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DEVELOPMENT: A RE-EVALUATION*
GEORGE MORA
Astor Home for Children, Rhinebeck, New York and Yale School of Medicine
Pinels treatise on mental diseases, which describes his new approach to the
treatment of mental patients-thus beginning modern psychiatry, is preceded by
an historical description of the early methods of treatment of mental patients whose
value in psychiatric historiography has thus far not been duly noted. Thus, psychiatry and the history of psychiatry were initiated simultaneously at the end of the
eighteenth century in the climate of belief in humanity and in progress of the French
Enlightenment. The nineteenth century emphasized exclusively Pinels importance
as the initiator of modern psychiatry. But in the last two decades, the emphasis has
switched from this historical event more to attitudes toward mental patients and
beliefs regarding causes and treatment of mental disorders; attitudes and beliefs
which can be traced back as far as humanity has existed, though it remains questionable whether they are an intrinsic part of psychiatry. In fact, while various branches
of behavioral sciences have succeeded in delimiting their scope and boundaries in
historical terms, psychiatry instead has increasingly presented uncertainties in
regard to its scope and its boundaries.
With the advent of dynamic psychotherapy in the last few decades, many forms
of human relationships and rituals performed by primitive and ancient cultures in
the context of religious and magic practices have been ascribed to the realm of psychological healing. It is enough to think for a moment of the interpretation of
dreams as performed in primitive cultures, such as the aboriginal Indians or the rites
of shamanistic initiation, to understand the implications of this new position.2
Furthermore, psychiatry itself has come to signify, in addition to the traditional
meaning of professional treatment by the doctor on the patient, a whole variety of
forms of dual and multiple influences on people aflicted with emotional disorders.
Thus, the history of psychiatry has greatly enlarged its spectrum by including these
early expressions of treatment of mental diseases in its boundaries. The result has
been that the end of the eighteenth century, rather than representing the official
beginning of psychiatry-as traditionally is held in the history of psychiatry, has
come to signify the passage from unconscious forms of psychological healing in
cultures and eras unaware of the importance of psychological problems to the intro*A modified version of this paper was originally presented at the Xth International Congress of
the History of Science, Ithaca-Philadelphia, August 26-September 2,1962. The bibliographic citations
have been brought up to date.
See in particular the early literature on, social sychiatry by E. Sapir, R. Benedict, M. Mead,
G. Roheim, as well as the more recent studies by
Kluckhohn, M. K. Opler, A. J. Hallowell, A.
Kardiner, G. Bateson, G. Devereux, E. Erikson and others. A survey on this topic is in: C. Kluckhohn, The influence of psychiatry on anthropology in America during the past one hundred years,
in J. K. Hall (ed.), One Hundred Years of American Psychiatry, New York, Columbia Univ. Press,
1944; see also La Barre W., The Influence of Freud on Anthropology, Amer. Imago, 1958,15,275-328.
%ee, for instance, for the interpretation of dreams by Indians, M. K. Opler, Dream analysis in
Ute Indian therapy, in M. K. Opler (ed.), Culture and Mental Health, New York, Macmillan, 1959.
For the shamanistic rites of initiation: E. H. Ackerknecht, Psychopathology, primitive medicine and
primitive culture, Bull. Hist. Med., 1942, 14, 30-67; Boutellier M., Chamanisme et gudnson mqique,
Paris, Presses Univ. France, 1950; Eliade M., Le chamanisme et les techniques de lextase, Paris, Payot,
1951; H. Ellenberger, The ancestry of dynamic psychotherapy, Bull. Menninger Clin., 1956, 20, 2 8 8
299. See also in general: Frank J. D., Persuasion and Healing. A Comparative Study of Psychopathology, Baltimore, Johns Bopkins Press, 1961.
8.
