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Week Nine: Psychiatry and Hereditary Degeneration, 1860-1914

Psychiatry, Hereditary Degeneration and Mental Illness

Within history of psychiatry there are 2 major interpretations of mental disorders:

- a psycho-social perspective, which emphasises problems in the individual"s personal history and surroundings;

- a somatic, organic perspective, which emphasises brain-biology, brain-chemistry, genetics and heredity.

One of these perspectives is often more common in psychiatric communities during a specific period. We have seen, for example, that during the first half of the 19th century with Pinel and Esquirol, a psycho-social perspective was the dominant theory to understand mental disorders. A psycho- social perspective was the basis of the moral treatment as well. Many psychiatrists believed that mental illness could be cured exactly because they believed that mental disorders were psychologically and sociologically caused. Of course, psychiatrists, such as Pinel, also believed that in some cases mental illness was caused by heredity (e.g. dementia and idiocy). In history, it is very rare to find a psychiatrist who does not admit that mental illnesses can be influenced by heredity or physical causes. At the same time it is very rare to find a psychiatrist who does not acknowledge the influence of the social environment and the patient"s personal history. Nevertheless, generally speaking, one of the two paradigms prevails in different historical times and in different communities: a psycho-social perspective or an organic perspective.

In the second half of the 19th century a physical, an organic understanding of mental illness was most common. European psychiatrists increasingly believed that most mental disorders were hereditary and particularly from the 1870s, a biologically deterministic model of insanity dominated European psychiatric communities. The asylum, previously praised as the site of moral therapy and cure, was not able to cope with an increasing number of admissions. Pessimism replaced the curative optimism typical of early nineteenth-century psychiatrists. In the second half of the 19th century, asylum psychiatrists noticed that while some patients

recovered from some mental disorders, most patients did not recover, and some even worsened. This psychiatric pessimism was in part the result of those populating the asylums: patients with intractable and irreversible organic diseases were filling asylums, notably those with tertiary syphilis, which was a major problem in the nineteenth century. Syphilis was one of the most common sexually transmitted diseases in the nineteenth century and, in an advanced stage, caused infection of the nervous system, followed by evident personality changes. Advocates of moral therapy and asylum reform had expressed confidence in treatment and environmental manipulations. By the middle of the century, the accumulation of long-stay cases in asylums, and attention to the family background of patients, suggested that psychopathic traits could be transmitted from parents to their children. The most common way to explain insanity in the second half of the 19th century was through so-called "degeneration theory". This theory, as used by 19th century psychiatrists, is hard to define because it is vague and general. To put it simply, degeneration theory implied a hereditary and biological model of insanity.

Degeneration appeared as an idea before the 19th century.

Buffon used of the term degeneration to explain the variation of species in the 18th century and Blumenbach also spoke about "degeneration" in relation to the human species.

Blumenbach believed that all varieties of the human race were degenerated from the Caucasian race. Both Buffon and Blumenbach used the term "degeneration" to mean variation. In 19th century psychiatry, however, degeneration meant more than this. It was more like a "deviation from the normal type".

Darwin’s work on evolution and heredity made evident the potential for retrogression as well as evolution. Darwin"s idea was that because of natural selection, only the fittest survived. However, the entire process of eevolution implied that mankind"s development was no longer fixed and certain. Mankind"s development could evolve or degenerate into an unknown future. In Darwinian terms, evolution did not necessarily mean progress and improvement.

In the second half of the 19th century, phenomena like madness, criminality, and diseases made people think that civilization did not bring necessarily progress. Cities seemed to have specific forms of diseases, crimes and disorders and medical men wondered how to explain these diseases and criminality. Why had insane people survived the process of evolution?

People began to think that modern society presented many examples of regression. The popularisation of the theory of degeneration, both within medical writers and amongst the general public, spread the alarming idea that civilisation was nothing more than a fragile phenomenon, and that civilised man might still "go ape".

