Category: Book Reviews

Review: Social Science for What?

Mark Solovey, Social Science for What? Battles over Public Funding for the ‘Other Sciences’ at the National Science Foundation (Cambridge, MA: M.I.T. Press, 2020). 398 pp. $50.00 (pb). ISBN: 978-0-262-53905-0.

Lucian Bessmer, Harvard University

Social Science for What? is a remarkably detailed history of the National Science Foundation (NSF) from 1945 to the late 1980s that makes a compelling case for the influence of the Foundation on American social science. Those familiar with author Mark Solovey’s Shaky Foundations will recognize the care that he has put into presenting an account built on rich archival materials to “follow the money” in order to show the impact of what he calls the “politics-patronage-social science nexus” (10-12). Where Shaky Foundations examined how the Ford Foundation, the U.S. military, and the NSF shaped the social sciences, Social Science for What? delves deeper into the NSF in an attempt to address a gap Solovey identifies in the literature: the role of civilian agencies as patrons of social science. This in itself makes this book an important contribution to the large body of work on Cold War scientific patronage, which generally focuses on the relationships between science, the military, and intelligence agencies. But the more ambitious claim of Social Science for What? is that the NSF played a significant part in positioning the human sciences as participants in the “unified scientific enterprise” (12). Solovey argues that mimicking the methods and epistemic justification of the natural sciences may have enabled the social sciences to carve out a tiny redoubt in the NSF, but ultimately it created barriers to their health and development, disincentivizing the most beneficial aspects of these fields.

The book’s ten chapters offer a roughly chronological investigation of how stakeholders of the social sciences, both inside and outside of the NSF, sought to legitimize a collection of fields that were treated with skepticism at best and as a menace to American society at worst. Solovey crafts each chapter around a person, a set of legislative proposals or controversies, or the shifting organization and priorities of the social science division leadership at the NSF. Chapter 1 sets the stage with the first efforts to create the NSF in 1945. During the post-war period there was tremendous enthusiasm for science (and especially physical science) in the United States, creating an opportunity for prominent figures in the scientific community to advocate for additional federal support for basic physical science. Many of the most influential people spearheading this effort, such as Vannevar Bush, science advisor to President Harry Truman, doubted the relevance and rigor of the social sciences, but calculated lobbying led to the reluctant inclusion of the social sciences in the NSF, on the grounds that these fields were a nascent branch of a unified science. Chapter 2 follows Harry Alpert, the head of social science efforts at the NSF during the McCarthy era. In a time when social science was under intense scrutiny, Alpert chose a pragmatic approach to champion social science, described by his successor Henry Reicken as “underdogging” or “allying one’s cause with stronger others, in this case the physical and biological sciences” (56). Chapters 3 and 4 show how this further cemented the strategy of proponents of the social sciences at the NSF from the late 1950s to the late 1960s, with a continued effort to attract funding through the proximity to other more respected fields at the Foundation. Many scholars opposed this positivist approach, instead calling for a defense of social science through a demonstration of its unique strengths. Despite this criticism, leaders at the NSF sought to maintain legitimacy through scientism, actively working against attempts to separate from their aspirational peers such as the creation of a separate National Social Science Foundation (130). Chapter 5 shows how the combination of financial austerity and opposition from legislators in both the Democratic and Republican parties in the late 1960s and 1970s created a hostile environment for social science research at the NSF. Emblematic of this period was Senator William Proxmire’s “golden fleece,” which he awarded to the federal research that he saw as the biggest waste of taxpayer money – often NSF-supported social science research (146-155). Chapters 6 and 7 highlight the emphasis the NSF put on the “hard wing” of social science. This included “big science” work like the National Election Studies, and projects that incorporated economics methods and theories (195, 256). Chapters 7 and 8 bring us through the massive cuts to federal support of social science during the Reagan era, further driving the NSF to supporting only the “hardest” social science research.

The two final chapters directly address the through line of the book: The NSF played a major role in the post-war ascendance of a positivist case for the social sciences, one where research is objective, non-controversial, and above all, scientific enough to be a part of a unified scientific community. Those controlling the NSF’s purse strings perennially sought legitimacy through association with more respected fields, a choice that ultimately weakened, rather than strengthened, social science. Solovey closes with the recommendation that social scientists should seriously consider advocating for a separate national foundation. He acknowledges how unlikely it is for such an effort to succeed but argues that we should not make excuses “for resigned acceptance of the status quo” (316). This is a compelling argument, and this history of the social sciences at the NSF is strong evidence that the scientism approach has failed, but it is unclear who Solovey is trying to convince. He points to Congress and the NSF itself as obstacles to such a foundation, but what about rank-and-file social scientists?

Social Science for What? includes portraits of those in or closely tied to the NSF who were true believers in the unity of science, those that promoted scientism despite their private beliefs, and examples of the exclusion of left-leaning social scientists from decisions on the future of the NSF. An important part of this story is the choices made by departments that prioritized the “hard wing” of social science to legitimate themselves, and their legacy through the students that they trained, which could be addressed more explicitly in this study. Social Science for What? is an excellent book, and one that I am glad to have on my bookshelf, but it leaves open the question of where a new National Social Science Foundation would fit into existing efforts to buttress nuclear age social science. Perhaps the implications of the NSF’s impact on these fields further reinforces how patronage moulds social science, but are the biggest barriers to a better social science Congress, the NSF, and private sources of funding? I left this book wondering that if social scientists must abandon the positivist argument of their contribution, does the path forward involve convincing the people with the purse strings or should we rather convince our colleagues?

Review: The Sense of Movement

Roger Smith: The Sense of Movement. An Intellectual History (London: Process Press, 2019)

Sonsoles Hernández Barbosa, University of the Balearic Islands 

The Sense of Movement addresses bodily perceptions of movement over the last four centuries. The work begins by presenting philosophical debates about movement as a vital force which emerged in parallel with the birth of modern science in the seventeenth century, linking these with modern notions about the operation of the human brain. As the author points out, the study of movement and its conceptualisation involves setting up a dialogue between current and past understandings of the sense of movement.

Although The Sense of Movement begins with these reflections about the operation of the world of the senses connected with the scientific revolution in the seventeenth-century, some of its arguments reach back much further in time, specifically to the Aristotelian classification of the five senses. The very use of the expression ‘sense of movement’ implies a direct confrontation with the Aristotelian philosophical tenet, which held that movement could only be understood in relation to the sense of touch. Indeed, the extent to which we can refer to a sense of movement that is independent from touch is one of the main issues addressed by the book. Many of the historical difficulties raised by this issue are to do with the fact that the sense of movement and that of touch cannot be pinned down to a specific organ, insofar as the skin covers the whole body. Today, however, a conceptualisation of the senses that goes beyond the five traditional senses, including the perception of pain, temperature and even time, is widely accepted.[1]

Smith, whose areas of specialisation straddle the fields of philosophy and the history of science, argues that it was around 1800 that philosophy began to address the issue of human movement, when muscular motion was first recognised as a specific sense, distinct from touch. Charles Bell, who in an 1815 work referred to muscular sense as a sixth sense, played a pioneering role in this development. In another section of the book, however, Smith argues against the independent study of both senses – touch and movement – stating that the history of touch cannot neglect movement as a sense. In this, he follows the recent arguments of philosopher Matthew Ratcliffe, who considers movement part of the sense of touch. Thus, while in some parts of the book touch and movement are jointly considered, in others Smith makes a clear distinction between them.

In addition to the problematic distinction between the senses of touch and movement, the book deals with two additional thorny conceptual issues, ‘kinaesthesia’ and ‘proprioception’, which are not always used consistently even today. The former was introduced by the neurologist H. Charlton Bastian in the 1860s as a synonym for the ‘sense of movement’ but Smith prefers to use the term to refer to the ‘conscious awareness of one’s own movement’ (p. 193); ‘proprioception’, on the other hand, is used to allude to what the neurophysiologist Charles Scott Sherrington calls ‘the sensory nervous system, largely but not necessarily functioning without conscious awareness, central to the coordination of movement and posture’ (p. 10). Kinaesthesia, therefore, would imply conscious movement as opposed to proprioception, which involves a rearrangement of posture and movement that not always engages conciousness. As Smith points out, if we accept the existence of an embodied psyche this conceptualisation leads to an unsustainable dualism between body (unconscious) and mind (conscious) (p. 202). It is perhaps for this reason that other authors, in contrast with Smith, have preferred to understand proprioception as the perception of our muscles and internal organs.[2]

A final related aspect, which also hampers the imbrication of movement into traditional conceptualisations of the senses is the embodied conception of all sensorial impressions, which implies that all sensorial experiences mobilise more than one sense. In the same way that vision is embodied, the sense of movement does not depend solely on the muscles, but also on other mechanisms, such as retina images, the inner ear, tendons, joints, skin and other tissues, which means assuming the synesthetic character of all sensorial experiences.

Smith’s history of the sense of movement is a history of ideas. As such, the subject of study spans a number of fields, notably the history of science, the history of philosophy and the anthropology of the senses. The book is divided into fifteen independent chapters that could have been assembled into various sections in the table of contents, especially because some common threads readily come to mind, for instance that which links the postulates of natural science (Chapter 2) with thoughts on causality developed by natural philosophers in the eighteenth and nineteenth centuries (Chapter 5).

The mechanist consideration of the concept of force as movement – for instance through the principle of action-reaction – allows the author to situate this concept at the root of evolutionist ideas, thanks to the assumption among naturalists that living beings are subject to the same laws that rule over Nature . The application of this principle to the human body and the understanding of the process of evolution undergone by it emerged in the fields of naturalism and physiological studies (chapters 8 and 9). As a way of example, Herbert Spencer’s study of the phylogenetic evolution of the human body suggested the sense of touch, which includes muscular tension, as the most primitive of the senses, from which the rest of the body’s sensorial capacities derived.

Muscular effort, understood as an active force that poses resistance to events was a concept shared by scientists and idealist philosophers. The seminal nature assigned to the sense of movement in the development of the foundations of the self is a central aspect in philosophical thought that threads through the book, from Berkeley’s (Chapter 3) and Condillac’s (Chapter 4) empiricism to idealism (Chapter 7) and the phenomenology of perception (Chapter 14). Smith’s book shows that Enlightened philosophy introduced the will as a key element in the capacity for motion. Will is no longer considered dependent on the activity of the soul, but emerges from ‘la faculté de vouloir’ (p. 76), which idealism developed further as the idea of causal action (‘the Deed’) as a source of knowledge (Chapter 7). Chapter 10 specifically focuses on psychological reflections around movement.

