精神医学の歴史―隔離の時代から薬物治療の時代まで

by Edward Shorter

The history of madness and its treatment is a fascinating one. At one time, the mentally ill were diagnosed as demonically possessed; later, when mental illness became the province of psychoanalysts, those conditions that are actually physical in nature, such as schizophrenia or manic depression, went insufficiently treated, their sufferers consigned to asylums. In his book, A History of Psychiatry, Edward Shorter, a medical historian at the University of Toronto, presents a concise chronology of mental illness and its treatment. Shorter favors a biological understanding of these disorders, concentrating on medical approaches to helping the seriously mentally ill.

Genres: Psychology, History, Psychiatry, Nonfiction, Mental Health, Medicine, Mental Illness

Tankobon Hardcover

First published December 27, 1996

Reviews

[jo · Rating 2 out of 5]

i'm reading through it, wondering whether to use it for teaching, and feeling squeamish about its annoying whiggishness, its refusal to see how psychiatry is not exactly a science and the way it evolved is not driven solely by good intention and a pure drive towards genuine improvement.

*********************

this man has an irritatingly aggressive way of writing. he really, really doesn't like antipsychiatry, and he takes constructionism very literally. he lurvs hard-core biological psychiatry, and although i am not dumb enough to deny that something may be very, very wrong in the brain functioning of some "mentally ill" persons, i also think that the scene is a bit more... complex? yes? that there are many factors at play when we decide the someone is mentally ill (often against the person's own assessment of his or her mental illness) and needs to be treated (often against his or her seriously informed consent)? the we can and do construct hard-core reality all the time, by investing it with all sorts of values and valences and meanings? etc. etc. etc.?

why is it anyway that the proponents of psychiatry-as-science squirm away from discussing centuries of intolerable psychiatric cruelty? it's as if i couldn't believe in christianity unless i denied that a lot of people were badly damaged by people who acted in the name of the it. one can still believe that christiany is valid, good, and true in all sorts of ways while recognizing that people acting in the name of some version of it caused a lot of terrible suffering... yes?

it is amazing how much is at stake in holding this or that conception of mental illness and this or that conception of what it takes to make the mentally ill better. why do we get so angry about this?

what saddens me the most when i read books such as this is that the field of mental health is VERY RARELY seen as a field to which patients can contribute as well. it's as if patients had absolutely no say, ever, in what they need to get better. i find this one of the most shocking realities of mental health.

[Xexets · Rating 1 out of 5]

This book is shameful. The author has clearly no knowledge of psychoanalysis and instrumentalises historical data just to openly offend psychoanalysts and psychotherapists. All this to conclude that medication+psychotherapy is the most effective way of dealing with mental illness. The author's aggressiveness and his fits of rage against certain celebrated and important currents of thought are downright unacceptable in an academic environment and bring him to open contradictions and misuses of quotes. Pity because this is to the best of my knowledge the only recent compendium of the history of psychiatry and it is so rich in data that all those who work in the field have to confront with it. I'll have to cite it of course and I bought it, but I am really angry at having to do this with such an ignorant and annoying author.

[Beth · Rating 3 out of 5]

If you are looking for a general view of the history of psychiatry (the timeline, major figures, etc.), this is a useful book. Otherwise, it's a diatribe against Social and Cultural History, neither of which the author actually understands.

[Durakov · Rating 1 out of 5]

I found it...I finally found it...after years of reading extensively in the history of psychiatry and madness, I have finally found the Holy Grail of truly bad books on the topic.

This book can be summed up as "Biology=good, Social/Psychological=bad." I have no issue with a history of the biological in psychiatry, but Shorter's work is an exercise reeking either with ill-concealed resentment or excited titillation that comes off on every page. Shorter seems to genuinely believe that anything done in a lab by people wearing white coats and with the necessary titles conferred upon them is an episode of the grand progress of the field of psychiatry. Anyone who pays the slightest attention to the social or to fantasy or really anything else gets to enjoy a number of choice adjectives surely befitting the "objective" history Shorter believes he's constructing: stuff like "awful," "disgusting," "terrible," "foolish," etc. Everyone who discounts this narrative, or who deigns to introduce folds or complications, is a "Zealot."

