Apparatus XY

Psychiatric Implantation: 1880-1900

6In the nineteenth century, psychiatry was the youngest of the major branches of medicine, primarily because its development largely depended on the Enlightenment effort to place mental illness back into the hands of medical men (Ackerknecht 1982, 204). The French physician Philippe Pinel anchored this effort with the publication of his Medico-Philosophical Treatise on Mental Alienation or Mania (1801), in which he advocated reducing mechanical restraints in mental asylums, producing the famous image of Pinel "striking the chains off the mad."[8]See e.g. Goldstein, chap. 3; Zilboorg and Henry, chap. 8. In fact, historians debate over the role of the asylum "mad-doctors" as humane moral reformers or authorities who were more concerned with social control than disease treatment. This somewhat dated historiographical debate, however, rests outside the scope of this paper. For a recent set of essays that reviews and attempts to open up new research directions in the history of psychiatry, see Scull. According to historians of medicine such as Erwin Ackerknecht, French romantic psychiatry dominated the first half of the nineteenth century, followed by German somatic psychiatry dominating the latter half.[9]Ackerknecht 1968, 1982, p. 205; and Goldstein. Alternatively, Shorter, chap. 3, maintains that German psychiatry strictly dominated the entire 19th century. As this transition unfolded, the boundary between psychiatry and neurology became more defined after the 1880s, when the task of psychiatrists gradually evolved to dealing with diseases unexplainable or untreatable by neurologists (Clark; Jacyna). Eventually, a decline in somatic psychiatry and an increasing level of interest in psychogenic explanations of mental disorders distinguished the psychiatric profession at the beginning of the twentieth century, when Kraepelin's nosological treatise and Freud's psychoanalytic writings began to disseminate broadly on both sides of the Atlantic.

7Reacting to the early nineteenth-century "Romantic" character of the mental health profession, most psychiatrists between 1850 and 1880 attributed mental illness to physiological causes, particularly anatomical abnormality in the brain. In the opening chapter of his influential text Mental Pathology and Therapeutics, German pioneering neuropsychiatrist Wilhelm Griesinger, founder of the Archiv für Psychiatrie und Nervenkrankheiten and the Society for Medical Psychology, proclaimed that "the brain alone can be the seat of normal and abnormal mental action" and that "the normal state of the mental process depends on the integrity of this organ" (3). Similarly, the eminent psychiatrist Henry Maudsley, who was as highly regarded in England as Griesinger in Germany, also considered mental pathology as a somatic illness, as he explicitly expressed in Body and Mind (1870): "The physiology and the pathology of mind are two branches of one science; and he who studies the one must, if he would work wisely and well, study the other also" (2).[10]On Maudsley's emphasis on the somatic aspects of mental organization, see also Maudsley 1902, 1916.

8In Vienna, the work of Theodore Meynert, teacher of Sigmund Freud, emblematized the contemporary psychiatric trend to interpret diseases of the mind as structural pathologies of the brain. Culminating in his famous Psychiatry: A Clinical Treatise on Diseases of the Fore-Brain, Meynert's life-long commitment to understanding mental states as epiphenomena of neurophysiological processes was evident in his explanation of people's "individuality":

The innervation centre for the third nerve is anatomically connected with a number of mutually associated centres…distributed over the entire cortical area [. . . ]. The sum of these "centres" constitutes the "individuality," the "ego" of abstract-psychologists[. . . ] This unequal activity of the fore-brain, constituting individuality, varies as regards contents and degree with each person; it is designated also as the character of the individual. It has been justly observed, if the character (individuality) of a person were entirely known we would be able to predict the thoughts and deeds of such an individual, however complicated they might be.(167-8, emphasis original)

Based on his histopathological studies, Meynert not only identified specific physiological processes in the forebrain as the corresponding cerebral features of "individuality," he even hinted the possibility of predicting an individual's thoughts and behavior quantitatively, if sufficient data were gathered. Such an attempt to measure and quantify human thoughts, while locating the "seat of human action" in neuroanatomy, enabled Meynert to postulate that normal human behavior followed a regular set of laws:

The idea of individuality is an artificial one, though valuable from a practical point of view, for the degree of intensity by which these images and their connections adhere to this conception will not admit of accurate measurement; and it is plainly impossible to say that at a certain intensity a presentation becomes a factor of the ego, and not yet at another. There is but one safe stand to take on this question, and that is to attribute to the ill-defined conception of individuality only those presentations which, as soon as the "character" of an individual is known, will enable us to predict his deeds; whence it follows that the deeds of the individual obey certain laws.(172, emphasis original)

Even though individuality was not necessarily an organic concept, for Meynert, it could still be valuable, as long as it allowed mental scientists and clinicians to systematize the relationship between psychological functions and neuroanatomical pathways.

