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Inheriting Madness

Inheriting Madness: Professionalization and Psychiatric Knowledge in Nineteenth-Century France

Ian R. Dowbiggin
Copyright Date: 1991
Pages: 227
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  • Book Info
    Inheriting Madness
    Book Description:

    Historically, one of the recurring arguments in psychiatry has been that heredity is the root cause of mental illness. InInheriting Madness, Ian Dowbiggin traces the rise in popularity of hereditarianism in France during the second half of the nineteenth century to illuminate the nature and evolution of psychiatry during this period. In Dowbiggin's mind, this fondness for hereditarianism stemmed from the need to reconcile two counteracting factors. On the one hand, psychiatrists were attempting to expand their power and privileges by excluding other groups from the treatment of the mentally ill. On the other hand, medicine's failure to effectively diagnose, cure, and understand the causes of madness made it extremely difficult for psychiatrists to justify such an expansion. These two factors, Dowbiggin argues, shaped the way psychiatrists thought about insanity, encouraging them to adopt hereditarian ideas, such as the degeneracy theory, to explain why psychiatry had failed to meet expectations. Hereditarian theories, in turn, provided evidence of the need for psychiatrists to assume more authority, resources, and cultural influence.Inheriting Madnessis a forceful reminder that psychiatric notions are deeply rooted in the social, political, and cultural history of the profession itself. At a time when genetic interpretations of mental disease are again in vogue, Dowbiggin demonstrates that these views are far from unprecedented, and that in fact they share remarkable similarities with earlier theories. A familiarity with the history of the psychiatric profession compels the author to ask whether or not public faith in it is warranted.

    eISBN: 978-0-520-90993-9
    Subjects: History

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Acknowledgments
    (pp. ix-x)
  4. Introduction
    (pp. 1-10)

    If cancer is arguably the disease of the twentieth century, then it is equally arguable that mental illness was the disease of the nineteenth century. Or so thought the French republican deputy Léon Gambetta. Speaking before theCorps législatifon 21 March 1870, Gambetta claimed that public concern over the rising number of hospitalized lunatics and the incapacity of asylum psychiatrists to tame insanity was mounting “to the point,” he stressed, “where madness seems to be the disease of the century.”¹ Gambetta may not have been far wrong. Like cancer in this century,² mental illness in the nineteenth century sparked...

  5. Chapter One The State of Psychiatric Practice and Knowledge in the Nineteenth Century
    (pp. 11-37)

    In its efforts to improve its professional standing in the early nineteenth century, French psychiatry encountered two major difficulties. In 1838 the French state gave alienists important privileges to treat the insane in public asylums. Yet at roughly the same time, the growing failure of psychiatrists to cure their patients under the conditions of hospital medicine was becoming glaringly obvious. This therapeutic failure placed great pressure on psychiatrists to demonstrate their special knowledge of insanity’s causes, symptoms, and underlying organic pathology, and here too their shortcomings were evident. The stakes for psychiatrists were high because unless they could prove they...

  6. Chapter Two François Leuret and Medical Opposition to Moral Treatment, 1835–1850
    (pp. 38-53)

    The gaps in French psychiatric knowledge at midcentury left alienists vulnerable to clerical allegations that medicine did not deserve exclusive rights to the institutional treatment and care of the insane. Particularly upsetting to many psychiatrists was that the Catholic Church’s belief that insanity warranted moral therapies appeared to be vindicated by some alienists, principally François Leuret (1797–1851). Largely because of Leuret’s efforts in the 1830s and 1840s, there was renewed interest in moral treatment, an approach to madness that advocated primarily psychological methods of therapy such as reasoning, kindness, and persuasion. However, moral treatment also called into question the...