His big enemies are all those who dare to discuss their "pet bugaboos" like capitalism, the state, or patriarchy. The problem is, he seems to have no idea what these even are. He suggests at multiple points that capitalism is when rich people do things. Chiarugi's reforms in Italy couldn't possibly have any relation to capitalism, because Florence "was hardly capitalist", according to Shorter, which I presume to mean that it wasn't very wealthy at that time? Or Chiarugi wasn't wealthy? I have no idea, because the notion that capitalism is wealth is so childish and ridiculous and he doesn't think it's worthwhile to expand on that. It doesn't for a moment occur to him that capitalism consists of relations between people. Apparently, if you just don't mention money or think about it at all, you can be non-capitalist. Great news for the anti-capitalists out there! It's also great news for Shorter who doesn't talk about funding at all, unless it dries up for one of his favorite projects, then this is what he calls "Politics," which is bad.

As he dances through the parade of Great Men with magnificent beards and magnifying glasses, Shorter rests assured that "patriarchy" is another of these "pet bugaboos" that apparently only exists in conditions of extreme explicit misogyny. Oh to live in the simple world of Shorter! After dispensing with it early on, he only again brings up gender to discount his enemies: above all Freud and anyone else who displaces the biological as the central character.

He clearly has a singular hatred towards Foucault, which he can't conceal, but he doesn't even identify the correct issues there or understand his book at all. Very few take Foucault's madness book seriously as an actual history, but usually as a series of stimulating philosophical questions concerning the concepts of unreason and madness. Shorter apparently does, but then doesn't even get his critique right. He claims Foucault saw the rise of psychiatry as a "fiendish" collaboration between the state and capital. Please, Edward, point me to this section, because I've read the History of Madness multiple times, and I'm really struggling to find this. In the end, I'm glad he didn't try to approach any of the philosophy, though for I take no pleasure in watching grown university men fail, suffer, and whine. That Shorter also wrote a history of women's bodies (oh god, I shudder to imagine the Shorter touch there), and multiple books on the history of sexuality, desire, strikes in France, and porn makes me think he's just obsessed with the bald old French guy.

The whole enterprise can be distilled into the image of a small child smashing two action figures together: one is labelled "Social Psychiatry" and the other "Biology." After all the requisite "Pows!" and "Booms!" Shorter finally throws Social to the wall and declares Biology the winner. Everything the Bad Guy does is because of intrinsic qualities, everything Good Guy does is because of that evil thing "Politics" or maybe that tricky thing "history" and its "events." Damn politics and events! Curse you! He claims towards the beginning that he will pay attention to the "social context" of developments; to him, this means mentioning where someone went to school and who their famous colleagues were, and perhaps, if he's feeling especially spicy and complex, what the parents were like. Damn, man, careful not to overwhelm us with all that social reality!

But the real kicker comes right at the end in a truly delicious passage. Shorter ends his book by suggesting that what makes psychiatry so special is the combination of medical treatment and psychotherapy. He bizarrely suggests that the average psychiatric appointment is 40 minutes, most of which he presumes is psychotherapy apparently. My first thought is: wow, this guy has clearly never been to a real psychiatric appointment in his life! But that's not even the punchline. He says that patients feel more at ease, more comforted, more healed, really, when it's a physician they are talking to as opposed to a social worker or therapist. Look, I have no issue with erotica and porn, but he should've said at the beginning that this tome was one big Doctor-Daddy fantasy. For all his books about sexuality, Shorter needs to learn about and respect consent before subjecting us to his wet dreams. This is a book that spends hundreds of pages trying to discount the psychological and sexual theories of the bad guys and ultimately provides them with huge dunk after dunk. It would be enough to make you feel sorry for the author were he not considered a serious historian. That's the true travesty here.

