A History of Psychiatry in Objects

by Bettina Alavi and Ralph Höger


Using the agency of objects as an approach in university-based teacher training seminar
During the winter semester of 2017/18, students on the teacher training course at Heidelberg University of Education and students at the University of Heidelberg took part in the seminar “A History of Psychiatry in Objects”. This seminar was designed and taught by the history educationalist Bettina Alavi and Ralph Höger, a doctoral candidate at the Heidelberg School of Education. The seminar adopted Disability History (Waldschmidt/Bösl 2017; Bösl 2010) as its approach, focusing in particular on the question of the “agency” of material culture (that is, the agency of things and objects). The seminar enquired to which extent objects both contribute to and constitute 20th- and 21st-century understandings of psychiatry: how are the boundaries drawn between healthy/unhealthy, normal/not normal, socially acceptable/inacceptable? Our underlying assumption was that social ideas and orders are inscribed into psychiatric objects and that the psychiatric objects themselves in turn influence the emergence of social orders. Students’ task was to summarise the findings arising from this specific perspective of psychiatric objects in the form of articles for this specialist blog. The seminar thus gave teacher training students the opportunity to take part in a form of Public History. At the same time, the seminar itself constituted a form of Public History, promoting the themes and concerns of Disability History to educators able to disseminate them more widely across society.

Schmidt, Heinrich, Die Pfälzische Kreis-Heil- u. Pflegeanstalt Klingenmünster, Landau 1926, p.2.

Seminar participants traced the agency of objects in the following historic psychiatric items: restraint belts, injection needles, keys, regulations for nursing staff, a medical file, and a carpet made by patients. The objects all came from the Pfalzklinikum Klingenmünster, a psychiatric and neurological clinic in a remote part of the southern Palatinate near Landau. The clinic served as a local example, providing participants with both a concrete context and previously unstudied objects.

We would like to take this opportunity to thank the Pfalzklinikum staff Andreas Dietz and Christel Flory. Christel Flory worked at the clinic for many years as a laboratory technician and collected the objects we investigated herself.

State of research

Psychiatric history is already an established field of research within social history and forms the subject of several relevant publications. Brink’s Grenzen der Anstalt (2010) was helpful in the context of our seminar, as the concept of boundaries – both between the outside world and the institution and within the institution, between open and closed wards and gardens and buildings, for example – proved particularly stimulating for our object-focused approach.

Excerpt from the construction plan 1867 ©Pfalzklinikum Klingenmünster

Beyer’s Ph.D. thesis (2009), which looked specifically at the Pfalzklinikum Klingenmünster, contained a lot of detailed information on the clinic, which helped to place the objects in context. Previous studies on the agency of objects in the history of psychiatry include Majerus (2017), who looked at pills, walls and room layouts, and Ankele (2017), who investigated hospital beds.

The students’ blog articles

In their sheer materiality, the regulations of 1903 formed the foundations of employment relations between nurses and the clinic, regulating nurses’ entire period of service. The regulations set out the training nurses were to receive and detailed the scope of their duties. They reveal a certain margin for interpretation and highlight their own normativity, for example by setting out the sanctions applied for specific conduct.

The nurses’ keys tell us about power relations, regulating how people were locked in and out of the institution. At the same time, the keys highlight the fluidity of the boundary between “inside” and “outside” the institution. The keys made both temporary openings and unplanned, forced imprisonments possible. The power of the keys thus invested care staff with significant authority. Accordingly, staff needed to be very careful with these power-bestowing objects.

A woman’s medical file from the National Socialist period reveals performative agency. The acts of writing performed in these records led to momentous decisions in a later court case. The diagnosis set down in the medical file became the main grounds for the woman’s forced sterilisation.

Injection needles were ambivalent objects. They were vehicles of therapeutic care on the one hand and medical force on the other. As objects associated both with the hope for a cure as well as with sedation and control, injection needles defined the boundaries in doctor-patient relations.

The restraint belts represent compulsory measures that restricted the patients in their free movement. With the restraint, power is directly transferred to the nursing staff which executes the compulsory measures. Even just the look of the belts might have triggered patients' anxieties.

