Extending the boundaries of psychiatry : The professional strategies of Richard Von Krafft-Ebing
University of Maastricht, Faculteit de Cultuurwetenschappen, Vakgroep Geschiedenis, Postbus 616, 6200 Maastricht, The Netherlands
Although revisionist historians of psychiatry have pictured 19th-century psychiatrists as powerful agents of social control, in fact their position within medicine, as well as in society at large, was precarious. During the first half of the 19th century psychiatrists had won dominion over the most serious and dangerous forms of mental dysfunction, but their authority was basically confined to the walls of the lunatic asylum, which housed especially the chronically insane of the pauper classes. Moreover, even in the second half of the century, alienists had difficulties in convincing other scholars and the public that as physicians, they had an exclusive and scientific insight in the nature of insanity. For psychiatry to be accepted as a distinct branch of modern medical science, it was necessary to prove that mental disorders were organic diseases of the brain and the nervous system and that they could be cured. There was, however, hardly any anatomical or physiological evidence of the somatic basis of mental illness and as a therapeutic institution the asylum did not come up to expectations. Throughout the nineteenth century, psychiatry's scientific program remained inadequate and its intellectual and professional weaknesses made it vulnerable. Psychiatrists operated in the margins of medicine as well as of society.
In this paper, I will deal with the career of the prominent German-Austrian psychiatrist Richard von Krafft-Ebing (1840-1902) as an example to show in which ways late nineteenth-century psychiatrists tried to solve these professional difficulties and to promote the scientific and social status of their spacialty. To clarify Krafft-Ebing's professional strategies, I will focus on the close connections between the divergent cognitive contents of his work, the changing institutional setting of his psychiatric practice, and the shift in the social background of his patients.
The career of Krafft-Ebing shows that divergent, even contradictory tendencies in his psychiatry can be explained by looking at it from the perspective of his professional policies. Like other late 19th-century psychiatrists, he sought to uplift the scientific and social prestige of psychiatry by extending its boundaries. The diversity of and contradictions in his theoretical and practical approach of mental disease were functional : ideas about the proper explanation and treatment of mental disorders were more or less geared to the changing institutional contexts in which he worked, and the shifting social background of his patients. Moving from the public asylum to the university clinic, and founding a sanatorium and a private practice, he tried to enhance the autonomy of psychiatry and enlarge its domain as well as to attract a new clientèle. Whereas the somatic model of mental disease and degeneration theory promoted the scientific status of psychiatry, a psychological approach was more fruitful to attract middle and higher class patients suffering from rather mild disorders like nervousness and neurasthenia. Krafft-Ebing must have been aware that the social prestige of psychiatry (and its profitability) depended for a large part on the social status of its patients.
Panel 1B (Evolution and Dissolution)
Tuesday, 14 September 1999
The Neurosciences and Psychiatry: Crossing the Boundaries
Joint Congress of theEuropean Association for the History of Psychiatry (EAHP), the European Club for the History of Neurology (ECHN), and the International Society for the History of the Neurosciences (ISHN)
Zurich and Lausanne, Switzerland, 13-18 September 1999