[Claire · Rating 2 out of 5]

I'm having trouble recalling what I thought about this book before I read the last chapter as it sent me into an amnesia-inducing rage. I'll write what I thought of the last chapter first to hopefully get it out of my system.
It is absolutely astounding how someone can be so lacking is self-awareness. To spend nearly 300 pages writing about the harms of disregarding the reality of mental illnesses (as those in the deinstitutionalization/anti-psychiatry movement often did) and then spend the last 40 or so pages disregarding new diagnoses?? It's absolutely absurd. How can he not see that he's doing exactly what he so often spoke out against? To say that psychiatrists invented PTSD, personality disorders, and ADHD by pathologizing behaviour simply to retain a place in the market place is absolutely insulting. Not that there isn't anything to be said about over-pathologizing, because there certainly is. But the implication that PTSD/personality disorder/ADHD symptoms are not disordered? Simply wrong. He literally makes nearly the exact same argument that the anti-psychiatry thinkers made, arguments that he supposedly greatly disproved of. Similarly, his bizarre hatred for Prozac and other recent drug discoveries makes no sense. Again, there is something to be criticized in how heavily they are marketed and perhaps over-utilized (though I think the criticism lies more in the disastrous state of our society that makes people turn to drugs rather than use of the drugs themselves or people somehow not "needing" them, because they certainly do). However, he writes about the EXACT same narrative occurring in the 1950s with chlorpromazine and tricyclics (the narrative being drug companies pushing them) with no judgment; in fact, he supports this as they further biological psychiatry. It just makes no sense how he criticizes these new drugs and new diagnoses when he seems to be supportive of those exact same things, but only 40 or so years earlier.
Overall, I found his tone and bias throughout the book quite distasteful. Not because I disagreed with him necessarily - certainly psychoanalysis and the antipsychiatry movements had very negative impacts. He was just so unbearably self-righteous and judgmental to the point of absurdity. I don't believe that history books need to be completely dry and unbiased, but his downright mockery of certain figures and ideas was crass.
All that said, there is a lot of valuable information in the book and it's generally a good overview of the history of psychiatry. His frequent lack of compassion towards mentally ill people, even going as far as disregarding highly unethical experiments (that included sexual assault, which he conveniently left out) in the name of medical advancement, was distasteful. And just on an organizational note, it wasn't entirely chronological, occasionally going over the same area of time a few times, which made it feel repetitive at times. But I did come away with some useful knowledge. I just wish Shorter recognized how childish his bias was coming across in writing (or perhaps he did and didn't care? either way, not my cup of tea) and when he was being hypocritical. I simply cannot understand how he suddenly changed his view in the last chapter of the book and said, actually, no, expanding upon the science of psychiatry both in how we treat mental illness and how we diagnose it is bad and we should remain in the 1970s, I guess? It's beyond confusing and makes me think that he a very specific idea of what mental illness Should Be. And that's just not for me.

[Christel · Rating 4 out of 5]

When you actually enjoy a book you have to read for your thesis :D

This book was a fascinating timeline of psychiatry, all the way through asylums in the 18th century until the advent of psychopharmacotherapy from the 50s-now. Edward Shorter is a fantastic writer and one can really sense his passion for mental illness by the way he tells a story. I really enjoy non-fiction books that are so well-written they flow and read as easily as a fictional story. Shorter is one of those types of writers. This was especially helpful for me, because this is a book I needed to read and take notes on. I think the fact I read this book in a week is testament to how well-written and readable it is. I learned a lot of new words while reading this book! Having a psychology degree means I knew quite a bit of the background/topics discussed in this book, but I still found myself gasping at a lot of what was written in this book, particularly the statistics of the 17- and 1800s. I also noted down quite a few early books Shorter referenced that are written from the perspectives of people with mental illness and those in early asylums, which I am looking forward to reading. This book certainly added a lot more than a substantial reference point in my thesis!

[vea]

Interesante lo que dice sobre el psicoanálisis

[Psipsipsi · Rating 5 out of 5]

This book gives a very clear and believable account of its chosen topic. The author is strongly opinionated and gives a powerful narrative. I will not swallow everything he says whole, but he has given me a framework for thinking about why Psychiatry is where it is and where it is going. His view on why asylums lost their way is to me novel and credible. They relied on kindness and attention to the mentally ill, but after a successful 20 years or so the average asylum started to be swamped with patients who were really mentally ill. This was not the incarceration of deviants spouted by Foucault but families and communities relieving themselves of the burden of caring for the behaviourally disturbing. What had been their responsibilities became those of the Government. There were though other lesser causes of the overpopulation of asylums. Neurosyphilis reached epidemic proportions in the middle of the 19th century. And alcohol problems soared. But intriguingly the author looked carefully at the idea that schizphrenia was a new disease at this time, or an old one that became much more common. Here Shorter did not express a clear opinion but weighed the facts, more of which are needed.