Chapters that consider the cultural implications of movement are of special interest, for instance chapters 12 and 13, which link the perception of movement and mountaineering and contemporary dance, respectively, in connection with the idea of the individual as an active agent (Chapter 11). This amounts to a dialogue with the cultural history of the history of the senses, although Smith explicitly states that his intention is not to take a cultural history approach to the history of movement.

Overall, The Sense of Movement is a key contribution not only to understand the sense of movement but also as a general reflection on the senses more broadly. From the perspective of the history of ideas, it is a fundamental text to understand the epistemological potential of movement, which tracks a theoretical tradition that acted as a counterweight to ocularcentrism and the consideration of vision as the objective and epistemological sense par excellence.

[1] Phillip Vannini; Waskul, Dennis; Gottschalk, Simon: The Senses in Self, Society and Culture. A Sociology of the Senses [2012]. New York: Routledge, 2014, p. 6.

[2] Vannini; Waskul; Gottschalk, p. 6.

Review: Closing the Asylum

Peter Barham, Closing the Asylum: The Mental Patient in Modern Society (London: Process Press, 2020)

Steffan Blayney, University of Sheffield

When the first edition of Peter Barham’s Closing the Asylum was published in 1992, it attempted to describe the historical underpinnings of a protracted upheaval in mental health provision which was still very much ongoing. While the dismantling of the Victorian asylum system had been the professed aim of successive British governments dating back at least to the 1959 Mental Health Act – and while the overall asylum population had been declining steadily since its peak in 1954 – still in the early 1990s deinstitutionalisation remained an unfinished project. By the time of the book’s second edition in 1997, with the majority of hospitals open a decade previously now closed, this seemed harder to argue, yet by this point characterisations of ‘care in the community’ as a failure were already becoming mainstream. This new edition, published in 2020, arrives in the wake of the 2018 Independent Review of the Mental Health Act amidst ongoing debates about the extent of coercion and legal compulsion within the mental health system.

Barham’s original text, reissued here with a new prologue and preface, situated twentieth-century debates over deinstitutionalisation within the longer history of how modern societies have dealt with the ‘problem of insanity’. This has always been a social question at least as much as it has been a medical one. In nineteenth-century Britain, and particularly after the New Poor Law of 1834, the public asylum emerged – alongside the workhouse and the prison – as a means to deal with surplus populations produced by industrialisation. Idealistically imagined by their founders as spaces of care and rehabilitation, the Victorian asylums quickly became little more than overcrowded repositories for incurables and undesirables. The segregation of the mad was given legitimacy by an emerging psychiatric profession whose own optimism about the possibility of cure quickly ceded to essentialising views of mental patients as inherently ‘broken’ or ‘flawed’ individuals, who for the most part would remain incapable of participating in society and undeserving of recognition as fully human. While such conceptualisations were never without their critics, Barham argued, the eventual movement towards asylum closure that emerged in the twentieth century failed to seriously challenge the underlying ideological structures which continued to produce madness as a social problem and the mental patient as a second-class citizen.

The resulting story of deinstitutionalisation was one in which the hopes held by many for the full liberation of hospital inmates would always be secondary to more cynical policy motives. Focusing primarily on mental health law and policy in England and Wales, and weaving historical and sociological analysis with the views of service users and campaigners, Closing the Asylum described how hopes entertained by reformers from the mid-twentieth century for progressive alternatives to the authoritarian psychiatric hospital were repeatedly frustrated or co-opted. Too often, talk of patient freedoms or more enlightened approaches to care functioned as little more than ideological cover for governments eager to cut expenditure by avoiding the costs associated with long-term custodial care. Hospitals emptied, but the services which would allow former inmates to live meaningfully independent lives fail to materialise, with new developments in psychopharmacology enabling the management of symptoms without the need for costly social or psychological therapies. For some who would formerly have been hospitalised, the institutions of the criminal justice system expanded to fill the vacuum (a growing prison population since the 1990s includes an increasing proportion of inmates identified as suffering from a mental health condition). For many more, especially those already from deprived backgrounds, newfound freedoms were undermined by persistent poverty, insufficient welfare support, and the stigma of illness leading to discrimination in housing and employment. Where the mental patient is still viewed by society as a problem to be solved rather than a full political subject, Barham demonstrated, ‘community care’ can function just as effectively as the asylum as a technology of social exclusion and marginalisation.

Another aspect of the old regime which failed to disappear along with its physical architecture was its use of force and legal compulsion. While it might have been expected that the move away from the rigid hierarchy of the asylum would lead to greater liberty for patients, evidence from the last three decades, which Barham details in the prologue to the new edition, shows that the opposite is true. The use of constraint and coercion, justified by the supposed risk posed by patients to themselves or others, has not only persisted through deinstitutionalisation but is increasing. Despite falling numbers of long-stay patients, the total number of people being detained involuntarily almost tripled between 1988 and 2015. This combined with drastic reductions in the overall number of psychiatric beds through years of austerity means that half of all psychiatric inpatients are now detained under the Mental Health Act  – compared to around 10% in the 1970s. Moreover, with the arrival of Community Treatment Orders (CTOs) in 2008, mandating compulsory outpatient treatment under threat of detention, formal coercion is now no longer limited to the hospital setting. The violence of the system, it might be added, is not evenly applied: black patients are more than four times more likely to be involuntarily detained than their white counterparts, and more than ten times more likely to be subject to a CTO. Nor is the ‘shadow of coercion’ (8) which extends over the mental health system limited to those against whom the provisions of the Mental Health Act are directly mobilised. As service user activists (and some psychiatrists) have argued, in a system where patients and doctors know that the threat of compulsion is always available, it becomes difficult to see any treatment as fully voluntary.

While sharply critical of the way deinstitutionalisation has played out in practice, Barham has remained neither nostalgic for the asylum nor pessimistic about the prospects for more progressive services in the future. As he makes clear in the prologue to the new edition, ‘though the book is consistently critical and questioning of the way in which policies of community care have been implemented, it nonetheless holds steadfast to a positive view of the capabilities of the diverse range of people who are assembled under the banner of the “mentally ill”, and to the promise of community-led, above asylum-led lives for enhancing their life prospects.’ Deinstitutionalisation in this context should be seen not as an irrecoverable failure but as an unfinished ‘emancipatory project’ (28).

The ‘real questions’ that societies need to answer, as Barham maintained in 1992, have never been ‘about dismantling the mental hospitals as such, but about the prospects for manufacturing the social and political will adequate to the task of bringing back and reassimilating into society what had been thrust into the mental hospital’ (151). For Barham this means reaching a point where individuals are treated not primarily as ‘patients’, defined in law by their diagnosis, but as ‘persons’ entitled to full rights as citizens. Drawing on ideas advanced by the psychiatric survivor movement (the new edition includes a preface from the veteran campaigner Peter Campbell) he advocates a shift from managerial or paternalistic conceptions of care, underpinned by coercion, towards a focus on empowerment and autonomy for service users. This will not be achieved through legal or medical fixes, but only by reckoning with the centuries-old legacies of a system which has created the ‘mentally ill’ as a class apart.

Review: On the Heels of Ignorance

Owen Whooley, On the Heels of Ignorance: Psychiatry and the Politics of Not Knowing (Chicago, IL: University of Chicago Press, 2019), ISBN: 9780226616384


Ahlam Rahal, McGill University, Montreal

Positioning himself in psychiatric knowledge as a researcher, Owen Whooley starts On the Heels of Ignorance by describing memories from his childhood, which planted the seeds that grew into his writing about psychiatric ignorance. As the son of a man with a mental illness, young Whooley had daily experienced questions related to his father’s mental health problems. His attempts to understand his father’s depression and drug addiction had always been surrounded by ignorance, uncertainty, and inscrutability. As the author explains, both he and mental health professionals failed to grasp his father’s inner world or to define clearly the characteristics of his mental illness. This experience impacted Whooley’s thoughts and provided the impetus to study historical ignorance within psychiatric knowledge. 

Unlike earlier scholars, who critically investigated the profession of psychiatry and the sociopolitical interests that underlie health professions (e.g., Foucault, 1976; Fromm, 1955), Whooley investigates both challenges in psychiatric knowledge and power interests that proliferate within the psychiatric field. The biggest challenge, according to Whooley, is ignorance, which hampers our grasp of mental illness. 

Ignorance, Whooley argues, is related to two self-reinforcing dimensions: ontology and epistemology. The ontological dimension refers to descriptions, causes, and the nature of “insanity”; whereas epistemology involves the assumptions, investigations, and inquiry approaches that grasp the essence of the mental illness. Whooley argues that the multiple definitions of the nature of the mental illness that psychiatry has offered throughout history have influenced the investigation of mental illness, and therefore, created incoherent psychiatric knowledge. Explaining these attempts to redefine and reinvent psychiatric identity, Whooley suggests that psychiatry has aimed to maintain its prestigious position, professional authority, and social control over the population and other health fields through the recreation of its discourse. Through writing this book, the author attempts to answer the following question: How has psychiatry dealt with its knowledge’s challenges, securing itself as a prestigious profession, and restoring professional power? 

To answer these questions, Whooley traces the historical development of psychiatric discourses. The author uses qualitative methods of inquiry, collects data from multiple sources, including the American Journal of Psychiatry over its entire run, professional journal articles such as the American Journal of Psychoanalysis, institutional documents, and interviews with thirty mental health professionals. Through this data, Whooley reconstructs the knowledge of psychiatry, illuminating both crises that have emerged within its body of knowledge and the strategies psychiatry has used to deal with unknown fields (i.e., ignorance). 

The book is divided into five chapters. In each chapter, the author discusses the reinvention of psychiatric knowledge in a specific period, ontological assumptions regarding mental illness, dominant therapeutic modes, and psychiatric institutional infrastructure. Each chapter ends with a remaining unknown field in psychiatry, which threatens psychiatric authority, and therefore motivates policymakers and practitioners to reinvent the body of psychiatric knowledge.

