Author: HHS Contributor

Alfred Freeborn (Max Planck Institute for the History of Science) was awarded the 2024 History of the Human Sciences Early Career Prize for his essay ‘Testing Psychiatrists to Diagnose Schizophrenia: Crisis, Consensus and Computers in post-war Psychiatry’. The article is forthcoming in the journal. We asked him some questions about the winning text and his future research.

History of the Human Sciences: Congratulations on winning the Early Career Prize. Could you begin by briefly introducing your winning article, situating it in the context of your broader research project?

Alfred Freeborn: My current project looks at the history of psychiatric epidemiology and medical statistics in the 20th century in order to understand how mental health became the global field it is today. I seek to explain how the place and meaning of diagnosis in psychiatry fundamentally shifted in this period from being an act of detective-like intellectual synthesis to something more like automated pattern recognition and statistical analysis. In my article I show how the availability of certain technologies, such as mainframe computers and videotapes, enabled new ways of experimentally dissecting and reassembling the diagnostic procedure, ultimately laying the ground for a new way of evaluating the quality of the diagnostic data produced both in mental hospitals and in research. In a nutshell, the epistemic threshold of psychiatric diagnosis was massively lowered in order to secure professional consensus, and the purpose of diagnosis was increasingly understood as a tool for surveying populations, rather than the identification of natural disease entities.

HHS: What was the US-UK Diagnostic Project (DP) (1965-1975) and how did you come to be interested in it?

AF: The DP was a series of important studies comparing how psychiatrists in these two countries diagnosed people experiencing psychosis, in order ultimately to test the trustworthiness of mental hospital statistics. The basic idea was to take two mental hospitals, one in Brooklyn and one in London, and install a small group of psychiatrists trained to use a standard diagnostic procedure at both. These psychiatrists would diagnose new patients over a set period of time and their results would be compared with the local hospital statistics. The findings revealed that while the local hospital statistics showed more cases of schizophrenia in Brooklyn, the trained psychiatrists from the DP diagnosed more or less the same number in each hospital. In addition to this, a set of patient interviews were videotaped and shown to large audiences of psychiatrists in both countries who were then asked to make a diagnosis. The results in some cases were really dramatic: for one patient, known as Patient F, three-quarters of the American psychiatrists diagnosed schizophrenia, compared with almost none of the Brits. I first really took interest in the DP while working in the UK National Archives with records of the Medical Research Council when I discovered some early exchanges between the American and British sides of the project.

HHS: How is the DP usually remembered by psychiatrists and/or historians?

AF: Among psychiatrists the DP is remembered as a famous study in which the British collaborators undermined the professional credibility of American psychiatrists. It is canonised in the cultural memory of modern psychiatry as having shown that American psychiatrists over-diagnosed schizophrenia. While historians take note of the DP, the US-centric historiography has by and large failed to dwell on the importance of this collaboration. Through my archival work I realised there was another dimension to the DP. While the Americans had the money, machines and manpower and were further along in doing psychiatric epidemiology than the Brits, there was no national system for collecting mental hospital statistics in the US. The UK’s National Health Service and the statistics of the General Register Office were therefore seen as a useful data set by researchers from the American side. The Americans had ambitious plans to establish a research centre for psychiatric epidemiology in London and conduct studies with the UK census data but this was rejected by the Brits. I think the DP was not just an interesting episode in understanding how psychiatric diagnosis works, but was part of a broader struggle over how psychiatry would be reconfigured as a public health problem in the postwar era. In other words, as a struggle over who would count as an expert in the evaluating and planning of the new community care services as mental hospitals started to be closed. 

HHS: How did the DP influence diagnostic reform in psychiatry?

AF: Key players in the DP went on to reform both the International Classification of Diseases (ICD) and the American Diagnostic and Statistical Manual of Mental Disorders (DSM) and in the latter case the DP’s results were used as leverage to replace psychodynamic concepts with ostensibly testable and statistically reliable diagnostic criteria. I also think the focus on schizophrenia in the DP had an impact. On the one hand, the DP was about enabling reliable comparisons of local and national statistics, and the focus on distinguishing schizophrenia and affective psychoses was in response to increasing evidence that lithium salts helped treat mania but not schizophrenia, therefore distinguishing these two disorders had real therapeutic implications. But the DP was also strategically designed to capture the difference between American and British psychiatrists. The very design of the DP Project aimed to highlight and showcase the psychodynamic approaches to diagnosing schizophrenia which were dominant in New York at the time and, unsurprisingly to everyone involved, it was successful in revealing that these psychiatrists in New York did things rather differently than the psychiatrists in London.

