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Copyrighted Material a Istorica __, Ictiona of a HISTORICAL DICTIONARY of Psychiatry This Page Intentionally Left Blank a HISTORICAL Copyrighted Material A istorica __, ictiona OF A HISTORICAL DICTIONARY OF Psychiatry This page intentionally left blank A HISTORICAL DICTIONARY OF Psychiatry EDWARD SHORTER 3 2005 3 Oxford University Press, Inc., publishes works that further Oxford University’s objective of excellence in research, scholarship, and education. Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Copyright © 2005 by Edward Shorter Published by Oxford University Press, Inc. 198 Madison Avenue, New York, New York 10016 www.oup.com Oxford is a registered trademark of Oxford University Press All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Oxford University Press. Library of Congress Cataloging-in-Publication Data Shorter, Edward A historical dictionary of psychiatry / Edward Shorter. p. cm. Includes bibliographical references and index. ISBN-13 978-0-19-517668-1 ISBN 0-19-517668-5 1. Psychiatry—History—Dictionaries. I. Shorter, Edward. [DNLM: 1. Psychiatry—history—Dictionary—English. WM 13 H673 2005] RC438.H524 2005 616.89'003—dc22 2004049507 987654321 Printed in the United States of America on acid-free paper This page intentionally left blank For Tom Ban from one of his students This page intentionally left blank Preface This is the first-ever historical dictionary of psychiatry. It is needed because clini- cal psychiatry today, as well as all the mental health-care specialties, is emerging from a period of turmoil. The past 40 years have seen the virtual death of one of the great intellectual paradigms that guided psychiatry—psychoanalysis—and its replacement by a starkly different kind of paradigm, one emphasizing brain biol- ogy in the understanding of illness and psychopharmacology as the leading edge of treatment. Inevitably, amidst this vast change of paradigms, a number of psy- chiatry’s key concepts and diagnostic traditions have undergone a kind of unhitching from the continuity of history and float in conceptual confusion: What does psychiatry still owe to Freud? Where does all this emphasis on phar- maceuticals come from? Who was Kraepelin (and how does one pronounce the name)? This dictionary will enable quick reference to these questions and many others, arranged as it is alphabetically, with a comprehensive index to give information about historical figures and concepts not included in the main alphabetical listing. The book also takes many key concepts, such as “depression” and “psy- chotherapy,” and traces their evolution in chronological order (the concepts themselves appear alphabetically). The Dictionary is designed for the edification of clinicians and scientists today as well as for general readers who wish to know the origins of currently familiar concepts; it is not conceived as an encyclopedia of im- portant events in the history of psychiatry, and much of history that has somehow not left its mark on the present is left out. The entries in a dictionary of this nature will lend flesh to the skeleton of change adumbrated in the following Introduction. However, the reader is ad- vised that several areas are covered rather poorly if at all. My intent has been to make this dictionary useful to today’s mental health professionals, and so much of the history of psychiatry that is important to historians—and celebrated in their academic annals—does not really appear here. I have included almost noth- ing on psychiatry before the mid-eighteenth century, a shame given that medical writing on mental illness stretches back to the Ancients. The asylums of the Preface nineteenth century, which bequeathed relatively little to today’s psychiatry, also receive short shrift in these pages. On the other hand, such issues as the devel- opment of diagnosis, a matter of really intense interest in today’s medicine, re- ceive extensive coverage, likewise the origins of psychopharmacology, again for reasons that are evident. In terms of personalities, the most important psychi- atric thinkers have been given independent entries; many other leading psychia- trists of the past are mentioned in the diagnosis narratives, and readers may find them through the index. Readers will soon discover my preference for the biological approach to psy- chiatry in contrast to the doctrines that previously prevailed. Yet, I bear in mind that biologism too represents a kind of fad, and the reductionism of the biologi- cal model—meaning the assumption that clinical illness is reducible to malfunc- tioning molecules—will almost certainly yield pride of place to other approaches that lie yet undiscovered before us. It is thus important to approach today’s bio- logical psychiatry tentatively, with the mere suspension of disbelief, rather than trumpeting neurotransmitter hypotheses as though they represented the Rosetta Stone of human misbehavior. The selections in this dictionary