Considering the multiple transformations that psychiatry has undergone and the wide range of literature the book embraces, readers might get frustrated by seeing the incohesive forms of knowledge and different tactics that psychiatry has used in an attempt to overcome ignorance. After reading about psychiatric knowledge in each period, I pause for a breath, thinking of the varied tactics that policymakers, directors and regulators in psychiatry have used to restore psychiatric authority in each era. As the book details, these tactics mainly include cultural and institutional strategies. Culturally, officials have redefined the nature of the mental illness, starting with adopting religious morals in early times, continuing through embracing biological and psychoanalytical principles, and ending with borrowing knowledge from medicine and neuroscience. Institutionally, psychiatry has concealed its ignorance by attaching itself to a secured and prestigious doctrine that dominates the science of each period. In current times, psychiatry has attached itself to the fields of medicine and neuroscience. 

This book not only provides mental health professionals with rich information about the historical development of psychiatric knowledge, but also stimulates readers’ thoughts about psychiatrists’ interests in changing their professional knowledge. Readers who might have been diagnosed with mental illnesses might also benefit from reading this book to rethink the appropriateness of the treatments they receive. Do those treatments meet their needs? Do psychologists understand their clients’ inner worlds? Should clients be hesitant to trust mental health professionals? 

Whooley devotes a great deal of effort to exploring challenges and debates within psychiatry but pays less attention to external social events that played a role in reshaping psychiatric knowledge. An example of that is the economy. In the last chapter, Whooley shows that, when psychiatry has turned to diagnosis and medications, pharmacological companies have benefited from this transformation. But it remains unclear how the financial benefits of such companies have motivated changes in psychiatric knowledge, supporting its scientific power in turn. But incomplete answers in this book might provide readers with opportunities to study the political-economic forces that have reshaped psychiatric discourse. Such studies might grasp the understanding of how psychiatry has dealt with its ignorance in light of internal and external power relations.

Review: Psychedelic Prophets

Review: Paul Bisbee, Cynthia Carson, Erika Dyck, Patrick Farrell, James Sexton, and James W. Spisak (eds.), Psychedelic Prophets: The Letters of Aldous Huxley and Humphry Osmond (Montreal: McGill-Queen’s Press, 2018) lxxix and 644 pp. ISBN: 978-0-7735-5506-8

Charlie Williams, Queen Mary University of London

Humphrey Osmond is best known as the man who turned Aldous Huxley on to mescaline in 1953. Following a brief correspondence, Huxley invited Osmond, a psychiatrist based in Saskatchewan, Canada to come and stay with him and his wife in Los Angeles. In another letter, he suggested that Osmond might bring some mescaline. Huxley’s mescaline trip was described in detail in The Doors of Perception (1954), a book which would introduce countless psychic wanderers to the powerful subjective experience of mescaline and the ‘labyrinth of endlessly significant complexity’ discovered in the folds of Huxley’s grey flannel trousers. Their meeting in California was also the beginning of a close friendship, now captured in this recent edited collection of their correspondence, Psychedelic Prophets.

As a preface to the collection tells us, both men were prodigious letter writers. Huxley is estimated to have written 10,000 letters in his lifetime. Osmond, was both an ardent letter writer and a meticulous archivist, keeping copies of both sides of the transaction. Thus, the volume is said to represent a complete set of their correspondence (apart from one or more missing pages from a letter written by Osmond on April 30, 1956). Consisting of over 275 letters, Psychedelic Prophets begins formally, with a letter addressed to “Dear Mr Huxley” on March 31, 1953 and ends ten years later with tones of much deeper affection – “My Dear Aldous” – one month prior to Huxley’s death on November 22, 1963. Their discussions follow the arc of a close friendship and a rich intellectual connection, taking deep dives into questions of psychopharmacology, schizophrenia, parapsychology, mysticism, cybernetics, Jungian psychology and psychoanalysis, alongside never-ending intrigue about the effects of psychedelic drugs. The letters also feature their impressions of numerous notable figures they encountered over this period, including Timothy Leary, Norbert Wiener, Abram Hoffer and Gerald Heard.  

The most famous moment contained within this correspondence involved a question raised by Osmond about what to label psychoactive pharmaceuticals such as mescaline. In a letter dated March 15, 1956 Osmond wrote that he felt the widely used term “psychotomimetic” (psychotic mimicry) did not do justice to the full range of experiences these drugs could produce. Various candidates for an alternative were put forward including “psychophrenics”, “psycholytics” and the accurate yet clunky “euleutheropsychics” (260-263). Huxley was keen on phanerothyme (soul revealing) and signed off his letter with a short rhyme: “To make this trivial world sublime, take half a gramme of phanerothyme” (266). But they eventually settled on Osmond’s suggestion “psychedelic”, combining “psyche” – the Greek for “mind” – and “delos” – meaning “to manifest” or “bring to light”. Osmond even penned his own ditty: “To fathom Hell or soar angelic, just take a pinch of PSYCHEDELIC” (267).

It was certainly an artful piece of branding. “Psychedelic” met their criterion of having a clear meaning, being easy to pronounce and being unlike any other name. It captured their idea that the consciousness altering experience of psychedelic drugs was no mental aberration but instead facilitated a widening of the doors of perception, an opening up of the self and the possibility of furthering human potential beyond the limits of everyday consciousness. It was an idea that would not only shape early approaches to psychedelic therapy, but also carry through to popular culture as LSD became a symbol of rebellion and cultural change in the 1960s. More recently, Nicholas Langlitz has shown how the idea derived from Huxley and Osmond that psychedelics remove some kind of vestigial filter on the mind or brain remains influential in psychedelic culture and research today, despite conflicting neurophysiological evidence (2012, 125-127).  

In the last two decades proponents of psychedelics have championed a so-called ‘psychedelic renaissance’ (Sessa, 2012). Strict regulations that all but put an end to legitimate research in the 1960s have been cautiously lifted and psychedelic drugs are once again being touted for their potential to treat various common and chronic mental conditions. This resurgent biomedical interest has also been accompanied by a wave of scholarship in the humanities and social sciences, much of which has shown how difficult it is to decouple contemporary psychedelic research from its turbulent history (Dyck, 2008; Richert, 2019; Evans, 2017; Langlitz, 2012; Hartogsohn, 2020).. Despite remarkable progress in the decriminalisation of psychedelics for clinical use, Ericka Dyck, an editor of Psychedelic Prophets, points out that the latest phase of psychedelic research shares much in common with its historical beginnings – ‘enthusiasm and awe, and hyperbolic claims about the drug’s potential impact on a wide range of medical concerns’ (2017).  Navigating this hyperbole, Dyck suggests, requires attention to the same fault lines and epistemological problems that psychedelic research has tripped up on in the past. In Britain today, ketamine therapy for depression is available on the NHS and advocates hope that psilocybin, MDMA and LSD will all be added to the roster of widely prescribed pharmaceutical therapies within the next five to ten years. But the popularity of microdosing, retreats and informal encounters with psychedelics also show that self-medication and experimentation are how the majority experience these drugs, suggesting that psychedelic therapy will continue to traverse the boundaries of the medical establishment even as these drugs become part of more orthodox therapeutic interventions.   

Other scholarship has focused on the question of how cultural meanings of psychedelic drugs influence how an experience plays out in a lab, clinic or recreational setting. During the first wave of psychedelic research both Osmond and Huxley were well aware that the psychedelic experience was influenced by social and environmental factors often referred to as ‘set’ and ‘setting’. Set may be understood as any factor that an individual brings to the experience, including their personality, motives, previous knowledge or experience, mood and preparation. Setting refers to both the physical and social environment in which the experience takes place. More recently, researchers have referred to set and setting under the more general umbrella term “context” (Carhart-Harris et al, 2018). If context is key to the effectiveness of psychedelics in therapy so is an understanding of the history of ideas that surround them. In his account of post war LSD research, Ido Hartogsohn argues that the principles of set and setting may be applied historically to understand the ‘psychosocial construction’ of drug effects through an examination of the complex interactions between psychopharmacological effects and broader socio-cultural factors shaping drug experience (2020; see also 2017). Hartogsohn (2017), for example, suggests that early 1950s experiments which studied psychedelics under the pretext of inducing psychosis were far more likely to foster negative experiences and instigate ‘the very responses they expected to find’. Many of the epistemological challenges encountered by psychedelic researchers, including set and setting, are dealt with in Langlitz’ Neuropsychedelia: The Revival of Hallucinogen Research Since the Decade of the Brain (2012). Langlitz suggests that the age of psychedelic research offers a unique opportunity for empirical research scientists to apply the kinds of approaches associated with the medical humanities and science studies scholarship.  

Much of the history of psychedelics, particularly those that incorporate a more diverse understanding of the actors, places and cultures that have lent psychedelics their meaning is still to be written. But between 1956 and 1963 Osmond and Huxley found themselves in a unique position, with access to many newly synthesised or recently “discovered” psychoactive substances and amongst a network of influential intellectuals interested in how these drugs could reshape not only therapy but society more broadly. Their history as well as that of psychedelic research is mapped out in the comprehensive introduction and epilogue to Psychedelic Prophets. But for historians, scientists or anyone else interested in delving deeper into the foundational ideas that have driven psychedelic culture, this huge volume of Huxley and Osmond’s correspondence contains rich pickings.  

Review: A Philosopher’s Economist: Hume & the Rise of Capitalism

Margaret Schabas and Carl Wennerlind, A Philosopher’s Economist: Hume & the Rise of Capitalism (Chicago: University of Chicago Press, 2020), 316pp. $45.00. ISBN: 9780226597447

by Tyson Leuchter, King’s College London

Margaret Schabas and Carl Wennerlind announce their intentions in the title: David Hume, a “philosopher’s economist” and not “an economist’s philosopher.” Hume has long enjoyed a towering reputation in fields ranging from ethics to political theory to metaphysics to epistemology. While his economic thought, particularly on monetary matters, has been studied, until now there has been no full-length, English-language work on his economic doctrines as a whole (16).[1] Schabas and Wennerlind, both leading scholars in the history of economic thought, seek to redress this oversight in A Philosopher’s Economist: Hume & the Rise of Capitalism. Their aim is to “restore the sense in which Hume’s life and writings form an integral whole centered on economics, broadly construed, as a unifying thread” (6). Rather than a philosophical giant with brilliant, but piecemeal insights into economics, for Schabas and Wennerlind Hume is equally a thoroughgoing economist, whose doctrines were developed in tandem with his philosophical dispositions. In this interpretation, Hume’s thought on the specie-flow mechanism – the means by which international specie circulation might, in the long run, smooth out trade imbalances – must therefore be thought together with his empiricist epistemology. The result is an effective reconstruction of Hume’s cosmopolitan economic vision.