HHS: Could you introduce Aubrey Lewis and Morton Kramer and explain the significance of their ‘competing interests’ for your arguments?

AF: So Aubrey Lewis was probably the most influential psychiatrist in postwar Britain: he was clinical director of the Maudsley Hospital in south London and the first professor of psychiatry (from 1946 to 1966) at its medical school, renamed the Institute of Psychiatry in 1946. The hospital and medical school became the leading centre for a methodology-focused form of social psychiatry. Maudsley psychiatrists, led by Lewis, prided themselves on taking meticulously detailed patient case histories and avoiding the theoretical excesses of both organic and psychodynamic approaches. Morton Kramer in contrast was a stats guy. Kramer became Director of the Biometrics Branch of the US National Institute of Mental Health in 1949 with no experience of psychiatry, having been trained in statistics and epidemiology. He was perceived by his more clinically engaged colleagues as a serious epidemiologist who was focused strictly on data about populations, lacking perhaps the concern for the individual patient.

These two figures were by no means the only players in shaping the DP, but I show how their different perspectives on how to reform diagnostic classifications reveal an ongoing tension in our attempts to standardise psychiatric diagnosis. Lewis argued that reliable statistics would only be possible if psychiatrists working across the NHS could be convinced to take diagnosis seriously and use careful and detailed methodology. Kramer argued that a field trial was necessary to create public trust in psychiatrists and that the diagnosis of schizophrenia was the most suitable test case for this task since there seemed to be sufficient consensus on this issue. The DP was a synthesis of these two interests: the Maudsley consensus was used to establish a trustworthy gold standard for schizophrenia diagnosis. But the tension between these two interests endured, as I argue that the creation of these standards in the long run alienated the diagnostic intelligence of the psychiatrist and reduced the role of the expert diagnostician.

HHS: What role did computers and videotapes play in the story your article tells? What does this reveal about the relationship between technology and psychiatry?

AF: There is a wonderful passage I cite in my article where Aubrey Lewis talks about fighting for the “diagnostic souls” of psychiatrists in order to make sure they do not simply apply labels but produce careful and accurate diagnoses. For me, this is a rejection of the idea that psychiatric diagnosis can be treated purely as a technology: it is a recognition that the psychiatrist is as much part of the process of diagnosis as the particular tool they use. The videotape and the mainframe computer were deployed in the experimental dissection of psychiatric diagnosis into two parts: recording mental symptoms and applying a diagnostic algorithm. Both offered analogues for an idealised scenario in which psychiatrists would all observe the same symptoms when interviewing the patient and reliably apply the same diagnostic decision-making tree. In this scenario, the theoretical differences between individual psychiatrists and their concepts of mental disorder were made into comparable statistical differences. Using videotapes to train psychiatrists to diagnose is now completely standard practice. Computers not only enabled the application of totally reliable diagnostic algorithms, but more work intensive forms of statistical analysis to try and identify new clusters of mental symptoms and potentially improve existing classifications. However, by the mid-1970s this approach had already proved more or less a dead end. While engagement with these statistical methods led psychiatrists to re-describe diagnosis as a type of statistical analysis, in reality they made little impact on actual diagnostic classifications, which reflected consensus positions reached by committees of psychiatrists like those in the DP.

HHS: Why was ‘schizophrenia’ such a contested diagnostic category?

AF: In a fundamental sense, schizophrenia or dementia praecox has always been a contested category since its inception as a disease concept at the end of the 19th century; it is more like a set of competing yet overlapping concepts with vague boundaries than a stable or singular entity. But in the 1960s the diagnostic category became the focus of public controversy for several reasons: neo-Freudian, existential and social psychiatric ideas became dominant and challenged older views of schizophrenia as an inherited brain disease; numbers in mental hospitals peaked in the 1950s leading to overcrowding and awful conditions for patients while the mass media was filled with reports from within asylums; the new social movements grew around patient rights and so on. This story is well known by historians of psychiatry. But while most historians have tended to agree with contemporaries that schizophrenia had become a catch-all term under the influence of psychodynamic theories, I turn this on its head by suggesting that in fact in the UK there was widespread consensus on the important symptoms involved in diagnosing schizophrenia.

What do you mean by the ‘methodological imperialism of the Maudsley’?

