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Mental Health in History: Psychiatry and Anti-Psychiatry
Episode 1228th October 2022 • Meeting Street • Cogut Institute for the Humanities
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How did the World Wars shape the practice of psychiatry and the larger mental health field? And how has psychiatric discourse in turn changed how we think about the self? What constitutes mental illness? Who gets to define it and how it should be treated?

In this episode of “Meeting Street,” performance studies scholar Leon Hilton and historian Jennifer Lambe join host Amanda Anderson for a conversation exploring the development of contemporary psychiatry, the role of reformist movements within the field, how gay rights activism and disability justice have challenged our understanding of mental illness and the domain of psychiatry, and the ways in which historical and cultural contexts can inform ongoing scientific study of the mind.

Transcripts

Amanda Anderson:

From the Cogut Institute for the Humanities at Brown University, this is “Meeting Street.” I’m Amanda Anderson, the show’s host.

Amanda Anderson:

One of the most important issues of the present day is how we conceptualize and approach mental health care, and I’m really pleased today to have a chance to talk with two scholars about the history and politics of psychiatry. My guests today are Leon Hilton and Jennifer Lambe, two colleagues here at Brown University, who in spring 2022 co-taught a graduate seminar titled “Global Histories of Psychiatry and Anti-Psychiatry Since 1945.”

Amanda Anderson:

In this course, they explored developments in psychiatry in the wake of World War II, with attention to various movements, both within and outside of psychiatry, to change the approach to mental health. They take up several fascinating and important issues. They show how the aftermath of the war, including movements of decolonization and the geopolitics of the Cold War, influenced psychiatric thought, as well as practices of care. They consider as well how social movements in the ’60s, ’70s, and beyond helped redefine therapeutic culture. And they illuminate how newer movements around disability have impacted mental health frameworks and activism.

Amanda Anderson:

I’m really looking forward to speaking with them today about this richly conceived topic, one which is deepened in part because their collaboration involves such a generative encounter between different disciplinary perspectives and areas of scholarly research. To bring that disciplinary encounter into focus, let me now introduce my guests.

Amanda Anderson:

Leon Hilton is a faculty member in the Department of Theatre Arts and Performance Studies, and is also affiliated with the Gender and Sexuality Studies program, as well as the program in Science, Technology and Society. His research integrates performance studies and disability studies with particular attention to questions of neurodiversity. His book on this topic, “Feral Performatives,” is forthcoming from the University of Minnesota Press.

Amanda Anderson:

Jennifer Lambe teaches in the Department of History, where she specializes in Latin American and Caribbean history. She is the author of “Madhouse: Psychiatry and Politics in Cuban History,” published in 2017 by the University of North Carolina Press, and one of her current projects explores the transnational history of psychiatric de-hospitalization.

Amanda Anderson:

Leon and Jenny, welcome to “Meeting Street.”

Leon Hilton:

Thank you for having us.

Jennifer Lambe:

It’s great to be here. Thank you, Amanda.

Amanda Anderson:

I’ll begin with a question about the general framework of the course, and in particular its focus on the period since 1945. Jenny, in tracing the global history of psychiatry, what’s important about the postwar context specifically?

Jennifer Lambe:

Yeah, this is a great question, because in fact, it requires us to look back a little bit, because the postwar period is important because, in fact, the war was so important to the development of psychiatry in the Western world and beyond. That’s true of World War I and World War II, which served as medical laboratories in many ways for the most pioneering approaches then being developed in the mental health field, but also, and especially in the United States, a kind of testing ground for a new generation of reformist psychiatric professionals who would utterly transform the field in the war’s aftermath.