France

The concept of degeneration to explain mental disorders originated in France. Since the 1850s,

Jacques Joseph Moreau de Tours (1804-1884) had emphasised the role of hereditary predisposition in the phenomenon of insanity. Moreau also believed that a hereditary predisposition to insanity could be recognised by certain signs or "stigmata" as they were called in psychiatry.

The psychiatrist that initially popularised the concept of degeneration was Benedict Augustus Morel (1809-1873). Morel was born in Vienna to French parents and received his medical education in Paris. As a poor medical student he earned his living giving private lessons in English and German. In 1839 he obtained his medical doctorate, and two years later became an assistant to the psychiatrist Jean-Pierre Falret (1794–1870) at the Salpêtrière. In 1856 he was appointed director of the mental asylum at Saint-Yon in northern France. Here, he combined political radicalism with Catholicism when approaching mental disorders. As with many men of his time, Morel was shocked at the increase in crime, sickness, and forms of insanities, and attempted to identify the underlying "natural forces" that shaped mental disorders. Morel was struck that many of his patients looked unusual and he noticed that asylum patients often had a special physiognomy. For example, he noted that some of his patients with mental retardation ("the cretins") had goitres. He suggested that psychological disorders, and generally all abnormalities of human behaviour, were an expression of an abnormal constitution in the organisms that displayed disorders. He believed that an abnormal constitution could be inherited and was subject to progressive evolution towards decay.

In 1857 he published Treatise on Physical and Moral Degeneration, which became highly influential in the second half of the 19th century. In this work he advanced the idea that there was an original perfect type of the human being and then defined degeneration as follows:

"Degenerations are deviations from the normal human type, which are transmissible by heredity and which deteriorate progressively towards extinction".

Therefore Morel understood "degeneration" as a "deviation from the normal type". Degeneration was considered to be a wide range of pathological alterations in this "normal human type", and such alterations were caused by the influence of environment and the actions of the parents on their offspring. Morel believed in the inheritance of acquired characteristics. For example, degeneration might start as an acquired characteristic: alcoholism, or dissolution in the slums of big cities. These vicious characteristics would the pass into the individual"s seed and be transmitted via heredity, worsening with each generation. Degeneration was a retrogressive process in which various factors such as diet, climate, disease, and moral depravities could weaken the human body, and such weakness passed from one generation to another and induced a high proportion of neurotics, criminals, and paupers in the next generation. The degenerative influence was especially transmitted to the third generation, which had a high number of insane, mental defectives, and monstrosities. This process gave way in successive generations to defects of a severe degree, producing sterility and the eventual extinction of the tainted family. A typically degenerating family might pass from mild nervous disorders such as hysteria or even headache, through alcoholism and narcotic addiction, then to prostitution, criminality, and proper insanity, ending in idiocy. This gradual worsening of the family tree happened because degeneration was subject to the "law of progressivity’: the first generation of a degenerate family might be merely nervous, the second would tend to be neurotic, the third psychotic, while the fourth consisted of idiots and died out. Because of this phenomenon, diseased families were becoming more frequent, and modern society was approaching extinction.

According to Morel, degeneration could be caused by: 1.intoxication (malaria, alcohol, opium, epidemics, food poisoning); 2. social milieu; 3. pathological temperament; 4. mental sickness; 5.inborn or acquired damage; 6. heredity. The combined effect of physical and mental injuries was particularly dangerous. By means of a very hazy and vague concept of "hereditary predisposition", Morel was able to attribute the most diverse illnesses in one generation to the occurrence of quite different illnesses in the next.

The degenerative illness par excellence was insanity, although Morel admitted the existence of a small number of mental illnesses that were not degenerative. Morel described four main classes of mentally ill people who were affected by degeneration:

1. Persons of nervous temperament, i.e. neurasthenia; hysterical women and even eccentric people.

2. Persons who have unimpaired intellectual processes but who have a disturbance of their feelings and impulses, and consequently great defects and perversity in their behaviour. This was the problem of moral insanity (see Pritchard, previous lecture). Degeneration was largely understood as a failure of the will to command the senses: modern man was increasingly perceived as a slave of physical desires.

