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The genesis of therapeutic practices in Basaglia’s psychiatric community (1962–68)
Marica Setaro

This chapter considers the therapeutic community established by Franco Basaglia at the Gorizia Psychiatric Hospital in Italy. It maintains that the general assembly is one of the most notable and under-investigated therapeutic practices introduced in the community. Indeed, the general assembly is the first expression of what Basaglia called ‘l’utopia della realtà’ (i.e. the actual utopia), which was actual to such an extent that it produced the dismemberment of the psychiatric institution while creating an actual, new and cohesive psychiatric system in Italy, with legislative repercussions (the closing of mental hospitals from the 1980s). In their reshaping of doctors’, nurses’ and patients’ roles, assemblies acted as primary tools for bringing the patients to the centre of the stage, as reformist psychiatrists dreamt of, and for their resubjectification. An unpublished set of sources in which the minutes of the general meetings were reported – the patients’ bulletin Il Picchio (1962–66) – will be read alongside the foundational works curated by Franca Ongaro Basaglia and Franco Basaglia. The comparison between these publications and the numerous issues of the internal ‘newspaper’ written by patients-as-journalists will prove instrumental to a more comprehensive appreciation of Basaglia’s endeavour.

in Doing psychiatry in postwar Europe
Monika Ankele

The starting point of my chapter is a sociological study conducted by Rudolf Forster and Jürgen M. Pelikan at the psychiatric hospital Baumgartner Höhe in Vienna from 1974–78. Their study on the quality of patient care in the hospital scientifically confirmed what had already come to the attention of the public and media at the time of its publication: the shortcomings and abuses in the inpatient care of the hospital. In their study, which was financed by the Ministry of Health and Environmental Protection, the sociologists also made recommendations for a reform of psychiatric care in Vienna. These were widely accepted by policymakers. Thus, the study became a cornerstone of psychiatric reform and tells of the collaboration between the social sciences and politics. The chapter develops a multilayered contextualisation of the study and asks what doing social sciences at the site of psychiatry meant at that time. It refers to the context of the history of the social sciences, which discovered the psychiatric hospital as an object of study from the 1950s onwards, to the sociopolitical context in Austria, which led to the study’s impact, and finally to the funding of the first improvements in the care of the patients, even if the research findings and reform proposals were not new at the time of their publication. The chapter builds on contemporary publications, newspaper reports, printed sources and conversations with Eberhard Gabriel, who was the hospital’s medical director from 1978 to 2004, and with the sociologist Rudolf Forster.

in Doing psychiatry in postwar Europe
Open Access (free)
Just another turn? Practices, doing psychiatry and historiography
Volker Hess
and
Marianna Scarfone

This chapter provides a methodological and epistemological foundation for the study of psychiatric practices, which are the core of the book. It argues that, from a praxeological perspective, psychiatry presents itself less as a science grounded in theory or laboratory research than as an art of doing, which can be understood as the outcome of practices. Practices, indeed, produce unforeseen or unintended consequences, which can be articulated in new structures, rules and norms, but also new meanings, habits and routines. Providing a thick description of the multiple practices that contributed to the transformation of the mental health field thus becomes a way to rehabilitate everyday practices and their performance with regard to theories and their elaboration, which means that practices cannot be reduced to the mere ‘application’ of theoretical concepts, the execution of normative rules or the intentionality of actions. Post-war psychiatry has often been reduced to the introduction of neuroleptics, to deinstitutionalisation, or to the blurring of its disciplinary frontiers. This chapter suggests looking in a more nuanced and fine-tuned way at different aspects that can define the new ways of doing psychiatry that developed in the aftermath of World War II and in the following decades. Through the reconstruction of (parts of) the daily functioning of psy-services, we can see the emergence of new actors from inside as well as from outside the mental health area of competence, and the new fields of expertise they contributed to shape (which in turn gave them new credibility in the social arena).

in Doing psychiatry in postwar Europe
Discourse and practice of psychosurgery in Strasbourg (late 1940s to early 1960s)
Florent Serina

