The Confinement of the Insane: International Perspectives, 1800–1965

This useful little volume will quickly bring clinicians interested in the history of psychiatry up to speed on what is happening in the discipline. David Wright, a social historian of medicine at McMaster University in Hamilton, Ontario, and the late Roy Porter, who was a professor of the social history of medicine at the Wellcome Trust Centre for the History of Medicine at University College, London, asked leading scholars in the history of the mental hospital to update us on their research. In doing so, these scholars generally make clear what has been happening in the history of psychiatry. Porter’s introductory historiographical essay places the asylum in the context of recent writing, and the 14 following monographs give us a worldwide tour, ranging from Japan to Argentina, from South Carolina to Vaud, Switzerland.

A number of the contributions really do not get much beyond rather conventional institutional history, chronicling who was admitted, what diagnoses they received, and (usually) how beastly the asylum doctors were to the patients, operating, as physicians did, on the basis of the ideas available to them, which in retrospect the wise historian recognizes as sadly inadequate. Ironical quotation marks accompany much of the material of the day, and suspiciousness of the discipline of psychiatry is well represented on many of these pages. Women and their supposed psychiatric plight are never far from anyone’s mind.

Some bright spots are worth mentioning. Jacques Gasser and Geneviève Heller report on their massive ongoing analysis of more than 50,000 charts in the Swiss Romande. Patricia Prestwich looks at family relations of patients in a Paris asylum from 1876 to 1914. David Wright and collaborators offer a quantitative analysis of such matters as length of admission in several Ontario mental hospitals. I found the analysis by Andrea Dörries and Thomas Beddies of the Wittenauer mental hospital in Berlin in the years 1919–1960 of particular interest because the authors look at mode of treatment by diagnosis so that one can see for which indications the clinicians used, for example, ECT or occupational therapy.

In terms of what is happening in asylum history today, this volume represents the cream of the cream. By way of criticism, one might offer that innovative new techniques in psychiatric history, such as the retrospective diagnosis of patients’ charts, are quite absent here. It is surprising that historians of psychiatry have made little use of retrospectively diagnosing the often rich charts in the way that has served clinical psychiatry so well. One thinks of the retrospective analysis of charts at the University of Iowa, for example. The authors collectively are quite incurious about the causes of the huge 19th-century explosion in the number of patients hospitalized, except to urge upon us the notion that there was something quite repressive about the whole idea. Finally, the history of therapeutics comes off quite short: It would be very interesting to know more about the early days of ECT, for example, now that the treatment is making a comeback, or extrapyramidal symptoms in the phenothiazines: Were there really so many as subsequent makers of rival compounds have claimed? The quantitative analysis of charts in the mental hospital could be quite productive. It is a shame that professional historians of psychiatry remain so attached to questions of the days of bell-bottom pants and the Beatles.