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GEORGE MORA
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GEORGE MORA
DEVELOPMENT:
A RE-EVALUATION
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GEORGE MORA
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I n the latter part of the nineteenth century, another cultural trend based on
strong individualism, started to appear a little everywhere in Europe. Just because
of their individualism, the representatives of this trend-from Kierkergaard to
Dostoevski and Nietzsche-did not initiate a school and, furthermore, their influence was felt in the literary and artistic, rather than in the scientific, circles. These
latter came instead to be dominated entirely by positivism and materialism, and
psychiatry was no exception to it. However, a reaction against this was initiated by
Dilthey-the first representative of storicism in philosophy-who assigned psychology to the sciences of spirit rather than to the sciences of nature. This
view did not have repercussions in the history of psychiatry at that point. However, both the school of degeneration of the German Mobius and of the French
Morel and the school of criminal anthropology of the Italian Lombroso,22which
flourished at that time, came to signify an expression of neuropathology filtered
through the individual personality and ultimately a combination of the organic with
the individualistic philosophy of psychology. In the light of these new trends the
history of psychiatry progressively lost importance.
The third period of psychiatric historiography is a very recent one, beginning
only two decades ago. In the interval between the beginning and the fourth decade
of our century fell Freuds introdution of the new dimension, that of the unconscious
and its progressive acceptance in psychology. This constituted a complete revolution in psychology inasmuch as its focus came to be on the genetic-historic approach
to the individual personality. As the unconscious, by definition, has no history, it is
no wonder that Freud himself and the early psychoanalysts remained largely unconcerned with the historical antecedents of psych~analysis.~~
I n spite of the fact that,
Among the early historical studies are: C. B. Farrar, Some origins in psychiatry, Amer. J . Psychiatr.,
1908, 94, 523-552, 1908, 95,84101, 1909, 95, 277-294; H. M. Hurd {ed.) The Institutional Care of
the Znsane i n the Unzted States and Canada, Baltimore, Johns Hopkins Univ. Press, 1916, 4 vols.;
E. S. Jelliffees historical studies on general paresis, Korsakoff s psychosis, paranoia, schizophrenia,
manic-depressive psychosis and early American ps chiatry which appeared between 1908 and 1930.
Among the historical studies on institutions:
Psychiatric Milestone. Bloomingdule Hospital
Centenary, 1821-1921, New York, (no other data given) 1921; L. B. Briggs, History of the Psychopathic
Hospital, Boston, Wright & Potter, 1922; W. L. Russell, The New York Hospital. A.History of the Psychiatric Service, 1771-1956,New York, Columbia Univ. Press, 1936. Among the historical studies on
sychoanalysis: C. P. Oberndorf, A History of Psychoanalysis i n America, New York, Grune, 1953;
Hendrick, The Birth of an Institute. Twenty-$fth Anniversary of the Boston Psychoanalytic Institute,
Freeport, Bond, 1961; Waugh M. (ed.), Fifty Years of Psychoanalysis in New York, New York, Int.
Univ. Press, 1963. Among the biographical monographs: F. J. Tiffany, Life of Dorothea Diz, Cambridge, Houghton Mifflin, 1891; N. Goodman, Benjamin Rush, Philadelphia, Univ. Penn. Press, 1934;
H. E. Marshall, Dorotheu Diz, Forgotten Samaritan, Cha el Hill, Univ. North Carolina, 1937; E. D.
Bond, Dr. Kirkbride and His Mental Hospital, Philadeghia, Lippincott, 1947; ib., T . W . Salmon,
Psychiatrist, New York, 1950. Among the autobiographical studies: Memories of Pliny Earl, Boston,
Dannell, 1898; A. M. L. Hamilton, Recollections of an Alienist, New York, 1916; W. A. White, The
Autobiography of a Purpose, Garden City, Doubleday, 1938. In recent years, E. T. Carlson and N.
Dain have published a number of studies on early American psychiatry, among which especially
important are: Amariah Brighan, Amer. J . Psychiatr., 1956, 112, 831-836, 1957, 115, 911-916; ib.,
The psychotherapy that was moral treatment, Amer. J . Psychiatr., 1960, 117, 519-524. On moral
treatment in American sychiatry, see also: J. S. Bockoven, Moral treatment in American Psychiatry, J . New. Ment. As., 1956, 124, 167-194, 292-321 (republ. in volume, op. nt.); N. Dain, Concepts of Insanity in the United States, 1789-1865,. New Bruns.wick, Rutgers Univ. Press, 1964.