AF: The phrase first occurred to me when interviewing the American psychiatrist William Carpenter Jr. about his time working on the WHO International Pilot Study of Schizophrenia (1965-1973), a study which used many of the same methods developed in the DP. He recalled how as a young psychiatrist he was deeply impressed and intimidated by the Maudsley psychiatrist John Wing’s knowledge of German psychopathology and that Wing reminded him of Colonel Nicholson from The Bridge on the River Kwai (1957). This comparison really stuck with me. In the film the Colonel orders his men to build a bridge for their Japanese captors in order to maintain their morale and professional image as soldiers, but in the process lets his enthusiasm for this technical project and following the rules obscure his sense of the bigger conflict and values. Looking at the longer history of diagnostic reform in psychiatry and its failure to identify valid disease concepts or lead to better treatments, the comparison is striking. In this article I wanted to use the phrase to evoke how the methodological authority of the British psychiatrists in this period was perceived by their American colleagues. I think there is something more to say here analytically, but that will have to wait for another paper.

HHS: What do you conclude was most historically significant about the DP?

AF: The argument I am making in the article concerns in particular how psychiatric diagnosis was evaluated: it describes changes in methodological concepts, rather than changes in everyday clinical practice. This is not because I am not interested in clinical practice, but that I think too often historians gloss over the difficulty of actually making generalisable claims about diagnosis in clinical practice. The historian seeking to make such claims must make use of the statistical data from the time and faces the same methodological challenges as their historical actors who doubted the accuracy of these numbers. Other historians have already argued that the real changes in diagnostic practices in the UK and USA were most likely shaped by changes in health insurance and pharmaceutical companies, not the official classification systems. What I think is important is that the DP showed that to create reliable statistics on psychiatric diagnosis required small groups of trained psychiatrists conducting lengthy and detailed interviews, and this approach was clearly not suitable for everyday clinical practice. Rather than solve the problem of whether we can trust mental hospital statistics, the DP helped usher in a new way of evaluating psychiatric diagnosis in statistical terms – the tensions of which remain with us today.

HHS: Finally, I wonder if you could briefly discuss what you’re currently working on and what your next project might be?

I recently hosted a conference in Berlin on the history and legacy of the WHO studies of schizophrenia which was a wonderful experience: we not only had historians of psychiatry, but anthropologists, philosophers and psychiatrists from the field. I am now working on turning that into a collected volume. I am also currently working up revisions on my first monograph Biomedical Madness: Schizophrenia and the Making of Biological Psychiatry which will hopefully appear with University of Chicago Press next year. As in my article, which is based on a chapter from the book, I use the British context to develop new perspectives on the history of postwar biological psychiatry. 

Interview by Hannah Proctor.

Libby O’Neil (Yale University) was awarded the 2024 History of the Human Sciences Early Career Prize for her essay ‘Thinking in Systems: Problems of Organization at the Center for Advanced Study in the Behavioral Sciences and the Society for General Systems Research, 1950-1957’. The article is forthcoming in the journal. We asked her some questions about the winning text and his future research.

History of the Human Sciences: Congratulations on winning the Early Career Prize for your article ‘Thinking in Systems’. Could you begin by briefly introducing your winning article, situating it in the context of your broader research project?

Libby O’Neil: The article emerged from a chapter of my dissertation that I’m working on right now. My broader dissertation project is called ‘The Sciences of Unity: Organicist Systems Thinking Between Vienna and the United States’. My project is trying to trace a series of questions about the unity of science, about reductionism and holism, the mind-body problem and the nature of life across the 20th century. I do this by focusing on the careers of several Central European émigré scientists and philosophers. Part of my method has been to follow around Ludwig von Bertalanffy, who appears in my paper. He’s an idiosyncratic figure, who, I think, has been relatively understudied in the English language history of science literature because he was didn’t fit into the disciplines very traditionally. This has taken me to several interesting places, and one of those places is the Center for Advanced Study in the Behavioral Sciences at Stanford, where he was one of the 1954-1955 research fellows.

In 2023, I spent a few weeks in Palo Alto working with the archival collections there, which is currently held at Stanford Special Collections. That’s when I started thinking about trying to pair together the histories of the Ford Foundation’s Center for Advanced Study and the Society for General Systems Research. I argue that both were important for thinking about interdisciplinarity and the organization of the sciences, especially the human and social sciences, and that both were looking for ways to scale between the social scientific laboratory and the national or international system. In both cases, I highlight a reflexive turn that came up during the study of these problems of organization. Both groups found that the most ready to hand laboratory for studying organization was their own organization.

HHS: How would you define ‘general system theory’ and how did you come to be interested in this?