9As the nineteenth century reached its final decade, however, psychiatrists had yet to establish enough convincing connections between mental diseases and somatic causes, which hindered the profession's drive to advance the legitimacy and autonomy of their field of specialization in medicine (Ackerknecht 1968, 82; Duffin, 285). As such, psychiatrists' renewed interest and investment in dynamically-oriented approaches appeared around the same time. Echoing the earlier Romantic physicians' understandings of mental illness, this new wave of psychogenically-inclined psychiatrists began to shift their emphasis from bodily to psychological causes in explaining mental disorder. One of the key figures responsible for this transition was Emil Kraepelin, who combined Karl L. Kahlbaum's catatonia, Bénédict A. Morel's démence précoce, and Ewald Hecker's hebephrenia into the single category dementia praecox in the fourth edition (1893) of his textbook Clinical Psychiatry, the precursor to the modern Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association. In his Lectures on Clinical Psychiatry (1917), Kraepelin reminded his audience the mental, non-biologic roots of this particular disease of the mind:

[the patient] occasionally composes a letter to the doctor, expressing all kinds of distorted, half-formed ideas, with a peculiar and silly play on words, in very fair style, but with little connection…These scraps of writings, as well as his statements that he is pondering over the world or putting himself together a moral philosophy, leave no doubt that besides the emotional barrenness, there is also a high degree of weakness of judgment and flightiness, although the pure memory has suffered little, if at all. We have a mental and emotional infirmity to deal with, which reminds us only outwardly of the states of depression previously described. This infirmity is the incurable outcome of a very common history of disease, to which we will provisionally give the name of Dementia Praecox. (23, emphasis original)

"In giving a careful account of dementia praecox, or schizophrenia, as a distinct disease," according to historian Edward Shorter, "Kraepelin had handed psychiatry its most powerful term of the twentieth century" (106). By placing the two types of "functional" psychoses that he had developed-manic depression in addition to schizophrenia-at the top of the psychiatric agenda by 1899, Kraepelin gave birth to a revolutionary current in psychiatry in which psychical explanations of mental illness gradually replaced causal understandings derived from brain anatomical research, the primary focus of earlier nineteenth-century psychiatrists.[11]1899 was the year of publication of the sixth and the first definitive edition of his seminal textbook <em>Clinical Psychiatry</em>.

10It was against this background of professional frustration and therapeutic despair with somaticism, reflecting the unstable footing of psychiatry within the larger profession of medicine at the time, that Meynert's Viennese successor Richard von Krafft-Ebing first published his magnum opus Psychopathia Sexualis in 1886.[12]Krafft-Ebing authored a number of significant writings on sexuality before <em>Psychopathia Sexualis</em>. See e.g. Krafft-Ebing 1877. Historians of science, medicine, and sexuality have correctly documented how Krafft-Ebing's description of homosexuality as a diseased neurotic degeneracy had profoundly influenced the way other scientific and medical experts thought about various forms of sexual perversion around the turn of the twentieth century. Most, however, simply stop there and fail to explain why Krafft-Ebing adopted the degeneration theory first posited by the French psychiatrist Bénédict A. Morel, why he was reluctant to abandon the theory altogether even until the end of his career (Oosterhuis 103), and the broader implications of these conscious decisions made on his part with respect to the larger disciplinary contexts of psychiatry and sexology, especially since he was such an acclaimed international figure.[13]Oosterhuis' biography of Krafft-Ebing is perhaps the only exception to this generalization. Oosterhuis, however, focuses on the emergence of "sexual identity"; whereas in this paper, I am trying to contextualize Krafft-Ebing's contribution within the larger discourse of early sexology in order to make claims about the emergence of "sexual freedom," beyond "sexual identity." Nonetheless, my work should be viewed as complementing Oosterhuis' work, rather than challenging it. In what follows, I suggest that Krafft-Ebing's intention in publishing his widely read medico-forensic text Psychopathia Sexualis, which had undergone at least twelve German editions and two different English translations by the early 1900s, had three fronts: (1) to legitimate the psychiatric establishment within the larger medical profession; (2) to establish the credibility of psychiatrists and their work; and (3) to demonstrate the kind of scientific progress that such credibility required.