The authors’ task is in some ways archaeological. The bulk of Hume’s economic thought resides in his Political Discourses (1752), later collected in Essays Moral, Political, and Literary (1741-77). But, Schabas and Wennerlind suggest, focusing solely on these works gives an incomplete picture of the expansiveness of Hume’s economic thought, as well as its connection to the rest of his philosophical oeuvre. Hume’s works must be mined deeply and assembled into a coherent form for his economic doctrine to fully come to light. Schabas and Wennerlind thus examine the Political Discourses, but also find significant economic theory in more unexpected places, such as Hume’s youthful (and, much to his disappointment, far from sensationally received) tome on epistemology, metaphysics, and moral philosophy A Treatise of Human Nature (1739-40), as well as in its later reworkings as An Enquiry Concerning Human Understanding (1748) and An Enquiry Concerning the Principles of Morals (1751). Hume’s bestselling The History of England (1754-62), they find, contains significant material on economic topics, as does his posthumously published Dialogues concerning Natural Religion (1779). What emerges, Schabas and Wennerlind argue, is a particular kind of economic thought, attentive both to the quantitative implications of economic growth, but also to the moral dimensions of global economic transformations. Hume, in this view, uncannily anticipated recent developments in economics, such as the behavioral turn and the dramatic increase in attention to distributional issues and inequality, inspired by figures such as John Rawls and Thomas Piketty; such “ethical and behavioral foundations” to economics, the authors claim, were strikingly absent for much of the twentieth century (5). Hume thus becomes a sort of epistemological econometrician with interests in both prices and psychology, an economist whose normative orientation is not simply towards efficiency or individual preference maximization, but also towards the virtues of “nonpecuniary goods,” such as happiness, justice, and friendship.

Schabas and Wennerlind pursue this argument across seven tightly argued chapters. They first place Hume’s long-standing pursuit of economic knowledge in biographical context. The authors detail Hume’s birth in 1711 (as “David Home,” changed to “Hume” in 1734) to modest circumstances in Scotland, his brief clerkship to a Bristol sugar importer (a position from which he was dismissed for correcting his employer’s grammar – surely a sobering warning to aspiring pedants everywhere), his time living abroad in continental Europe, where he observed the cultural and demographic effects of differing levels of economic development (25-39). This chapter also reveals Schabas and Wennerlind’s main approach to contextualization: they take great care to reconstruct Hume’s intellectual network, combing through his correspondence to trace the paths of influence and intellectual development. Throughout the book, the authors note his interactions with a diverse range of figures, such as the Dutch financier Isaac de Pinto, Scottish “stadial theorists” Adam Ferguson and Lord Kames, famed natural historian Comte de Buffon, as well as with other leading Enlightenment figures including Adam Smith, Diderot, and Rousseau (from whom he later became estranged, a not unusual occurrence given Rousseau’s temperament) (27-28). These reconstructed intellectual networks are connected with significant events in Hume’s life – the authors note, for instance, that his time in Bristol would have exposed him to complex economic transactions, surely influencing his later thoughts on economic flows and monetary issues. Indeed, with Bristol’s leading place in the sugar industry, Hume would have had firsthand experience of one of Britain’s most dynamic economic sectors, but also a sector that was fundamentally connected with Caribbean slavery and the Atlantic slave trade (32).

Chapter two details Hume’s approach to economic methodology. Hume’s principal concern, Schabas and Wennerlind argue, was to create a true “science” of economics. His approach was thus nomothetic, with the variety of human experience brought into lawlike order and unity (51-52). The authors draw nuanced connections to Hume’s epistemological skepticism regarding the limits of human knowledge. Hume’s critique of these limits regarding the physical world has become famous enough to be called the ‘Hume Induction Problem’. In brief, given the epistemic apparatus of our senses, we are essentially locked out from knowing the “inner causes” of most phenomena covered by the physical sciences. Thus, while we may have seen one event constantly follow another – billiard balls striking each other, in Hume’s famous example – and thus may strongly expect (or mentally associate) that they will act similarly in the future, this sort of induction from experience does not, in the end, produce sure knowledge of the necessary logical connection between cause and effect. However, Schabas and Wennerlind observe, for Hume this is not the case with economic behavior. As they write,

Whereas in the physical sciences, we must ‘confine our speculations to the appearances of objects,’ as Hume had said, with human actions we can also venture into the internal causes, presumably via the same process of introspection that Hume used to establish the mental laws of association. The moral sciences have this advantage of permitting us to grasp a layer of causation that is blocked for the most part in the natural sciences (62).

Because economic behaviour is the interaction of human agents, in principle we can probe the nexus of causal factors: willed action, moral dispositions, habit, customs, and so on. On an epistemological level, then, for Hume economic science was actually more secure than the physical sciences.

Schabas and Wennerlind next tackle Hume’s account of the institutions of property and commerce. Hume placed property rights at the center of his theory of justice, they argue, so that the rule of law could securely channel individual economic interests into virtuous circuits of exchange. Hume, they write, put much stock in the potential of commerce to engender more refinement, prudence, and liberty. He also believed that the concomitant urbanization would induce more civility, friendship, and humanity. Above all, the modern economy would foster a wide array of social virtues, notably honesty, politeness, and beneficence. All of this depended critically on upholding the system of property rights and hence the rule of law. It was these beneficial outcomes, the effects of the law, that gave it warrant, not a more primitive appeal to fairness or equality (96).

The putative utilitarian logic of mutually beneficial commercial exchange, in this view, would polish manners, pacify hostilities, and lead to aggregate increases in happiness. To do so effectively, the authors note, required two further institutions: markets and money. Schabas and Wennerlind’s focus is mostly on the latter – fittingly, given Hume’s attention to monetary issues. They suggest that money, for Hume, was “intrinsically semiotic” (99). Rather than constituting an inherent store of value, money was a kind of language, in which different commodities could be “translated” into each other through market exchange. Monetary transactions thus represented a kind of pledge, a promise that two commodities were, in the minds of the transacting parties, of commensurable value. Insofar as monetary transactions depended on the fulfillment of a promise, Schabas and Wennerlind note, Hume thus saw money and credit as residing on the same continuum (100-103). Hence the importance of maintaining faith in the security of the money supply and, as the authors examine in later chapters, of avoiding the seductive pitfalls of public credit.

 What moral qualities might characterize this improving world? Schabas and Wennerlind suggest that, for Hume, the material particularities of commerce produced a host of moral benefits: greater urbanization, greater equality between the sexes, the softening of hostile impulses, the promotion of cross-cultural trade, the development of new tastes, the fostering of a spirit of “industry” (115-119, 127). Schabas and Wennerlind compellingly argue that industry was particularly important for Hume not only for the commodities and wealth it might produce, but also for the virtuous habits and dispositions it might inculcate: “Hume insisted that by working diligently in one’s profession, one could not only find happiness but also inadvertently cultivate various virtues and thus contribute to the refinement of society. Because work occupies the majority of one’s waking hours, it offers the means to discipline and dignify one’s life” (121). The authors further connect this dispositional advantage of industry to Hume’s sociology: the “middle ranks” of society were those most able to sustainably produce the spirit of industry, while also integrating the honest virtues of the lower classes and the generous sociability of those above (136).

Schabas and Wennerlind return to monetary matters in chapter five. This is where the authors examine Hume’s antimercantilist arguments about the specie-flow mechanism, in which individual consumption patterns in the aggregate necessarily frustrated any top-down political attempts to dominate the global marketplace (143-146). Schabas and Wennerlind also lay out the “non-neutrality” of Hume’s quantity theory of money: money might be a kind of language, for Hume, but it was a language that could create real effects in the system of production. The authors build this argument by exploring one of Hume’s characteristic thought experiments: a galleon, laden with specie, arrives from Cadíz and unloads in a local port. What happens to the local economy? Both authors agree that, for Hume, this influx of money stimulates economic growth. But at this sole point in the book, the authorial voices splits in two. Wennerlind favours a broadly demand-side explanation: the influx of foreign specie is a result of increased demand for exports, raising both domestic wages and output, which increased wealth, in turn, filters into other sectors of the local economy through market exchange. Schabas, on the other hand, expounds an initially supply-side account, focusing particularly on the money supply. The influx of foreign specie replaces the poor-quality money in which wages were normally paid – in a kind of inverse of Gresham’s Law, good money here drives out bad. With workers now paid in high-quality specie, they happily work more intensively, allowing manufacturers to respond dynamically to increased foreign demand for output, with spillover effects on other domestic sectors as workers also increase domestic spending. Whichever explanation is favored, the authorial voice reconverges in suggesting that Hume had thus foreseen the economic concept of the multiplier (153-158).

Hume was deeply concerned about the distributional and political implications of international trade and public finance. The authors here find him at, simultaneously, his most and least cosmopolitan. Schabas and Wennerlind dissect Hume’s critique of the “jealousy of trade” plaguing eighteenth-century capitalism. In a world crisscrossed by imperial rivalries, Hume noted a distressing tendency to towards zero-sum thinking, with one nation’s economic ascendancy thought to entail another’s decline. This, in turn, dictated protectionist policies, destructive imperial competition, and devastating wars. Hume pleaded for nations to abandon the malevolent passion of jealousy and instead, through free trade, channel “envy and emulation” to more globally salutary ends (177-180). Free trade would not eliminate interstate competition but domesticate it, with nations spurring each other to ever-greater heights of improvement and wealth. For Schabas and Wennerlind, Hume here becomes an early theorist of globalization: given the variety of initial conditions, free trade policies would set countries along differing developmental paths, with rich countries specializing in high-quality manufactures and poor countries specializing in agriculture and rougher commodity production. But, given the mobility of labour and capital, in the long run the benign effects of emulation and trade would spread improvement across the globe (182-186). Free international trade would thus accomplish the economic ends of empire, but, supposedly, without the need for violence or conquest. Hume’s cosmopolitanism did, however, slam into racial barriers. As the authors note, though he opposed slavery and the slave trade, his dismissive opinions regarding the developmental capacities of non-white peoples, particularly Africans, were nothing short of appalling (191-194). This chapter also sees the authors explicating Hume’s pessimistic account of public debt. Since debt funded imperial warfare, led to burdensome taxation, perverted the political order, and so offered an irresistible tool for irresponsible policymakers, to Hume it represented an existential threat to states (195-202). Thus, as he put it, “either the nation must destroy public credit, or public credit will destroy the nation” (195-202). Hume preferred the former.