Jennifer Lambe:

This was a generation — again, particularly in the United States — that was most aligned with psychoanalytic ideas or psychotherapeutic ideas as opposed to some of the biological perspectives that had predated them. In fact, the first DSM [“Diagnostic and Statistical Manual of Mental Disorders”] with a heavy psychoanalytic emphasis grew out of an army diagnostic manual developed in the course of the war. This reformist generation of psychiatric professionals, who are known colloquially as the Young Turks in the United States, also were really interested in reimagining their relationship to psychiatric institutions at that point very much under siege, or warehousing, custodialism, abuses against psychiatric patients, and so in many cases were looking to either reform or entirely jettison the institutional approach to psychiatric treatment. Psychoanalysis or psychotherapeutics seemed to promise to do exactly that.

Jennifer Lambe:

But the classic dynamic in the history of psychiatry really prevails here: What at one point seems progressive almost immediately becomes regressive and orthodox. That’s very much the case with the new psychoanalytic culture that emerges in the 1950s and ’60s in the United States. The Young Turks soon in turn come into contact and conflict with emergent anti-psychiatric ideas and figures, countercultural activists who are seeking to dethrone that psychoanalytic orthodoxy altogether. That’s a dynamic that I think, as we traced in the course in different ways, really persists throughout the decades to come.

Amanda Anderson:

That’s fascinating. Now, your own scholarly work explicitly takes up the Cold War context and its focus on the history of psychiatry in Cuba. Can you say a little bit about how that particular history illuminates larger forces at play in the mental health and geopolitical field?

Jennifer Lambe:

Yeah. I think it’s safe to say that most people wouldn’t put Cuba at the center of the story of the history of psychiatry in this moment, even within Latin America, where Argentina has always been the dominant touchstone, for better or worse. But as I trace in my work, before 1959, Cuban psychiatrists and psychoanalysts — there was an emergent psychoanalytic community in Cuba as well — were closely integrated into international intellectual circuits, especially those in the United States, which in some ways helped to prompt the analytic emphasis in the psychiatric field before 1959, even if psychiatrists, unlike their counterparts in the US, did not enjoy broad social relevance or influence leading up into the 1959 Cuban Revolution.

Jennifer Lambe:

What’s so interesting about Cuba, I think, is that there this collision between politics and psychiatry that comes to mark this period globally is perhaps uniquely visible and fraught because of the revolution itself, which helps to precipitate a change of emphasis within the field away from the Freudian emphasis that had prevailed before 1959 and towards the Pavlovian, reflexological, but really biological orientation to psychiatric treatment that was the standard in the Soviet Union at that point, for example. You get here a classic story of intellectual transition in dialogue with political forces and alignments.

Jennifer Lambe:

But I think the even more interesting story is that psychiatrists, contrary to some of their expectations in this moment of great social and cultural upheaval, did not in fact come to expand dramatically their political or social profile in the aftermath of the 1959 revolution, with a few important exceptions who collaborated really closely with the government like their counterparts in the United States. But in fact, the revolutionary government itself comes to ingest, incorporate, and disseminate what I regard as organic psychiatric ideas and practices as part of a broader bio-political project of subject reformation, wielded here not by mental health professionals, but by revolutionary officials themselves. This is a kind of apotheosis in some ways of the forces that we see set into motion by the Cold War elsewhere, where psychiatrists on one hand, but also governments on the other, are becoming heavily invested in influencing literally and figuratively what’s happening inside people’s minds.

Amanda Anderson:

Related to that is the question of certain psychological issues that came to the fore in the wake of what we might call the catastrophes of the 20th century. I’m thinking in particular of the psychological question of how to account for human aggression and impulses toward authoritarianism. Are there important developments in the postwar era that take up some of the darker implications of the catastrophes of the war and its aftermath, specifically the experiences of fascism and totalitarianism? Leon, could you speak to that?

Leon Hilton:

Absolutely. I think there are two trajectories to this question that are interesting to think about. First, as you say, in the period immediately following World War II, we do witness a dramatic rise in the prestige of psychiatric expertise generally and I think what could be called a generalization of psychiatry’s domain. Psychiatrists increasingly came to concern themselves not only with people diagnosed as mentally ill or institutionalized in asylums, but increasingly weighed in on broader problems facing the entirety of society. There was a real interest in studying the psychology of human personality more broadly, as you say, in the wake of the Second World War, an interest in what gets called the authoritarian personality, what are the social conditions that create the conditions for people to have certain beliefs, and with this also, a generalization of psychiatric concepts, themes and therapeutic techniques much more broadly than may have been the case before.