His account of society psychiatry in the 19th century and how Psychiatry in the 20th century captured this lucrative market from neuorology and general physicians is intriguing, as is his account of how an army of counsellors is now biting back.

Th calamity to the host population of American Psychiatry is well expressed and the greed that lay and still lies behind it is perusasivley presented. Much of the content of the later chapters has been expanded on in the author's recent book "Before Prozac" using new material released by the US government. That book is well worth reading.

My main interest in reading this book is that I have been tasked to advise on the future of an asylum in Africa. This book has undoubtedly changed the advice I will give. A clear take away message for me is use history to learn from mistakes and to avoid repeating them.

[Mr. Monahan · Rating 4 out of 5]

I found this book to be very insightful and it built my foundation on the history of psychiatry. Needless to say it fills in some gaping holes left by introductory and intermediate psychology textbooks.

I noticed another reviewer refer to this work as Pop history, but I would defend Shorter (Professor at University of Toronto) as an academic in this case. His notations are meticulous and this is an example of scholarship; not pop lit.

That being said, there are certainly instances in this text where Shorter's interpretations and opinions concerning the philosophy of psychiatry shine through (I particularly liked his treatment of the Quaker 'Moral Treatment' and his criticisms of the medical model of psychiatry) but he's not exactly plotting with Tom Cruise and Scientologists.

Do you care about psychiatry? Are you considering a career in public health, mental health, medicine, or psychology? If so, reading this book is critical to building an understanding of mankind's struggle and ultimate inability to cure mental illness in the last 250 years. If you come into reading this book thinking that the solution to mental illness is simple and comes in pill form, you're in for a rude awakening. Even if you already know better than that, there is much to be gained by looking at the seemingly random history of psychiatry and the competing goals of curing vs. treating mental illness.

[Mary Sherritze]

When my daughter first gave me the book, I had thought I would mostly use it as a reference, but after I dipped into the pages, I soon began reading it from beginning to end. The book covers a period of 200 years of treating the mentally ill. The author shows the scientific and cultural factors that shaped the treatment of mental illness. I was particularly interested in his discussion of the development of phenothiazines, which had such a profound effect on the treatment of mental illness.

[Lucy Allison · Rating 4 out of 5]

I don't agree with the core argument presented by this book, or with the lack of space given to the voices of those treated by psychiatry, but there's no denying it's incredibly well-written, covering a lot of ground in a very accessible way for an academic text.

[John Hancock · Rating 1 out of 5]

The title of this book should be "A Distorted History of Psychiatry" http://psychiatricsurvivors.wordpress...

[Rahemah Siddiqui · Rating 3 out of 5]

Not a fan of Shorter, having been his student, but he writes a sweeping and lucid history.

[Peter · Rating 3 out of 5]

Edward Shorter is a Professor of the Medical History and Psychiatry at the University of Toronto in Ontario. Shorter’s 1997 book, A History of Psychiatry: From the Era of the Asylum to the Age of Prozac is a history of Biological Psychiatry in Europe, the United States, and Canada from the 18th-Century until the 1990s. Shorter’s definition of Biological Psychiatry is the branch of Psychiatry that “stresses the neurosciences, with their interest in brain chemistry, brain anatomy, and medication, seeing the origin of psychic distress in the biology of the cerebral cortex” (26). Shorter’s focus on the branch of Biological Psychiatry leads him to be a very single-minded focus on biological psychiatry lead him to write about Biological Psychiatry at the expense of the other branch of psychiatry. For example, Shorter writes of community psychiatry that “community psychiatry though worthy in the spirit became discredited as a practical means of treating serious psychiatric illnesses that, not having arisen in the community, could not be cured in it either” (281). Shorter may have a point, but he is too quick to completely dismiss community care. For example, Shorter does not cover the history of community care in Italy starting in the 1960s. I think keeping Shorter’s preferences in mind, this book is a good history of Biological Psychiatry.