22For the history of the school of degeneration: G. Genil-Perrin, Hzstozre des ongznes et de lluolution de 1 idke de dhgknhrkscence en mkdecine mentale, Paris, Leclerc, 1913; Wettley A., Zur Problemgeschichte der d6g6n6r6scence, Sudhofls Arch., 1959, 43, 193-213. On Lombrosos criminal-anthropological school, M. E. Wolfgang, Pioneers in criminology: Cesare Lombroso (1835-1909), J . C r i ~ .
Law. Criminal. & Police Sci., 1961, 52, 361-391 (republished in N. Mannheim (ed.), Pioneers zn
Criminology, Chicago, Quadrangle, 1960).
23Among the earliest attempts to present psychoanalysis from an historical perspective: L.
Kaplan, Hypnatismus, Animiwus und Psychoanalyse, Historisch-kritisch Versuche, Wien, 1917; M.
Dorer, Historische Grundlage der Psychoanalyse, Leipzig, Meiner, 1932.
f.
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GEORGE MORA
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In the meantime, psychoanalysis has turned its focus from the unconscious to
the ego-its autonomy, its development, and its mechanisms of defense. Thus far,
however, the few studies attempting to review the developments of ego psychology
or of the different psychoanalytic schools, have been presented in the limited context of modern psychology rather than on the broad background of cultural
There is now a need to continue this trend further from the viewpoint of ego psychology; namely, from a viewpoint resulting from the interplay between unconscious and ways of dealing with it, expressed not so much by individuals but by the
culture altogether in line with the developments of cultural anthropology and of
sociology.28 Modern historians, such as Burckhardt, Huizinga, Febvre, have attempted to excavate deeply into the roots of civilizations, and their followers today
are not insensitive to the influence of the psychoanalytic movement.29 A remarkable
example of this trend is Dodd's analysis of unconscious elements in the Greek cult ~ r e . ~ OThe style of life, the inner motivations, the underlying sociopsychological
27Amongthe few studies on this point: Thompson C., Psychoanalysis: Evolution and Develop
ment, New York, Kelson, 1950; F. Alexander and H. Ross (eds.), Dymanic Psychiatry, Chicago, Univ.
Chicago Press, 19.52; F. Alexander and H. Ross (eds.), Twenty Years of Psychoanalysis, New York,
Norton, 1953; R. R. Grinker (ed.), Mid-Century Psychiatry, Springfield, Thomas, 1953; 1). Rapaport,
An historical survey of psychoanalytic ego-psychology, Bull. Philadelphia Assoc. Psychoanal., 1958,8,
105-120; J. A. C. Brown, Freud and the Post-Freudians, Baltimore, Penguin, 1961; D. Wyss, Die
tiefenpsychologischen Schulen von den Anfdngen bis zur Gegenwart, Gottingen, Vandenhoeck und
Ruprecht, 1961.
@Asidefrom the literature on social and cultural psychiatry mentioned in note # 1, see also the
studies by B. Laubscher on the South African pagan natives; by G. Roheim on psychoanalysis and
anthro ology; by J. Carothers on the African mind; by R. Linton on culture and mental disorders; by
M. Fierd on psychiatry in Ghana; by E. Weinstein on psychiatric delusions in the Virgin Islands; by
G. Devereux on Mohave suicide; by A. Leighton on the sychiatric disorders mong the Yoruba. A
review of the literature up to 1960 is in: R. Kaelbling,
psychopathology and psychotherapy, Acta Psychoth. & Psychosom., 1961, 9, 10-28. As examples of studies on cultural characteristics in the Western hemisphere: G. W. Allport, European and American Theories of Personality;
in H. P. David and H. von Bracken, (eds.) Perspectives i n Personality Theory, New York, Basic Books,
1957, pp. 3-24; Mdtraux R. and others, Some Hypotheses about French Culture, New York, Columbia
Univ. Press, 1950; 1). C. McClelland, The United States and Germany, J . A h . SOC.Psychol., 1958,
56, 245-255 (repr. in The Roots of Consciousness, Princeton, Van Kostrand, 1964).