Leon Hilton:

I think a second issue is that with the end of World War II and the reckoning with the human capacity for cruelty on such a massive scale, and indeed a bureaucratic scale as epitomized in the concentration camps, I think this really brought with it a need to reexamine the conditions in which people diagnosed with mental illness were frequently housed — Jenny used the term warehousing, that’s a term that was often used — and there really was, during the first decades following the end of World War II, a real comparison actually in some cases between the conditions of large state run asylums and the Nazi concentration camps. I think both of those really speak to why that postwar period is so interesting and key for understanding the history that we were interested in looking at.

Amanda Anderson:

Jenny, did you want to add anything to that?

Jennifer Lambe:

Yeah, I think the Holocaust as a metaphor or a figure or a motif in reformist discourse around psychiatry is really interesting, because the flip side of this engagement between social questions and psychiatric professionals and psychiatric questions is the dark side, the weaponization of psychiatry, in fact, in the war’s aftermath, a kind of expansion of a weaponization that had begun in the war. I’m thinking here particularly about the mind control research race that set in around the world and we know quite a lot about in the United States, thanks to some pioneering efforts to declassify documents related to this in the United States, but finding out that, in fact, many of the most important mental health professionals or researchers in the field were open to, and actively involved in, efforts that originated within security forces — within the CIA and the FBI to some degree — to try to bridge the so-called my control gap that was presumed to exist to counter communist efforts at brainwashing by effectively learning to do the same thing.

Jennifer Lambe:

The public critique of the potential of psychiatry or medical professionals to contribute to different kinds of violent processes has its dark counterpart in the continuation of exactly that kind of sinister collaboration that many are drawing attention to in the war’s aftermath and that won’t be fully reckoned with arguably until the 1970s, or some would say still [exists] in light of the reformation of some of those relationships, for example, in the context of Guantanamo.

Amanda Anderson:

This may be related to what you’re saying here, Jenny. A key term in your course title is “anti-psychiatry.” I would love to hear you both talk a little bit about what anti-psychiatry is and how we should understand it. Leon?

Leon Hilton:

Yeah, absolutely. Anti-psychiatry is a term that for many people is associated with names like R.D. Laing and David Cooper, two figures who actually trained as psychiatrists in the immediate post–World War II period, but who increasingly found themselves critical, and indeed in many cases horrified, by the state of their profession, and who, particularly beginning in the 1960s, started to formulate a series of really radical critiques and, indeed, in some cases, calls for the total abolition of psychiatry as a field of expertise and all of the attendant techniques of therapy and care that came with it.

Leon Hilton:

In place of, for example, mental hospitals, many of the figures associated with this movement were interested in finding alternative arrangements of community and care, in many cases attempting to erase the hierarchies that existed between patients and doctors and medical staff. They really thought that by totally abolishing and starting from scratch with a totally new context that there would be a possibility for a complete revision of our understanding of what mental illness even is. I could paraphrase a common refrain from this moment of the ’60s, that it’s not the individual human subject who is sick from a mental disease, but actually the society in which that human subject is formed that’s sick and that needs to be repaired.

Leon Hilton:

But I would say that beyond the immediate historical referent of anti-psychiatry with Laing, Cooper, and others from that moment of the ’60s, I think you can really see an anti-psychiatric impulse embedded within and totally intertwined with the history of psychiatry itself. I think certainly the legacies of that ’60s moment are still with us, and people continue to wrestle with these questions up until today, when there are still really powerful and important articulations of a kind of abolitionist perspective on psychiatry that continue to be articulated and that we incorporated into our class as well.