3. "Imbeciles" with defects of the intellect so that instincts hold sway over understanding.

4. "Idiots", in whom the entire mental development is extremely low.

Morel also believed that people affected by degeneration had some stigmata of degeneracy: i.e. distortion of the ear shape, facial asymmetry, supernumerary digits, high-domed palates, etc. These physical manifestations of degeneracy also had psychological parallels.

Use of phrenology and physiognomy

By using degeneration theory, Morel seemed to attempt to explain almost the entire range of psychopathology, although he based this concept of degeneration originally on the more obvious and severe forms of mental deficiency.

In the phenomenon of degeneration the body, mind and environment of the mentally ill interacted in a complex way. A man could begin being affected by degeneration because he lived in a bad environment, which was then passed on to his child, who was inevitably mentally ill, and so on. Degeneration affected the entire individual"s constitution. The degenerate was an individual whose entire constitution was tainted, from his body and brain to his feelings.

As mentioned, the idea that mental disorders were hereditary was not new. We have seen that Pinel believed this too. Why then did this degeneration theory become the dominant explanation of mental disorders, and deviation in general, in the second half of the 19th century?

1. General medical practitioners questioned the scientific value of moral treatment, and psychiatry in general. They were pointing to people like Tuke in England, who was not even a physician but who was practising moral treatment. Psychiatrists adopted degeneration theory because they thought it provided a scientific explanation for mental illness. 2. In the second half of the 19th c. many psychiatrists realised that moral treatment did not work in all cases and most of the time they were unable to treat mental disorders. Psychiatrists realised that they could not help all patients through psychological therapy. Soon, it became the patient"s fault. There was either a physical reason for which the patient couldn"t be cured (for example, idiocy or cretinism), or it was an underlying, inborn reason (what we would not call genetic, although this term is much, much later). To support this new idea that it was the patients" fault they could not be cured, psychiatrists referred to degeneration theory. In this way, psychiatrists were justifying their inability to treat mental disorders because: if mental disorders were part of the individual"s constitution, psychiatrists could do very little to help that person. What they could do, however, was to try to prevent the spread of degeneration in society. 3. Psychiatrists were attracted to the concept of hereditary degeneration because such a theory could virtually explain all forms of mental disorders. The whole constitution, the degenerate"s constitution, became especially handy when psychiatrists found it impossible to demonstrate that there was a single physical cause in each individual case of madness. As we will see later when we go through the case history of a degenerate (case 21 Krafft-Ebing"s Psychopathia Sexualis), psychiatrists in the second half of the 19th century often did not even attempt a therapy when they thought that an individual was affected by degeneration. (compare Pinel"s case histories with Krafft-Ebing"s case history n. 21). 4. The doctrine of degeneration was also favourably received in contemporary psychiatric circles because it offered a simple explanation for all the major problems being addressed by research into the causes of mental illness.

In each country, Morel and degeneration theory had their advocates.

Britain

In Britain the main supporter of degeneration theory was Henry Maudsley (1835–1918). He was a prolific medical writer, and, as with many psychiatrists of his time and Morel"s, he believed that mental disorders were hereditary. Already in 1867, in his Physiology and Pathology of the Mind, Maudsley had discussed degeneration. At the time Maudsley believed that degeneration did not pose a serious threat to social progress because it could only engender its own eventual extinction. The mad and the unfit were the "inevitable spin-off in the process of the evolutionary struggle. By the time he published Body and Will in 1883, he argued that degeneration was the universal counter force of evolution. Degeneration was now a threatening phenomenon.