Nurses’ uniforms are a “social skin”, delineating the boundaries between doctors and nurses, nurses and patients, and doctors and patients. At the same time, these boundaries are subject to negotiation, which can be seen from the fact that in many places, female nurses no longer wear a cap; in some institutions, uniforms have disappeared altogether.

The construction plans reflect the major shifts in child and adolescent psychiatry in the late 1960s and early 1970s. Modern facades sought to express the field’s successful “clinification”. However, it remains doubtful whether this was enough to truly draw a line under its inglorious previous history.

The carpet woven by patients in the 1970s exemplifies the tension between the economic activity required for the clinic’s upkeep and the therapeutic measures structuring inmates’ daily routines, such as art therapy. Thus it reveals the somewhat contradictory aspects of occupational therapy, oscillating between the aspiration for meaningful, useful work and the desire for artistic self-realisation.

Students’ blog contributions were edited to various degrees.

Bettina Alavi is professor for history didactics at the Heidelberg University of Education. Ralph Höger is a doctoral candidate the Heidelberg School of Education.

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References
Ankele, Monika (2017): Wie das Krankenbett zum Medikament wurde.
http://science.orf.at/stories/2847043/ (last accessed 2 May 2018)

Beyer, Christof (2009): Von der “Kreis-Irrenanstalt” zum Pfalzklinikum. Eine Geschichte der
Psychiatrie in Klingenmünster. Neustadt: Institut für Pfälzische Geschichte und Volkskunde.

Bösl, Elsbeth (2010): Was ist Disability History? Zur Geschichte und Historiographie von
Behinderung. In: Elsbeth Bösl, Anne Klein, Anne Waldschmidt (eds.): Disability History.
Konstruktion von Behinderung in der Geschichte. Eine Einführung. Bielefeld: Transcript, pp.
29-43.

Brink, Cornelia (2010): Grenzen der Anstalt. Psychiatrie und Gesellschaft in Deutschland ;
1860 - 1980. Göttingen: Wallstein Verl. (Moderne Zeit, 20). Available online at
http://www.h-net.org/reviews/showrev.php?id=46189.

Majerus, Benoît (2017): Material Objects in Twentieth Century History of Psychiatry. In:
BMGN - Low Countries Historical Review 132 (1). DOI: 10.18352/bmgn-lchr.10314.

Waldschmidt, Anne/Bösl, Elsbeth (2017): Nacheinander/miteinander. Disability Studies und
Dis/ability History. In: Nolte, Cordula/Frohne,Bianca/Halle,Uta/Kerth, Sonja (eds.) (2017):
Dis/ability History der Vormoderne. Ein Handbuch. Affalterbach: Didymos, 40-49.

Recommended citation:

Bettina Alavi / Ralph Höger (2019): A History of Psychiatry in Objects. In: Public Disability History 4 (2019) 1.

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Who belongs in the murder clinic? The trouble with Nebel im August

By Ylva Söderfeldt

Germany is obsessed with narratives – movies, TV-series, novels – about its 20th century history. The most successful exports in later years have dealt with Nazi crimes and GDR oppression, not to mention the many productions directed at national audiences. No doubt, several of these works have been both of an outstanding artistic quality as well as having contributed to public awareness about the past, not least also about the continuities into and effects on the present German society.

One of the current movies on this theme (in the theatre where I watched it, there were at least two other films about Nazi Germany currently on the program) is somewhat unusual in that it addresses the murdering of sick and disabled people during the Second World War. Based on a novel that was in turn based on an actual biography, Nebel im August (Gloom in August) tells the story of Ernst Lossa (Ivo Pietzcker), who was murdered at the age of fourteen in a clinic in Irsee on August 9, 1944.
Lossa was Yenish, a minority that suffered persecution under the Nazis, had lost his mother, and was furthermore considered to have behavioral problems, all factors contributing to his institutionalization. We encounter him in the movie as he is transferred to the clinic in Irsee after having been in a series of other facilities. The initial impression is twofold: Lossa appears relieved at the friendly attitude he encounters from the head clinician Walter Veithausen (Sebastian Koch), but reacts with fear and contempt when he meets his fellow inmates, protesting that he doesn’t belong among "idiots".