LO: There were a lot of different interdisciplinary programs that were using the phrase ‘systems theory’ in the US around 1950. It is often tied to cybernetics by historians, for good reason. But while introducing his ‘general system theory’ or Allgemeine Systemlehre to American audiences in 1950, Bertalanffy claimed a slightly different genealogy for systems theory that drew on his training in philosophy and theoretical biology in interwar Vienna. His thinking about interdisciplinarity emerged from his study of biological growth and dynamic equilibrium. Although there are many varieties of systems theory, and a lot of them do emerge out of interdisciplinary wartime research, Bertalanffy offered a slightly different genealogy that created productive tensions within the American context.

HHS: What was the role of the Ford Foundation in shaping work in the behavioural sciences (via the creation of the Center for Advanced Study in the Behavioral Sciences)? How did this fit within the broader context of social scientific research at this point in the period?

LO: I think something I’m always struck by when I’m reading the writing of a lot of my actors is this really close relationship they draw between the atomic bomb and the social sciences. There was simultaneously hubris and anxiety around the relationship between science and society. The Ford Foundation was one of several institutions that saw reforming the social scientific research apparatus as the key to managing some of these tensions. Beginning in the late 1940s, the Ford Foundation carried out studies of various universities, looking at their training for social scientists, human scientists, behavioural scientists and trying to understand what the gaps were. This was related to the Ford Foundation’s “Area Five” of their overall research program, which focused on interventions within the sciences to promote human welfare.

A lot of this history has been detailed by other historians. Historians like Mark Solovey, Hunter Heyck, and Jamie Cohen-Cole, for example, discuss the Ford Foundation in the broader context of social scientific funding by foundations during this time, for example. But what I focused on is how they specifically came to decide in the early 1950s that they needed a dedicated centre where they could offer advanced training for social scientists. During the planning process, foundation officials had all these arguments about the tension between humanists and scientists within the academy. Throughout there was tension between quantitative and qualitative work and explicit debate about what interdisciplinarity actually means. Is it a team with one sociologist, one anthropologist, one biologist, etc? Or is it a project that spans across the individual boundaries of disciplines? That’s the context in which they decided to found this centre. My archival work reveals how some of those tensions really persisted throughout the first few years of its operation.

HHS: You’ve spoken a little already about Ludwig von Bertalanffy. Could you introduce Kenneth Boulding and describe what was distinctive about the work they did together.

LO: Boulding is a fascinating figure. He was born to a fairly working-class family in England but ended up attending Oxford, where he studied philosophy and economics as an undergraduate. He came to the attention of John Maynard Keynes and Joseph Schumpeter early in his career and spent time at the University of Chicago and at Harvard. He also became deeply involved in the Society of Friends and Pacifist activism. Boulding spent most of his career in the US — he would say in interviews that because of his working-class background he felt more comfortable in the US, rather than in British academia. His wife, Elise, is also an interesting figure. She was a peace activist who earned a PhD in sociology and worked closely with Margaret Mead in the sixties and seventies.

Boulding wrote The Organizational Revolution in 1953 (with support from the Rockefeller Foundation and the National Council of Churches). In this book, he considered a wide variety of organizations, from labour unions to churches, and analysed them using concepts like homeostasis, feedback, hierarchical order. This work brought him to the attention of the Ford Foundation. In the early 1950s he began corresponding with Bertalanffy, who’d recently published an article in Science where he talked about his general system theory. After Boulding was recruited to the Center, he wrote a last-minute recommendation for Bertalanffy to the board, where he says – to paraphrase – that ‘other biologists think Bertalanffy is something as a crackpot but as a fellow crank I have strong fellow feeling with him’. Incredibly this recommendation letter got Bertalanffy invited to the Center and that’s the start of their official collaboration. Throughout their time at the Center, they worked together closely with a few other fellows to put on various workshops, lectures, and seminar series on general system theory, trying to recruit people from across the disciplines, to think in their particular way about how to bridge the gaps across the disciplines.

HHS: How did social scientists at the Center define ‘problems of organization’ and why was this such a conceptually complicated and controversial topic?

LO: The phrase ‘problems of organization’ is both my own analytic term and something my actors used in their writing. When I was working in the archive, I was reading through a folder where they had the statements that each fellow had written out of their proposed activities. I read through dozens and dozens of descriptions of how they’re going to reorganize their own discipline, or how they’re going to unify across the disciplines. This led me to write in my own archive notes a little paragraph about how it seems that problems of organization are the through line between all the different projects that the fellows were bringing. There was a blend of both hubris and anxiety where they both believed they could come to understand the nature of organization, and that it was crucial for our society to do so, and to enact those principles in the world.

