A History of Psychiatry: From the Era of the Asylum to the Age of Prozac / Edition 1

by Edward Shorter

Overview

"PPPP . . . To compress 200 years of psychiatric theory and practice into a compelling and coherent narrative is a fine achievement . . . . What strikes the reader [most] are Shorter's storytelling skills, his ability to conjure up the personalities of the psychiatrists who shaped the discipline and the conditions under which they and their patients lived."—Ray Monk The Mail on Sunday magazine, U.K.

"An opinionated, anecdote-rich history. . . . While psychiatrists may quibble, and Freudians and other psychoanalysts will surely squawk, those without a vested interest will be thoroughly entertained and certainly enlightened."—Kirkus Reviews.

"Shorter tells his story with immense panache, narrative clarity, and genuinely deep erudition."—Roy Porter Wellcome Institute for the History of Medicine.

In A History of Psychiatry, Edward Shorter shows us the harsh, farcical, and inspiring realities of society's changing attitudes toward and attempts to deal with its mentally ill and the efforts of generations of scientists and physicians to ease their suffering. He paints vivid portraits of psychiatry's leading historical figures and pulls no punches in assessing their roles in advancing or sidetracking our understanding of the origins of mental illness.

Shorter also identifies the scientific and cultural factors that shaped the development of psychiatry. He reveals the forces behind the unparalleled sophistication of psychiatry in Germany during the eighteenth and nineteenth centuries as well as the emergence of the United States as the world capital of psychoanalysis.

This engagingly written, thoroughly researched, and fiercely partisan account is compelling reading for anyone with a personal, intellectual, or professional interest in psychiatry.

Product Details

ISBN-13:	9780471245315
Publisher:	Wiley
Publication date:	03/03/1998
Edition description:	REV
Pages:	448
Sales rank:	207,311
Product dimensions:	6.08(w) x 9.39(h) x 1.19(d)

About the Author

EDWARD SHORTER, PhD, is Hannah Professor in the History of Medicine at the University of Toronto. He is the author of ten books, including the international bestseller The Making of the Modern Family and a two-volume history of psychosomatic illness.

Table of Contents

Preface

1 The Birth of Psychiatry vii

A World without Psychiatry 1

Traditional Asylums 4

Heralding the Therapeutic Asylum 8

Organizing the Therapeutic Asylum 18

Nervous Illness and Nonpsychiatrists 22

Toward a Biological Psychiatry 26

Romantic Psychiatry 29

2 The Asylum Era 33 

National Traditions 34

The Pressure of Numbers 46

Why the Increase? 48

Redistribution of Illness 49

Rising Rate of Psychiatric Illness 53

Dead End 65

3 The First Biological Psychiatry 69  

Enter Ideas 69

A German Century 71

French Disasters 81

Anglo-Saxon Laggards 87

Degeneration 93

The End of the First Biological Psychiatry 99

An American Postscript 109

4 Nerves 113  

Nerves Better than Madness 114

The Flight of Madness into the Spa 119

Tired Nerves and the Rest Cure 129

Neurology Discovers Psychotherapy      136

5 The Psychoanalytic Hiatus 145       

Freud and His Circle 146

The Battle Begins 154

American Origins 160

The Arrival of the Europeans 166

Triumph 170

Psychoanalysis and the American Jews 181

6 Alternatives 190      

Fever Cure and Neurosyphilis 192

Early Drugs 196

Prolonged Sleep 200

Shock and Coma 207

Electroshock 218

The Lobotomy Adventure 225

Social and Community Psychiatry 229

7 The Second Biological Psychiatry 239         

The Genetic Strand 240

The First Drug That Worked 246

The Cornucopia 255

Neuroscience 262

Antipsychiatry 272

Return to “the Community” 277

The Battle over ECT 281

8 From Freud to Prozac 288  

Maintaining Market Share 289

A Nation Hungers for Psychotherapy 293

Science versus Fashion in Diagnosis 295

The Decline of Psychoanalysis  305

Cosmetic Psychopharmacology 314

Why Psychiatry? 325

Notes 329                   

Index 421        

Editorial Reviews

3 Stars from Doody

This book reviews psychiatry's evolution from its beginning as a medical specialty with therapeutic asylums, through the early biological era, the descriptive period, the psychoanalytic era, and finally the medical era. With the previous major chronicles of psychiatry more than 30 years old, the author sought to update the historical perspective. Despite contrary popular media references, the psychoanalytic era—championed for years by the psychoanalytic societies and institutions—is ended. Beginning in the 1950s, medical advances, improved diagnosis, and later, managed care sealed the transition. The author captures the changing discipline's character, presenting his perspective with eloquence, style, and riveting novel-like quality. This book chronicles psychiatry for the student and updates professionals and others who may incompletely appreciate the field's paradigmatic shifts. Neither a psychiatrist nor a clinical psychiatry expert, the historian author objectively and credibly develops the story. Photographs of some historical characters are included, but some expected images are absent. Although the book describes a timeline, no figures, tables, or other graphs depict the paradigmatic shifts. Adequate references add to the excellent appearance, feel, and prose. Previously, no single source clearly and concisely captured psychiatry's evolutionary essence. The book identifies the asylum physicians' efforts to develop therapeutic interventions. It chronicles the ambitious hopes of those who sought to explain psychiatric illness with anatomy, pathology, and genetics. Documented is the descriptive era with development of a psychiatric illness nosology. The bookfairly describes the psychoanalytic era and the analysts' motivations and contributions. According to the author, this period was a hiatus for the understanding and treatment of true psychiatric illness. The modern era, built upon the descriptive one, utilizes empirically sound pharmacologic and other therapies. If the book has weaknesses, they are partial appreciation for community psychiatry, incomplete acknowledgment of the impact of the rapidly evolving psychopharmacology, and minimal conjecture about the next era. Overall, this excellent book is for anyone seeking insight into modern psychiatry.

