History of Psychiatry

http://hpy.sagepub.com Book Reviews : German Berrios and Roy Porter. A History of Clinical Psychiatry: The Origin and History of Psychiatric Disorders. London: The Athlone Press, 1995. Pp. 684. Hbk, 60.00. ISBN 0-485-24011-4. Pbk, 19.95. ISBN 0-485-24211-7
George J. Makari History of Psychiatry 1996; 7; 467 DOI: 10.1177/0957154X9600702709 The online version of this article can be found at: http://hpy.sagepub.com

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467-

Book Reviews

German Berrios and Roy Porter. A History of Clinical Psychiatry: The Origin and History of Psychiatric Disorders. London: The Athlone Press, 1995. Pp. 684. Hbk, £60.00. ISBN 0-485-24011-4. Pbk, £19.95. ISBN 0-485-24211-7.
In 1984, Stanley Jackson justly noted that historians of psychiatry were without a sound textbook (Jackson 1984: 66). In the dozen years that have elapsed since then, the need for such a work has only become more pressing. The dated, often Whiggish, textbooks available in English, such as those by Zilboorg and Henry (1941), Lewis (1941), Ackerknecht (1959), Schneck (1960), and Alexander and Selesnick (1966) grow - with every passing year - less representative of scholarship in the field. Enter German Berrios and Roy Porters compendium, A History of Clinical Psychiatry: the Origin and History of Clinical Disorders. An ambitious and rewarding volume, A History of Clinical Psychiatry brings together over forty contributors who span twenty six clinical constructs in a meaty six hundred and eighty four pages. Presented in dense, short sections (typically 10-20 pages), written in non-polemical tones, ballasted by excellent bibliographies and a solid index, this work is one any historian of psychiatry will want on his or her shelf as a reference tool or pedagogic aid. Even better, the editors suggest that a follow-up volume on sub-specialties and clinical treatments may be in the offing (:vi). Edited by Berrios, a neuropsychiatrist

whose impressive historical work has involved internalist attempts to clarify the history of disease entities, and Porter, one of our most eminent social historians of psychiatry, this volume makes a significant effort to present both historiographical approaches. To do so, the editors organize their history by clinical disorder, and allot each disorder a Clinical section and a Social section. Given the sometimes heated differences between our intellectual and social historians, this was a wise editorial strategy. But it is one that, it should be noted, reflects the nagging

di~culty -

some

might

say

inability -

most

contemporary historians encounter in uniting both perspectives when it comes to psychiatry. Along these lines, we are left to contemplate why some clinical constructs in this volume can find no social historians

(i.e Multiple Sclerosis, Unitary Psychosis, Cycloid Psychosis), while other clinical
sections cannot be written without at least, en passant, engaging social history (i.e Mental Retardation, Substance Abuse Disorders, Post-Traumatic Stress Disorders). The notion of parsing psychiatrys history not by historical period, but by clinical disorder/construct is an intriguing one that has the immediate advantage of making this volume very user friendly for the historian, as well as the clinician, teacher and student. This approach also has its disadvantages, for it can implicitly seem as if all diseases have equal historical import. Also, overarching theories of disease have no natural home here. So, for example,

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468
iatro-chemical and

iatro-physical theories,

germ theory and degeneration theory are either left to other histories or must be

into discussions of specific disease entities. The editors propose three broad arenas for their history of clinical psychiatry: 1. Neuropsychiatric Disorders, 2. Functional Psychoses, and 3. Neuroses and Personality Disorders. The book opens with the essays on the Neuropsychiatric Disorders, which are simply outstanding. Berrios and Porter team up to give us authoritative, crystalline accounts of the history of dementia, Parkinsons disease, and epilepsy. Francis Schiller contributes an elegant essay on Huntingtons disease, which is further complimented by Porters graceful and astute social history. Disorders like multiple sclerosis, delirium and mental retardation are also well handled. I only would have wished that the editors included a section

smuggled

lesser-known system for parsing the psychoses is rescued from general obscurity and interestingly followed into the work of Karl Kleist and Karl Leonhard. Strong essays on Einheitspsychose or Unitary psychosis,
as