Maudsley is also famous for his critique of psychiatry. In the 1890s, Maudsley openly questioned whether psychiatrists were doing more harm than good. He believed that asylums could not treat mental disorders and that for poor people, public asylums were the cheapest solution. For rich people, private asylums provided the necessary control to ensure the insane individual did not hurt himself, but they could not provide any therapies. In many cases, asylums actually made patients permanently worse: the confinement, the monotony, the lack of stimulation and occupations, and the absence of family made the patients worse, rather than better. He criticised the abuse of sedatives to treat the insane, which were only a "chemical restraint", because they did not help the patient to recover. Instead, he favoured the treatment of insanity under medical supervision outside of an asylum, and he even opened a few private clinics where he treated rich people. These patients did not live in his clinics; they merely came in for regular visits.

Italy

Cesare Lombroso (1836-1909) was a psychiatrist who first began publishing his theories regarding the criminal type, which was linked to Morel"s degeneration theory. In the extreme, he maintained that there is a born criminal, whose behaviour was determinded by his heredity. He explained phenomena such as insanity and criminality through "atavism", which was a version of degeneration. Atavism was thought to be the tendency to reproduce ancestral types in plants and animals, and, where humanity was concerned, to resemble one"s grandparents or great-grandparents more than one"s parents. Atavism was a reversion, a "throw back’, so to speak.

He extended Morel"s list of the "stigmata of degeneracy", and felt that there was a correlation between the type of insanity/crime and the physical variations of the degenerate. Degenerates, or people affected by atavism, were characterised by enormous jaws, high cheek bones, highly arched eyebrows, solitary lines in the palms, extremely large eyes, and handle-shaped ears, as well as various moral deformities like the propensity for excessive idleness, a love of orgies, and craving for evil for its own sake. These features were all signs of a form of primitive existence which normal men and women had moved beyond, but which the criminal was condemned to relive. In his physiognomy, as in his psyche, the criminal and the insane bore the traces of humanity"s history and development.

Germany

While in the first part of the 19th century French psychiatry dominated in Europe, in the second half of the 19th century Germany became known as the leader in European psychiatry. In the 19th century, Germany had developed prominent asylums as in France and Britain, but German psychiatry, along with medicine, was chiefly associated withuniversities and their research-oriented medicine. In order to be able to teach in a German university, a doctor had to take the "habilitation", which involved publishing a substantial piece of research and making a serious contribution to accepted knowledge. The country possessed more than 20 separate universities, all competing with each other for scientific advancement.

Unlike asylum superintendents in France or Britain, the top university psychiatrists in Germany did not live with their patients night and day. German psychiatrists" main goal was not therapy. The goal of German university psychiatry was the scientific understanding of psychiatric disorders through systematic observation, experimentation and dissection. In Germany and Austria, the physical or organic approach to psychiatry was particularly strong. This meant that the mind was understood to be a function of the brain, and disordered emotions, reason, and will power could be localised in separate areas of the cerebral organs and nervous system. Laboratory medicine was very strong in Germany, and psychiatrists followed the examples of laboratory medicine here. German psychiatrists focussed on the study of brain anatomy, neurophysiology, and biochemistry. The clinical-pathological method, which was general to the whole of medicine, dominated in Germany. This approach was circular. The cause of a patient"s symptoms before his death was looked for during an autopsy, and then the findings from the autopsy were then again tied to symptoms when observing the next patient.

One of the most prominent German psychiatrists was Wilhelm Griesinger (1817-1868), who was a strong supporter of university psychiatry. In 1865, Griesinger was appointed professor of psychiatry at the famous Charité hospital in Berlin, where he established the modern model of the psychiatry department. Psychiatrists at the Charité were dedicated to researching and teaching, rather practicing psychiatry in an asylum. The physician had to be trained as a scientist and psychiatrists who trained at the Charité had to practice general medicine and then psychiatry. The Charité, as with other German clinics, was a teaching facility: patients were shown to medical students and discussed on ward rounds, and they were the subjects of lectures.