Jennifer Lambe:

I’ll maybe pick up a little bit on Leon’s last point. I think what’s really interesting about the category of anti-psychiatry is, of course, as Leon pointed out, the fact that psychiatry is contained within it and that the people who are credited with originating the movement to some degree were themselves trained and, to a certain point, practicing psychiatrists. Leon and I, in constructing the syllabus for this course, were really eager to move away from the guru-centric vision of anti-psychiatry that has tended to structure historical accounts of the field.

Jennifer Lambe:

I would say that corresponds to a revisionist impulse that has emerged in scholarship about anti-psychiatry recently, which in fact sees the line between psychiatry and anti-psychiatry as a whole lot fuzzier than I think it would’ve even appeared 10, 20, 30, 40 years ago. That’s in part because so much of what became intrinsic to anti-psychiatry had been anticipated by the Young Turks, reformist progressive psychiatrists who preceded them, or in some cases were them, that is to say these are one and the same people, but also because psychiatry, perhaps more than any other scientific or medical discipline, has, as Leon was alluding to, been defined by its relationship, a kind of definitional relationship, to anti-psychiatric critique or critiques of psychiatry.

Jennifer Lambe:

That we could say is a result of the fact that psychiatry, unlike almost any other medical discipline, has long hunted for and never found magic bullets, has encountered few magical or decisive solutions to the objects it presumes to treat, and so therefore remains vulnerable at every point in its history to this kind of extramural criticism, that in fact what it’s proposing to treat most of the time are social rather than medical problems, as Thomas Szasz, another important psychiatrist-cum-anti-psychiatrist, would argue that mental illness is just a myth.

Jennifer Lambe:

Although I think we’ve moved pretty far away from that perspective in mainstream, especially US, society today, that sense of vulnerability at the heart of psychiatric expertise is still with us, along with the perpetual quest for the magic bullet right around the next corner.

Amanda Anderson:

Well, to continue this really interesting question of the relationship between psychiatric care and let’s just say larger society, Jenny, let me turn and ask you about the French West Indian psychiatrist and political philosopher Frantz Fanon, who is a hugely important figure within the history of psychiatry, given his focus on colonialism and the more general treatment of the political and the psychological across his work. How does he fit into the history that you are alluding to? What was interesting about Fanon, both theoretically and practically, in terms of the concrete work he did in changing the institutions that housed mental patients?

Jennifer Lambe:

Yeah. As much as Leon and I were eager to get away from gurus, I have to say we left a little bit of room for one, a standalone week for Fanon. In part, I think that is a result of the fact that historically he has not been at the center of many discussions of psychiatry and anti-psychiatry, even though I think, in our perspective, he perhaps better anticipates many of the questions we are having about psychiatry today, namely its cultural specificity and even the role that it can play in shoring up racial, social, class, ethnic hierarchies.

Jennifer Lambe:

Of course, Fanon, like many of the others we’ve discussed, is someone who was trained as a psychiatrist, who practiced as a psychiatrist, and he was profoundly interested in reforming psychiatric practice. At the same time of course that he pursued a broader critique, for which he has become most famous, of the ways in which psychiatry and psychoanalysis in particular, or a particular strand of colonial psychiatry, served to naturalize and shore up white supremacy in the colonial project; moreover, that the Western subject, as conceived at the moment, was to some degree a construction of psychiatry; and that therefore one had to inhabit and deconstruct that psychoanalytic language in order to in turn dismantle white supremacy.

Jennifer Lambe:

I think Fanon, like many of the figures we’ve discussed, also begs the question of where action should lie, if it should be targeted at the individual or the society. I think at many points he answers “both,” even though over the course of his career, of course, he shifts towards a more radical, revolutionary politics and away from institutional solutions that he had sought early on.

