Table Of ContentInternational Relations in Psychiatry
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Rochester Studies in Medical History
Senior Editor: Theodore M. Brown
Professor of History and Preventive Medicine
University of Rochester
ISSN 1526–2715
The Mechanization of the Heart: The Value of Health:
Harvey and Descartes A History of the Pan American
Thomas Fuchs Health Organization
Translated from the German by Marcos Cueto
Marjorie Grene
Medicine’s Moving Pictures:
The Workers’ Health Fund in Eretz Israel Medicine, Health, and Bodies in American
Kupat Holim, 1911–1937 Film and Television
Shifra Shvarts Edited by Leslie J. Reagan, Nancy
Tomes, and Paula A. Treichler
Public Health and the Risk Factor:
A History of an Uneven Medical Revolution The Politics of Vaccination:
William G. Rothstein Practice and Policy in England, Wales,
Ireland, and Scotland, 1800–1874
Venereal Disease, Hospitals and the Urban Poor:
Deborah Brunton
London’s “Foul Wards,” 1600–1800
Kevin P. Siena Shifting Boundaries of Public Health: Europe
in the Twentieth Century
Rockefeller Money, the Laboratory and
Edited by Susan Gross Solomon, Lion
Medicine in Edinburgh 1919–1930:
Murard, and Patrick Zylberman
New Science in an Old Country
Christopher Lawrence Health and Zionism:
The Israeli Health Care System, 1948–1960
Health and Wealth:
Shifra Shvarts
Studies in History and Policy
Simon Szreter Death, Modernity, and the Body:
Sweden 1870–1940
Charles Nicolle, Pasteur’s Imperial
Eva Åhrén
Missionary: Typhus and Tunisia
Kim Pelis International Relations in Psychiatry:
Britain, Germany, and the United States to
Marriage of Convenience:
World War II
Rockefeller International Health and
Edited by Volker Roelcke,
Revolutionary Mexico
Paul J. Weindling, and Louise Westwood
Anne-Emanuelle Birn
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International Relations
in Psychiatry
Britain, Germany, and the
United States to World War II
Edited by
Volker Roelcke, Paul J. Weindling, and
Louise Westwood
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Copyright © 2010 by the Editors and Contributors
All rights reserved. Except as permitted under current legislation, no
part of this work may be photocopied, stored in a retrieval system,
published, performed in public, adapted, broadcast, transmitted,
recorded, or reproduced in any form or by any means, without the
prior permission of the copyright owner.
First published 2010
University of Rochester Press
668 Mt. Hope Avenue, Rochester, NY 14620, USA
www.urpress.com
and Boydell & Brewer Limited
PO Box 9, Woodbridge, Suffolk IP12 3DF, UK
www.boydellandbrewer.com
ISBN-13: 978-1-58046-339-3
ISSN: 1526-2715
Library of Congress Cataloging-in-Publication Data
International relations in psychiatry : Britain, Germany, and the United States to
World War II / edited by Volker Roelcke, Paul J. Weindling, and Louise Westwood.
p. ; cm.—(Rochester studies in medical history, ISSN 1526-2715 ; v. 15)
Includes bibliographical references and index.
ISBN 978-1-58046-339–3 (hardcover : alk. paper) 1. Psychiatry—History—20th
century. 2. Comparative psychiatry—History—20th century. I. Roelcke, Volker,
1958– II. Weindling, Paul. III. Westwood, Louise, 1947- IV. Series: Rochester studies
in medical history, 1526–2715.
[DNLM: 1. Psychiatry—history—Germany. 2. Psychiatry—history—Great Britain.
3. Psychiatry—history—United States. 4. Cross-Cultural Comparison—Germany.
5. Cross-Cultural Comparison—Great Britain. 6. Cross-Cultural Comparison—
United States. 7. History, 19th Century—Germany. 8. History, 19th Century—Great
Britain. 9. History, 19th Century—United States. 10. History, 20th Century—
Germany. 11. History, 20th Century—Great Britain. 12. History, 20th Century—
United States. 13. Internationality—Germany. 14. Internationality—Great Britain.
15. Internationality—United States. 16. Interprofessional Relations—Germany.
17. Interprofessional Relations—Great Britain. 18. Interprofessional Relations—
United States. WM 11.1 I605 2010]
RC438.I58 2010
362.196’89—dc22
2010002420
A catalogue record for this title is available from the British Library.