inevitably reflect the subjective tastes of the author, for there is no preordained measure of what was important in the past. It is mainly casting back from what one finds important today, and on that, opin- ions will vary widely. So the choices made are one man’s view, the choices of an author who has spent years of research in the history of psychiatry, to be sure, but nonetheless they are inevitably somewhat arbitrary. In any event, given lim- ited space, much that is significant has been left out, and readers who make a good case for the inclusion of a beloved figure or concept may have their wishes granted in future editions. Despite the most meticulous editorial attention, it is inevitable in a work of this nature that errors will creep in. That they may be expunged from successive printings, sharp-eyed readers are invited to contact me at the History of Medicine Program, University of Toronto, 88 College Street, Toronto, Canada, or to send an e-mail to [email protected]. Susan Bélanger, the world’s best research assistant, was terribly helpful in bringing together material for this dictionary. Andrea Clark, the administrative as- sistant in the History of Medicine Program of the University of Toronto, deserves special mention for her efficiency and patience. Heather Dichter and Ellen Tulchinsky dug ably in the University of Toronto’s tremendous libraries. For com- ments on earlier drafts, Susan Abbey, Gemma Blok, Gabrielle A. Carlson, Max Fink, Colin Gale, Cyril Greenland, Jeremia Heinik, Donald Klein, Walter Kuchar- czyk, Isaac Marks, Harry Oosterhuis, and Robert Spitzer must be thanked. Oxford University Press could not have made a better choice for outside readers than Joel Braslow, Mark Micale, and Simon Wessely, and the work is much richer for their thoughtful and painstaking comments. I would like to acknowledge the help of Jeffrey House and Fiona Stevens at Oxford University Press who are, how can one viii Preface put this, simply wonderful to work with. Literary agent Beverly Slopen eased the hull into the water. This book was forged in many long conversations with Tom Ban about individual entries. Tom shared with me his enormous knowledge of the history of psychiatry. Some of his suggestions for change were accepted, others were not. For my recalcitrance, I have only myself to blame. ix This page intentionally left blank Contents Introduction 3 Dictionary 17 Bibliographical Essay 313 Bibliography 317 Index 325 This page intentionally left blank A HISTORICAL DICTIONARY OF Psychiatry Introduction Psychiatry is the medical specialty concerned with mental symptoms caused by disorders of the brain and mind. Because medical attention to such symptoms stretches back to the Ancients, psychiatry has a long history indeed, moreover a history thoroughly interleaved with the culture and society of the day. This kind of connectiveness to culture makes psychiatry particularly vulnerable to social changes, and the history of psychiatry is associated with discontinuities that do not necessarily occur in the history of other medical specialties. Yet, this highly eventful nature also gives the history of psychiatry its charm. What are the major moments in the evolution of the discipline? THE HISTORY OF PSYCHIATRY The history of psychiatry may be divided into roughly three periods: the asylum period of the years 1770–1870, in which biological concepts held sway; the psy- chotherapy period of the years 1870 to around 1970, in which Freud’s doctrine of psychoanalysis came increasingly to the fore; and the second biological psy- chiatry, from the 1970s to the present, in which biology has come rushing back with a vengeance and psychodynamic explanations have largely been un- horsed, psychotherapy sliding from the psychiatrists to the psychologists.1 Inevitably, cutting history at the joints in this manner vastly oversimplifies, for even as psychoanalysis became all the rage in community psychiatry, the number of patients in mental hospitals continued to rise. And even in the heyday of American psychoanalysis, the 1950s and 1960s when every department chair lay in the hands of an analyst, centers of excellence in psychopharmacology and neuroscience were establishing themselves. Yet, grosso modo the image of the pen- dulum swinging from biology to psychogenesis and then back to biology does capture the main trend. Psychiatry as a discipline began in the last quarter of the eighteenth century with the founding of a new kind of asylum—the therapeutic rather than the 3 Introduction custodial asylum. The world had known asylums since the Middle Ages, hospices in which the insane were thrown together willy nilly with the halt, the diseased, the senile, and the impoverished. Such hospices made no pretense of therapeutics and existed merely for the convenience of removing psychotic and demented individuals, those whose families were unable to care for them, from the streets of the big cities.
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