The seventh and final chapter discusses Hume’s lasting influence on economic thought. Schabas and Wennerlind make a convincing argument for Hume’s enduring influence on his friend and younger contemporary Adam Smith (211-221), as well as on later economic theory of both libertarian and liberal convictions (230-237). Other connections are drawn a bit more thinly. The authors, for instance, claim that the Encyclopédie’s famous plates, which promoted the dignity and importance of the mechanical arts, “reflects Hume’s own emphasis on the economic importance of manufacturing and practical knowledge” (222). But while Hume was undoubtedly influential, the Encyclopédie plates drew from a vast array of intellectual wellsprings.[2]

The book ends on a decidedly ambivalent note. Until the end of his life, Hume remained optimistic about the potential of actions enmeshed in the web of commerce and capitalism to improve the world. But were he to land in current times, the authors ask, would he hold the same opinions (240)? They leave it a provocatively open question.

A Philosopher’s Economist marks an important scholarly intervention. The authors make a compelling case for the importance, if not the centrality, of economics to Hume’s work. They skillfully reconstruct Hume’s multiple and interlocking economic doctrines, a difficult task given both the complexity of Hume’s thought and the comparatively short length of the volume. Particularly impressive is the way that they connect these doctrines to Hume’s epistemological and metaphysical stances, connections which otherwise might have been overlooked. Their contextualization of Hume’s social and intellectual networks, and how they shaped his work, is also well executed. In their overall construction, Hume articulates a broadly optimistic vision of how commerce might lead to an improved world, but it was still a world vulnerable to human vanity, weakness, and jealousy.

This is a compact volume, Hume’s thought is expansive, and the authors have written elsewhere on the topic.[3] That said, for a standalone work, there are two areas that might have been profitably addressed. Firstly, the question of how Hume’s personal stances on slavery and empire may, or may not, have intersected with his economic thought. As mentioned, Hume, despite his contempt for the mental capabilities of nonwhite peoples, was an opponent of slavery. However, he also seems to have lent money to a friend involved in the slave system, as well as maintained friendships with those connected to Atlantic slavery (192). Schabas and Wennerlind do not obscure any of this. But they also do not press these connections much beyond the charge of hypocrisy. For all his disapproval of slavery, Hume was nonetheless willing to carve out a degree of space for the circulation of slave-produced commodities. As the authors note, Hume at one point suggested that, however temporarily, tariffs might be designed to steer domestic demand away from foreign brandy and towards British rum (180) – a distilled molasses product, the sugarcane for which would have been produced within the hellish world of the Caribbean slave complex. Similarly, they rightly note that Hume was firmly opposed to military conquest and empire by the sword (177-178). But that does not necessarily imply being opposed to empire tout court. Indeed, Hume served (as a noncombatant) in the abortive invasion of Lorient in 1746, and later as undersecretary of state during an age of imperial expansion (xiv, 177). And as Hume’s friend and correspondent Diderot, in his contributions to the Abbé Raynal’s massively influential Histoire des Deux Indes, argued, colonies were theoretically permissible under certain circumstances.[4] The degree to which Enlightenment thought was or was not sympathetic to empire, colonization, and enslavement continues to be a live topic.[5]

Second is Hume’s position on finance. Schabas and Wennerlind observe that, in 1761, Hume invested about one thousand pounds in securities, likely publicly traded “bonds or shares in a mercantile company” (41). Hume was, apparently, adamant that his financial holdings were ‘real’, as opposed to the speculations of stockjobbers. How might this notion of ‘real’ financial wealth intersect with Hume’s overall starkly negative account of public debt, along with his theoretical concerns over money and credit? Given that capital mobility and the liquidity of money were central to his accounts of the specie-flow mechanism, global development, and economic multiplier effects, it would be valuable to know more not just about what Hume thought of the concept of finance, but also about the mechanics of financial markets.

Such explorations would perhaps have added further to what is already a strong and important intellectual contribution. A Philosopher’s Economist is an insightful, well-argued, and compelling volume, written and researched with great skill by two expert scholars. It will be of great interest to readers in the history of economic thought, the history of capitalism, and Enlightenment studies.

Tyson Leuchter (@inkybrained) is a lecturer in Global History at King’s College London. He is currently composing a book manuscript on financial capitalism, the Paris Stock Exchange, and the transformations of the French empire in the early nineteenth century.

[1] In English, the closest work the authors note is Eugene Rotwein’s editor’s introduction to a collection of Hume’s economic writings, originally written in 1955, then revised and reissued in 1970 and 2007; other book-length studies have addressed Hume’s economics, though Schabas and Wennerlind argue that these works do not take as systematic an approach as their own.

[2] John R. Pannabecker, “Representing Mechanical Arts in Diderot’s ‘Encyclopédie’,” Technology and Culture, 39 (1998), 33-73.

[3] Both authors have written several articles specifically on Hume, in addition to hosting a workshop on his economics (241), and co-editing David Hume’s Political Economy (Routledge: Abingdon, 2008).

[4] As Diderot wrote, “Both reason and equity permit the establishment of colonies, but they also mark out the principles from which one must not stray when founding them.” See Denis Diderot, “Extracts from the Histoire des Deux Indes,” in John Hope Mason and Robert Wokler, eds, Diderot: Political Writings (Cambridge: Cambridge Unversity Press, 1992), 175.

[5] The classical statement of the issue is Michèle Duchet, Anthropologie et Histoire au Siècle des Lumières (Paris: Albin Michel, 1971). See also Sankar Muthu, Enlightenment Against Empire (Princeton: Princeton University Press, 2003); William Max Nelson, “Making Men: Enlightenment Ideas of Racial Engineering,” American Historical Review, 115 (2010), 1364-94; Jennifer Pitts, A Turn to Empire: The Rise of Imperial Liberalism in Britain and France (Princeton: Princeton University Press, 2005); Anthony Pagden, Lords of All the World: Ideologies of Empire in Spain, Britain and France c. 1500-c. 1800 (New Haven: Yale University Press, 1998).

Review: Reproduction

Reproduction: Antiquity to the present day, edited by Nick Hopwood, Rebecca Flemming and Lauren Kassell (New York: Cambridge University Press, 2018) pp. 730. $125.00.

Caroline Rusterholz, Wellcome Trust Research Fellow, Faculty of History, University of Cambridge

Reproduction Antiquity to the present day is a massive, interdisciplinary and highly ambitious publication featuring 44 chapters, 40 exhibits – each consisting of a short essay focused on an image and artefact – and about 70 authors from different fields including history, demography, sociology, history of art, philosophy and theology, among others. Edited by Professor of History of Science and Medicine Nick Hopwood, Senior Lecturer in Ancient History Rebecca Flemming and Professor of History of Science and Medicine Lauren Kassel, all based at Cambridge University, this impressive collaboration reassesses the history of reproduction from Graeco-Roman antiquity to the twenty-first century from a Western perspective. The volume results from the work of Cambridge’s Generation to Reproduction Group, an interdisciplinary project led by Cambridge historians of medicine and biology, funded by the Wellcome Trust, which started in 2004. This group of researchers have organised a wide range of seminars, reading groups and workshops, and one of these workshops provided the impetus for this ground-breaking volume. The collection is beautifully illustrated and highly accessible.

The coherence of the volume lies in its sustained focus on a set of key questions: when and where did ‘generation’ and ‘reproduction’ begin and end, what did people mean when they talked in these terms, and how and why were their beliefs and actions like or unlike those that went before and came after? (17) This volume traces the transition from generation to reproduction and focuses on the Mediterranean, Western Europe, North America and their empires. It dates this change in terminology to the mid-eighteenth century.  Generation, a ‘looser framework for discussing procreation and descent’ (4), appeared in written productions when authors drew on different ancient discourses in philosophy, medicine and agriculture to try to make sense of the issue of ‘coming to be’. In so doing, they paid attention not only to human beings and their souls but also to plants, animals, stones and minerals. Reproduction progressively replaced generation in the mid-eighteenth century and signified, in contrast, how things were re-produced. This new meaning centred mainly on living organisms and the process of perpetuating species. This gave rise to a focus on population, its quality and quantity.

The volume is divided into five parts. As a historian of the modern period, my review will concentrate on parts IV and V. Part IV, ‘Modern Reproduction’, traces the meaning of reproduction in the industrialised world of the nineteenth century up until the Second World War, while Part V, ‘Reproduction Centre Stage’, shows how reproduction became paramount on the national and international levels after the war and how it was always contested. Since then, two somewhat contrasting phases of change have occurred: an acceleration of the medicalisation of reproduction, which gave rise to a challenge to this medicalisation by feminism and social movements from the 1960s onwards. In the context of fertility decline in Western countries from 1870, with the exception of France whose fertility decline was already in train by 1800, and fears about degeneration, nation-states became worried about the quality, namely the ‘fitness’ of the population, and quantity of their population and the prospect of depopulation in their colonial possessions. In this context, procreation became a battleground. In addition, population became an international and global problem over the twentieth century; fears around population growth fuelled the creation of international organisations and philanthropic foundations aimed at curbing this increase, where population experts such as demographers, geographers, birth control campaigners, economists and ecologists shared knowledge and devised international family planning campaigns (Alison Bashford). These family planning campaigns prescribed the new technologies of contraception and abortion that had developed from the second quarter of the twentieth century onwards (Jesse Olzynko-Gryn and Nick Hopwood); some of the campaigns relied on coerced contraception. However, as the century advanced, reproductive rights as human rights became the key motto of international organisations, which emphasised ‘reproductive health’ and choice under pressure from feminist activists.

In these two rich parts of the book, we learn that the breeding of animals inspired eugenic thinking and that artificial insemination saw fertility specialists join forces with animal physiologists (Sarah Wilmot). Reproduction and sex became separate due to campaigning movements that included neo-Malthusians, eugenicists and radical sex reformers (Lesley Hall). Despite strong opposition from the medical profession, governments and the Catholic Church, birth control campaigners advocated the use of contraception and thus made the concept of limiting births a possibility. In so doing, they paved the way for the provision of contraception that would become acceptable in the interwar years. While the dissemination of information on birth control, partly carried out by birth control campaigners, increased dramatically in the first half of the twentieth century, ignorance was still the dominant frame for understanding how individuals acquired knowledge about sex and reproduction and who produced information on these subjects, especially in Britain (Kate Fisher).