  7. Chapter Three Jacques Moreau de Tours and the Crisis of Somaticism in French Psychiatry, 1840–1860
    (pp. 54-75)

    The controversy over insanity’s somatic pathology did more than cast doubt on psychiatry’s claim that it alone was qualified to treat mental diseases. If alienists could not identify lesions for each type of mental disturbance, they were unjustified in contending that only doctors were capable of diagnosing insanity. This fundamental weakness in psychiatric knowledge meant that the psychologically oriented academic philosophers of the French university system could claim that they were no less adept than alienists at distinguishing madness from sanity, particularly in borderline instances involving apparent reason mixed with hallucinations. Thus, French alienists’ occupational status during the July Monarchy...

  8. Chapter Four Alienism and the Psychiatric Search for a Professional Identity: The Société médico-psychologique, 1840–1870
    (pp. 76-92)

    The psychiatric move toward hereditarianism was caused by other factors than simply those relating to the treatment and diagnosis of insanity. Sociopolitical disorder affected the efforts of the alienists of theAnnales médico-psychologiquesto organize a learned society of psychiatrists between 1843 and 1852. The political events of 1848–1851 interfered with alienist attempts to professionalize through association and were responsible for the clerical reaction that marked the first decade of the Second Empire (1852–1870). To ensure the success of the first psychiatric society in French history, alienists had little choice but to accommodate themselves to the new regime...

  9. Chapter Five French Alienism and Antipsychiatry, 1860–1900
    (pp. 93-115)

    Just when it seemed that the Société médico-psychologique’s policy of accommodation would solve psychiatry’s political problems, mental medicine was confronted with an antipsychiatric campaign launched by the French press after censorship laws were relaxed in 1861. Newspapers of every political stripe questioned the therapeutic usefulness of lunatic asylums and accused alienists of complicity in the hospitalization of innocent people, triggering a series of ineffective legislative attempts to revise the 1838 law. Even some physicians cast doubt on psychiatric competence. Alienists reacted by debating the intellectual and institutional foundations of their profession. As the criticism continued, many psychiatrists came to see...

  10. Chapter Six Hereditarianism, the Clinic, and Psychiatric Practice in Nineteenth-Century France
    (pp. 116-143)

    By the early years of the Third Republic the psychiatric profession in France had reason to feel anxious and defensive about its social status. Antipsychiatric sentiment was running high, fanned by journalistic allegations of wrongful confinement and medical ignorance and incompetence. Public outrage had called into question the existence of the asylum, the social usefulness of the 1838 law, and the integrity, expertise, and authority of psychiatry. Furthermore, the profession had been stigmatized as Bonapartist because its efforts to appear conciliatory to the imperial state had not escaped the attention of ardent republicans like Gambetta. Under the pressure of trying...

  11. Chapter Seven Science, Politics, and Psychiatric Hereditarianism in the Nineteenth Century
    (pp. 144-161)

    With the advent of hereditarianism in the 1860s, alienists began the intellectual struggle to vindicate themselves as medically useful asylum physicians. Yet alienists longed to be recognized not just as institutional “moral entrepreneurs” but also as positivistscientists. The rhetorical form of hereditarianism and degeneracy theory was appropriate for their purposes because it blended biomedically and culturally congruent themes into a hegemonic body of knowledge that reassured Republican officials of their dedication to the positivist goals of progress and order. Psychiatric hereditarianism and degeneracy theory imposed an ideologically acceptable logic on madness and other pressing social problems. By adopting hereditarianism...

  12. Conclusion: The Social History of Psychiatric Knowledge
    (pp. 162-172)

    Almost as soon as its popularity peaked in the 1890s, the theory of mental degeneracy began to decline. During the heyday of degeneration theory there had never been a shortage of skeptics willing to point out the inconsistencies and imprecision of hereditary degeneracy as a clinical concept, but it was only in the early years of the twentieth century that criticisms of degeneracy theory gained widespread support. When Genil-Perrin observed in 1913 that degeneracy theory was poorly defined, vague, and susceptible to many different psychiatric interpretations, he was saying nothing substantially new.¹ What was new was alienists’ growing feeling that...

  13. Notes
    (pp. 173-212)
  14. Index
    (pp. 213-217)