A young boy with shaved head Ernst Lossa (Ivo Pietzcker)  is being
viewed by a doctor Dr. Werner Veithausen (Sebastian Koch) standing behind him. Courtesy of StudioCanal.

Between working in the fields and daydreaming of emigration, Lossa however soon comes to witness what quietly goes on in the clinic: inmates are being killed. At first, they disappear in enigmatic transports, then given lethal doses of medicine or deliberately starved on the premises.
The story is told at a slow pace and offers the viewers an almost excessive amount of scenic footage. At the same time, it is packed with information. When the camera doesn’t sweep over a beautiful landscape or interiors reminiscent of Vermeer paintings, it follows the protagonists in dialogues that painfully incorporate as many facts as possible about the ‚euthanasia’ programs. The ideological backdrop, the bureaucratic particulars, the role of scientific research as well as the Catholic church: it’s all in there, represented in the clearest way possible. This makes the viewing tedious, and the experience more like reading a Wikipedia entry than following a story. It is thanks to the generally very good acting and in particular Pietzcker’s brilliant performance, as well as David Bennent in an outstanding supporting role, that the movie still manages to engage and touch the viewer beyond the mere telling of historical facts.

A nurse (Henriette Confurius) hands a drink to a boy in a hospital bed. Courtesy of StudioCanal.

This tendency to be overly pedagogic is a common trait for the genre and for German film in general (in a German detective story, you always know who the killer is, no mystery is tolerated). But it might also be due to the specific topic. The makers cannot anticipate that the viewers bring much previous knowledge into the theatre, and obviously felt it necessary to clearly lay out the facts in order to tell the story.

More troubling is the message that follows Ernst Lossa’s story throughout, and is articulated by one of his caretakers – and possibly, his killer  – "but he is a healthy boy!" The idea that Lossa "does not belong there" never quite leaves us even though his alliance shifts away from the staff and to his fellow inmates as the plot unfolds. This trope is all too familiar in narratives about the Nazi crimes against the sick and disabled: outrage tends to be directed especially at the abuse and murder of those who ‘weren’t even actually sick’ but ‘just’ labelled antisocial and degenerate. That line of reasoning, of course, implies that some people did ‘belong there’ and that certain illnesses and disabilities were, if not rightful, at least understandable grounds for extermination. From a public disability history perspective this particular presupposition  is precisely what needs to be questioned, and it is unfortunate that this production does not take the opportunity to do so.

Two boys with shaved heads(Niklas Post and Ivo Pietzcker) and a man (David Bennent)
sit outdoors by a pile of potatoes looking amused and shocked. Behind them, men are making baskets.
Courtesy of StudioCanal.

Nebel im August
StudioCanal, Germany, 2016
Director: Kai Wessel
Screenplay: Holger Karsten Schmidt
Lead cast: Ivo Pietzcker, Sebastian Koch, Thomas Schubert, Fritzi Haberlandt, Henriette Confurius

Recommended Citation:
Ylva Södrfeldt (2016): Who belongs in the murder clinic? The trouble with Nebel im August. In: Public Disability History 1 (2016) 18.

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Disability History Beyond Borders: The Story of Ryoichi Ishii and Takinogawa Gakuen in Japan

By Yoshiya Makita

In the countryside, an hour’s train ride away from the noisy central districts of Tokyo, the buildings of Takinogawa Gakuen stand in solitude, surrounded as they are by deep forest and tiny streams. As a social welfare center, Takinogawa Gakuen provides services to people with mental disabilities. The small institution has a long history. Visitors learn with a sense of surprise that this first institution of its kind, which was established in Japan more than a hundred years ago, continues its mission on the western outskirts of the metropolis.

In the past ten years, the field of disability history has been expanding hugely to include various areas of research from diverse perspectives. No historian can now ignore the critical importance of disability, which influences one’s social life, at the intersection with other social attributes such as race, gender, and class. To this current state of the field, the story of Takinogawa Gakuen and its founder Ryoichi Ishii will add another new viewpoint: a transnational perspective on the history of disabilities. What it means to be disabled varies with location. But historical inquiries reveal that different institutions of disability in various localities have often developed through transnational exchange of ideas and practices beyond borders.

Portrait of Ryoichi Ishii (Courtesy of Takinogawa Gakuen)

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