[Blake · Rating 3 out of 5]

Edward Shorter begins his book, A History of Psychiatry, with “Before the end of the eighteenth century, there was no such thing as psychiatry.” He then covers the last two centuries of psychiatric care, detailing the evolution of the practice, the wrangling within the medical world as psychiatry and psychology vied for a seat at the scientific table. Shorter documents psychiatry’s treatments of insanity, often focusing on schizophrenia and other nervous disorders, theories about degeneration, the role of asylums, mad houses, nervous clinics, the rise of community therapy, while exposing the Freudian influence in psychoanalyses, the debates between analysts and psychiatry, the studies on nature-vs-nurture, the rise of antipsychiatry, the various treatments for the insane, and the alternatives to psychiatry. The author provides history regarding the development of Kraepelin’s influence on the DSM in the second biological psychiatry, and explores the development of medications for the supposed cure for mental illness, giving major focus to Prozac, among others.

Strengths: Clear, in-depth study; well-documented; honest about the failures of psychiatry; very informative regarding the development of various attempted treatments of insanity throughout history, the use of alternatives, and the powerful influence medicine had in changing treatment.

Weakness: Evolutionary basis for view; belief in the existence of mental illness and assumption that mental illness results from disorders of brain chemistry; unclear about conclusions of genetic studies; failures of medical treatments are not addressed adequately.

Use in Biblical Counseling: Demonstrates the broken cisterns of ever-changing psychiatry, psychoanalyses and magnifies the authority of the unchanging Word of God for counseling.

[Auno Rintamäki · Rating 4 out of 5]

Hyvin kattava ja mielenkiintoinen teos! Joissakin kohdin kirjoittajan henkilökohtaiset mielipiteet paistavat läpi, esimerkiksi kirjoittajan väite mm. persoonallisuushäiriöiden keinotekoisesta "luomisesta" markkinaosuuden säilyttämiseksi ei ole kovin kestävä. Muutoin oikein pätevä yleisteos psykiatrian historiaan.

[Tiina Lehtonen · Rating 3 out of 5]

Ihan mielenkiintoinen teos mutta en pitänyt tavasta miten kirjoittaja tuo esiin näkemyksensä psykiatrisista sairauksista ja kuinka hänen mielestään moni psykiatrinen sairaus ei ole oikeasti psykiatrinen sairaus. Käsittääkseni kirjailija on historioitsija, ei lääkäri. Myöskin omien mielipiteiden esittäminen historiaa käsittelevässä teoksessa on niin ja näin.

[Baha Somii · Rating 4 out of 5]

I recommend this book to psychiatrists to get an overview of the history of psychiatry in the past two centuries.

[Cristina Chițu · Rating 2 out of 5]

ignorant in so many ways

[Hope · Rating 5 out of 5]

my favorite part was when they used an ice pick and "squiggled" it around in the frontal lobe (that's called a lobotomy, friends)

[natasha · Rating 4 out of 5]

really interesting

[Sagar Jethani · Rating 5 out of 5]

Shorter does a remarkable job compressing over 200 years of medical history into a single, readable volume. Rather than attempting to provide the reader with an exhaustive chronology of psychiatry, Shorter tells a story which weaves seamlessly between intellectual movements, popular culture, and advances in drug therapy. The principle which guides this narrative-- and, indeed, psychiatry overall-- is the humanitarian impulse to help those who suffer from psychiatric illness.

What I found most surprising was the degree to which Freudian psychoanalysis has become thoroughly discredited:

"All sciences have to pass through an ordeal by quackery," observed Hans Eysenck in 1985. "Chemistry had to slough off the fetters of alchemy, the brain sciences had to disengage themselves from the tenets of phrenology... Psychology and psychiatry, too will have to abandon the pseudo-science of psychoanalysis..."

Far from taking psychological care down an aimless garden path, Freudian analysis is shown to have done real harm to those who suffer from psychological maladies by denying them other forms of care beyond the analyst's couch-- forms of care, including drug therapy, which could have led to real improvement in patient's lives.

Shorter's account begins with the early days of organized asylums, institutions which, despite today's negative associations with the word, were staffed by people who sought to bring relief to hundreds of people who would have otherwise languished being tied to wooden posts or locked in a room for years. The great failings of the asylum system resulted not from its intentions, but from an overwhelming crush of intake. The exponential increase in asylum patients led to substandard care and occasional depictions of gross negligence-- and these latter images are those most strongly associated today with the era, despite their relative infrequency.