Jennifer Lambe:

But I have to just say, on a personal note, Fanon holds interest for me, as a scholar of Cuba, because whenever anyone learns that I work on Cuba or the history of psychiatry in Cuba, they in fact assume that Fanon is an important touchstone for Cuban psychiatrists. I always have to explain that, in fact, he was not, that he was very rarely referenced, but that does not mean that the project that he was pursuing was unfamiliar to Cuban psychiatrists. In fact, from my vantage point, the corner of the world that I study and approach in my research, this question about the cultural specificity of psychiatry is the question of the 1960s, ’70s, ’80s, ’90s, the aughts, and today.

Jennifer Lambe:

In other words, many of the themes that we associate with anti-psychiatry in the global North, in fact as experienced and registered in the global South, look quite different, and in fact are targeted to critiquing imperialism, colonialism, as themselves being upheld by psychiatry to some degree and insisting on a need for a psychiatry or mental health practice, mental healing practice, that is attuned to the cultural specificities of places outside the global North.

Amanda Anderson:

One thing that’s interesting is that Fanon’s work within institutions, and then of course the larger trajectory of his thinking, raises the larger question of the tension between institutional reform and anti-institutional impulses in the history of psychiatric activism, as you pointed out. Leon, can you talk a little bit about that issue, since I know it was central to discussions in the seminar?

Leon Hilton:

Yes. One of the things that was really fascinating about where we read Fanon in the course of the syllabus is that it actually allowed us to trace a parallel between histories of anti-colonialism, anti-imperialism, and histories of what gets called deinstitutionalization. Deinstitutionalization is a complex concept. It’s much disputed now. But basically it’s thinking about the history of attempts to basically shut down large state-run asylums and hospitals that had developed over the course of the late 19th and first part of the 20th century.

Leon Hilton:

There’s a question about what to replace them with, but if you look at the rapid decline in the number of, for example, psychiatric hospital beds in just the United States from around the 1960s through the present, it’s really, really striking how there is this massive movement of people from institutions out into other settings. Really, the question of the institution and its social role, its role as a social space, became really crucial for us. Fanon was somebody who is not necessarily read often in that context, but provided insight into the other critiques of institutions that we were reading from around the same time. It was a really interesting reframing of some of the ways in which these ideas are understood in relationship to each other.

Amanda Anderson:

One aspect of the history that you trace is the powerful effect that social movements of the ’60s and ’70s had on therapeutic practices and cultures. For example, feminism and feminist therapy really challenged any normalization of women’s roles or any approach that advocated individual adjustment to conventional roles or dynamics. The gay rights movement had a profound effect on the way the field approached homosexuality, which had been pathologized. How do you see the current therapeutic field? Are there forces at present that are playing a role similar to the role that certain radical movements played in the ’60s and ’70s, or are we looking at a different landscape altogether? Jenny, perhaps we can start with you.

Jennifer Lambe:

Yeah, I encountered this question a lot in the course of not only teaching this class with Leon, but teaching undergraduates about the history of psychiatry. In part what I have discovered very quickly, and in an evolving way, is that this history associated with the ’60s and ’70s in some ways is endemic to the way that we understand psychiatry now, but also that we’ve moved quite far away from it.

Jennifer Lambe:

Part of this is a function of some of the perpetual questions that I mentioned regarding psychiatry, I think the most important one being “Has psychiatry found a way to, as philosophers of science call it, carve nature at its joints? Are the categories that we use to describe the ways our minds experience reality intrinsic to nature or are they categories that we’ve imposed on nature, this idea of mental illness as itself a myth?”

Jennifer Lambe:

What I think is often striking for students in encountering the ’60s and ’70s and the multiple fronts of contestation that psychiatry was confronting at that moment, from gender to sexuality — we’ve talked about race and culture as well; we could name others — is that the 1980 DSM-III so shifts the terms of the conversation that, in fact, that history can seem almost unthinkable from the perspective of 2022.

Jennifer Lambe:

What I mean by that is that DSM-III represents this revisionist attempt, and also ends up being, I would say, a revolutionary attempt, to recenter diagnosis in the practice of US psychiatry, to actually put diagnosis at the heart of what psychiatrists do, and to do so in a way premised on clear, discreet diagnostic criteria presumed to respond to the reality out there in nature.

