development of “psychical medicine” and early psychiatry after 1800 in the sense of the paternalistic “moral treatment”, which had already been established in England (by Tuke) and France (by Pinel). The claim was to rehabilitate the mad as members of society, while modern psychiatry was established and defined as a special branch of medicine.

Literature

Brückner, B. (2007): Delirium und Wahn. Geschichte, Selbstzeugnisse und Theorien von der Antike bis 1900. Vol. 2, Das 19. Jahrhundert – Deutschland Hürtgenwald: Pressler.

Dörner, K. (1969): Bürger und Irre. Zur Sozialgeschichte und Wissenschaftssoziologie der Psychiatrie. Frankfurt/Main: Suhrkamp.

Gregor, A. (1921): Johann Christian Reil. In: T. Kirchhoff (1921, ed.): Deutsche Irrenärzte. Einzelbilder ihres Lebens und Wirkens. Berlin: Springer, pp. 28–42.

Hagner, M. (1997): Homo cerebralis. Der Wandel vom Seelenorgan zum Gehirn. Berlin: Berlin Verlag.

Hansen, L. A. (1998): Metaphors of Mind and Society. The Origins of German Psychiatry in the Revolutionary Era. In: Isis – Journal of the History of Science Society 89 (9), pp. 387–409.

Kaiser, W., R. Mocek (1979). Johann Christian Reil. Leipzig: Teubner.

Kaufmann, D. (1995): Aufklärung, bürgerliche Selbsterfahrung und die “Erfindung” der Psychiatrie in Deutschland, 1770–1850. Göttingen: Vandenhoeck & Ruprecht.

Koschorke, A. (2004): Poesis des Leibes. Johann Christian Reils romantische Medizin. In: G. Brandstetter, G. Neumann (ed.): Romantische Wissenspoetik. Die Künste und die Wissenschaften um 1800. Würzburg, pp. 259–272.

Marneros, A., F. Pillmann (2005): Das Wort Psychiatrie wurde in Halle geboren. Von den Anfängen der deutschen Psychiatrie. Stuttgart: Schattauer.

Marx, O. M. (1990): German Romantic Psychiatry. Part I. In: History of Psychiatry 1, pp. 351–381.

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Catharina Bonnemann, Burkhart Brückner

Photograph: Schnor von Carolsfeld (painter); F. W. Bollinger (engraver), (http://www.sammlungen.hu-berlin.de/dokumente/6994/) / Source: Wikimedia / public domain.

American psychiatrist, psychotherapist and critic of psychiatry.

Thomas Szasz (1920–2012) was born in April 1920 into a Jewish family in Budapest, Hungary. He was the second child of his parents, Lily Wellisch and Gyula Szász, and initially bore the Hungarian name Tamás István. Thanks to a privileged visa, he was able to emigrate to the US in 1938, before the beginning of WW II. As he later recalled in his Autobiographical Sketch (2004), it was already in Budapest in the 1930s that he had read Freud’s and Ferenczi’s writings on psychoanalysis and developed his ethical positions on the relationship between psychiatry and psychotherapy under the influence of Hungarian writer Frigyes Karinthy.

Szasz matriculated at the University of Cincinnati in February 1939 and obtained his B.S. (Hons) in physics in May 1941, with the prospect of joining medical school (Szasz 2004: 14). However, because of his Jewish background numerous applications were needed before he was finally accepted at the College of Medicine in August 1941. After receiving his M.D. from the University of Cincinnati in June 1944, he completed his residency at the Chicago General Hospital and then trained in psychiatry and psychoanalysis in Chicago (2004: 18). He opened his own practice as a psychoanalyst in 1948 and received a tenured position in psychiatry at the New York State University in Syracuse in 1956. He retired in 1990. Szasz was married to Rose Loshkajian, with whom he had two daughters. He died in 2012 in Manlius, NY. Having suffered a serious fall, he decided to take his own life instead of living on in chronic pain.

Schizophrenia as a myth

Szasz achieved international attention with his 1961 book The Myth of Mental Illness. He deemed the concept of mental illness a pseudo-scientific product of negotiation processes lacking factual substance. Instead, he argued, this concept of illness was there to rationalise and pathologise personal “problems in life” and “unwanted” thoughts, feelings and behaviours. Fifteen years later, Szasz picked up on the issue in his book Schizophrenia, explaining once again that “[t]he point I wish to emphasize here, right at the outset, is that the claim that some people have a disease called schizophrenia (and that some, presumably, do not) was based not on any medical discovery but only on medical authority; that it was, in other words, the result not of empirical or scientific work, but of ethical and political decision making” (Szasz 1976/1988: 3).

The opening statement of Szasz’s historical analysis The Manufacture of Madness reads, “The concept of mental illness is analogous to that of witchcraft” (1997/1970: 23). He argued that modern psychiatry resembled the Inquisition: “The end of one ideology is thus the beginning of another: where religious heresy ends, psychiatric heresy begins; where the persecution of the witch ends, the persecution of the madman begins” (1997/1970: 110).