I saw a consistent desire to understand organization as almost a philosophical, teleological concept. But at the same time, there was a slippage many of these writers made between organization as an abstract concept and concrete organizations (like businesses, institutions, centres for advanced study, etc). I think the key for the Ford Foundation was to move between these two levels, to find ways to think about organization in general that allowed them to scale between different kinds of organizations, so they could pursue their

poorly defined goal of human welfare in the world.

HHS: What was the General Systems Yearbook?

LO: The General Systems Yearbook was one of the main interventions that the Society for General Systems research made. They framed it as a communication tool. Early members of the Society for General Systems Research all agreed that they needed a way to help promote interdisciplinary, to help overcome the strict specialization within the sciences, to overcome the barriers of jargon and specific words. But they weren’t quite sure how to do that. There was a feeling that there were already too many interdisciplinary conferences. Many of the early members had been to the Macy conferences, and were a little unsure as to whether that had been a helpful experience. There were also too many new journals to keep up with. The goal for the General Systems Yearbook was not to solicit new articles, but to collect articles from across the discipline that were relevant to general systems theory. They imagined the Yearbook as a tool for interdisciplinary communication that would allow interested scientists to keep up on the literature without having to read dozens of journals across multiple fields. It’s been published yearly in one form or another since 1956.

HHS: You emphasise the ‘disunity’ of systems thinking in the case study you focus on – what is significant about that argument / how does it depart from the existing scholarship on systems thinking in this period and how does it relate to questions of interdisciplinarity?

LO: This is one of the themes that I’m interested in pursuing in the dissertation overall. My project’s working title is ‘The Sciences of Unity’, which is trying to invert the unity of science to understand the multiple ways human and physical scientists studied unity in the 20^th century. Systems theory is a unifying program that shows up in a lot of really diverse contexts in the 20th century, including engineering, biology, literary theory, and anthropology. Although many people called themselves systems theorists and referenced the same founding figures, I saw real differences in the basic goals that different systems theorists had, the different metaphysical assumptions they had, and the different institutional and political purposes that they ended up serving.

My goal in this paper about the Center was to get really specific about this particular approach to systems theory and the unique models of organizations they were using. I think this is especially important for thinking about systems theory because it claims to transcend individual models. I think the task for historians of systems theory is to resist that totalizing impulse and to look for the particularities and the provincial aspects of the moments when people come together to say they’re doing systems theory.

Why was there this demand for systems theory in this idiosyncratic, weird environment of the Center? Why was it there that systems theory became popular? How were different people and institutions using systems theory for different goals? My hope in the broader project is to ask what gets left out when we generalize away from the specific.

HHS: Reading your article I wondered if there was something tricky to navigate methodologically when you’re writing something that’s a bit ‘meta’, in the sense that it’s a research project on research projects. How do you think about that?

LO: It’s something I’ve definitely thought about because I am studying scientists and academics who are doing really similar work to what I do. There are ways that the history of systems theory interacts with the history of the history of science. In the early 1970s, Bertalanffy actually became very interested in the work of Thomas Kuhn. He was on a panel at the American Historical Association with Kuhn and Christopher Lasch talking about cultures as systems, and he saw “paradigm shift” as a systems concept. There’s certainly a genealogy of the history of science that comes from systems theory. I don’t totally have a solution for the fact that I’m sort of studying my own discipline. My hope is that by doing this we can understand the conditions of knowledge production better. I do think this is a broader challenge, that in the history of science where we end up studying our own field in a lot of ways.

HHS: Finally, I wonder if you could briefly discuss what you’re currently working on and what your next project might be?

LO: My main focus is trying to finish the dissertation. The chapter that this paper is on based sits right in the middle of the dissertation, temporally. I’m moving in two different directions through time right now. On one hand, I’m both moving back in time to look at interwar Viennese philosophy of science and then the early days of cybernetics. On the other hand, I’m moving forward to look at how systems theory was taken up at the Menninger Clinic and in humanistic psychology.

Beyond the dissertation, what I would hope to do is to have some space to expand on some of the themes and questions that have emerged for me while I do this work that I don’t think will fit in the project. Specifically that’s been the really persistent recurrence of religious and spiritual language in these popular science, fictional and philosophical writings about science in the post-war era. There was a lot of collaboration between systems theorists and theologians. That is surprising to me, considering how we often think about the boundaries between science and religion. Thinking about popular science and science fiction as a way to understand the history of science has also been something I’ve been pursuing in my teaching at Yale. That’s the general direction I might move in; but we’ll see!

Interview conducted by Hannah Proctor. The discussion was edited for length and clarity.