Jennifer Lambe:

Now, almost every person who has spearheaded a process of DSM reform in the post-DSM-III era has come to repudiate the document that they or others have created as not matching reality closely enough. Yet, what’s so interesting, I think, and striking about our moment in particular, is how naturalized these DSM categories have become, how many of us in the United States and beyond — of course the DSM is the document in the United States; the ICD [International Classification of Diseases] prevails on the international level — become linked not only to psycho-pharmaceutical treatments, of course, beginning in the 1990s, but also to ways of understanding self, that we have come to bear these diagnostic categories that many of us understand, and certainly the psychiatrists who wield them understand, to be necessary fictions or complicated nonfictions or lying somewhere in between as a way to mark and understand our place in the world and the way in which we experience the world.

Jennifer Lambe:

It’s actually not as common today, and I certainly hear much more rarely a call to dismantle psychiatry altogether as would have been the standard presumption in the ’60s and ’70s, so much as in fact to expand psychiatry in some ways to better cover gaps in care, to make psychiatry more responsive to our social and political realities, but also to make it more expansive in its ability to provide mental health care for the population.

Jennifer Lambe:

That’s a very complicated enterprise, of course, when there are so many questions being raised perpetually about the categories on which that expansion rests. The question of cultural difference in a document that presumes biological universality remains, I would say, the most complicated one of our psychiatric moment, yet not one that has excluded that universalization that I was talking about.

Amanda Anderson:

Right, that’s fascinating. In part, you’re talking about the universality of certain, say, personality diagnoses, as opposed to, say, culturally contextualized understandings of self and community.

Jennifer Lambe:

Yeah, I think that’s right. I’ll maybe leave it to Leon to add more about that, since I think his research really picks up this interaction in an interesting way.

Leon Hilton:

Well, just one thing that I would add about the question about how social movements have engaged with psychiatry and anti-psychiatry: I think it’s really an important point that gets us to think about whose voices are prioritized in these conversations. In particular, the two movements that you mentioned, both the feminist movement and the gay rights movement, were really concerned with shifting the hierarchy in terms of whose voices have priority, who has the expertise over someone’s experience.

Leon Hilton:

There’s this really pivotal moment in 1973 when homosexuality is no longer a mental diagnosis, and that really is marked as this pivotal moment in the mainstream acceptance of gay rights as a platform, but it’s also a complex movement. Several of the pieces that we read for the class actually point us to think about how this moment also can be thought of as a distancing from disability: so homosexuality is sort of re-scripted, not as an illness, but as something that’s healthy, and what are the implications of that for the broader politics of mental health and disability generally?

Amanda Anderson:

Leon, your scholarly work is largely focused on disability, specifically on neurodiversity and larger questions arising out of disability studies. How would you elaborate on the connections or disconnections between the politics of mental health and questions around neurodiversity, and also what is generally captured by the term intellectual disability?

Leon Hilton:

One of the key interventions, I think, of disability studies and disability rights generally is this idea of “nothing about us without us.” If there is a field of expertise, like psychiatry, that has this immense power to diagnose and in some cases constrain and medicalize, what about the perspectives of those who are on the receiving end of those discourses?

Leon Hilton:

I often think about the development of a term like “neurodiversity,” which appears first in the 1990s, primarily online in the autistic community. How do we think about neurodiversity as a counter-discourse? In other words, using the very terms and language by which certain subjects are diagnosed or described back against those forces that are diagnosing them and describing them. For me, that’s what is really fascinating about thinking about neurodiversity as a kind of extension and expansion and deepening of this longer history of psychiatry and anti-psychiatry.

Leon Hilton:

In particular, neurodiversity obviously in the word itself has “neuro,” which implies something about the brain sciences and their increasing prominence in psychiatric science itself and psychiatric research. I think the relationship between a term like neurodiversity and disability is really rich and contested, and there are so many different perspectives on it that we tried in the class especially to incorporate a whole range of writers and artists and thinkers who were thinking richly with this concept and really expanding our understanding of psychiatry itself, but also what disability or ability even means in the context of neurodiversity.

