Posts Tagged 'history of medicine'

Body and Mind: A Historical Problem?

“To talk about the mind,” historian Roger Smith suggested in the final keynote of the recent EAHMH conference on the topic of Body and Mind in the History of Medicine and Health, “is to use shorthand for modern western talk about people.” Concluding a fascinating array of papers at this biennial conference of the European Association for the History of Medicine and Health, Smith directly addressed a theme on which many speakers touched: is the mind-body problem a fundamentally historical one? Certain ways of looking at the natural world suggest we should hold a linear perspective: that knowledge changes in order to explain being. Yet, from another perspective, knowledge and being can be considered to change together. Do modern concepts of ‘self’ based in brain neurobiology or pharmacology actually create new ways of being human?

Despite shifts in scientific thought, Smith reminds us that much everyday language remains dependant on mental, rather than biological, categories. Neuronal concepts of mental functioning might appear to contradict the very notion of free will (just as nineteenth century physiological theories threatened to), but other fields, most notably the legal system, continue to attribute significance and responsibility to mental actions. Thus, it is not simply a criminal act alone, but the motive – and even the emotions of the accused (for example, remorse) – that determine punishment.

Psychiatry has long grappled with the variety of ways in which culture and history shape our concepts of mental health and illness, as indicated in a panel on the classification of mental illness. Rhodri Hayward, for example, discussed the ways in which, in the 1970s, psychiatrists attempted to deal with temporality in the onset of illness. How do we determine whether past events have shaped a present illness, or if the present illness has caused a re-evaluation of the past? Indeed, as Katherine Angel suggested in her discussion of ‘Female Sexual Dysfunction’, the frequently used metaphor of a pendulum swinging between biological and psychological models of mental health and illness does not do justice to the complexities of the body-mind debate. Yet the very popularity of such metaphors serve, for many, to reinforce a distinction that suggests only one (the biological) can be “real”, while the psychological is somehow “imaginary”. As the conference indicated in a number of different areas, questions about the body-mind relationship have frequently been raised in medicine, for a variety of reasons and in a variety of historical contexts. Many of these questions have a particular resonance in contemporary society.


A Former ‘Madhouse’: The Museum Boerhaave

Earlier this month, our Friends’ Secretary paid a short visit to Holland to attend biennial conference of the European Association for the History of Medicine and Health, on the topic ‘Body and Mind’. The weekend included a fascinating visit and guided tour of the Museum Boerhaave (the Dutch National Museum for the History of Science and Medicine) in Leiden. The building in which the museum is housed has a long and complicated history: built as a nunnery in the early 15th century, shortly before 1600 it became a ‘plague hospital and madhouse’ (not the most obvious combination from a modern viewpoint!). Still, as the museum’s collection illustrates, many connections have been made historically between physical and mental illness. During the seventeenth century, standard medical practices were based on humoral theory, in which mental illness (often regarded as due to an excess of black bile in the body) was generally treated by the same techniques as diseases like plague: for example bloodletting, purging and vomiting. The Boerhaave, like other medical collections, has numerous instruments for such practices.

Brugmans Skull

Anatomy is also well-represented in the collection, and a late eighteenth century collection of skulls illustrates the way in which doctors of the time tried to learn about the mind by studying the physical body. One cabinet contains a collection of skulls prepared by Sebald Justinus Brugmans (1763 – 1819), Professor of Medicine at Leiden from 1795 (further indicating the fluid nature of boundaries in the period, Brugmans had previously been a Professor of Physics and Mathematics, and also of Botany). Brugmans’ teaching specimens include animals preserved in alcohol, used for comparative anatomy, as well as human and animal skulls. The image above shows one skull listed by Brugmans as “the skull of a maniac.” During the late eighteenth and early nineteenth century, it was thought by many that examining the skull could inform the physician about the brain and mental state of the individual. This idea informed anatomist Franz Joseph Gall’s system of phrenology, developed in 1796 and popular well into the nineteenth century. The Bethlem collection contains several phrenology heads (one of which is pictured below), designed to show the “organs” of the brain, which were supposed to correspond directly to human faculties such as capacity for language, affection or pride.

The Museum Boerhaave is currently under threat of closure, with a major fundraising campaign to raise 700,000 Euros by the end of 2011 underway. To find out more, visit Save Museum Boerhaave. As previously mentioned on this blog, the exhibition ‘The Weighty Body (previously at the Museum Dr Guislain), which includes Elise Warriner’s The Anger Within from the Bethlem Art Collection, will open at the Boerhaave in 2012.