William F. Gabrielli

The view of psychiatry held by both insiders and the general public has changed considerably in the past few decades, in ways that Shorter (From the Mind into the Body) both acknowledges and celebrates. For the most part, psychiatrists have moved from what Shorter calls the "Freudian Interlude" to a role as gatekeepers of psychopharmaceuticals. Shorter covers psychiatry's birth as an attempt to create "mental asylums" as places of refuge. This attempt, argues the author, capsized because new major psychiatric illnesses (notably neurosyphilis and schizophrenia) arose in the 19th century, deluging the asylums. Young psychiatrists turned to Freudian analysis to earn a living by treating less sick and more financially secure patients. This "interlude" ended because analysis has become too expensive at the very time that psychiatric drugs have become available. While the book is a bit dry in places, it covers a great deal of fascinating material. -- Mary Ann Hughes, Neill Public Library, Pullman, Washington

Library Journal

...[C]oncise, well-organized, well-documented...

Books & Culture: A Christian Review

An opinionated, anecdote-rich history of a branch of medicine strongly shaped by culture. Canadian physician and medical historian Shorter (University of Toronto) begins his lively account by describing the horrific treatment of the mentally ill before the advent of the custodial asylum. It was, he says, the discovery that asylums could have a therapeutic role that led to the birth of psychiatry at the end of the 18th century. Shorter examines the failure of the therapeutic asylum movement, attributing it largely to an overwhelming number of inmates in the 19th century. Always divided by two visions of mental illness, one finding its origins in the biology of the brain and the other looking to psychosocial factors, psychiatry was dominated by the biological view throughout the 19th century. Shorter presents the German physician Emil Kraepelin, who revolutionized the approach to categorizing and diagnosing mental illnesses, as the central figure in ending the sway of biological psychiatry. As for Freud, says Shorter, "His doctrine of psychoanalysis, based on intuitive leaps of fantasy, did not stand the test of time." Citing studies indicating that the majority of American psychoanalysts and their patients were Jewish, the author links the growing social assimilation of Jews (and their abandonment of their "encapsulated little subculture") with the post-'60s decline in popularity of psychoanalysis—a theory sure to arouse controversy. Shorter chronicles the discovery of the various drugs that formed the pharmacological basis of the new biological psychiatry and hails the alliance of psychiatrists with geneticists, biochemists, and other scientists that has brought the scientificmethod to the investigation of mental illness. Where does psychiatry go from here? Shorter predicts a combination of the neuroscientific and the psychotherapeutic, that is, a blend of "neurochem" and "neurochat."

While psychiatrists may quibble and Freudians and other psychoanalysts will surely squawk, those without a vested interest will be thoroughly entertained and certainly enlightened.

Kirkus Reviews

Reviewer: William F. Gabrielli, Jr., MD, PhD (University of Kansas Medical Center)
Description: This book reviews psychiatry's evolution from its beginning as a medical specialty with therapeutic asylums, through the early biological era, the descriptive period, the psychoanalytic era, and finally the medical era.
Purpose: With the previous major chronicles of psychiatry more than 30 years old, the author sought to update the historical perspective. Despite contrary popular media references, the psychoanalytic era — championed for years by the psychoanalytic societies and institutions — is ended. Beginning in the 1950s, medical advances, improved diagnosis, and later, managed care sealed the transition. The author captures the changing discipline's character, presenting his perspective with eloquence, style, and riveting novel-like quality.
Audience: This book chronicles psychiatry for the student and updates professionals and others who may incompletely appreciate the field's paradigmatic shifts. Neither a psychiatrist nor a clinical psychiatry expert, the historian author objectively and credibly develops the story.
Features: Photographs of some historical characters are included, but some expected images are absent. Although the book describes a timeline, no figures, tables, or other graphs depict the paradigmatic shifts. Adequate references add to the excellent appearance, feel, and prose.
Assessment: Previously, no single source clearly and concisely captured psychiatry's evolutionary essence. The book identifies the asylum physicians' efforts to develop therapeutic interventions. It chronicles the ambitious hopes of those who sought to explain psychiatric illness with anatomy, pathology, and genetics. Documented is the descriptive era with development of a psychiatric illness nosology. The book fairly describes the psychoanalytic era and the analysts' motivations and contributions. According to the author, this period was a hiatus for the understanding and treatment of true psychiatric illness. The modern era, built upon the descriptive one, utilizes empirically sound pharmacologic and other therapies. If the book has weaknesses, they are partial appreciation for community psychiatry, incomplete acknowledgment of the impact of the rapidly evolving psychopharmacology, and minimal conjecture about the next era. Overall, this excellent book is for anyone seeking insight into modern psychiatry.

Doody's Review Service