Abstract
In the very active research area of the history of psychiatry in the nineteenth century, German historian Jens Gründler makes a notable addition with his study on the relationship between poverty and insanity, using the example of Woodilee Asylum founded near Glasgow in Scotland in 1875. At the centre of this dissertation, which he submitted as part of the special research area ‘Fremdheit und Armut’ at the University of Trier, are ‘poor lunatics’ and their relatives. Gründler goes beyond the realm of the institution and reconstructs the life stories of the patients before and after their stay there. He achieves this with records from the organizations that cared for the poor, in addition to patient files and documents from the hospital administration, analysing samples of both invent-ories. While the poverty files and the psychiatric records only partly reconstruct the ‘patient’s view’ as Roy Porter (1985) defined it, the sources do provide an insight into the social situation of the family of institutionalized patients outside this institution, thus enabling a glimpse into their life stories as a whole.
In the German history of psychiatry, the approach to make patients visible as agents using Alf Lüdtke’s (1994) concept of ‘Eigensinn’ (which means both obstinacy and self-will) is not a new one. Thus, Gründler moves from the largely known arguments to the question of how the institutionalized male and female patients around 1900 behaved within a ‘total institution’ (Goffman, 1961). Yet the author does not primarily want to investigate the ‘interior life’ at the institution in all its facets. Rather, he asks what opportunities for action these ‘poor lunatics’ and their relatives had, despite all the restrictions, in their attempts to straddle the spectrum of care for the poor and psychiatry as it was practised at the institution. Accordingly, in expanding his gaze onto the history of psychiatry, Gründler enters a new terrain and reveals astonishing findings. He emphasizes that, while a large portion of the patients were admitted at the request of the relatives, their expression of ‘madness’ had been endured or borne for a longer period of time beforehand by their social surroundings. Furthermore, the same number of patients were picked up by the police due to deviant behaviour and were treated with compulsory institutionalization.
With his case files, Gründler convincingly argues against the assumption that psychiatric institutions during the nineteenth century mainly served as a place of custody because, as he shows, a large number of cases achieved a ‘recovery’ in the sense that the patients not only found a job but also eventually even reintegrated into society. For the less ‘successfully’ treated, the author manages to follow their ‘hospital careers’ through an analysis of the poverty files.
Relatives hardly had a say in the decisions the doctors took within the confines of the institution. Yet, when the release of the patient was under discussion, often the expert opinion of the psych-iatrist was of lesser value than the interests of the authorities in charge of the poor. For financial reasons, these often supported a family’s application for a release even if medical reasons opposed such a decision.
The author concludes that psychiatry in the institution was used in two ways: (a) as a ‘temporary maintenance institution’ (temporäre Versorgungseinrichtung, p. 322) in a moment of crisis, and (b) as an instrument for disciplining socially deviant behaviour. Previously, the history of patients had been written exclusively on the basis of patient files, and subsequently relied on the written documentation produced by psychiatrists and nursing staff. Hence, the reconstructions contained corresponding methodological problems and were restricted to the time the patients had spent at the institution. With the expansion of the source material to include the poverty files, Gründler presents a fundamentally new perspective on the history of institutional psychiatry during the nineteenth century. In this very accessible volume he integrates the housing of the ‘poor lunatics’ within an institution into a complex net of agents who pursued their own interests within and outside that institution.