Amanda Anderson:

I’d really like to follow that up by hearing a little bit about how the encounter between your two disciplines, history on the one hand and theatre and performance studies and disability studies on the other, shaped the development and the experience of the course.

Jennifer Lambe:

I think Leon and I were surprised, maybe, to find out that we had a lot more in common than we thought, heading into the process of syllabus design especially. I remember early brainstorming sessions where we were generating texts and titles and subjects for weeks, and in fact there was so much overlap that sometimes it was hard to decide which week belonged to which person and who was going to pick the readings that we assigned.

Jennifer Lambe:

I think in part that was because of our shared desire to move away from classic anti-psychiatry canon, that we’ve described already a little bit, that would have consisted of a week on Szasz and a week on Laing and a week on Cooper and then maybe a week on the removal of homosexuality from the DSM, as Leon has described, and to figure out if we could come up with a different story to tell that wasn’t necessarily a homogenous story, in other words, that had fissures and cracks and did not presume a universal process.

Jennifer Lambe:

Because of course, as someone who does not primarily study the United States or Western Europe, I am acutely aware of how inadequate in some ways the traditional narrative of psychiatry and anti-psychiatry is for the rest of the world and was interested to think about how we could center other experiences and trajectories in the class without at the same time losing students who may not already have had that narrative to hang our anti-narrative on, as it were. That required us to think about and trace themes. We were both really interested in culture. It made Fanon, I think, a real point of inflection in the course for so many reasons.

Jennifer Lambe:

But I think also helpfully, for a historian, Leon also really helped orient our conversations to issues, questions, sources, voices that would resonate with the students now and, I think, introduced a couple touchstones really early on in the class that I was surprised, not because I didn’t find them fascinating, [but] because I don’t think I could have anticipated what our new anti-canon canon would look like that came to function for the students as a really important point of reference moving throughout the semester, precisely because they could identify with the questions and approaches at hand.

Jennifer Lambe:

Leon, you also really have worked hard to put pop culture at the center of conversations about psychiatry and anti-psychiatry in your own work and in the way you conceived the class.

Leon Hilton:

Yeah, absolutely. It was such a great opportunity to co-teach this class with somebody from a discipline that’s adjacent in many ways, but bring our own emphases and perspectives on it. In particular, I think thinking about the issue of cultural representation: How are these histories absorbed by artists and writers and then transmuted or translated into the work that they produce?

Leon Hilton:

Jenny mentioned that there were a couple of things that we read at the beginning of the class that were maybe not part of the traditional canon of thinking about this history. One text that we read toward the beginning is actually a book called “Shy Radicals” [“Shy Radicals: The Antisystemic Politics of the Militant Introvert” (Book Works, 2017)] by an artist and writer named Hamja Ahsan, who’s based in the UK. It’s almost a kind of science fiction meta project that imagines the establishment of what he calls a new country, which he calls the Shy People’s Republic of Aspergistan, in which shyness becomes this kind of organizing logic for a new way of structuring society itself. That was exciting to see the students respond to the really provocative work that Ahsan does in that book to shift our perspective on thinking about the role of diagnostic categories in not only psychiatric expertise, but in the culture at large.

Leon Hilton:

I think another thing that came up continuously in our conversations was just how saturated our cultural and media landscape is with psychiatric and therapeutic concepts and terms. The television show “Severance” was just airing as we were teaching, and that became an interesting point of discussion: thinking about if you could sever your work self from your self outside of work, would you do that and how would that actually work, what would the implications of that be? It aired after the class, but the comedian Nathan Fielders’ recent series, “The Rehearsal,” also really takes up, I think, themes of therapeutic culture and how it’s become so embedded in how we think about ourselves and our relationship to others.