Social history and history-of-science background

Szasz’s arguments met with fierce opposition from the outset (see, e.g., Shorter 2011; Clarke 2007; Schaler 2005) but also helped establish a fundamental criticism of psychiatry in a historical situation when institutional reforms of the care system seemed just as necessary as revisions of psychopathology and diagnostics. At about the same time, the British psychoanalyst Ronald D. Laing published his first critical analysis The Divided Self (1961), the French philosopher Michel Foucault his first major work Histoire de la Folie (1961) and the Canadian-American sociologist Erving Goffman his criticism of institutions in Asylums (1961). This was also the time when Franco Basaglia (1968) initiated the dismantling of asylums in Italy. The work of Szasz was well-perceived and received in these scholarly contexts. Although Szasz can be considered one of the most radical critics of psychiatry in the second half of the 20th century along with David Cooper (1967), he rejected the classification of his work as part of so-called “anti-psychiatry” just as much as much as he disapproved of the British strand around Laing and Cooper did (Szasz 2008a; 2008b).

Beyond psychoanalysis, the theoretical foundations for Szasz’s work were provided by interactionist sociology as developded by the second Chicago School, namely Herbert Blumer’s and Erwin Lemert’s theory of social deviance, which Thomas Scheff (1966) specified with regard to psychiatric theories of disorder and stigma (cf. Szasz 2000). Heiner Keupp welcomed the results of these new approaches in his 1972 book on the myth of illness in psychopathology and hoped that a social-science model of mental disorders would offer a theoretical backing for the incipient reform of German psychiatry. Karl-Peter Kisker (1978: 816, 820) wrote that Szasz still presented “the most well-founded arguments for detaching psychiatry from the medical frame of reference” but, at the same time, was ignorant towards the “brutal daily experiences” inside and outside of psychiatric institutions, especially since Szasz treated his own patients in Syracuse in “absolutely conventional” ways (all quotes translated from German). Szasz also published numerous texts on the issue of psychotherapeutic practice (e.g., 1976a; 1957; cf. Plessis 2001). More recent commentaries emphasise the historical function but also the anachronicity of the main arguments in Szasz’s criticism of psychiatry to which he adhered until the end (e.g., Shorter 2011). This makes Thomas Szasz one of the most prominent but also controversial representatives of his discipline in the second half of the 20th century.

Radically liberal and ultra-conservative agenda

His 1994 book Cruel Compassion, which addressed the issue of involuntary psychiatric treatment, deepened his radical liberal views. Basically, Szasz saw people as merely individual economic subjects; their possible dependence on state support would make them "predators" of social goods: "In sum, there are three ways a person can obtain the necessities of life: (1) As a dependent, receiving food and shelter from donors (parents, family, church, state); (2) as a producer, providing for his own needs; or (3) as a predator, using force or the threat of force to rob others of the goods and services he needs and wants. An individual who does not want to be, or cannot be, a producer, must become a dependent or a predator or perish." (Szasz 1994, p. 143).

Involuntary psychiatric hospitalization prevents the people from learning anything by suffering the consequences of their selfish or unwise actions. Szasz called for a strict separation between psychiatry and state, described compulsory treatment as an “abuse” of state power and argued that everyone had the right to free self-medication. He described psychiatric patients as “socially unwanted” victims of the state’s exercise of power, just like the poor and homeless, but remained vague about how they should be treated instead and what their social position should be. Altogether, his point was that dealing with deviance should be a matter of law enforcement, not psychiatry. Szasz’s entire concept was distinctively individualistic, ultra-conservative and right-libertarian, while the ideas of welfare-state compensation or of socio-structural reforms apparently did not occur to him.

Involvement with the Church of Scientology

In 1969, Szasz and the Church of Scientology co-founded the Citizens Commission on Human Rights International to oppose involuntary psychiatric treatment. According to Westbrook (2017), he worked as a psychiatric expert for the Church of Scientology in a lawsuit against a member of the organization. According to Lehmann (2013: 24), connections between Szasz and Scientology could still be proven for the year 1978. Moreover, Szasz received an award from the Citizens Commission, co-founded by him, still in 1994 and took part in a Russell Tribunal in Berlin in 2001, during which psychiatry was accused of human rights violations.

Awards

2001: Honorary doctorate awarded by the Upstate Medical University (Syracuse, NY).

Literature

Basaglia, F. (1968): Instituzione negata. Turin: Einaudi. 

Breeding, J. (2011): Thomas Szasz: Philosopher of Liberty. In: Journal of Humanistic Psychology 51 (1), pp. 112–128.

Clarke, L. (2007): Sacred Radical of Psychiatry. In: Journal of Psychiatric and Mental Health Nursing 14 (5), pp. 446–453.

Cooper, D. (1967): Psychiatry and Anti-Psychiatry. London: Tavistock, Paladin.

Foucault, M. (1961): Histoire de la folie à l’âge classique: Folie et déraison. Paris: Plon.

Goffman, E. (1961): Asylums. Essays on the Social Situation of Mental Patients and Other Inmates. New York: Doubleday & Company.

