Guest Editorial
High Society: Drugs, Mental Health, and the History of Psychiatry
David Wright 1
Psychiatrists and historians used to exist in a state of mutual mistrust and suspicion. Professional historians of a generation ago, much influenced by the radical epistemology of Michel Foucault (1), the sociological critiques of Erving Goffman (2), the countercultural theorizing of RD Laing (3), or the trenchant libertarianism of Thomas Szasz (4), came to portray the entire enterprise of modern psychiatry as a thinly veiled experiment in social control and professional monopolization. French-language scholars such as Robert Castel (5) and Yannick Ripa (6), as well as Anglo-American academics from David Rothman (7) and Andrew Scull (8) to Phyllis Chelser (9) and Elaine Showalter (10), constructed stinging histories of the rise of psychiatry (and its asylums), ripping into almost every aspect of modern psychiatric theory and practice. Psychiatry was attacked, from the left and from the right, by Marxists, feminists, and libertarians alike, as well as from within its own ranks. Little wonder, as Trevor Turner, the distinguished British psychiatrist-historian, remarked, that many psychiatrists retreated from engaging with their own history when it seemed that historians were preoccupied with framing psychiatry as the culprit responsible for most of modern society’s social problems (11).
In the late 1980s, however, a leading medical historian, Roy Porter (12), and a philosopher-psychiatrist, German Berrios (13), sought a rapprochement by promoting a constructive exchange of scholarship between academic humanists and clinician-researchers (14). Their project was realized in the British-based journal History of Psychiatry (established in 1990). Psychiatric journals such as the London-based Psychological Medicine soon followed suit, integrating historical articles within their pages. This new collaboration between psychiatrists and historians was also aided indirectly by new research in the philosophy of science that tried to break down the simplistic dualism of biological determinism vs social constructionism. In particular, the former University of Toronto scholar Ian Hacking made a particularly thoughtful case for creating a space for dialogue between the 2 camps (15). His work affirms the existence of psychiatric illness in the face of transtemporal diagnostic discordance.
It may come as a surprise to many readers that much of the new scholarship in the history of mental health and psychiatry is “home-grown,” emerging from Canadian universities. Edward Shorter’s eminently readable A History of Psychiatry (16) has been become a standard text on the emergence of the mental health professions in the Western world; Geoffrey Reaume’s unconventional history of the Toronto Asylum breaks new theoretical ground by rewriting the history of the mental hospital from the perspective of the patients (17). Thierry Nootens’ (18) and Marie-Claude Thifault’s (19) exploration of familial responses to madness in 19th-century Quebec have opened up as-yet-unexplored vistas onto the history of care of the mentally ill outside the walls of the asylum (18). A new anthology, encompassing the work of both prominent and promising scholars in the field, will soon be published by McGill–Queen’s University Press (20).
This issue’s In Review section seeks to add to this new and innovative research by exploring one small but vitally important corner of the history of psychiatry: the history of drugs and mental health in postwar North American society. In the first article, Andrea Tone, Professor of History and Canada Research Chair in the Social History of Medicine at McGill University, analyzes the rise of (minor) tranquilizers within North American society as a treatment for anxiety (21). She details the changing social and political context that framed and informed the social practice of drug taking. Tone also emphasizes the role that the media and (ultimately) politicians played in encouraging and then stigmatizing the users of the new anxiolytics.
Many of the same forces are also held up for scrutiny in the second article. Erika Dyck, a final-year doctoral student at McMaster University, examines the controversial history of LSD experimentation in postwar Canada (22). Her research on LSD trials in Saskatchewan offers an outlook on the history of “psychedelic psychiatry” different from the perspective that has traditionally focused on Ewen Cameron, the CIA, and the Allan Memorial Institute. In this piece, Dyck demonstrates that LSD research was not marginal but, rather, represented one of several promising new avenues of psychiatric research concerning the modelling of schizophrenia and the treatment of chronic alcoholism. However, like the fate of tranquilizers in the 1970s, the social and professional uses of LSD became overwhelmed by shifting cultural discourses and the politicization of the use of psychoactive drugs.
