Timeline of Ruptures in the History of Psychiatry

This timeline attempts to trace a history of the major ruptures in psychiatric history. It is meant to be read with and to complement the general timeline page. While the general timeline on this site was trying to trace the broad developments of psychiatric practice and thought in relation to the law, prisons, and policing, this timeline will focus on psychiatry's response to internal and external crises as well as the role of professed radicals or revolutionaries in psychiatric history. There is some crossover when necessary, but I have tried on the whole to keep the two timelines unique. With this focus on break, ruptures, and new forms, there is no attempt to be comprehensive nor to represent any place or person's full development. In the writing section of this site, I will continue to delve into and explore the ideas and histories of persons and events merely collected here.

Navigating Psychiatry's Crises

Apologetic historians of psychiatry like Edward Shorter have argued that ever since the great rational liberator Philippe Pinel heroically unlocked the chains binding the insane in Paris, it has steadily advanced in pace with technological and medical innovations to become an exemplary positivist science, set back only by the shortsightedness and political vendettas of ideologues and detractors. I've tried to demonstrate with this timeline that psychiatry proceeds by kicks and starts, changing dramatically in periods of great violence and upheaval. What is a "revolution" in psychiatry? It's essential that we remember that the medical epistemologies, treatments, forms, and structures taken for granted as backwards and misguided relics of the past or as common-sense mainstays of psychiatry today were once considered revolutions in their own time: the medical model supplanted the spiritual and moral framework in late 19th century Germany and then the world; the asylum was once celebrated as a utopian refuge for rehabilitation; mental hygiene and early forms of eugenics were lauded for their emphasis on prevention and education. Under what conditions do these "revolutions" occur? Are they the fruits of an internal development or contradiction or are they simply the desperate measures psychiatry takes in response to external events to remain relevant to the demands of a world in accelerated flux?

Emergency Therapeutics

In Europe, mental health care underwent its broadest transformations in the midst of revolutions, wars, and humanitarian crises. In Asia and Africa, psychiatry was brought in as an external force and either began eliminating local knowledge of health and healing or risked remaining external to the native society, seen solely as a technique for settlers or as an alternative mechanism of naked social control. As Fanon notes in "Colonialism and Medicine," conditions, underlying forms, and prerequisite assumptions about native constitutions changed most dramatically and quickly during periods of militant anti-colonial struggle and social disorder. The eugenics movement gained steam in the US and around the world during a period of mass emigration and movement of people, when a surplus of cheap labor made a program of eliminating social undesirables economically feasible and politically attractive to white capitalists. Psychiatry transforms in the midst of crisis; it might even be said that psychiatry operates to preserve capitalism during crisis by preserving a broken labor force and restructuring the idle unemployed (SPK). Of all the crises that have transformed psychiatry, war has been the most aggressive and prevalent motor for change throughout the world. Wars have everywhere accelerated the development of psychiatry and resulted in abrupt—comparatively speaking—paradigm shifts. The ubiquity of "shell shock" in World War I convinced a generation of psychiatrists of the reality of reactive neuroses and psychoses. The experience of the prison and concentration camps during World War II was the common background for a great many of the 20th century's most radical psychiatrists; images and stories of the camps' horrors fueled campaigns against asylums, which were often compared to them, and damaged eugenics' reputation. In the 60s, the Vietnam War, the increased media visibility of racist violence of the West, and the Cold War convinced psychiatrists like R.D. Laing and radicals like Malcolm X that capitalism, Western society, white supremacy, the family, or the state was pathogenic and spurred them to create alternative therapeutic structures "outside the system"; at the most radical end of this discourse's spectrum, it was argued that to be mad could be a natural, or even necessary, reaction to an insane world.