Wee in particular: J. Burkhardt, The Civitization ofthe Renaissance i n Italy, Eng. Tr., New York,
Harper, 1929 (repr. Harper Torchbooks, 1958, 2 vols.) ib., Force and Freedom: Re$edions on History,
New York, 1943 (repr. Meridian Books, 1955); J. Huisinga, The Waning of the Middle Ages, London,
1924 (New York, Anchor Paperback, 1953); L. Fevbre, Le probllme de l'incroyance au X V I sakcle, L a
religion de Rabelais, Paris, Michel, 1942 (new ed., 1962); ib., Combats pour I'histaire, Paris, 1953. See
also: G. Lefevbre, L a grande peur du 1789, Paris, Sedes, 1932; A. Von Martin, Sociology of the Renaissance, Eng. tr., London, Kegan Paul, Trench and Trubner (Harper Torchbooks, 1963); N. Cohn,
The Pursuit of the Millenium, Kew York, Essential Books, 1957 (Harper Torchbooks, 1961), aside
from the extensive literature on epidemics (especially plague) and on witchcraft. Among the recent
contributions to the subject of history and psychiatry: R. De Saussure, Psychoanalysis and history;
in G. Roheim (ed.) Psychoanalysis and Social Sciences, vol. 2, New York, Inter. Univ. Press, 1950;
W. Langer, The next assignment, (1958 Presidential address to the American Historical Association),
Amer. Hist. Rev.., 1958, 63,283-304 (repr. in B. Maslish (ed.) Psychoanalysis and History, Englewood
Cliffs, N. J., Prentice Hall, 1963, which contains also several other important apers). For a methodological and historical review of the relationship between history and psychoyogy, see the volume by
H. Gruhle, Geschichtsschreibung und Psychologie, Bonn, Bouvier, 1953, which deals with the psychological value of biographical and autobiographical studies and of personality traits as represented in
literature and art. Z. Barbu, Problems of Historical Psychology, New York, Grove Press, 1960, constitutes an agile, though a t times oversimplified, presentation of three topics: the historical development of perception, the emergence of personality in the Greek world and the origins of the English
character. A more superficial and not too convincing presentation of history from the psychoanalytic
viewpoint is by A. Feldman, The Unconscious i n History, New York Philosophical Library, 1959.
Instead, E. Erikson, Young Man Luther, A Study i n Psychoanalysis and History, New York, Norton,
1958 (paperback ed., 1962) is doubtless the most thorough and engaging concrete application of
sychoanalysis to history. A similar application has been attempted by K. Eissler, Leonard0 da
f i n c i , Psychoanalytic Notes on the Enigma, New York, Inter. Univ. Press., 1962; ib., Goethe, A Psychoanalytic Study, Detroit, Wayne Univ. Press, 1963, 2 vols. See also: F. Schmidl, Psychoanalysia
and History, Psychoanal. Quart., 1962, 31, 532-548.