Raising hopes of an effective treatment for mental illness, psychosurgery was widely practised throughout the Western world and beyond in the mid-twentieth century. While the history of the diffusion of this therapy, once seen as revolutionary, and the controversies it provoked are now fairly well known, the expansive field of practice still offers historians a vast amount of material to explore. By comparing scientific publications and patients’ medical records, this chapter provides an understanding of the history of the surgical treatment of mental pathologies in the main university hospital of the mental health system in north-eastern France, the University Psychiatric Clinic of Strasbourg. To do so, it combines an analysis of concrete statistical data with an illustration of the major principles, formally established or not, that guided the implementation of this therapy, while also questioning the conclusions transmitted by the main actors of this history.

in Doing psychiatry in postwar Europe
Sedating deviant youth in the 1960s and 1970s in Belgium’s juvenile institutions
Benoît Majerus
and
David Niget

The introduction of neuroleptics in the 1950s revolutionised psychiatry, as these drugs made psychiatric hospitals more manageable and contributed to the deinstitutionalisation that took place in various Western countries beginning in the 1960s. However, recent revisions paint a more nuanced picture. A revisionist historiography has shown that the definition of chlorpromazine as an antipsychotic drug took several years and that its introduction did not prevent the use of other drugs and therapeutic interventions. In addition to their therapeutic function, it became clear that neuroleptics, like other biological therapies, also had strong disciplinary potential. A complex and multilayered history of neuroleptics has emerged. This article examines the practices at one youth guidance institution in Belgium, highlighting three elements: the mobility of drugs, the interconnection between various institutions of social deviance, and the debate around the therapeutic and/or disciplinary functions of these psychotropic drugs. The article shows how impoverishing it is to look at psychiatric institutions in isolation, as the various institutions of social deviance are linked through inmates, staff, objects and other elements. Furthermore, the article seeks to deepen the debate around the therapeutic and/or disciplinary functions of these psychotropic drugs, examining the prescriptive framework of the local practices at this Belgian institution. The article concludes that biological psychiatry must be understood within the broader field of early twentieth-century psychiatric biology.

in Doing psychiatry in postwar Europe
Group psychotherapy in Greece and the Open Psychotherapy Centre of Athens, 1960s–1980s
Despo Kritsotaki

The chapter focuses on the unexplored history of group psychotherapy in Greece, starting with the first experiments of the late 1950s and moving to the more extended and standardised experiences of the 1980s. It examines two case studies: the therapeutic club of the Centre for Mental Health and Research of Thessaloniki in the 1960s, and the Open Psychotherapy Centre of Athens in the 1980s. Based on scientific publications and the services’ reports, as well as oral history interviews of mental health professionals and former patients, the chapter approaches group psychotherapy practices as ‘dreaming’ ways of doing psychiatry in a twofold sense. First, it highlights their political implications: through methodological innovation, group psychotherapy practices were intended to address broader issues – such as the class inequalities of mental healthcare provision – or even make an impact on society, by cultivating autonomy, freedom and equality. Second, the chapter brings out the idealised portrayal of group psychotherapy, especially in the case of the Open Psychotherapy Centre, whose professionals, in their retrospective accounts, tend to stress the pioneering aspects of their work, and to emphasise successes rather than shortcomings. In order to understand the ‘visions and dreams’ of group therapy practices, the chapter situates them within the broader context of their time, mainly the endeavours of psychoanalysis and social psychiatry to treat the underprivileged in different countries since the interwar period, and the social, political and psychiatric reforms in Greece after the fall of the dictatorship in 1974.

in Doing psychiatry in postwar Europe
The outpatient treatment of drug-using young people in Finland, 1969–75
Katariina Parhi

The chapter analyses the development of expertise in treating young drug users in the metropolitan area of Finland between 1969 and 1975. The focus is on the role of psy-sciences in new forms of outpatient care, which were situated on the border between social work and medicine. The main argument is that the psy-sciences exerted a major influence on drug treatment, but not directly. Instead, it was embedded in practices that stemmed from various sources, such as folk healing, the Mental Research Institute in the United States and therapeutic communities. The chapter introduces two significant facilities, Arkadian klinikka and Nuorisoasema, set up in 1969 and 1970. The chapter builds on oral history sources, supported by archival data, research reports and published sources. Overall, the chapter demonstrates processes of professionalisation and discusses expertise based on actions.

