From the Great Confinement of Louis XIV of France to a Chemical Gulag (part 2)

At the end of the 18th century, there was no psychiatry as a medical specialty. The word ‘psychiatry’ was coined by Johann Reil in 1808. The new profession took for granted a postulate that had roots in the medicine of ancient Greece. A postulate is a proposition that is admitted without proof. The postulated platform of the new profession assumed the organic origin of psychic disturbances. This postulate elevated to an axiom, and even to dogma, prevented the introduction of subjectivity in the study of mental disturbances.

As we saw with John Modrow [explained in a previous chapter of the online book], the reality is the diametrically opposite. Only by introducing the subjectivity of a soul in pain, and by rejecting the organic hypothesis, is it possible to understand what the hell is going on in the innermost chambers of those who suffer from mental distress and disorders. Objectivity in matters of the internal world of a subject is as impossible as the opposite case: approaching the empirical world in the manner of philosophers like Plato, who, from his idealist Olympus, despised the practical study of nature.

This colossal error cost the Greek culture its moving upward, just as the antipodal error of reducing the humanities to science is misleading our civilisation. It is a categorical mistake trying to understand psychological trauma through neuroscience, as it is a categorical mistake trying to understand the empirical world, say astronomy, through social discourse. Postmodernist philosophers and psychiatrists represent two symmetrical, albeit diametrically opposed, attempts at extreme ideologies. The former want to reduce science to the humanities; the latter, the humanities to science: and none respects the other as a separate and intrinsically legitimate field. In another place I will delve into these two antithetical errors.

The birth of modern psychiatry occurs when the outcast leaves the jurisdiction of the houses of confinement in France and the rest of Europe and is left in charge of the medical institution. In the profession of the 21st century, armed with a battery of genetics, neurology and nosological taxonomy, it is impossible to see what psychiatry is at its root. But in the book by Johann Christian Heinroth, Lehrbuch der Störungen des Seelenlebens (Textbook on the Disturbances of Mental Life), published in 1818, we see the fundamentals of psychiatry without the pseudoscientific smokescreen so common in our days.

Following the tradition of the 17th and 18th centuries, Heinroth used the expression ‘mental illness’ and defined it as ‘selfishness’ or ‘sin’: terms he used interchangeably. Heinroth not only equated the Christian concept of sin with that of mental illness. Although he considered mental illness an ethical defect, Heinroth’s great innovation consists that he treated it with medical procedures.

How did Heinroth take this conceptual leap? Or we may ask, why should MDs reroute the flock of the straying sheep? This turn was not contemplated in the blueprints of the architects of the Great Confinement of the 17th century. Once the Inquisition was officially abolished, Heinroth himself wonders who would be the new social controller: ‘would this be the task of a doctor?, or perhaps of a cleric?, or of a philosopher?, or an educator?’ [7]

The task fell, finally, on the physician. Presumably this was because, as the doctor deals directly with the physicality of human beings, it was easier to cover physical violence in the medical profession than in the other professions. At a time when the ideals of the French Revolution were still in the air, civil society would have suspected a cleric or a philosopher with jurisdiction over other people’s bodies, but not a doctor.

In order for people to accept the new inquisitor, they also had to literalise the central metaphor of the profession. Originally ‘mental illness’ was understood as a mere metaphor of what in previous centuries had been called ‘men of unreason’, which put together the dissidents with the disturbed. When the doctor assumed the responsibility of occupying the role that used to be occupied by the officials of the houses of confinement, Heinroth assumed that the selfishness and sin that he treated were medical entities: something like saying that the ‘viruses’ that infect our hard drives are not metaphor of subversive programs, but microorganisms.

The literalisation of the metaphor ‘mental illness’ into an authentic illness would not have been possible if Heinroth and many other professionals of mental health had not counted with societal approval. The 19th century was the most bourgeois of recent centuries, and the social forces that drove the wealthy to lock up the undesirables were still expanding, even more than in the times when Heinroth himself was born.

The only way to understand Heinroth and his philosophy of the hammer is to let him speak. I have borrowed the following paragraphs from a study of Thomas Szasz. The first quoted sentence is taken from Medicina Psychica Politica (Psycho-Political Medicine): a title that perfectly illustrates how, in its origins, the psychiatrists did not speak in Newspeak but in Oldspeak. Heinroth wrote: ‘It is the duty of the State to care for mentally disturbed persons whenever they are a burden to the community or present a public danger; and the accommodation, cure, and care of such individuals is the duty of the police’. But who are ‘mentally disturbed’? He answers: ‘It is those least deserving of freedom, namely the maniaci [maniacs], who love freedom best; and as long as they are left to themselves and to their perverted activity, even if only in an Autenreith chamber, no recovery is thinkable’.[8] The Autenreith chamber and the mask of the same name were torture apparatuses on which he explains his modus operandi:

