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The Early Psychiatrist: A Piercing Eye and Commanding Presence: Page 2 of 2

The Early Psychiatrist: A Piercing Eye and Commanding Presence: Page 2 of 2

Influenced by Christian theology and Romanticism, the German “mental physician” Johann Christian Heinroth (1773 - 1843) extended this analogy still further in 1818, claiming an almost Christ-like status for psychiatrists. “From the very outset,” he said, “[the mental physician] influences the patient by virtue of his, one may be permitted to say, holy presence, by the sheer strength of his being, his glance, and his will.”5

Perhaps no one exemplified the figure of the charismatic psychiatrist in the 19th century more than Jean-Martin Charcot (1825 - 1893). Trained in neurology, the Frenchman conducted research and taught at the famous Salptrire Hospital in Paris from 1862 to 1893, where he made his fame studying and treating hys­teria. He turned the hospital into a public showcase for himself and his methods.

Charcot introduced a set of weekly lectures of staged presentations during which he hypnotized ostensibly hysterical (mostly female) patients in order to dramatically provoke and alleviate acute symptoms. While his Tuesday lectures were reserved for students and physicians, his Friday lessons were open to the public and were attended by a mix of avidly cu­rious spectators—including artists and writers from all over Europe.6 They, of course, only helped extend his fame as an accomplished researcher and healer.

The advent of the First World War, with its total mobilization of re­sources and its heavy casualties, ushered in a period of heroic medicine that lasted well into the 1940s. From 1914 to 1918, war psychiatry was overwhelmed by tens of thousands of shell-shocked victims, otherwise healthy soldiers who showed all the signs of hysteria (a malady commonly associated with women and girls).

In Germany, the Hamburg neurologist Max Nonne (1861 - 1959) developed what he called “the lightning cure” for “war neurotics,” professing to cure ailing soldiers almost instant-ly through the use of hypnosis. His counterpart in Ludwigshafen, the physician Fritz Kaufmann (1875 - 1941), boasted of similar results by applying painful electric shocks to various body parts while barking out military orders to the soldier: “[O]ne must seek to convince the patient in every way possible that you are in the position to force your own strong will upon him,” Kaufmann insisted. “In short, you must participate in the treatment with your entire personality.”7

In the 3 decades following the end of the Great War, international psychiatry took an increasingly aggressive and invasive turn. Mass compulsory sterilization, malaria fever therapy, metrazol shock therapy, insulin therapy, electroconvulsive therapy, and lobotomy all emerged and spread during the years 1920 to 1950. A variety of interrelated institutional, social, political, and economic factors played critical roles in the rise of what I have termed “militant psychiatry.”

One of these factors was the continued acceptance of the ideal of the compelling and forceful psychiatrist. To be sure, the clinician’s aura and willpower were now rarely cast as inherently therapeutic, except within psychoanalytic circles. But the successful careers of the self-promoting, media-savvy developers of prefrontal lobotomy, Egas Moniz (1874 - 1955) and Walter Freeman (1895 - 1972), attest to the fact that self-confidence, conviction, and zeal did much to make up for the less than overwhelming results in persuading others of the benefits of the operation.8

It would be wrong to assume that all patients—universally and uncritically—accepted these claims to authority by clinicians. On the contrary, there is ample evidence that many patients—although perhaps fewer family members—were skeptical, if not outright defiant, toward those charged with treating them. But if we wish to understand historically the agenda of not only client-centered therapy but also social psychiatry and anti-psychiatry during the second half of the 20th century, we need to be sensitive to how these new attitudes and methods represented a response to the historical disparity in power between physicians and patients.

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References

References

1. Rogers CR. The attitude and orientation of the counselor in client-centered therapy. J Consult Psychol. 1949;13:82-94.
2. Porter R. The Greatest Benefit to Mankind: A Medical History of Humanity. New York: WW Norton & Company, Inc; 1997:58-59, 668-672.
3. Macalpine I, Hunter R. George III and the Mad-Business. London: Pimlico; 1995:270-272.
4. Pinel P. A Treatise on Insanity. Sheffield, England: Todd; 1806.
5. Heinroth JC. Textbook of Disturbances of Mental Life, or Disturbances of the Soul and Their Treatment. Vol 1. Baltimore: Johns Hopkins University Press; 1975:29.
6. Goldstein J. Console and Classify: The French Psychiatric Profession in the Nineteenth Century. New York: Cambridge University Press; 1987:169-171.
7. Eghigian G. From Madness to Mental Health: Psychiatric Disorder and Its Treatment in Western Civil­ization. New Brunswick, NJ: Rutgers University Press; 2010:237.
8. The Lobotomist. From the PBS documentary series The American Experience. WGBH Educational Foundation; 2008. http://www.wgbh.org/programs/-97/episodes/The-Lobotomist-11466. Accessed December 14, 2011.
 
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