Phrenology Head

History of Emotions: New Blogs and more

Following a recent fascinating conference on the topic of ‘Mastering the Emotions’, the Centre for the History of Emotions at Queen Mary, University of London, have set up a new History of Emotions blog. The blog, which includes several reviews of the many topics covered during the recent conference, will include reviews as well as historical perspectives on current affairs, contemporary culture, and public policy. Ideas of feeling and emotionality have long been bound up in concepts of mental health and ill-health, as well as shifting understandings of what it means to be human and the connections between man and animals. As the recent Centre conference enquired, what does it mean to master one’s emotions? Following the emergence of the modern category of ‘the emotions’ in the early nineteenth century, many writers became concerned with the potentially involuntary nature of human feeling, and the problem of constricting emotions – and producing them on demand – has since troubled psychologists, physicians, philosophers, scientists, writers and artists alike. For topics exploring the pathologisation, regulation, manipulation and repression of emotions, see abstracts from conference papers here, and reviews of the event on the History of Emotions blog here.

This new blog joins the well-established h-madness, which some of our readers may have come across previously. This blog includes reviews of books, journals and conferences within the field of the history of psychiatry, forming a resource for scholars interested in the history of madness, mental illness and their treatment (including the history of psychiatry, psychotherapy, and clinical psychology and social work). Meanwhile, postgraduate researchers in the history of medicine recently decided to set up their own blog on the topic. A recent discussion forum indicated the strong interest in many aspects of the history of psychiatry among such researchers, with papers refuting the “no-neurosis myth” of the Second World War (the widely promoted idea that civilians did not suffer from “war neurosis”), exploring the way in which masculinity was framed in the nineteenth century asylum, and the role of the family in new schizophrenia support groups in the 1970s. The website for this group is still in progress, but Twitter users can sign up for updates by following @PGHistMed.

 Expression of the Emotions
History of Emotions: “Surprise” and “Disgust” in Darwin’s The Expression of the Emotions in Man and Animals, Wellcome Library, London

A Visit to the Science Museum Stores

The recent meeting of London’s Museums of Health and Medicine  gave some of our staff a fascinating opportunity to explore the Science Museum’s stores  in a pre-meeting tour. Housed in the former headquarters of the Post Office Savings Bank, Blythe House is a huge warren of beautifully tiled corridors, of which the basement and most of the ground floor house the history of medicine collection. Most of this enormous and fascinating assortment of objects was collected by Henry Wellcome, whose life and work is the subject of the ‘Medicine Man’ exhibition at the Wellcome Collection.

The history of medicine collection includes a remarkable array of exhibits, including two whole rooms dedicated to prosthetic limbs! The museum uses the former purpose of the building well; a secure bank vault, for example, houses the historical surgery equipment. “Everything in this room can kill you!” warned our guide, as he turned the massive wheel on the solid vault door.

Scattered throughout this vast collection are a large number of items relating to the history of psychiatry and psychology, and the Museum employs a specialist Curator of Psychology, supported by the British Psychological Society. You might remember our post earlier this year about the Psychoanalysis exhibition, which included some of these exhibits. As well as antique asylum equipment, the collection contains items relating to early psychological testing, such as IQ test puzzles, and there is a ‘Psychology Trail’ around the Museum galleries. To explore the Science Museum’s History of Psychology and Medicine collections further, click here.


Birdcage from the Sussex Lunatic Asylum: Science Museum, London

Dangerously Young: Child and Adolescent Psychiatry from a Historical Perspective

Staff from the Archives and Museum recently attended the 3rd International Conference on the History and Heritage of Psychiatry, which was held at the Museum Dr Guislain in Ghent on the 28th and 29th April.

The theme of the conference was Dangerously Young: Child and Adolescent Psychiatry from a Historical Perspective. Bethlem’s archives were featured in two papers: Colin Gale and Caroline Smith examined the cases of several child and adolescent patients treated at Bethlem in the nineteenth century and Zbigniew Kotowicz of the University of Lisbon drew upon his extensive research in the Bethlem archives to examine the development of child psychiatry. Surprisingly few children were treated at Bethlem; of the 1069 patients under the age of 21 admitted between 1815 and 1899 only 58 were 15 or under.

The Belgian perspective was provided by a number of high-profile speakers, including the Flemish Commissioner for the Rights of Children. Belgium has relatively high levels of teen suicide, children in prison, child abuse and domestic violence (shockingly it is statistically more dangerous to be a Belgian woman than a Belgian soldier) and several papers explored the connection between child abuse and delinquency.