Keupp, H. (1972): Der Krankheitsmythos in der Psychopathologie. Munich: Urban & Schwarzenberg.

Kisker, K. P. (1978): Antipsychiatrie. In: K. P. Kisker, J. E. Meyer, C. Müller, E. Strömgren (Eds.): Psychiatrie der Gegenwart. Vol. I,1. Berlin, Heidelberg: Springer, pp. 811–826.

Laing, R. D. (1960): The Divided Self. An Existential Study on Sanity and Madness. London: Tavistock.

Lehmann, P. (2013): Me & Thomas Szasz. Contrary Approaches to Anti-Psychiatry. In: Asylum. The Magazine for Democratic Psychiatry 20 (1), pp. 24–25.

Pies, R. (1979): On Myths and Countermyths. More on Szaszian Fallacies. In: Archive of General Psychiatry 36 (2), pp. 139–144.

Plessis, R. d. (2011): Social Class and Psychotherapy. A Critical Reading of Thomas Szasz’s The Ethics of Psychoanalysis. In: Psychology in Society 42, pp. 21–34.

Schaler, J. A. (2004, Ed.): Szasz under Fire. The Psychiatric Abolitionist Faces His Critics. Chicago: Open Court.

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Sedgwick, P. (1982): Psycho Politics. London: Pluto.

Sedgwick, P. (1982): Psycho Politics. Laing, Foucault, Goffman, Szasz and the Future of Mass Psychiatry. New York: Harper & Row.

Shorter, E. (2011): Still Tilting at Windmills: Commentary on ‘The Myth of Mental Illness’. In: The Psychiatrist 35 (5), pp. 183–184.

Szasz, T. S. (2011): The Myth of Mental Illness: 50 Years Later. In: The Psychiatrist 35 (5), pp. 179–182.

Szasz, T. S. (2008): Psychiatry. The Science of Lies. Syracuse: Syracuse University Press.

Szasz, T. S. (2008a): Antipsychiatry: Quackery Squared. Syracuse: Syracuse University Press.

Szasz, T. S. (2008b): Debunking Antipsychiatry: Laing, Law, and Largactil. In: Current Psychology 27 (2), pp. 79–101.

Szasz, T. S. (2006): Secular Humanism and ‘Scientific Psychiatry’. In: Philosophy, Ethics and Humanities in Medicine 1 (5), pp. 1–5.

Szasz, T. S. (2004): An Autobiographical Sketch. In: J. A. Schaler: Szasz under Fire. The Psychiatric Abolitionist Faces His Critics. Chicago: Open Court, pp. 1–28.

Szasz, T. S. (2000): Second Commentary on ‘Aristotle's Function Argument’. In: Philosophy, Psychiatry & Psychology 7 (1), pp. 3–16

Szasz, T. (1997/1970). The Manufacture of Madness: A Comparative Study of the Inquisition and the Mental Health Movement. New York: Syracuse University Press.

Szasz, T. S. (1996): Our Right to Drugs. The Case of Free Market. Syracuse: Syracuse University Press.

Szasz, T. S. (1994): Cruel Compassion: Psychiatric Control of Society’s Unwanted. New York: Syracuse University Press.

Szasz, T. S. (1988): A Social History of Madness. Stories of the Insane. In: Medical History 32 (4), pp. 472–473.

Szasz, T. S. (1985): Ceremonial Chemistry. The Ritual Persecution of Drugs, Addicts and Pushers. Holmes Beach: Learning Publications.

Szasz, T. (1976/1988): Schizophrenia. The Sacred Symbol of Psychiatry. New York: Syracuse University Press.

Szasz, T. S. (1976a): Anti-Freud. Karl Kraus’s Criticism of Psychoanalysis and Psychiatry. Syracuse: Syracuse University Press.

Szasz, T. S. (1963): Law, Liberty and Psychiatry: An Inquiry into the Social Uses of Mental Health Practices. New York: Macmillan.

Szasz, T. S. (1961): The Myth of Mental Illness. Foundations of a Theory of Personal Conduct. New York: Harper & Row.

Szasz, T. S., W. F. Knoff, M. H. Hollender (1958): The Doctor-Patient Relationship and Its Historical Context. American Journal of Psychiatry 115 (6), pp. 522–528.

Szasz, T. S. (1957): A Contribution to the Psychology of Schizophrenia. In: Archives of Neurology and Psychiatry 77 (4), pp. 420–436.

Vatz, R. E. (1983): Thomas Szasz. Primary Values and Major Contentions. Buffalo: Prometheus Books.

Westbrook, D. A. (2017): “The Enemy of My Enemy Is My Friend”. Thomas Szasz, the Citizens Commission on Human Rights, and Scientology’s Anti-Psychiatric Theology. In: Nova Religio: The Journal of Alternative and Emergent Religions 20 (4), pp. 37-61.

Burkhart Brückner, Robin Pape

Photograph: Jennyphotos / Source: Wikimedia / License: CC BY-SA 3.0 or GDFL