Psychiatry, Clinical Psychology, and Psychotherapy: The Question of Politics

[[{"type":"media","view_mode":"media_crop","fid":"17368","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_3513241162780","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"931","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"margin: 5px; float: right;","title":" ","typeof":"foaf:Image"}}]]If historians have demonstrated anything, it is that psychiatry, clinical psychology, and psychotherapy cannot be neatly associated with any one particular kind of political ideology or movement. In 2002, I published an article in the Harvard Review of Psychiatry in which I posed the question, “Was there a communist psychiatry?”¹ Admittedly, my intention was to be a bit provocative. The question pushes in two directions at once. On the one hand, it raises the general possibility of psychiatry being defined by the political environment in which it operates; on the other hand, it suggests that perhaps psychiatry as such did not historically exist in post-1945 communist countries.

At a talk I gave on the subject, a psychiatrist who had practiced in Cold War Eastern Europe assured me (somewhat annoyedly) that psychiatric services were offered there at the time and that clinicians had been medically trained, not simply politically indoctrinated.

I actually agree with this psychiatrist, as I think my article makes clear. The provocation of the original question was and is intended less for practitioners in the former Eastern Bloc, than for audiences in the West, where an abiding image had emerged of a Soviet-era psychiatry inevitably corrupted by political ideology. My point was to push us to reconsider this image historically and to question whether communism was the prime-or even a significant-mover in the development of psychiatry in the East.

All of this raises broader questions. Is there invariably a political-and here I mean “politics” to refer to the ideas and efforts of organized parties, movements, and states-dimension to psychiatry, clinical psychology, and psychotherapy? If so, what effects do political ideologies and systems have on them? As fields of inquiry and intervention, do psychiatry and psychotherapy have inherent political affinities and tendencies?

Historians of mental health have actually shown a great deal of interest in these issues. The Enlightenment pedigree and revolutionary leanings of Philippe Pinel (1745-1826), chief physician at the hospitals of Bicêtre and Salpêtrière, have been well documented, for instance. His so-called moral treatment-ostensibly replacing shackles, purging, and blistering treatments with a nascent form of talk therapy-was, it has been shown, directly informed by his general attitudes about government and human dignity.² In fact, post-revolutionary France was the site of a general rethinking of human psychology that purposely and directly threatened established elites.³

The London-based sociologist Nikolas Rose, over the years, has argued for the generally liberal political propensities of psychotherapy, mental hygiene, and preventive mental health care, tools which he understands to promote personal autonomy and growth.^4,5 This view squares nicely with the self-perception of practitioners-especially since the 1960s-who have tended to see themselves and their work as not only comforting, but also empowering.

Others have questioned such claims, however. Feminist and gendered readings of the historical record have highlighted alienism’s and psychiatry’s reinforcement of traditional conventions and hierarchies.^6-9 And a recent work has faulted the growth of mental health care over the past few decades for contributing to a therapeutic form of governance that encourages dependence on public institutions at the expense of individual responsibility and family support.¹⁰

Do the disciplines enhance personal independence or support social conformity? These both, of course, are rather familiar lines of argument to anyone following the public responses to successive revisions of DSM since 1980. While psychiatric professionals have largely debated classification in terms of scientific veracity and clinical integrity, lay observers have been more inclined to consider the issue in more moral and political terms. This should come as no surprise, for mental health care touches on matters inextricably bound up in ethics and public action, such as our standards for normality and deviance, our expectations about social responsibility, and our prevailing ideals of the good life.

Germany in the middle of the 20th century offers a good example of a historic view of the complexities of psychiatry, clinical psychology, and psychotherapy. During the Third Reich, leaders in the psychiatric and psychotherapeutic communities made it clear to Nazi officials that they considered their work to be perfectly compatible with the racist and authoritarian agenda of the regime.^11,12 Within a decade after the end of World War II, however, American social psychology and clinical psychology were inspiring West German clinicians to implement a rehabilitative plan in prisons based on the democratic principles of tolerance, plurality, and personal development.^13,14

So, yes, psychiatry, clinical psychology, and psychotherapy unavoidably have political dimensions and implications. What those may be in practice, however, is hardly something set in stone.

Disclosures:

Dr Eghigian is Associate Professor of Modern History and former Director of the Science, Technology, and Society Program at Penn State University, University Park, Pa. He is Section Editor for Psychiatric Times, History of Psychiatry. His detailed biography can be found here.

References:

1. Eghigian G. Was there a communist psychiatry? Politics and East German psychiatric care, 1945-1989. Harv Rev Psychiatry. 2002;10:364-368.
2. Goldstein J. Console and Classify: The French Psychiatric Profession in the Nineteenth Century. Cambridge, UK: Cambridge University Press; 1987.
3. Goldstein J. The Post-Revolutionary Self: Politics and Psyche in France, 1750-1850. Cambridge, MA: Harvard University Press; 2005.
4. Rose N. Inventing Our Selves: Psychology, Power, and Personhood. Cambridge, UK: Cambridge University Press; 1996.
5. Rose N. The Politics of Life Itself: Biomedicine, Power, and Subjectivity in the Twenty-First Century. Princeton, NJ: Princeton University Press; 2006.
6. Showalter E. The Female Malady: Women, Madness, and English Culture, 1830-1980. New York: Penguin Books; 1987.
7. Scull A. Hysteria: The Disturbing History. New York: Oxford University Press; 2009.
8. David G. Schuster, Neurasthenic Nation: America’s Search for Health, Happiness, and Comfort, 1869-1920. New Brunswick, NJ: Rutgers University Press, 2011.
9. Tone A. The Age of Anxiety: A History of America’s Turbulent Affair with Tranquilizers. New York: Basic Books; 2009.
10. Dowbiggin I. The Quest for Mental Health: A Tale of Science, Medicine, Scandal, Sorrow, and Mass Society. New York: Cambridge University Press; 2011.
11. Burleigh M. Death and Deliverance: “Euthanasia” in Germany c. 1900-1945. Cambridge, UK: Cambridge University Press; 1994.
12. Cocks G. Psychotherapy in the Third Reich: The Göring Institute. New Brunswick, NJ: Transaction Publishers; 1997.
13. Däumling A. Die Aufgaben des Psychologen im sozialpsychologischen Strafvollzug. Zeitschrift für Strafvollzug. 1951;2:7-11.
14. van Strien PJ. The American "colonization" of northwest European social psychology after World War II. J Hist Behav Sci. 1997;33:349-363.