Simon Szreter and Christina Benninghaus touch upon the issue of infertility; Szreter does so via new estimates of the prevalence of venereal diseases as potential contributors to the fertility decline in Britain, while Benninghaus argues that infertility took a modern meaning in the years around 1900. She reveals that while the female body became the object of increasingly invasive intervention, national differences existed with regard to the male body. In Germany, sperm testing was first practised in the 1880s, whereas the practice was rare in Britain. Female sterility was perceived to be connected to gonorrhoea transmitted to an ‘innocent wife by a promiscuous husband’ (462). Over the years, new medical technologies such as artificial insemination, glandular extracts and later hormones and transuterine tubal insufflation became routine medical practice for treating ‘sterile’ couples. These developments and the new faith in scientific medicine boosted patients’ expectations and accounted for the increasing number of patients seeking fertility treatments. Sterile couples looked to medicine to overcome their condition before IVF, but IVF did represent a watershed moment in that it gave birth to a private flourishing new industry (Nick Hopwood).  

In the colonies, reproduction also had a prominent place in the political agenda of imperial powers, and women became the sustained targets of state intervention (Philippa Levine). Low fertility was at once perceived as an asset for settlers who considered locals a nuisance to be eliminated or relocated, and as a problem in colonies that relied on local labour. Maternal mortality was deplored, and childbirth became increasingly medicalised in the colonies and in the metropole. In continental Europe, hospital births became common practice by the 1960s. However, as Salim Al-Gailani argues, the medicalisation of birth was not imposed on passive women patients by all-powerful male obstetricians. Demand for it shaped the provision of maternity care, even when the maternal mortality rate was higher in hospital than at home. With hospital births gaining prominence, antenatal care expanded, and prenatal diagnosis and screening for defects became routine practice in the last quarter of the twentieth century, generating new stress for mothers-to-be (Ilana Löwy).

This volume shows the necessity to consider the history of reproduction from an interdisciplinary perspective. It is a must-read for students and scholars interested in the issue of reproduction.

Review: Chimpanzee Culture Wars

Nicolas Langlitz, Chimpanzee Culture Wars: Rethinking Human Nature Alongside Japanese, European, and American Cultural Primatologists. Princeton: University Press, 2020; 352pp; Paperback: £22.00. ISBN: 9780691204284

Alfred Freeborn, Humboldt University

The founding figures of science studies told us that we have never been modern (Latour, 1993), that we have never really been cultural agents independent from the natural world but have moved in a web of nature-culture hybrids. Nor indeed have we ever been human (Haraway, 2008), but exist on a continuum with our animal kin. How then are we to understand the exceptional destruction of biodiversity and climatic change that humans alone seem to be causing? This is one of the central questions Nicolas Langlitz poses in his journey alongside people who study chimps in order to understand why it ended up that we are interested in them. Chimpanzee Culture Wars asks what is at stake in understanding the limits of the “anthropo” in the Anthropocene and uses the disciplinary matrices of primatology, anthropology, psychology and science studies to explore this question.

So far, the book has only been reviewed by primatologists, one of whom is a central protagonist in the book: these reviews look at the book as a commentary on primatology (Nakamura, 2020; McGrew, 2021). This review, in contrast, will show the reviewer looking at Langlitz looking at primatologists looking at chimps. I met Langlitz at the Institute for Advanced Study in Princeton while he was completing this book. We had met because of a shared interest in the work of German sociologist Niklas Luhmann (1927-1998). I was on a research trip to the States and he had kindly invited me to lunch at the Institute. Langlitz originally studied medicine in Berlin before shape-shifting into a medical anthropologist in California, writing a book about neuroscientists studying psychedelics (Langlitz, 2012) and becoming associate professor of anthropology at the New School for Social Research in New York. After lunch he suggested we walk a woodland path through the empty waterlogged grounds of the Institute. 

As we walked, he told me that Bruno Latour had developed actor-network theory after studying baboons with the primatologist Shirley Strum in the late 1970s. Langlitz explained that while Latour’s designs for a ‘primatology of science’ understood human culture not as the result of a cognitive difference to apes but a quantitative proliferation of technical objects, which the apes did not have, subsequent primatology had left Latour behind. In the 1980s primatologists increasingly observed apes using objects. The question of what set human cultures apart from ape cultures remained fiercely debated and paralleled in many ways the debates over pseudoscience in the science wars. All this controversy had resulted in an impasse whereby communication between people interested in human cultures and those interested in primate cultures broke down. While Langlitz’s colleagues in cultural anthropology had followed Donna Haraway’s Primate Visions (Haraway, 1989) in dismissing the epistemic goals of primatology as a morally dubious political project of ranking humans and chimps, he could not help but sympathize with the desire of many primatologists to demoralize the study of apes and their behaviours. In this sense, Langlitz understood the debates over how to study chimp culture as a site from which to reflect on his own epistemic culture. I was surprised by this unfamiliar perspective on the intellectual origins of science studies and struggled to focus on our conversation while navigating the wet path on which my shoes quickly became sodden and caked in mud. 

As part of his virtuoso ‘experiment in reflexivity’, Langlitz walks with ease across disciplinary boundaries and alongside many different observers. The book operates across three levels: it is primarily ethnographic in that it follows Langlitz’s fieldwork from the mid-2010s with cultural primatologists and comparative psychologists across West Africa, Japan and Germany. At a second level, its analysis involves a comparative epistemology of laboratory work and field work including a comparison of national research traditions. Finally, as a historical work, its chronological arc begins with the origins of cultural primatology in 1950s Japan, through to the so-called North-American chimpanzee culture wars that began in the 1970s and up to the transformations in methods and professional politics that mark contemporary primatology. After two opening historical chapters, the book moves across the different sites where Langlitz was able to observe scientists observing chimps: the shrinking forests of Guinea and the Ivory Coast, a psychological laboratory attached to the zoo in Leipzig and the large chimp enclosures of a primate research institute in Inuyama, Japan. While the author’s determination to keep ideas in situ may overwhelm the reader lacking any prior knowledge of primatology – I strongly recommend watching one of the many documentaries about chimp intelligence before reading – it is nonetheless a book for historians of the human sciences.

Langlitz anchors his wide-ranging observations to the eighteenth-century project of philosophical anthropology, showing both how the last representatives of this European tradition (such as Jürgen Habermas and the Frankfurt School) have celebrated the idea of a strong distinction between humans and chimps, as well as how contemporary disciplinary differentiation continues to frustrate unifying visions of a science of primates. Langlitz’s own contribution to this project is to position the ability to observe observers, to conduct what Niklas Luhmann called ‘second-order observations’, as the distinguishing ability of humans against their primate cousins. In an entirely refreshing manner, the book relocates tired debates of positivism versus the humanities in what will be to many readers an entirely foreign landscape. To accompany Langlitz on such a journey is demanding, but it comes with its own rewards. I remember leaving Princeton on the Megabus back to New York relieved not to have lost my footing and with much to think about. 

To summarize my observations: there is no single consensus over the limits of chimp culture as an object of scientific study nor over what has made homo sapiens such a successful primate. The point of Chimpanzee Culture Wars, as the title suggests, is that culture as a concept must be understood as a term of conflict, born out of asymmetric comparisons, by which certain things are compared and certain things excluded from comparison. The essence of Langlitz’s (anti-)polemical argument is that the scientific study of culture, chimp or human, in the field or in the laboratory, need not be conducted in moral terms and that the reluctance of cultural anthropologists and science studies scholars to engage with the question of human distinctiveness blocks our ability to understand our current period of natural history (e.g. the Anthropocene). In a final epilogue, Langlitz suggests that we should by all means be more human about nature, preserving biodiversity and slowing climate change, but that we should also try to be more chimp about culture: sometimes, in between energetic bouts of working to control our environment, all we can do is move with the powerful forces around us. 

Bio: Alfred Freeborn (@Alfred_Freeborn) is a doctoral candidate in the History of Science at Humboldt University, Berlin. His research focuses on the history of biological psychiatry in postwar Britain, North America and Germany, with a special focus on the changing field of schizophrenia research – and he has published on the history of the Mind and Brain Sciences in HHS. He will join the Practices of Validation in Biomedical Sciences Research Group at the Max Planck Institute for the History of Science in July (link: https://www.mpiwg-berlin.mpg.de/research/departments/max-planck-research-group-biomedical-sciences) 

References 

Haraway, Donna. Primate Visions: Gender, Race, and Nature in the World of Modern Science. Routledge, 1989.

Haraway, Donna. When Species Meet. Minneapolis: University of Minnesota Press, 2008. 

Langlitz, Nicolas. Neuropsychedelia: The Revival of Hallucinogen Research since the Decade of the Brain. University of California Press, Berkeley, 2012. 

Latour, Bruno. We Have Never Been Modern. trans Catherine Porter. Cambridge, Mass: Harvard University Press, 1993.

McGrew, William C. “Chimpanzee Culture Wars: Rethinking Human Nature alongside Japanese, European, and American Cultural Primatologists, by Nicolas Langlitz.” Primates 62, no. 2 (March 1, 2021): 443–44.

Review: ‘Aṣfūriyyeh: A History of Madness, Modernity, and War in the Middle East

Chris Sandal-Wilson, University of East Anglia

Joelle M. Abi-Rached, ʿAṣfūriyyeh: A History of Madness, Modernity, and War in the Middle East (Cambridge, MA: The MIT Press, 2020)

In 1982, after more than eight decades of operation, the Lebanon Hospital for Mental and Nervous Disorders officially closed its doors. Seven years into the Lebanese civil war, as hospital employees – who had braved bullets and shells to continue providing counselling to the increasingly anxious population outside the hospital’s walls during the war – desperately sought to overturn the decision to close and to secure the salaries they were owed, the archives of the hospital were abandoned. It was through the initiative of Hilda Nassar, director (until 2013) of the Saab Medical Library at the American University of Beirut, and the work of the archivist Linda Sadaka that the archive of this remarkable institution was saved, as Joelle Abi-Rached tells us at the start of the equally remarkable history that she has woven out of both this and an impressive number of other archives.