This publication is printed on acid-free paper.
Printed in the United States of America.
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Contents
Introduction 1
Volker Roelcke, Paul J. Weindling, and Louise Westwood
1 Inspecting Great Britain: German Psychiatrists’ Views of
British Asylums in the Second Half of the Nineteenth Century 12
Heinz-Peter Schmiedebach
2 Permeating National Boundaries: European and American
Influences on the Emergence of “Medico-Pedagogy” in
Late Victorian and Edwardian Britain 30
Mark Jackson
3 Organizing Psychiatric Research in Munich (1903–1925):
A Psychiatric Zoon Politicon between State Bureaucracy and
American Philanthropy 48
Eric J. Engstrom
4 Germany and the Making of “English” Psychiatry:
The Maudsley Hospital, 1908–1939 67
Rhodri Hayward
5 Patterns in Transmitting German Psychiatry to the
United States: Smith Ely Jelliffe and the Impact of
World War I 91
John C. Burnham
6 “Beyond the Clinical Frontiers”: The American Mental Hygiene
Movement, 1910–1945 111
Hans Pols
7 Mental Hygiene in Britain during the First Half of the
Twentieth Century: The Limits of International Influence 134
Mathew Thomson
8 Psychiatry in Munich and Yale, ca. 1920–1935:
Mutual Perceptions and Relations, and the
Case of Eugen Kahn (1887–1973) 156
Volker Roelcke
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vi (cid:2) contents
9 Explorations of Scottish, German, and American Psychiatry:
The Work of Helen Boyle and Isabel Hutton in the Treatment
of Noncertifiable Mental Disorders in England, 1899–1939 179
Louise Westwood
10 Welsh Psychiatry during the Interwar Years, and the Impact of
American and German Inspirations and Resources 197
Pamela Michael
11 Alien Psychiatrists: The British Assimilation of Psychiatric
Refugees, 1930–1950 218
Paul J. Weindling
Selected Bibliography 237
List of Contributors 243
Index 245
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Introduction
Volker Roelcke, Paul J. Weindling, and
Louise Westwood
The decades around 1900 were a crucial period in the making of the vari-
ous national systems of health services, as well as the formation of the mod-
ern medical and social sciences. The fi eld of psychiatry and mental health
care can be understood as located at the intersection of these spheres. Here,
concepts, practices, and institutions emerged that marked responses to the
challenges posed by urbanization, industrialization, and the formation of
the nation-state. Psychiatry had a considerable impact on the modes of per-
ception and evaluation, and on the patterns of action toward contemporary
social concerns and political issues. These psychiatric responses were locally
distinctive, and yet at the same time they established, in part, infl uential
models with an international impact.
This volume addresses two important topics of late nineteenth- and early
twentieth-century history. The essays deal with the transformation of psychi-
atry into one of the most contested and infl uential modern sciences; and
they link this focus to broader issues of international relations and transfers
of concepts, practices, personnel, as well as funds in a context of rising inter-
nationalism and nationalism.
For instance, an orientation toward new career opportunities in the United
States by European physicians in the context of innovative and fl exible insti-
tutional structures and systems of funding may be documented for the 1920s;
yet this orientation has found almost no attention in the historiography of
psychiatry. Likewise, the impact of the transfer and variety of adaptations of
diagnostic, therapeutic, and preventative concepts in mental health care in
various local, regional, and national contexts has so far been neglected. The
Kraepelinian classifi cation and associated clinical and research practices and
the program of the mental hygiene movement are examples of such concepts
and related practices that had a broad international impact, while being gen-
erally embedded in local specifi cities. A further dimension that has so far
been given little attention is the importance of the ideal of internationalism in
the sciences, as opposed to the increasing political nationalism since the mid-
nineteenth century.1
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2 (cid:2) introduction
In general, historical research in the international dimension of psychiatry
has so far mostly followed two strands: First, since the 1990s, the emigration
of German-speaking physicians has been looked at in a number of studies.2
These studies mainly focus on individual biographies and the political con-
texts, but pay little attention to the impact of this forced migration on psychi-
atric care and research in the receiving countries.3 A second strand of such
historical literature, which classifi es itself as “comparative,” contrasts features
of psychiatric concepts, practices, or institutions in different national set-
tings.4 However, recent approaches, for example on the multitudinous and
close interrelations between institutionalized psychiatric genetics in Munich
(Germany) and Basel (Switzerland),5 are indicative of a phenomenon of gen-
eral importance; namely, that of the comprehensive cross-linking within the
fi eld of psychiatry that transcended national boundaries in the fi rst decades
of the twentieth century. This example points to a problem inherent in the
application of comparative approaches to the history of medicine: the ten-
dency to exaggerate the importance of the differences between the national
contexts and entities (institutions, disciplines) to be compared. This tendency
in comparative approaches is intrinsically linked with the danger of a historio-
graphically inappropriate assumption of national self-suffi ciency or even uni-
formity. Simultaneously, both the specifi cities of local or regional features are
neglected, and, in particular, the high degree of effectiveness of international
interactions in the form of mutual awareness, communication, cooperation,
and even mutual dependence resulting from the fl ow of conceptual, material,
and personnel resources is marginalized or even ignored.