in Doing psychiatry in postwar Europe
The sexological administration of transgender life around 1980
Ketil Slagstad

In the late 1970s, a new model for sex reassignment was developed in Norway. While people seeking medical treatment to transition had until then been cared for in an unorganised way, a new team based in a medical sexology department at the Oslo Health Council became the main medical facility for this group of patients. The team consisted of psychiatrists, psychologists, social workers, nurses and GPs with a professional interest in lesbian and gay health, sexuality and the negative health effects of stigma and discrimination, and many of the professionals were themselves lesbian or gay. However, the team’s normalising and depathologising approach to lesbian and gay patients did not translate into a similar approach to transgender patients. The professionals approached the question of sex reassignment from the standpoint of sexology and social medicine, but anchored it in a diagnostic and pathologising model of transsexuality. Based on archival material and oral history interviews with health professionals and former patients, the chapter analyses the role of psychiatric expertise in the welfare state context. It argues that the role of psychiatric expertise in trans healthcare, i.e. the administrative function of psychiatrists in decisions about non-psychiatric hormonal and surgical treatment, highlights the historical significance of the non-formalised evaluative expertise of psychiatry to the welfare state – of psychiatric practices beyond psychiatry. Drawing on science and technology studies, I explore how experts standardised and legitimised psychiatric practices by incorporating them into existing epistemologies and infrastructures, but also how psychiatry was transformed in the process.

in Doing psychiatry in postwar Europe
Practices at Heidelberg’s Psychiatric University Clinic in the 1960s and 1970s
Gundula Gahlen

The Psychiatric and Neurological University Clinic in Heidelberg developed into a pioneering location for psychiatric reform from the early 1960s and, along with Frankfurt, into a leading centre of social psychiatric research and practice in the Federal Republic of Germany. The literature on Heidelberg social psychiatry, written mainly by those affected themselves, focuses on the reform programmes. It emphasises the importance of the work of the leading psychiatrists inside and outside the clinic and states that social psychiatry no longer played a significant role in Heidelberg when the reformers left in the 1970s. In contrast, this chapter takes a praxeological approach. It analyses the social psychiatric practices in the Heidelberg Clinic in the 1960s and 1970s using medical records, annual reports, administrative files and the written records of the medical and nursing staff. The analysis reveals that, in the 1960s, the implementation of the social psychiatric reforms in everyday clinical practice took longer than the publications of the senior physicians imply, and sometimes met with resistance. In addition, the freedom that the reformers gave their employees meant that they were also able to implement their own ideas. In the 1970s, social psychiatric practices continued without normative guidelines – or in spite of them – and were strongly influenced by internal traditions and the spirit of the times. The employees had wide scope for action within which they made independent decisions. All in all, patient care at Heidelberg was much more influenced by social psychiatry in the 1970s than in the 1960s.

in Doing psychiatry in postwar Europe
Modernism, architectural research and evolving psychiatric reforms in post-war England
Christina Malathouni

This chapter discusses a new, purpose-designed admission and treatment unit, built in the mid-1950s for Fair Mile Hospital in Cholsey, Berkshire (now Oxfordshire), England. Placed under the remit of the British National Health Service, it was designed by a leading architectural firm. Through the analysis of administrative hospital records (as access to patient records remains restricted) and the professional papers of the architects, this chapter argues that the psychiatric reform these architects envisioned was two-fold. It comprised, firstly, the notion of deinstitutionalisation (albeit an early version of its various and nuanced readings, which involved giving mental healthcare buildings a non-institutional character), and secondly, the medical model of mental health (both the overarching shift towards treatment and specifically the adoption of physical treatments and the aspiration to align mental and physical healthcare provision). To reach these ends, from an architectural point of view, the architects adopted the design principles of architectural modernism and expanded their design practices to embrace interdisciplinary research on hospital architecture. Their engagement meant that, among the visionaries aiming to reform post-war psychiatry in this strongly transitional period, actors from outside the mental health field joined those more internally implicated. The research aims to complement the extensive literature on Victorian asylums by contributing to the development of the largely fragmentary, but growing, scholarship on mental healthcare architecture in the twentieth century, especially the virtually absent post-war period.

in Doing psychiatry in postwar Europe