History of Psychiatry: Madness,Science,Culture

In Norway the building of asylums started in 1855 with the establishment of Gaustad State Asylum. Until the 1950s Norwegian psychiatry was mainly a hospital psychiatry, strongly influenced by the pre-war German tradition. After World War II, it was influenced by British social psychiatry and American psychoanalysis. Psychiatric units in general hospitals were established in the 1960s onwards and outpatient clinics from the 1970s. During the last twenty years Norwegian psychiatry has taken a more biological trend with stronger emphasis on diagnostics and drug treatment. The increase in the number of psychiatrists and especially psychologists has been formidable during the last fifty years.

This paper examines the Swiss psychiatrist Ludwig Binswanger’s view of the doctor-patient relationship as a direct and trusting existential encounter in a 1935 clinical case of hysteria. Drawing upon unpublished materials from the patient record and correspondence, I show that his conception of existential encounter emerged from the Bellevue asylum context, where treatment choices were linked to maintaining order in a communal setting, and addressing a complex array of bodily and psychological symptoms. Binswanger touted the underlying, positive relationship with his patients as the critical factor in the efficacy of a wide variety of treatments, including some of the most forceful and authoritative. Sources from the patient’s perspective, however, demonstrate that, in this case, a mutual relationship of trust was not clearly achieved.

During the 1870s the Austro-Hungarian neuropsychiatrist Moritz Benedikt (1835-1920) proposed a remarkable neurological localization of morality in the human brain. More precisely, he thought of the ultimate parts of the occipital lobes as the seat of the moral sense. The so-called non-coverage of the cerebellum that was discovered in apes and criminals underpinned his localization. This paper studies the origin, background and reception of Benedikt’s unique but opiniated localization of human morality. It is argued that his self-labelling as a freethinker offers the most understandable reason why Benedikt looked so eagerly for the seat of the moral sense in the human brain and why he was ultimately bold enough to suggest a cerebral localization.

Throughout his work Johann Christian August Heinroth regarded sin to be the cause of mental illness. The present two-part paper investigates what exactly Heinroth understood by sin. Based on a thorough analysis of his own texts, this study shows that on the one hand Heinroth referred to sin in a Christian-Protestant sense. On the other, however, a moral-ethical code of conduct was also involved. Thus, Heinroth did not regard sin as a singular event, but rather as a life conducted in a wrong way for years or even decades, by which he meant a steady striving towards earthly, bodily satisfaction.

Ewald Hecker (1843-1909), a friend and disciple of Karl Ludwig Kahlbaum (1828-1899), was a relentless advocate of his teacher’s psychiatric nosology. This paper is an early manifesto of their ideas and sets the context for the following publications, namely Hecker’s seminal paper on hebephrenia to be published in the same journal and in the same year (1871) and Kahlbaum’s catatonia published in 1874. Their idea that age of onset and time course of an illness, together with close clinical observation, helps to delineate disease forms out of the mass of confusing psychiatric symptoms proved to be one of the most important paradigm shifts in middle to late nineteenth-century psychiatry. This had a strong influence on Kraepelin’s dichotomy between dementia praecox and manic depressive insanity, and thus on our modern notions of schizophrenia and bipolar illness.