Griesinger was a materialist and thought that mental disorders were brain diseases. The body, brain and mind were seen as one organism. He also thought that, generally speaking, different mental disorders were accompanied by different cerebral lesions and he tried to strengthen the link between neurology and psychiatry. His emphasis on mental disorders as brain diseases encouraged brain pathology research, which aimed at finding the physical location of mental disorders. Generally speaking, Griesinger believed that mental diseases were typically progressive, moving from depressive states to more mentally disturbed

conditions. The underlying organic abnormality would begin with excessive cerebral irritation, leading to chronic, irreversible patho-anatomical brain degeneration, and ending in the disintegration of the self, commonly in chronic mania and dementia. Amongst predisposing and precipitating causes of mental disease, he mentioned heredity, brain inflammation, anaemia, head injury and acute febrile disease. The underlying idea was that mental disorders tended to worsen, to degenerate.

Much of the intellectual effort of German psychiatry was devoted to "nosology" – or the classification of disease, rather than finding a cure. German psychiatrists like Griesinger were famous for their classifications of mental disorders, but this kind of work is perhaps best represented by the work of Richard von Krafft-Ebing. Born and educated in Germany, in the late 1860s Krafft-Ebing was a staff psychiatrist at the Illenau asylum in Baden. In 1874, he became the director of the provincial asylum in Graz, Austria, and then professor of psychiatry at the university there. During the 1880s he held the chair of psychiatry in Vienna and in 1879 he published his Textbook of Insanity, which became the German bible of degeneration theory. As with Griesinger, Krafft-Ebing believed the mental disorders were caused by the cerebral organs. Krafft-Ebing associated degeneration with the lack of control of the higher faculty, with what early 19th century psychiatrists had called "moral insanity". Epilepsy, abuse of alcohol, morphine and immorality were examples of what could cause lack of control of the brain"s higher faculty. Ultimately, degeneration was a lack of control of one"s will power. German emphasis on the classification of diseases created a plethora of new labels, especially around the sexual sphere. In 1886, Krafft-Ebing published, Psychopathia Sexualis, which became his best-known work. In this book Krafft-Ebing created labels that are still used today, although some are used in a different way.

Psychopathia Sexualis – Table of Contents

The sexual psychopath was considered to be the prime example of degeneracy. During the last 3 decades of the 19th century, psychiatrists such as Krafft-Ebing coined new psychiatric categories. These included "sexual inversion" (homosexuality) (1869, Westphal) "masochism" and "sadism" (1890, Krafft-Ebing), "paedophilia erotica" (Krafft-Ebing, 1896), and "fetishism (1887, Binet). During the second half of the 19th century, no other aspect of human experience was as closely tied to the concept of degeneration as sexuality. On the one hand degeneration was associated with lack of control of willpower; degenerates were prey to their passions because they were unable to exercise their free will to keep them in check. On the other hand, non-reproductive sexual practices (i.e. masturbation) were believed to contribute to the moral, physiological and mental deterioration that was thought to be afflicting European populations. Pathologies, especially those of cities, were often characterised by physical and moral corruption, and accompanied by uncontrolled emotional states. Through the theory of degeneration, sexual perversions came to be regarded as part of a wider spectrum of hereditary pathologies, which also included criminality and insanity.

Sociology:

In the field of sociology, the idea of degeneration was most forcefully adopted by Max Nordau (1849-1923) in the early 1880s. Relying mainly on the concept advanced by Morel and Lombroso, Nordau maintained that degeneracy and neurasthenia were becoming

increasingly prevalent among the "upper strata of the population; that a severe mental epidemic was in progress. In his work he attacked Nietzsche, Oscar Wilde, Ibsen, Tolstoy, Richard Wagner, Zola, and Walt Whitman as example of degenerates.