These complementary contributions speak to the relevance of historical research to current psychiatric knowledge and practice. The 2 articles involve debates that are crucially important today: who controls psychoactive substances, the meaning and nature of scientific evidence, and the multiple motives of researchers. Rather than present a tidy conclusion to their own research objectives, both authors highlight the ambiguity and complexity that is an unavoidable, but also fascinating, part of the history of mental health. Moreover, they point to the enduring importance of analyzing the social contexts of scientific research and clinical practice. As Tone eloquently explains in her own contribution, “In the age of biological psychiatry, social, political, and economic circumstances continue to be as important as biochemical responses in deciding a drug’s fate” (21, p 375).
References
1. Foucault M. Folie et déraison: histoire de la folie à l’age classique. Paris (FR): Plon; 1961.
2.Goffman E. Asylums: essays on the social situation of mental patients and other inmates. New York: Anchor/Doubleday; 1961.
3. Laing RD. The politics of experience and the bird of paradise. London (UK): Penguin; 1967.
4. Szasz T. The myth of mental illness: foundation for a theory of personal conduct. London (UK): Harper; 1961.
5. Castel R. L’ordre psychiatrique: l’âge d’or de l’alienisme. Paris (FR): Minuit; 1976.
6. Ripa Y. La ronde des folles: femmes, folie et enfermement au XIXe siècle, 1838-1870. Paris (FR): Aubier; 1986.
7. Rothman D. The discovery of the asylum. Boston (MA): Little Brown; 1971.
8. Scull A. Museums of madness: the social organisation of insanity in nineteenth-century England, London (UK): Penguin; 1979.
9. Chesler P. Women and madness. New York: Avon Books; 1973.
10. Showalter E. The female malady: women, madness and English culture, 1830-1980. New York: Pantheon; 1985.
11. Turner T. Dogma or stigma? Why are psychiatrists so bad at trying to be good? Paper presented at specialist workshop on ethics, history, and mental disorder; 2004 May 15; University of Warwick, Warwick (UK).
12. Porter R. Madness: a brief history. Oxford (UK): Oxford University Press; 2002.
13. Berrios G. The history of mental symptoms: descriptive psychopathology since the nineteenth century. Cambridge (UK): Cambridge University Press; 1996.
14. Berrios G, Porter R. [editorial]. History of Psychiatry 1990;1:1–2.
15. Hacking I. The social construction of what? Cambridge (MA): Harvard University Press, 1999.
16. Shorter E. A history of psychiatry: from the era of the asylum to the age of Prozac. New York: John Wiley; 1997.
17. Reaume G. Remembrance of patients past: patient life at the Toronto Hospital for the Insane, 1870-1940. Toronto (ON): Oxford University Press; 2000.
18. Nootens T. ‘Famille, communauté et folie au tournant du siècle.’ Revue d’histoire de l’amerique français, 53, 1999.
19. Thifault, M-C. Citoyennes de St-Jean-de-Dieu: L’enfermement asilaire des femmes au Québec: 1873-1921. Thèse présentée à la Faculté des études supérieures et postdoctorales B titre d’exigence partielle en vue de l’obtention du doctorat en histoire, Ottawa (ON): Université d’Ottawa; 2002.
20. Moran J, Wright D, editors. Mental health and Canadian society: historical perspectives. Montreal/Kingston: McGill–Queen’s University Press. Forthcoming.
21. Tone A. Listening to the past: history, psychiatry, and anxiety. Can J Psychiatry 2005;50:373–80.
22. Dyck E. Flashback: psychiatric experimentation with LSD in historical perspective. Can J Psychiatry 2005;50: 381–8.
Author
1. Hannah Chair in the History of Medicine and Associate Professor, Department of Psychiatry and Behavioural Neurosciences/Department of History, McMaster University, Hamilton, Ontario.
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