The role of DSM (the Diagnostic and Statistical Manual of Mental Disorders) in the ever-increasing number of mental disorders being diagnosed in children was a recurring theme, and Lisa Appignanesi (Chair of the Freud Museum) questioned how far an attempt is being made to medicalise ordinary emotions such as sadness, shyness and anxiety in order to benefit the drug companies.

Overall this was a thought-provoking conference and an excellent opportunity to meet representatives from museums of psychiatry throughout Europe. There was also a chance to pay a visit to one of Bethlem’s paintings: The Anger Within by Elise Warriner, on loan to the Museum Dr Guislain as part of their exhibition The Weighty Body: Fat or Thin, Vanity or Insanity. The exhibition explores the history of fasting, including those who stopped eating for religious or political reasons, and includes several works on the theme of anorexia nervosa. The exhibition has now closed but is due to be reprised at the Museum Boerhaave in Leiden in 2012.

Elise Warriner - The Anger Within

The Evolution of Occupational Therapy for Mental Health

Occupational therapy is ‘an active method of treatment with a profound psychological justification’, variously linked to moral, punitive and economic rationales. The 20th century codification of the profession was assisted by key individuals, wartime experiences and social context. An assumed mind-body interaction underscored the adoption of occupational therapy within psychiatry, but attention and resources were weighted in favour of its uses in physical rehabilitation.

The development of occupational therapy for mental health was amongst issues discussed at the History of Psychiatry and Psychology Postgraduate Conference at UCL, recently discussed on this blog. Emerging research based on analysis of primary source material used Bethlem as a case study for exploring the establishment and acceptance of this field. Archived hospital records were used in conjunction with relevant scientific literature, and interviews with former Bethlem nurses.

Evidence suggests a modest tradition of occupation for health at Bethlem, initially driven by the social and intellectual environment, and postwar, by economic concerns and fresh input from Maudsley staff within the new Joint Hospital. Pioneering work addressed the damaging effects of prolonged hospitalisation within a framework of bourgeois acceptability; later efforts concentrated on teaching transferable and vocational skills. Enthusiasm of individual proponents was stymied by medical disregard of occupational therapy, limiting activities offered and perpetuating amateurish stereotypes of the profession. However, it was proposed that today’s services evolved from former philosophies and practices, having weathered challenges from inside and outside the hospital gates.

Key themes included the social class and gender of therapists and their patients; global and interdisciplinary sharing of knowledge, changing methods and aims of occupational therapy, and calls for professional accountability. The institutional and wider significance of findings were discussed.

Although one should not over-generalise from case study evidence, the research broadly highlighted the range of factors involved in the conceptualisation and recognition of new fields of expertise. It also illustrated fluctuating motives underlying outwardly similar practices, whilst psychiatry’s ‘inheritance’ of occupational therapy from its hitherto physical – and often transient – uses, reinforces the ‘Cinderella service’ trope. Despite recent augmentation of occupational therapy’s status within psychiatry, there is an ongoing challenge of integrating treatment approaches within mental health care. Further insights can be achieved through continued engagement with current and historical literature, together with the oral histories of those involved in delivery of mental health services during the 20th century.

The programme for the conference, which took place on March 19th 2011, is available at:

The Future of Medical History

The Future of Medical History conference, organised by the soon-to-be closing Wellcome Trust Centre for the History of Medicine at UCL took place last week. The history of psychiatry and psychology was certainly high on the agenda, with papers on the topic ranging from music therapy in eighteenth century medicine, through the role of psychical research in nineteenth century scientific psychology, to a new take on the link (or, as was argued, the lack of one) between melancholia and clinical depression: if nineteenth century diagnoses of melancholia were specific to the period, our theories of clinical depression must also be reinterpreted.

These contributions, including a paper on post-war psychiatry in the United States by Professor Andrew Scull, a central figure in twentieth and twenty-first century history of psychiatry, indicate that psychiatric history certainly has a promising future. Indeed, one persuasive session on the importance of collaboration in medical history, reminded us of the need for historians to work together – and with those from other disciplines, including clinicians – to improve our understanding of the field. In the final paper of the day, Professor Sander Gilman reminded us that the role of the historian is never to stop asking questions, of him or herself as well as sources. Nonetheless, as post-paper discussion highlighted, such attempts do not have to be destructive. The future of medical history, it was suggested, lies in construction, an irony that will not be lost on those at the Centre, the announced closure of which came as a shock to medical history in April.

Visit the Friends of the Wellcome Trust Centre for the History of Medicine blog here.