Literature:
Bram Stoker: Dracula

(1987)

Robert Louis Stevenson: The Strange Case of Dr Jekyll and Mr Hyde (1886)

Emile Zola: Germinal (1885) & Nana (1880)

Stoker"s Dracula makes explicit reference to 2 key figures in the debate of degeneration – Lombroso and Naurdau. Part of Dracula takes place in London, a metropolis where degeneracy was easily spread, a place full of criminals and diseases. Dracula"s physical characteristics were those typical of the degenerate: abnormal ear shape (pointy), feminine looking, and with animal characteristics etc. One of the main protagonists is Van Helsing, a physician who fights Dracula, the vampire. Dracula is "undead"; he cannot die, but must go on, age after age, adding new victims and multiplying the evils of the world. Degeneration could not die, it could not be treated. The degenerate was a kind of social vampire who corrupted the nation.

Recommended Readings

1. Primary Sources

Lankester, Edwin Ray, Degeneration: A Chapter in Darwinism (1880). http://www.archive.org/details/degenerationach00lankgoog

Nordau, Max, Degeneration . [1892] (1895). http://www.archive.org/details/degeneration00nordgoog

2. Scholarship

Chamberlain, J. Edward, and Sander Gilman (eds.), Degeneration: The Dark Side of Progress (1985).

Dowbiggin, Ian, Inheriting Madness. Professionalisation and Psychiatric Knowledge in Nineteenth-century France (1991).

Dowbiggin, Ian, 'Degeneration and Hereditarianism', in Bynum, Porter & Shepherd (eds), Anatomy of Madness, vol. 1 (1987).

Foucault, Michel, The Will to Knowledge. History of Sexuality, vol.1 (1990).

Hekma, Gert, "A Female Soul in a Male Body": Sexual Inversion as Gender Inversion in Nineteenth-Century Sexology', in Herdt G., Third Sex, Third Gender: Beyond Dimorphism in Culture and History (1994).>

Henkin, Leo J., Darwinism in the English Novel 1860-1910: The Impact of Evolution on Victorian Fiction  (1963).

Huertas, Rafael and C.M. Winston, 'Madness and Degeneration: From "Fallen Angel" to Mentally Ill', History of Psychiatry   3 (1992):  391-411.

Hurley, Kelly, The Gothic Body: Sexuality, Materialism, and Degeneration at the Fin de Siecle (1996).

Martindale, Colin, 'Degeneration, disinhibition and genius', Journal of the History of the Behavioral Sciences, 7 (1971): 177-82.

Morris, Andrew R., 'Oscar Wilde and the Eclipse of Darwinism: Aestheticism, Degeneration, and Moral Reaction in Late-Victorian Ideology,' Studies in the History and Philosophy of Science , 24 (1993): pp. 513-40.

Morton, Peter, The Vital Science: Biology and the Literary Imagination 1860-1900. (1984).>

Nye, Robert A., Crime, Madness and Politics in Modern France: The medical Concept of National Decline (1984).

Oosterhuis, Harry, Stepchildren of Nature: Krafft-Ebing, Psychiatry, and the Making of Sexual Identity (2000).

Daniel Pick, "Terrors of the night": Dracula and 'degeneration' in the late nineteenth century', Critical Quarterly , 30 (1988): pp. 71-87.

Pick, Daniel, Faces of Degeneration: A European Disorder, c.1848-c.1914 (1989).

Andrew Scull, Charlotte MacKenzie and Nicholas Hervey, Masters of Bedlam (1996) see chapter on Maudsley.

Soloway, Richard, 'Counting the Degenerates: The Statistics of Race Deterioration in Edwardian England,' Journal of Contemporary History , 17:1 (1982): pp. 137-64.

T. Turner, 'Henry Maudsley', in Bynum, Porter and Shepherd (eds), Anatomy of Madness, vol. 3.

Walter, Richard, 'What Became of the Degenerate? A Brief History of a Concept,' Journal of the History of Medicine and Allied Sciences , 11 (1956): pp. 422 - 29.

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