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First-person accounts in the historiography of psychiatry

Burkhart Brückner (2017)

The Biographical Archive of Psychiatry employs participatory concepts in the historiography of the psychiatric profession by taking into account historically relevant life stories (and other contributions) of psychiatric users and their relatives.

A few historical precursors notwithstanding (cf. Birnbaum 1920; Mayer-Gross 1924; Peterson 1982; see also Eckart & Jütte 2014, S. 195 ff.), it was not until the mid-1980s that a patient-centred historiography of psychiatry was systematically introduced by the British historian of medicine Roy Porter, who sought to “... explore what mad people meant to say, what was on their minds. Their testimonies are eloquent of their hopes and fears, the injustices they suffered, above all of what it was like to be mad or thought to be mad. I wish simply and quite literally to see what they had to say. It is curious how little this had been done; we have been preoccupied with explaining away what they said” (Porter 1987: 1 f.).

This long-hidden history “from below” has been brought to light mainly by English-speaking authors, whereas comparable studies from German-speaking countries are still relatively rare (e.g., Rotzoll 2013; Schwoch 2013; Osten 2010; Brückner 2006; Duda & Pusch 1992). Nevertheless, first-person accounts of “madness” can be traced back to ancient times (Brückner 2007; Hodgkin 2007). In Europe, the increase in published testimonies coincided with the emergence and subsequent professionalisation of modern psychiatry, a process that started in mid-18th-century England. The late Enlightenment saw the development of three distinct sub-forms of the genre that still exist today: protests against the conditions of treatment, personal narratives and scholarly self-reflexions (cf. Brückner 2007: 473 ff.).

Our historiography of experience is part of the social history of medicine. It explores the views, perspectives and lifeworlds of users of medical treatment, looks at their attitudes towards professional experts and acknowledges their subjective theories (Bacopoulos-Viau & Fauvel 2016, Eckart & Jütte 2014, S. 195 ff.; Condrau 2007; Wolf 1998; Lachmund & Stollberg 1995). This approach integrates official documents, such as medical files and photographs, as well as materials produced by the users themselves, such as autobiographies, diaries and letters. However, we have to be aware of the fact that the term “patient” is itself a social construction and always have to ask, “Who is actually speaking about the experiences at question – and in which way?” Historical research with first-person accounts from the field of psychiatry can draw on a broad variety of interdisciplinary approaches and methods. There are ten different ways of handling this particular kind of sources:

• The personal narratives speak for themselves – as an individual form of coping, a means of communication and a medium of cultural identity. The narratives can be straightforwardly authentic (e.g., Schreber 1903; Krauß 1852), pragmatically reflective (e.g., Zerchin 1990; Beers 1908; Perceval 1838/40) or highly literary (e.g., Zürn 1977; Strindberg 1897; Rousseau 1782).

• Studies on the history of science and psychiatry include both compilations (e.g., LeCroy & Holschuh 2012; Hornstein 2011; Sommer, Clifford & Norcross 1998; Ingram 1997; Oakes & Kennison 1991; Peterson 1982; Birnbaum 1920) as well as medico-socio-historical analyses (e.g., Rotzoll 2013; Schwoch 2013; Blackshaw 2012; Osten 2010; Hornstein 2009; Brückner 2007, 2007a; Reaume 2006; McLennan 1992; Porter 1987).

• The methods of writing psychiatrically relevant biographies and pathographies have recently been revised and complemented from a cultural history and a feminist perspective (e.g., Hubert 2002; Shannonhouse 2000; Duda & Pusch 1992/1999; Furst 1995; Hughes 1993).

• First-person documents are approached as verbal data and analysed with empirical methods (e.g., Adame & Hornstein 2006; Stanton & Davis 2000; Freedman 1974).

• First-person accounts are often produced in therapeutic settings (e.g., Furst 1999; Barne & Berke 1971; Sechehaye 1950).

• Social psychiatry initiatives encourage personal narratives as a medium of participation (“Trialogue”; e.g., Basset & Stickley 2010; Rome et al. 2009; Bock, Deranders & Esterer 1992; Conti 1978).

• The aesthetic value of artistic creations and/or personal narratives produced in psychiatric settings are analysed from an art and literature studies perspective (“Outsider Art”; e.g., at the Museum Sammlung Prinzhorn in Heidelberg; cf. Röske & Rotzoll 2014; Brand-Claussen 2002; Jádi 1985; on literature: Koch & Keßler 1998; Ingram 1991).

• Advocacy organisations of psychiatric users sometimes also work with this type of sources (e.g., Costa et al. 2012; Survivors History Group 2011; Sweeny et al. 2009; Stastny & Lehmann 2007; cf. Brückner 2015; Tomes 2011).

• Some sources are documented and presented online (e.g., Asylum Magazine; Survivors History Group; 1st Person).

The Biographical Archive of Psychiatry follows the tradition of studies on published subjective sources that was developed by English-speaking scholars, most notably from the U.S. and the U.K. By drawing on approaches borrowed from social history, cultural studies and medical humanities, we emphasise the cultural and pragmatic function of these sources (cf. the concept of mad studies: Russo & Beresford 2015; Le Francois, Menzies & Reaume 2013). In contrast to the traditional understanding of the term “patient”, we speak of people “with psychiatric experience” in order to highlight the users’ own potential professionalisation (Prins 2006) as well as to direct attention to the professionals’ own potential affectedness, for instance, as family members, partners and friends.The role of relatives in this context is still largely unexplored (cf. Suzuki 2006).

Our approach intersects with the well-established tradition of a profession-centred biographical historiography of psychiatry – not only in terms of taking a critical stance vis-à-vis the sources but also with regard to the ethics of treatment and the relationship between professionals and patients.

In the English language, the preferential sources are typically referred to as “personal narratives” or “first-person accounts”. As we explicitly seek to attribute a source to a specific authorial subject, we prefer these terms over the term “ego document”, which also includes official sources like medical files and other third-party testimonials (Greyerz 2010). However, a history of experience nonetheless can make use of historical medical files since they often include letters, petitions and pictures (see, e.g., Rotzoll 2013; Reaume 2000). In taking a critical stance vis-à-vis the sources, we are interested in the individuals’ scope for action within a given social system, the diversity of their biographical subjectivities, their narrative constructions and, above all, the practical consequences of their actions. This entire line of research has an ethical aspect: it helps to reduce the stigma of mental disorder and psychiatric treatment and promotes a source-appropriate way of handling subjective documents that represent the user perspective.

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