Cycles of Reform/Failure

Psychiatry is ostensibly the art of healing the psyche and calming the emotions. The great reformers of the past have doubtlessly been motivated by this understanding of their practice; nevertheless, their projects and models have been animated by unconscious desires and by political or normative presuppositions of the good life. No reformist model or theory has been exempt from being appropriated for explicitly political ends; or, perhaps more accurately, as the school of Institutional Psychotherapy emphasized, no understanding of pathology and healing can free itself of its normative core and therefore the dream of an apolitical and morally neutral science is an impossible one. The medical model has rightly received the most criticism and scorn throughout psychiatry's history: at worst, it reduces human beings to mere automata; at best, it still over-values biological function over the social dynamics of any given material, economic, and political reality when applied in a vacuum. The bio-reductionist model (whether centered around chemistry, heredity, neurology, or other constitutional factors) has served as the grounding justification for racist science in the colonies (ex. the Porot school in Algeria), in fascist states, and in the US with its recurring infatuation with eugenics and hereditary or genetic manipulation under different guises. And yet, when this model was proposed by Wilhelm Griesinger in late 19th century Germany, it was heralded as a humanistic transformation: the "spiritual" and "moral" psychiatrists (Pinel, Rush, Reil) who placed such emphasis on psycho-dynamics and the psycho-social origins of madness also found that torture and abuse were among the most effective means of shocking the insane person out of their derangement. The proponents of the medical model scorned such backwards practices, before they too, in just a few years, would be accused of backwardness and inhumanity. The use of psychoanalytic theory by Nazi-collaborationist states in Yugoslavia to reeducate communist youth or in the US to "help" queer youth and prisoners sort out their "damaged egos" supposedly rooted in childhood trauma further suggests that there is nothing inherently more humane about a psychiatric practice based in psycho-social theory. What, if not an underlying model or theory, makes psychiatric practice an instrument of healing rather than a complex assemblage of crisis management or social control destined to degenerate into mere warehousing or social abandonment?

'Concrete and Working Utopias'

As a provisional thesis, I would like to make a distinction between the method of the reformer and the radical in the history of psychiatry: the former comes on the scene of history bearing a model they believe will save their discipline from cruelty, backwardness, and inhumanity; the radical examines existing conditions and seeks always to push the existent models and material forms as far as possible through political struggle towards a healing that will feed right back into political struggle. Psychiatry is a political art (as is, Peter Sedgwick reminds us, the entirety of medicine). Reformist psychiatry runs away from this fact, while a radical psychiatry accepts it as the foundation, situating their practice as an element of rather than a neutral auxiliary to political struggle. Such binaries are bound to be inadequate in the face of actually existing events and people, but there is, nevertheless, a profound difference between the major radical figures and movements of 20th century psychiatry like Frantz Fanon, Democratic Psychiatry, and Institutional Psychotherapy and the reformers who present alternative therapies (primal scream or EMDR) or alternative models separated from the political and economic contradictions of the contemporary moment. When methods learned from Institutional Psychotherapy weren't working for Algerian patients, Fanon dropped them and began looking towards the anti-colonial struggle for inspiration. When Franco and Franca Basaglia felt that the experiment at Gorizia could possibly become a new model to be exported, they evacuated and went somewhere new in search of a different battle. Nick Crossley referred to the psychiatric experiments of the 60s and 70s as "working utopias," as as "laboratories" and "schools" where new ideas could be tried out and tested and central locations where interested parties can meet and spread ideas. How does a "working utopia" relate to the world? Does it hermetically seal itself off in order to stay true to a higher code of ethics? Does it situate itself as a  meeting place for radical movements? Does it use the media to gain adherents to a set model or is it more concerned with a manner of approach and a political orientation to therapeutics ? 

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A Real Psychiatric State of Emergency

As the SPK argued, the category of "illness" and perhaps especially psychiatric illness, contains within it the contradictions of capitalism: laborers are compelled to labor in unsafe conditions that wear on their bodies and minds, which makes many of them ill. And, once they become ill, they find themselves in a sort of hostage situation where they are forced to accept means of healing geared centrally towards reconstituting the laborer rather than healing the person. The COVID-19 crisis has revealed this hostage situation working people find themselves in on a mass scale. The therapeutic moment thus encounters the person at a moment of crisis occasioned first of all by the dominant political and economic system. One of the common tenants of radical psychiatric movements is that to practice a liberatory healing means to orient care towards healing despite and against capitalism, not in order to adjust to it. This is never simple since we must keep living in order to fight and compromise is inevitable. Such an orientation requires being attuned to the local contingencies, dialects, and contradictions; a universal model is not only impossible, but works against the needs of different groups of people. Franca Basaglia said that Democratic Psychiatry "all began with a 'no.'" In this period of reactionary cuts to alternative facilities across the world, a radical psychiatry must regain its power of saying "no," not just to inadequate means of healing, but to a morbid and failing capitalist hegemony. The tradition of radical psychiatry asks: what kind of therapeutic practice opposes pathogenic forces, particularly when they seem to be essentially embedded in the order of the world? And can some manner of healing prefigure a different world or at least prepare us to fight?

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