well

as

Delusional disorders and

mono-

mania, compliment the earlier sections and

giving the reader a rich texture of differing historical views on psychosis. In the last grouping of psychiatric disorders, Neurosis and the Personality Disorders, A History of Clinical Psychiatry falters. We begin with a thin intellectual history of conversion disorders and hysteria. This sections inadequacy is cemented by
end up its minimal reference section. Conversely, despite the enormity of the task, Helen King does a fine job penning a terse but stimulating social history of hysteria, which, though short, is supplemented by a solid bibliography. The essays on Post-traumatic Stress Disorder and Shell Shock by Harold Merskey and Edward Brown deserve praise, as do the essays by Simon Wessely and Tom Lutz on neurasthenia. Berrios and Links description of anxiety disorders is solid and contains an excellent bibliography, but inexplicably ends circa 1917. Berrioss section on obsessive compulsive disorder is similarly exhaustively referenced and authoritative, but also ends with the nineteenth century. And what can one say about the gallant fellow who took on the task of writing a social history of anxiety disorders! How would you like to tackle the task of writing a few pages on &dquo;Normal&dquo; and &dquo;Abnormal&dquo; Anxiety in History (:567)?! One can hardly fault this author for doing his best with an impossible task. On the other hand, the most unfortunate section in this volume involves a task that was quite possible, and is quite crucial to the history of clinical psychiatry. I am referring to the seriously flawed few pages devoted to the clinical history of personality disorders. Which leads me to my final thoughts.

on

general paralysis.

The history of the Functional Psychoses is also deeply informative and solid, though the organization of this section can seem at times confusing. In fact, in less able hands it is easy to see how this section might have become a quagmire. Berrioss repeated caution to carefully distinguish between the histories of terms, concepts and behaviours seems to have acted as a helpful guide to contributors as they wrestled with the myriad of nomenclatures and theories for

psychosis.
Functional Psychosis opens with the only biographical sections in this volume, presenting the life and work of Emil Kraepelin and Carl Wernicke. This turn to the biographical is a bit jarring, and seems to ahistorically imply that the description of the psychoses began with Kraepelin (an impression that is dispelled in other sections). Nonetheless, Paul Hoffs essay on Kraepelins Kantian influences and the development of Kraepelins different positions on psychiatric nosology is concise, enriching and informative. Wernickes

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469
In attempting to encompass the whole of the history of clinical psychiatry, this volume forces us to reflect on what has been excluded. Most authors are understandingly a bit undone by the need to take in all places and ages in their allotted two dozen or so pages. While almost all contributors make serious efforts to engage British, French and German contributions, the extent to which other views are represented is quite variable. Those looking for the history of clinical psychiatry in America, Russia and Italy, for instance, will not find their fill here. Other authors deal with the overwhelming range of their task by imposing limits on time, rather than place. Few of the authors take up the pre-history of their clinical constructs. More strikingly, this volume almost invariably shuns developments in the history of clinical psychiatry after 1918 (exceptions include the sections on the social history of schizophrenia and dementia, and the clinical history of unitary psychosis and somatoform disorders). This absence of the twentieth century makes itself felt amongst those essayists who attempt to contrast present DSM-IV classifications with older conceptualizations, for quite strikingly, nowhere in this volume does a disease entity get followed as it migrated through the five versions of the American Diagnostic and Statistical Manual. But the absence of the twentieth century is most clearly felt in the category of Neurosis and Personality Disorders, and more specifically in the aforementioned clinical chapter on personality disorders. That section strangely turns out to be almost exclusively about one personality disorder, psychopathy or anti-social personality disorder. The flowering of the concept of character disorders in the 1920s and afterwards in the work of Karl Abraham, Sandor Ferenczi, Franz Alexander, Otto Fenichel, Edward Glover, Helene Deutsch, and Wilhelm Reich, to name a few, is

quickly brushed aside as the authors doggedly return to their disjointed history

psychopathy. Hence, this volume does not take up the important issue of how nineteenth-century psychiatric disorders such as hysteria and obsessional disorders came to be seen as disorders of ones personality. Unfortunately, this neglect is symptomatic of a broader problem: this history of clinical psychiatry contains very
of little on psychoanalysis save for obligatory references to Sigmund Freud. PostFreudian psychoanalytic conceptions of such things as hysteria, anxiety disorders, depressive disorders and schizophrenia are