After the second world war, psychoanalysts in America insisted that mental problems were solvable by means of obtaining a deeper understanding of the primal drives which govern human action. It rejected other forms of treatment as being purely palliative, and suggested that real cure required one to identify and make peace with his or her unresolved psychosexual impulses. (This, despite significant evidence that patients undergoing psychotherapy actually experienced longer recovery periods than patients with similar conditions who received alternate forms of treatment.)

Finally, advances in psychopharmacology in the last three decades of the twentieth century succeeded in dethroning Freud from the pinnacle of psychological care and allowed psychiatry to plant itself on firmer, scientific ground. New insights into the genetic origins of many forms of mental illness dispelled the Freudian notion that personal insight would lead to recovery. The identification of specific drug treatments allowed many to live happy, public lives who would have earlier suffered lonliness and marginalization in the era of asylums.

'A History of Psychiatry' is an excellent study of the major movements within psychiatric care over the past three centuries. Shorter has contributed a highly-readable story of a subject which, in less capable hands, would have been an unwieldy account.

[William Nist · Rating 5 out of 5]

This fascinating account of the development of Psychiatry from the operators of 18th century insane asylums to the gatekeepers of the psychopharmacological drug stable is a tour De force in Medical History writing.

With humor and a lot of interesting detail, the author takes us through the last 200 years of psychiatry; one in which the medical specialty began with NO effective therapies, went through some periods which were psycho-therapeutic wastelands, stumbled into questionable biological approaches, beat off competition from psychologists and social workers, and finally emerged with Prozac, Valium, and Xanax as their chief tools.

I noticed in some of the comments, that poor reviews of this book, were offered by individuals who seem to be defending Freudian Analysis. This book does discredit as unscientific such Analysis, and it has passed from a NYC obsession of the 1960's to a place where it is almost impossible to even find a practitioner.

But if you have no vested interests, I think you will find this work interesting, enlightening, and entertaining.

BTW, the author notes that there are fewer and fewer Psychiatric residences these days, but he does believe that Psychiatry still offers a unique combination of therapy and medication, that neither Psychologist nor Neurologists (or Internist) can offer.

[Jeroen · Rating 5 out of 5]

Very good book that summarizes the history of psychiatry in Western civilization and thoroughly addresses one of the most controversial periods in its history: the rise and fall of psychoanalysis. Refreshingly blunt about how this weird concoction of theories and schools was able to gain so much momentum when even Freuds contemporaries were underwhelmed by his arguments and supportive evidence for his outrageous hypotheses. A good read!

[Rashad Raoufi]

it ranges from the very boring fact attacks about dead germans to fasinating accounts of how psychiatry has evolved from bath treatments and enemas to prozac, its well researched and detailed which the latter can make it quite dull at times. on the whole its even and attempts very admirably to be evaluative such as the contribution of big corporates in making prozac and valium as common and accessible as soap to the self interest activites of the profession.

[Kyrie · Rating 2 out of 5]

I've read better books on madness and medicine. This one had its moments, but the author often went off on long tangents giving a particular doctor's resume and entire academic history. Those things didn't seem to relate to the topic under discussion. However, when I was in need of feeling sleepy, this book was wonderful.

[Caitlin Maddox · Rating 4 out of 5]

This was interesting and is very readable, especially for the early history of psychiatry. I wish Shorter had written it after all the controversy with psychiatric drugs (e.g., the placebo effect and SSRIs or the paediatric bipolar disorder scandal) But even so, it is fair reflection of the history.

[Charlotte Holst · Rating 5 out of 5]

This book is not a dull history book - while painting the big picture of the history of psychiatry in Europe and north America, it also gives you some very interesting perspectives on the social, political and economical factors that impacted this branch. This is a must read for everyone who is dealing with or has an interest in psychiatry.

[Echo · Rating 1 out of 5]

Disappointed I wasted $50 on this. This author has an overwhelming, aggressive disdain for the mentally ill that permeates everything. I couldn't even finish reading it because the way he describes historical conditions and treatments is appalling and dehumanizing. This book was such a let down because I haven't come across many like it.

[Niamh · Rating 3 out of 5]

A good overview, but not a very critical one.

Decent introduction to the field and the major changes that have taken place over the last 200+ years of Psychiatry.

The author makes a couple of quite surprisingly chauvinistic assumptions/statements in the book that made me gasp, though!!