Experience has shown that the patient in the sack is in danger of asphyxiation and of falling victim of convulsions… [In the confinement chair] the patient can remain bound in the chair for weeks on end without incurring the slightest bodily harm. [The pear is a] piece of hard wood, with the shape and dimensions of a medium-sized pear, has a cross-bar with straps which can be tied at the back of the neck of the patient. Since the oral cavity of the patient is more or less filled by the instrument, the patient can obviously utter no articulate sounds, but he can still utter stifled screams.[9]

Heinroth articulated some guidelines for the psychiatrist: ‘First, be master of the situation; second, be master of the patient’.[10] Szasz comments that in these phrases psychiatry appears naked as to what it was and continues to be today: subjugation, enslavement and control of one human being by another. He also comments that contemporary psychiatrists, although they do similar things, do not speak frankly as they used to speak in Heinroth’s time.

However, Heinroth understood from the beginning that in his profession he had to disguise the torture chambers for social control as a hospital activity, for which he recommended: ‘all impression of a prison must be avoided’, a situation that persists today. In Spain, for example, contemporary psychiatrists have changed the bars of the windows by external blinds, some cosmetic though rigid metal sheets that serve as prison bars. The façade of psychiatric gardens of our century follows 19th-century regulations. About what happens behind the façade, according to Heinroth:

The edifice should have a special bathing section, with all kinds of baths, showers, douches, and immersion vessels. It must also have a special correction and punishment room with all the necessary equipment, including a Cox swing (or, better, rotating machine), a Reils’s fly-wheel, pulleys, punishment chair, Langermann’s cell, etc. [11]

Here are other words of this doctor who lived a century before Orwell wrote 1984. According to Heinroth, the psychiatrist

appears to the patient as helper and saviour, as a father and benefactor, as a sympathetic friend, as a friendly teacher, but also as a judge who weighs the evidence, passes judgement, and executes the sentence; at the same time seems to be the visible God to the patient… [12]

Heinroth seems a hybrid between the Orwellian O’Brien and a contemporary man of his times: Sade. The fact that some psychiatrists see in Heinroth one of the founders of modern psychiatry and the precursor of Eugen Bleuler, speaks for itself and does not need further comment.

Thanks to Heinroth and other apologists of medical violence, in the mid-19th century the metaphor ‘mental illness’ was recognised as an authentic disease. In England, the parliament granted the medical fraternity the exclusive right to treat the newly discovered disease. The first specialised journals in psychiatry appeared. The American Journal of Psychiatry, which was originally called the American Journal of Insanity and whose first issue appeared in 1844, published data, since its inception, that now are known to be fraudulent.[13] Throughout the 19th century countless of ‘imprudent’ women like Hersilie Rouy and Julie La Roche [cases mentioned at the beginning of the online book] were imprisoned by their parents and husbands; and the psychiatrists resisted attempts to inspect their ‘asylums’, as they were then called, because it interfered with medical autonomy. Many doctors tried to obtain important positions in the asylums.

The psychiatric profession, in its modern version, was born.

In the 20th century, the psychiatric profession consolidated its power and prestige in society. A smoke-screen terminology was developed and, for the man of the street, it became impossible to see psychiatry in its naked simplicity. Some sadists like Heinroth became ‘psychiatrists’, their tortures ‘treatments’, the social outcasts ‘patients’, the asylums ‘hospitals’ and dementia praecox ‘schizophrenia’.

Before the creation of the Newspeak the asylums were properly called Poorhouses. Before drugs were designed to induce tortuous states for the mind, Emil Kraepelin and Bleuler used other methods of subjugation. In 1911 the latter experimented with a particularly disgusting medication that caused bleeding vomit, but at least Bleuler confessed with a frankness something no longer seen in today’s psychiatry: ‘His behaviour improves. From the ethical point of view, I cannot recommend this method’.[14] Similarly, in 1913 Kraepelin used to inject sodium nucleate to cause fever in his patients, who ‘become more docile and obey the doctors’ orders’.[15]

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[7] Johann Christian Heinroth, quoted in Thomas Szasz, The Myth of Psychotherapy (NY: Syracuse University Press Edition, 1988), p. 73.

[8] Ibid., pp. 74-75.

[9] Ibid., pp. 76-77.

[10] Ibid., p. 77.

[11] Ibid., p. 79.

[12] Ibid., p. 78.

[13] See, for example, Robert Whitaker: Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill (Cambridge, Massachusetts: Perseus, 2001), pp. 75ff.

[14] Bleuler, quoted in John Read, Loren Mosher & Richard Bentall: Modelos de Locura (Herder, 2006), p. 39

[15] Kraepelin, quoted in ibid.

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