ʿAsfuriyyeh: A History of Madness, Modernity, and War in the Middle East traces the rise and fall of an institution which started out life as the Lebanon Hospital for the Insane in the twilight years of the nineteenth century, became the Lebanon Hospital for Mental Diseases in 1915, the Lebanon Hospital for Mental and Nervous Disorders in 1950, and was in throes of a further transformation, this time into the Lebanon Psychiatric Institute in 1976, when war intervened. The hospital’s many names might be taken as indexing how the history of psychiatry unfolded in Lebanon across these decades, as the institution developed from a home for forsaken, impoverished, often chronic cases into the central node in a network of outpatient clinics which aimed to bring mental hygiene to the masses.

But the hospital could never shake off another name, derived from its original location to the east of Beirut on the foothills of Mount Lebanon: ʿAsfuriyyeh, the place of the birds. The name came – like Bedlam in the British context – to serve as a pejorative stand-in for asylums and madness in general, cropping up in novels, plays, and love songs, in spite of the institution’s relentless efforts to stress its scientific credentials and its relocation to a new site in the 1970s. It is a term which has regional currency, too, in a testimony to the hospital’s long history of treating patients and training medical students and psychiatric nurses from Syria, Palestine, Jordan, and beyond. Abi-Rached’s sympathy for this misremembered institution is clear. As well as rescuing ʿAsfuriyyeh from the myths and rumours which have grown to surround it, her concern is to remember the hospital at a time when its original site is at risk of being ‘developed’, like so much of historic Beirut, into amnesiac high-rises.

Weaving together a prodigious range of sources, including Arabic-language scientific and medical journals, missionary accounts, diplomatic correspondence, and hospital reports, Abi-Rached’s aim goes beyond simply narrating an institutional history. Instead, she treats the history of ʿAsfuriyyeh as a ‘sampling device’, or as ‘metonymy and metaphor’,[1] to reveal broader themes. Some of these will be of particular interest to historians of Lebanon and the wider region, but many of them have global resonances. In Abi-Rached’s capable hands, the story of ‘Asfurriyeh helps us think through the often complex relationships between the mind sciences and modernity; medicine, missionaries, and empires; war, conflict, and mental disorder; as well as a host of other crucial themes, including sectarianism, gentrification, memory, and ruination. ʿAsfuriyyeh’s six chapters proceed largely chronologically, with a pause near the middle of the book for a more synoptic exploration of the diagnosis and treatment of patients.

The opening chapter, ‘Oriental Madness and Civilization’, explores understandings of madness in the decades before ʿAsfuriyyeh was established, mobilising two distinct literatures to do so. The first half of the chapter draws on the writings of European and American travellers, missionaries, and medical doctors, who were concerned above all with the abusive treatment of ‘lunatics’ in the region, and the pathological nature of even the ‘normal’ local mind. The second half traces how the sciences of the mind were introduced and elaborated in the pages of Arabic-language scientific and medical periodicals like al-Muqtataf (‘The Digest’), which emphasised a naturalistic account of mental illness. Abi-Rached underlines the strikingly dissonant interests of these literatures and their authors: rather than accepting European accounts of the inherently pathological nature of the so-called ‘Oriental mind’, local intellectuals tied the question of insanity and the deterioration of care for the mentally ill to their wider programme for reforming the late Ottoman state and its people.

The second chapter, ‘The Struggle for Influence and the Birth of Psychiatry’, draws on diplomatic archives as well as the records of ʿAsfuriyyeh itself to reconstruct the history of the founding and early development of the hospital. Although founded by a Swiss Quaker missionary, Theophilus Waldmeier, Abi-Rached argues that the hospital needs to be understood not as a unilateral attempt at proselytization, but rather within the context of a complex struggle for power and influence in the region which involved local as much as international actors. Good relations with the Ottomans were key to the survival of the hospital, with its British medical director and matron permitted to remain on site during the First World War, when they were technically enemy subjects. Although avowedly non-sectarian and cosmopolitan in outlook, the hospital was perceived as ‘Protestant’ and ‘Anglo-Saxon’, both of which fuelled French suspicion of the institution once they replaced the Ottomans after the war, though their policies – covering hospital fees through the introduction of the assistance publique, for instance– indirectly benefited ‘Asfurriyeh.

The third chapter, ‘The Rise of ʿAsfuriyyeh and the Decline of Missions’, charts the transformation of the institution across the middle decades of the twentieth century, as the missionary zeal which had played a role in its foundation withered away and – contrapuntally – psychiatry’s domain was extended to encompass not just the obvious ‘lunatic’ but the everyday strains of industrial modernity. After the Second World War, a series of neuropsychiatric clinics were founded, as well as a forensic unit for prisoners, to bring mental hygiene to the home, school, factory, and military. If the impressive uptake at these outpatient clinics is any indicator, the wider population welcomed psychiatry’s expansionist ambitions. While in part encouraged by demand, these innovations were driven too by competition with a rival institution, Dayr al-Salib, a convent to the north of Beirut which had been converted in the 1920s by a Lebanese Capuchin priest into an asylum for elderly priests, and subsequently transformed into a psychiatric institution in the 1950s. Abi-Rached also stresses the role played by successive leaders in this period, above all Dr Antranig Manugian, medical director from 1962, whose transformational vision of ʿAsfuriyyeh as a modern psychiatric institute would be torpedoed by the outbreak of the Lebanese civil war.

The fourth chapter, ‘Patriarchal Power and the Gospel of the Modern Care of Insanity’, grapples with the backgrounds, diagnosis, and treatment of patients at ʿAsfuriyyeh right across its lifespan, notably through quantitative analysis of annual reports. This throws up interesting trends: peaks in admissions, for instance, to the hospital during the First and Second World Wars, as well as in the 1950s and 1960s at a time of growing economic prosperity, inequality, and substance use. While Abi-Rached makes some use here of patient case files – mostly from the hospital’s early years – she is reluctant to immerse herself in this archive, on the grounds that ‘the patients’ voices, personal narratives, and singular stories are buried in medical dossiers under the “tyranny” of their diagnosis’.[2] Instead, Abi-Rached largely limits herself to deploying these files to puncture myths surrounding the (in)famous case of Mayy Ziyadah, the influential feminist and poet admitted to the hospital in 1936. No one would deny that medical case files are tricky to work with, methodologically as well as ethically, and it may well be the case that these are amongst the files still in the process of being organised by archivists and so perhaps inaccessible. But they do seem to represent a rich, and here largely untapped, vein for researchers to explore further in future.

The fifth chapter, ‘The Downfall of ʿAsfuriyyeh and the Breakdown of the State’, was to my mind the most compelling and haunting of the book. Zooming in on ʿAsfuriyyeh between the start of the Lebanese civil war in 1975 and the hospital’s closure in 1982, Abi-Rached draws on the correspondence of the hospital’s medical director, Dr Manugian, to paint a deeply felt picture of a hospital which not only found itself in the midst of war, but a target within that war. Staff, students, and patients were kidnapped, injured, sexually assaulted, and killed, and every building hit at least once by shells. It is a harrowing story which Abi-Rached locates within a broader shift in the nature of political violence over the century towards targeting hospitals as a strategy of war – a strategy tragically familiar to us today, whether in Syria, Yemen, Gaza, Afghanistan, or elsewhere.  

The final chapter of the book, ‘The Politics of Health, Charity, and Sectarianism’, takes us past the official closure of ʿAsfuriyyeh in 1982 to develop some of the previous chapter’s reflections on non-sectarianism as the hospital’s deeply held – and ultimately, at a time of sectarian conflict, costly – ideology. Not only is it the case that health services, including mental health services, have been ‘sectarianised’ in Lebanon since 1982, but the very memory of ʿAsfuriyyeh itself is under threat of being sectarianised, with legal consequences: the Supreme Council of the Protestant Community in Syria and Lebanon is seeking to assert its control over this ‘Protestant’ institution in the courts. Abi-Rached vigorously contests this strategic misremembering of an institution whose executive committees, staff, and patients were always drawn from a range of backgrounds.

There is much here to digest for anyone interested in the histories of psychiatry, Lebanon, or the modern Middle East; certainly more than enough to guarantee the book a well-deserved place on undergraduate as well as postgraduate course syllabi, where some of its larger claims are sure to provoke reflection and discussion. At a time when re-institutionalisation is increasingly mooted in the West, Abi-Rached is at pains to emphasise that the closure of ʿAsfuriyyeh cannot be seen as part of any broader movement towards de-institutionalisation, as in Europe and North America. Instead, vast psychiatric hospitals continue to accommodate thousands of patients in Lebanon and the wider region: Dayr al-Salib, which historically rivalled and ultimately outlived ʿAsfuriyyeh, has a bedstrength of 1,100 today, a staggering figure which is nonetheless surpassed by at least two mental hospitals in Egypt and a further institution in Iraq.

Abi-Rached also takes issue with two components of Foucault’s account of the asylum: rather than replacing the leprosarium, Abi-Rached argues the asylum should be seen as emerging in the Middle East as a result of the decline of the bimaristan, charitable healing institutions with their own long history of managing the mentally ill; and rather than any ‘great confinement’, Abi-Rached argues that neither numbers, nor the routes by which patients arrived at ʿAsfuriyyeh, support this picture of the mass incarceration of the insane in Lebanon. While both these narratives have been roundly critiqued on empirical grounds not only in histories of psychiatry beyond Europe, but within it too,[3] one gets the sense that ʿAsfuriyyeh feels obliged to return to them, as the first English-language monograph on the history of psychiatry in the region, for its historiographical moorings.[4]

ʿAsfuriyyeh is a rich, original, deeply researched, and often moving work. Given its many strengths, I wondered whether it needed to be quite so pugnacious in its engagement with the few existing works on ʿAsfuriyyeh, which are criticised for being ‘still stuck in the Foucauldian and postcolonial frameworks’.[5] To give an example, in the otherwise excellent fifth chapter, Abi-Rached takes a tilt at Eugene Rogan for dismissing the hospital’s non-sectarianism as a mere public relations ploy. But Rogan doesn’t quite, at least in my reading, argue this.[6] At other points, a focus on rebutting these interpretations leaves some bigger, and more interesting, questions undisturbed. Responding in the fourth chapter to the claim that the Ottoman authorities embraced ʿAsfuriyyeh because it offered a means to cleanse the streets of lunatics, Abi-Rached marshals statistics to show that a majority of patients at the hospital were almost always private. But the more difficult question this leaves – as Abi-Rached recognises – is the degree to which coercion and dubious motives on the part of families, if not the state, may still have played a role in these admissions. Patient case records might have offered the beginnings of an answer.