Amanda Anderson:

As a last question, I want to return to something that you mentioned in your answer about neurodiversity, Leon, and that’s just a question about the larger impact of neuroscience on the story that you tell or on the current landscape in relation to the story that you tell. Neuroscience is one of the largest majors on campuses at the present time and has a hugely influential cultural force. How does neuroscience fit into the history of the field or the way that students are likely to approach the material that you taught? Do you have more to say about that, Leon?

Leon Hilton:

Yes, it’s true that neuroscience and the cognitive sciences as well are huge majors on campus. Many of our students in the classes that we teach are studying the neurosciences. I find it really valuable to actually offer them a slightly different perspective on the fields that they’re studying by thinking about the historical and cultural contexts in which these ideas emerge. I found that students are so eager to engage with that component of the field that they might be studying in a different context in their other classes.

Leon Hilton:

I also find that adding that critical scholarly perspective from the standpoint of someone in history or someone in theatre or performance studies can allow them to maybe step back a little bit and ask some questions that they might not have otherwise been able to ask about the ways in which they’re thinking about the role of the brain and the work that they’re doing outside of it.

Jennifer Lambe:

Yeah, I would have to second what Leon is saying about how receptive students are to contextual and historical analysis of our present. I have been delighted to find that the more of them become neuro concentrators, actually the more that dynamic prevails, which I think is really interesting. The refrain I hear from many students, especially in my undergraduate classes, is that in fact [they] wish that this was an integrated part of their training in neuroscience, to study the history and context of the discipline.

Jennifer Lambe:

Because the most obvious thing that quickly emerges, and you won’t be surprised to hear a historian say, is that this idea that neuroscience is going to gobble up or replace psychiatry is not new. In fact, at the end of the 19th century, we encountered exactly the same dynamic with regard to neurology, which promised to solve all of the problems that asylum psychiatry had not been able to solve, and surprise, not surprise, was not able to do so.

Jennifer Lambe:

Another way to think about the history of psychiatry is in fact who these turf wars that psychiatrists have played out with other pretenders to mind sciences, from neurologists to psychologists in the early 20th century … Neurosurgeons emerge at a particular moment. Psychoanalysts themselves are part of that dynamic. And how effective psychiatry has been at gobbling up the ideas and techniques of its competitors, how often psychiatrists have joined forces with brain-focused practitioners to ward off other pretenders to the throne.

Jennifer Lambe:

But also, I think the other theme that emerges from studying this history is that those neuro challengers or challengers focused on the brain are not necessarily any more remote from social and political forces than their psychiatric counterparts are. That’s clearest in hindsight. It’s easy to see looking at the late 19th century, when you have pioneering neurologists in the United States like S. Weir Mitchell, who now is not known for being a pioneering neurologist, but for having inspired the book “The Yellow Wallpaper” [(1892)] by Charlotte Perkins Gilman because of the infamous rest cure that he developed and promulgated.

Jennifer Lambe:

I think the message that I try to impart, and that students often come to organically on their own, is that for those studying any part of the history of the mind sciences or approaches to healing the mind more broadly, we should always start from a place of interpretive humility in judging not only the past, but also being circumspect about the answers our present promises to provide, because inevitably, somebody in 10, 20, 30, 40, 50 years will ask, how could those neuroscientists, psychiatrists in 2022 ever have thought they had solved this problem?

Amanda Anderson:

Well, that’s profoundly illuminating as a final statement. Thank you so much. I want to thank both of you for this wonderful conversation and for being on the show.

Leon Hilton:

Thank you very much for having us.

Jennifer Lambe:

It was a lot of fun. Thank you, Amanda.

Amanda Anderson:

“Meeting Street” explores some of the most important and creative work being done in the humanities today through conversations with scholars and thinkers who are extending the boundaries of their respective fields. The show is produced by the Cogut Institute for the Humanities at Brown University. Damien Mahiet is our production manager. Our sound editor is Jake Sokolov-Gonzalez. If you enjoyed this week’s episode of “Meeting Street,” please leave a review wherever you listen to your favorite podcasts.

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