WE. R. ]>odds, The Greeks and the Irrational, Berkeley, Univ. California Press, 1951 (paperback
ed., Beacon Press, Boston, 1957). See also: E. Rhode, Psyche: The Cult of Souls and Belief in Im-
comparative
52
GEORGE MORA
conflicts in which general historiography tries to delve into more and more todayin a word, what Huizinga has called Lconfiguration71
in his brilliant paper on cu1tural hi~tory~l-form the background on which the history of psychiatry should
come to be perceived more in the future. Perhaps this broader historiographic
approach will also offer the clue for a clarification of the contrast between the
cyclic development of psychiatry, as viewed by Zilboorg, and the more linearly progressive development of medicine.32 Beginning from Vico up to Toynbee, a series of
philosophers of history have explained the historical process on a cyclic basis in contrast to the view commonly held by the theologians and rationalists of explaining it
on a linear basis; so that it would seem that psychiatry, more than medicine in toto,
adheres to the cyclic development of the historical process. Truly, the fundamental
contrast between psychiatry and medicine, as viewed in their historical development, transcends mere historical theories or methodologies to find its reason in the
basic epistemologic ambiguity of psychiatry, which is art as well as science, whichto return to Dilthey-belongs to the sciences of spirit as well as to the sciences of
nature. The meaning of psychotherapy, which-under different names in different
times and cultures-remains the essence of psychiatry, somewhat justifies the
claim of the existentialists that it is ineffable and irrepeatable-thus posing a challenge to any attempt to define it in historical terms.a3
On the basis of the above considerations, it seems that the future historian of
psychiatry will, therefore, be confronted with a restatement of his philosophy in
terms of a comprehension of past events on the background of sociocultural movements and their unconscious roots; at the same time, he will have to take into consideration the existentialistic challenge to any historical systematization of the
individual psychotherapeutic relationship. The two poles between which psychiatry
has traditionally moved-the cultural on one side and the individual on the other
side-will, therefore, be represented in these new terms in the history of psychiatry.
The present study aims to be a contribution to the definition and clarification of
these basic issues.
mortality Among the Greeks, Eng. tr., London, Kegan Paul, 1925; R. De Saussure, Le miracle grec;
6tude psychandlytique sur la civilisation hellenique, Rev. Franc. de Psychanal., 1938, 10, 87-148, 323377,471-536; M. P. Nilsson, Greek Popular Religion,, Eng. Tr., New York, Columbia Univ. Press, 1940;
ib., A History of Greek ReZigion, Eng. Tr., New York, Oxford Univ. Press, 1949; Lain Entralgo P.,
Estudios de historia de la mdicina y de la antropologia medica, Madrid, Escorial, 1943, pp. 200-274;
ib., Therapeutische Katharsis und Logotherapie im Homerischen Epos, in Medicus Viator, Festgabe
Richard Siebecks, Stuttgart, Thieme, 1959, pp. 8-20; H. Jeanmarie, Dionysos, His@.re du culte de
Bacchus, Paris Payot, 1951; B. Snell, The Disvovery of the Mind. The Greek Origzns of European
Thought, Camdridge, Harvard Univ. Press, 1953 (Harper Torchbooks, 1960).
J. Huizinga, The task of cultural history, in Men and Ideas, New York, Meridian Books, 1959.
J*G. Zilboorg, op. cit., pp. 524525. On the development of the history of psychiatry in relatipn
to the cultural scene: J. Bodamer, Zur Phanomenologie des geschichtlichen Geistes in der Psychiatrie,
Nervenarzt, 1948, 19, 299-310; E. Wissfeld, Zur Geschichte der Psychiatrie in ihrer Abhangigkeit von
der geisteswissenschafftlichen Entwicklung seit der Renaissance, Arch. f. Psychiatr. u. Ztschr. f. d .
ges. NeuroZ., 1957, 196, 63-89; Th. Spoerri, Die historische Betrachtung als Methode fur die Psychiatrie, in Beitruge zur Geschichte der Psychiatrie und Hinzanatomie, Basel-New York, Karger, 1957,
pp. 11-20; J. Wirsch, Ueber Geschichte der Psychiatrie, +id.,
21-40; W. Leibbrand, Prologomena
zur einer Geschichte der Psychiatrie, Imprensa Medica (Lisbon?; 1959, 23, n.2. As far as Zeitgeist
in the history of psychology, see now: E . G. Boring, History, Psychology and Science. Selected Papers,
New York, Wiley, 1963.
Without entering into a discussion on existential psychotherapy, the fact remains that history
is either devaluated or inversely interpreted transcendentally by each existential philosopher, according t o his own atheistic, or inversely, religious orientation. This basic position has influenced
existential psychiatrists, too, who thus far have been disinterested in the development of attitudes
toward and treatment of mental patients.