In a sense, the book’s pioneering focus on the history of psychiatry in the modern Middle East means that Abi-Rached has to work hard to find bodies of scholarship with which to engage. While the connections she draws are almost always fresh and thought-provoking as a result, the invocation of a spectral figure of ‘Foucauldian and postcolonial frameworks’ at times jars. This does not at all detract from the accomplishment of this book, which not only provides a compelling history in its own right but generously offers future lines of inquiry an essential point of departure. In the opening pages of ʿAsfuriyyeh, Abi-Rached states that her goal is ‘to save this influential institution from oblivion’.[7] This is too modest a description of what she has achieved here, but it does capture a quality which I think characterises this remarkable history: a deep sympathy at its heart for ʿAsfuriyyeh, its reputation, and its people.

[1] Here Abi-Rached is drawing on Charles Rosenberg, ‘What Is An Epidemic? AIDS in Historical Perspective’, Daedalus 118, 2 (1989) and Michel de Certeau, L’écriture de l’histoire (Paris: Gallimard, 1975) respectively.

[2] Abi-Rached, ʿAsfuriyyeh, p.99. Here Abi-Rached is quoting Charles Rosenberg, ‘The Tyranny of Diagnosis: Specific Entities and Individual Experiences’, Milbank Quarterly 80, 2 (2002), pp.237-60.

[3] For example, in this journal, Andrew Scull, ‘Michel Foucault’s history of madness’, History of the Human Sciences 3, 1 (1990), pp.57-67. For colonial psychiatry and the ‘great confinement’, see Megan Vaughan, ‘Idioms of madness: Zomba Lunatic Asylum, Nyasaland, in the colonial period’, Journal of Southern African Studies 9, 2 (1983), pp.218-38.

[4] Happily this situation looks set to change in the near future, with forthcoming monographs by Lamia Moghnieh, Beverly A. Tsacoyianis, and this review’s author. For the history of psychiatry in Israel, see Rakefet Zalashik, Ad Nafesh: Refugees, Immigrants, Newcomers, and the Israeli Psychiatric Establishment (Tel Aviv: Hakibutz Hameukhad, 2008) [Hebrew] and Das Unselige Erbe: Die Geschichte der Psychiatrie in Palästina und Israel (Frankfurt: Campus Verlag, 2012) [German]; for the history of psychiatry in the Ottoman empire, see Fatih Artvinli, Delilik, Siyaset ve Toplum: Toptaşı Bimarhanesi (1873-1927) (Istanbul: Boğaziçi Üniversitesi Yayınevi, 2013) [Turkish]. For earlier histories of madness in the Middle East, see Michael Dols, Majnun: The Madman in Medieval Islamic Society, ed. Diana E. Immisch (Oxford: Oxford University Press,1992), and Sara Scalenghe, Disability in the Ottoman Arab World, 1500-1800 (New York: Cambridge University Press, 2014), esp. ch. 3. Much more attention has been paid to the career of psychoanalysis in the region: see in particular Omnia El Shakry, The Arabic Freud: Psychoanalysis and Islam in Modern Egypt (Princeton and Oxford: Princeton University Press, 2017).

[5] Abi-Rached, ʿAsfuriyyeh, p.18.

[6] The reference given here is to Eugene Rogan, ‘Madness and Marginality: The Advent of the Psychiatric Asylum in Egypt and Lebanon’, in Eugene Rogan, ed. Outside In: On the Margins of the Modern Middle East (London: I.B. Tauris, 2002), p.115. This is what Rogan has to say about ‘public relations’: ‘As a private institution without government support, the Lebanon Hospital dedicated tremendous effort to what would now be termed public relations. On the one hand, the hospital was entirely dependent on networks of private subscribers… On the [other] hand, they sought to preserve good relations with the Ottoman officials of the Mutasarrifiyya (governor general).’

[7] Abi-Rached, ʿAsfuriyyeh, p.xxvii.

Psychiatry’s Neoliberal Philosopher – Review: Thomas Szasz

Review: C. V. Haldipur, James L. Knoll IV, and Eric v. d. Luft (eds.), Thomas Szasz: An Appraisal of His Legacy. Oxford: Oxford University Press, 2019. xv and 298 pp. ISBN: 9780198813491

Alexander Dunst, Paderborn University, Germany

70 years after the publication of The Myth of Mental Illness, the book’s enduring impact can seem puzzling. Built on a series of outrageous simplifications and argumentative slips, Szasz’s polemic generalized its denial of mental illness from an understanding of hysteria as “malingering“, never engaged with the intricacies of long-term care it sought to deny to patients, and upbraided the sick for cheating the healthy. Nevertheless, Szasz emerged as the pre-eminent critic of psychiatry in the United States. He at once relished this status and vehemently distanced himself from the left-wing practitioners and theorists, from Franco Basaglia to Michel Foucault, that he was often lumped with. Szasz’s distinction was to be the only conservative so-called anti-psychiatrist, and his writings were feted by right-wing intellectuals and the counterculture alike. For patients and radical psychiatrists, The Myth of Mental Illness promised to remove the stigma of disease and seemed to offer freedom from paternalistic institutions. Despite its numerous shortcomings, then, Szasz’s work proved useful to a wide range of readers and inspired an institutional practice of mental health that combined self-help, state neglect, and psychopharmacology under the aegis of personal autonomy.

Unfortunately, Thomas Szasz: An Appraisal of His Legacy fails to answer, or even seriously ask, how his flawed ideas could have such enormous consequences. The editors and authors are psychiatrists and analytic philosophers and have surprisingly little to say about the real-world contexts of their subject’s writing, either at the height of his career or in our present moment. Neither does the volume contain contributions by former patients, a particularly disappointing oversight because the social movements that formed against institutional psychiatry were an important locus of Szasz’s reception in the United States and abroad. Instead, the chapters largely focus on his philosophical influences, extend Szasz’s reflections on psychoanalysis, suicide, and schizophrenia, or apply his writings to legal and theoretical issues in contemporary psychiatry.

A historical appraisal of Szasz’s legacy must therefore move along the edges of the volume’s dominant concerns. Many of its contributors note the significant impact The Myth of Mental Illness had on their professional development and testify to their lasting friendship with its author, lending the publication the air of a posthumous Festschrift. Even the contributors that disagree most strongly with Szasz assert his importance to critical debates within a field dominated by biomedical assumptions. Such personal testimonies reveal Szasz’s continued appeal to a small minority of philosophically minded psychiatrists. Coming from a generation of researchers that underwent graduate training in the 1960s or soon thereafter, these comments also emphasize the historical situatedness of Szasz’s critique. Writing with real rhetorical verve, Szasz attacked institutional psychiatry where and when it was weakest, exploiting the uncertain etiology of major mental illnesses as the psychodynamic consensus of the postwar years unraveled.

Throughout his writings, Szasz built on the central opposition between physical and mental illness. Adopting Rudolf Virchow’s definition of disease as cellular pathology, Szasz denied that psychological suffering could constitute an illness, or that it involved any suffering to begin with. If all illness was physical in this purposefully narrow sense, then mental illness was merely a metaphor or myth—a rhetorical ploy “to force others to provide for one’s needs“ (Szasz 171). This notion of myth was inspired by Gilbert Ryle, who saw the mind as a philosophical category mistake. Yet, it seems to have been Szasz, rather than any of his conservative forebears, who reinforced this argument with a psychiatric voluntarism that was breathtaking in its lack of empathy: So-called mental illness was merely an abdication of personal autonomy and society owed little to those who shirked responsibility in this manner. There was one decisive exception for Szasz—involuntary treatment. In the late 1960s and early 1970s, he founded two organizations that fought forced hospitalizations in court. The results, coming as large psychiatric hospitals closed, were decidedly mixed. Although some wards were rife with abuse and the quality of treatment varied considerably, Szasz and his followers saw no need to extend care to those freed from hospitalization. The only person worthy of attention became the freely contracting participant in a capitalist marketplace, the individual who paid for therapy out of their own pocket.

Several contributions to the volume point to the fallacies of this philosophy—Szasz’s misreadings of Virchow, Thomas Hobbes and Ryle, and his naive positivism that at once idealized medical science and denied any role for public health. In a memorable passage, the psychiatrist Allen Frances recounts that Szasz refused to treat severely ill patients during his residency in Chicago. When ordered to do so, he moved to Syracuse where he exclusively saw outpatients for the rest of his career. The man who routinely dismissed mental suffering, who railed against the laziness and stupidity of people with severe psychological problems, never actually worked with them.

Given these accounts, it’s difficult to agree with the praise accorded Szasz throughout the book, from describing his unmatched analytical rigor to lionizing him as the greatest defender of patient rights since Philippe Pinel. In part, these adulations stem from shared commitments, such as rejecting “statist medicine” (60). This opposition to public healthcare is widely shared in the United States, where it extends to a medical establishment that benefits from the inflated costs charged by private hospitals and resident doctors, pharmaceutical and insurance companies. Although Szasz was often dismissed out of hand by mainstream practitioners, his program shares more with the psychiatric status quo than may be apparent. As early as 1961, Szasz advocated a mental health policy that married conservatism with libertarianism and anti-communism, the main pillars of the Republican party that emerged under Ronald Reagan. Reagan had already implemented drastic cuts for psychiatric care during his time as governor of California, and state budgets have only shrunk further since. On the one hand, these measures have instituted a modern version of laissez-fare capitalism, with intensive psychotherapy for wealthy individuals and cheaply produced but highly profitable medication for the masses. On the other hand, a punitive regime has built on the moral condemnation that Szasz personified, pushing the desperate and needy into poverty and homelessness. For thousands, prison terms have replaced the mental hospitals that campaigners decried as incarceration. Szasz himself might have found punishment more palatable than treatment. For their part, patients and mental health workers proved pawns in a cynical, yet effective, game of cutting costs while crying freedom.

References

Szasz, T. S. (1971) The Myth of Mental Illness: Foundations of a Theory of Personal Conduct. New York: Harper & Row.