basically ignored. To comprehend these historiographic strategies, let me suggest that we view A History of Clinical Psychiatry - the first serious history of psychiatry to be published in English for almost 30 years alongside one of its predecessors, Franz
Alexander and Sheldon Selesnicks The History of Psychiatry (1966). Alexander and Selesnick form their narrative around historical periods and the great men of psychiatry; Berrios and Porter organize their history around clinical constructs. Alexander and Selesnicks history begins its sweep in prehistoric times; Berrios and Porters volume - centred as it is around clinical psychiatry - does not. Alexander and Selesnick chronicle the eighteenth and nineteenth centuries with insufficient detail; banking on a great deal of scholarship that has emerged in the past decades, Berrios and Porters volume wonderfully present these centuries as ones that are central, rich and formative for clinical psychiatry whole. Alexander and Selesnick as a triumphantly march their reader up to a long, final section on recent developments (1966: 268); Berrios and Porter want to have nothing to do with such obvious Whiggishness, and in contradistinction most of their authors summarily end their histories in the early twentieth century. In these important ways, these two

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470 books could not be more different. But, for all its historiographical sophistication and strong scholarship, I would suggest that A History of Clinical Psychiatry succumbs to a problem that is writ large in Alexander and Selesnick. One of the deeply problematic qualities of Alexander and Selesnicks methodology was the way they interpreted history in light of what they then believed was valid and true. In 1966, for these analysts in America, psychiatric truth was psychoanalysis. Hence it can seem, at times, as if Alexander and Selesnick were not writing the history of eighteenth- and nineteenth-century psychiatry, so much as scouring those centuries for precursors to Freud, while undervaluing or ignoring nonFreudian historical developments. Times have changed and neuropsychiatry has - in most clinical departments of psychiatry - supplanted psychoanalysis as clinical truth. With its strong, broad section on neuropsychiatry, its few tattered pages on personality disorders, and its unexplained silence for events after 1918 events that prominently include a psychoanalytic tidal wave that would sweep through much of European and American psychiatry - this history of clinical psychiatry gives the impression that it is playing to present neuropsychiatric verities. In this way, A History of Clinical Psychiatry can be seen as trading in older presentist frameworks for less visible contemporary
-

twentieth centuries. For those like myself who have despaired over the fields lack of an adequate textbook, the arrival of this work is cause for celebration. For scholars, teachers and students, this is a work that will reward and require study for years to
come.

Cornell

GEORGE J. MAKARI University Medical College

REFERENCES

Ackerknecht, Erwin H. . (1959) A Short History of Psychiatry, trans. by S. Wolff (New York and
London: Hafner

Publishing Co.).

Alexander, Franz G. and Sheldon T. Selesnick (1966). The History of Psychiatry: An Evaluation of Psychiatric Thought and Practice from Prehistoric Times to the Present (New York: Harper and Row). Jackson, Stanley (1984). History of Psychiatry, in Core Readings in Psychiatry: An Annotated Guide to the Literature, edited by Michael Sacks, William Sledge and Phyllis Rubinton (New York: Praeger Publishers). Lewis, Nolan D. C. (1941). A Short History of Psychiatric Achievement (New York: W.W Norton). Schneck, Jerome M. (1960). History of Psychiatry (Springfield, Ill.: Charles Thomas). Zilboorg, Gregory and George W. Henry (1941). A History of Medical Psychology (New York: W.W Norton).

German Berrios. The History of Mental

ones.

Despite these difficulties, A History of Clinical Psychiatry is a wonderful and much needed work, teeming with interesting, clarifying exposition and loaded with useful bibliographical reference. If I have dwelt on the absences in this collection, it is out of respect, for I believe A History of Clinical Psychiatry will now take its place as the standard English textbook of the field. In sum, Berrios and Porters volume is a sturdy introductory history to Western European clinical psychiatry in the eighteenth, nineteenth and pre-War

Symptoms: Descriptive Psychopathology since the Nineteenth Century. Cambridge: Cambridge University Press, 1996. Pp. 565. Hbk, £100.00 (US$165.00). ISBN 0-521-43135-2. Pbk, £40.00 (US$59.95). ISBN 0-521-43736-9. German Berrios, a well-known psychiatrist
historian, believes that historical information
should be available to clinicians as freely as statistical and clinical data. If this desirable state of affairs is ever achieved, it will revolutionize both psychiatry and medicine. Meanwhile, Berrioss impressive book makes a good start. He begins by humbling less learned readers by discussing the

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