The international travels of physicians and scientists, and of concepts,
practices, or material objects, have already been described for the early
modern period.6 During the nineteenth century, the development of new
communication technologies and means of transport led to a rapid increase
in the availability of knowledge about other countries and the facilitation of
travel and migration. New technological developments also led to the rise of
internationalism, which included the process of internationalizing cultural,
political, and economic practices, as well as the emergence of international
movements, organizations, and related exchanges.7 However, international
transfers were not neutral operations. Concepts and practices were acquired
for particular reasons, their selection was determined by certain criteria, and
their use served special purposes.8 Thus, processes of transfer and adapta-
tion might, for example, have helped to strengthen the collective identity of
a social group (such as psychiatrists or social workers). They might also have
been used as arguments to push individual or group strategies in establish-
ing or expanding new spheres of competence, or to facilitate the application
of new practices and technologies.9
These historical phenomena necessitate conceptual and methodological
approaches that go beyond analyses on the national levels, or comparisons
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introduction (cid:3) 3
as outlined above. Concepts such as transnational history and histoire croisée
are attempts from political and cultural historiography to meet such chal-
lenges.10 For the purpose of analyzing international relations and transfer
processes in psychiatry and mental health care, we suggest looking at a num-
ber of dimensions: personnel (study visits as well as migration); intellectual
resources (including explicit and tacit knowledge); clinical practices; insti-
tutional models, organizations, and disciplines (such as “mental hygiene”);
and fi nally, fi nancial resources. The resulting patterns of mutual perception,
inspiration, adaptation, and application of new concepts and practices open
up a gamut of questions: What were the exact geographical (local, regional)
origins, and what were the end points of transfer processes? In which tempo-
ral frameworks did they occur? Who were the initiators? Who were the main
historical actors? To what extent were the transnational interactions, the
travel of concepts and practices, or the migration of personnel, reactions
to specifi c local, regional, or national circumstances and infl uences? What
specifi c intellectual, institutional, and political confi gurations were in opera-
tion? In the case of the migration of individuals, what was the impact for the
place, institution, or society at the point of origin of transfer and adapta-
tion processes? And what was the impact for the place, institutions, or soci-
ety at the point of reception? Did the processes of transfer and adaptation
have simply an “additive” effect, or did they result in a new, transforming
quality? The volume addresses theses issues by fl exibly applying analytical
frameworks that take up recent efforts to overcome national conceptions of
history and capture transnational developments.
In spite of rising nationalism in Europe, the intellectual, institutional, and
material resources related to psychiatry and mental health care emerging
in the various local and national contexts were rapidly observed beyond any
national boundaries. In numerous ways innovations were adopted and refash-
ioned for the needs and purposes of new national and local systems. Thus,
during the mid and late nineteenth century, many German alienists (Irrenärzte,
a common term for psychiatrists in the nineteenth century) and medical offi -
cers traveled to England, Wales, and Scotland to become acquainted with the
different systems of mental health care, and to apply what appeared useful to
the architecture and organization of new or restructured asylums in the Ger-
man states and in the German-speaking contexts of Austria and Switzerland.
The frequently selective use and adaptation of knowledge acquired by Ger-
man psychiatrists in the course of such study visits to England and Scotland is
addressed in the contribution by Heinz-Peter Schmiedebach.
In the following decades, university departments and chairs in psychiatry
were established at almost every German medical school, a process paral-
leled by the formulation of an apparently coherent system of terminologies,
classifi cations, and related research programs for the description and analy-
sis of psychiatric disorders, in particular by Emil Kraepelin and his school.11
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