Pathologies of Modern Space

Empty Space, Urban Anxiety, and the Recovery of the Public Self

Kathryn Milun

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781135927370
• Edition: 1
• Topic: Architecture
• Subtopic: Architecture générale

Pathologies of Modern Space traces the rise of agoraphobia and ties its astonishing growth to the emergence of urban modernity. In contrast to traditional medical conceptions of the disorder, Kathryn Milun shows that this anxiety is closely related to the emergence of "empty urban space": homogenous space, such as malls and parking lots, stripped of memory and tactile features. Pathologies of Modern Space is a compelling cultural analysis of the history of medical treatments for agoraphobia and what they can tell us about the normative expectations for the public self in the modern city.

CHAPTER

1

The Disappearance of Public Space in Psychiatric Descriptions of Agoraphobia

Dr. Westphal (1871) and Dr. Boyd (1991)

To diagnose agoraphobia, some fear of and tendency to avoid public places is a sine qua non: the fear of fear or of harmful consequences to oneself are frequent concomitants but not essential features.

—Dr. Isaac M. Marks, Fears, Phobias and Rituals

Introduction

The term agoraphobia was first coined by Dr. Carl Friedrich Otto Westphal (1833–1890), a professor at Berlin University. Westphal was an innovator, one of the leaders of the movement for nonrestraint in the treatment of the insane and one of the first to lecture on mental disorders at the University. It was in 1871, shortly after the unification of the German nation-state and the emergence of Berlin as the nation's capital, that Westphal's paper “Die Agoraphobie: Eine Neuropathische Erscheinung” (Agoraphobia: A Neuropathic Phenomenon) first appeared. It provided the case histories of three young men who all presented the same complaint: a fear of crossing certain large, open public squares (freie Plätze) in Berlin. On approaching these squares, the men would be overcome with the physical signs of anxiety (heart palpitations, trembling, dizziness, and an immobilizing fear of dying).¹ Westphal had never before seen such symptoms triggered by this type of public space and thus gave the phenomenon a Greek name, Agoraphobie (a neologism that literally meant, “fear of the marketplace”) and a German name, Platzfurcht (“plaza/square fright”).

Westphal's article led to a furry of responses in other European psychiatric journals where doctors wrote of similar patients, mostly male, whose anxiety also made them falter at the curb of their cities' most immense plazas. The articles published on agoraphobia in this period all adopt more or less the same form. Case histories of the afflicted city dwellers, often using the patients' own words to describe feelings of anxiety and the sites of its occurrence, would be followed by an abstract description of the disorder tracing its etiology in terms of various contemporary theories of nervous pathologies. Thus agoraphobia was thought to be a problem of the liver (Cherchevsky) or the ear (M. Lannois and C. Tournier). Insufficient will (Paul Emil Lévy) was also thought to be a cause as was excessive sex and alcohol (Henry Sutherland) or coffee (Legrand du Salle). Others argued that fatigue (Emil Cordes), and childbearing (C.W. Suckling) were central factors.. In the German texts agoraphobia tends to be linked to a species of epilepsy or to an unknown optical malfunction (M. Benedikt). Later, in the 1920s and ′30s, it is common to find agoraphobia labeled as a displaced mental symbol (Helene Deutsche, Sigmund Freud) or a degenerative nerve disease linked to syphilis (J. de Busscher, T. Henusse). More recently, since the late 1950s, it is seen variously as a nervous habit to be broken (behaviorism), a misinterpretation of normal body sensations (cognitive theory), an imbalance of certain hormones, or a mechanical malfunction of “the suffocation centers in the brain” (psychopharmacology and biological psychiatry). The prescribed treatments always correspond to the description of the disorder. Thus, today we find agoraphobia most often described as a chemical imbalance and treated most commonly with a combination of drugs and cognitive-behaviorist techniques.

Given our interest in agoraphobia as a cultural pathology of modern space, we must wonder what has become of social space in the descriptions and treatments of this disorder. Where is the spatial component of agoraphobia in the above-mentioned treatments, and what is being done to reinsert the fearful citizen once again into public space? The past 130 years of clinical literature on the topic of agoraphobia manifest a gradual and eventually complete disappearance of any concern with the social space that originally gave rise to the psychic problem. Today the dominant treatments for agoraphobia show no regard for the common features of the most often reported urban trigger sites. In this chapter I examine how and why social space has been deleted from the description and treatment of agoraphobia by looking closely at how current psychology has translated and interpreted Dr. Westphal's original case studies.

From Dr. Westphal to Dr. Boyd: The Disappearance of Public Space

In 1991 the Journal of Anxiety Disorders published what the author and translator claimed was the first English translation of Dr. Westphal's 1871 case. The article includes translated excerpts of the original German by Ted Crump of the National Institute of Health Library Translation Unit and commentary by Dr. Jeffrey Boyd (M.D., M.P.H.) of Grand View Psychiatric Resource Center and Yale University. Let us follow the translation and commentary carefully in order to see how the public space that was so integral to the first descriptions of agoraphobia—and to subsequent descriptions up until the 1950s when randomized, controlled studies of behaviorists and biopsychiatrists took over—comes to be completely evac-uated in our own day. Here then is an excerpt from Crump's translation of Westphal's 1871 text concerning a thirty-two-year-old traveling salesman. At certain points I have inserted the original German text in brackets for comparison. In places where the German text was not translated I have inserted the original German and a translation in brackets.

He is a thirty-two year old, of medium height, slender build, healthy appearance and is lively in speech and movements. He complains that it is impossible for him to cross an open space [freie Plätzen]. If he attempts to do so, he is immediately seized with a feeling of anxiety [Angstgefühl], whose location upon questioning he reveals to be more in the head than in the heart region. However, there are often heart palpitations accompanying it. In Berlin the Donhofplatz is the most unpleasant for him; if he tries to cross it, he is struck by the feeling that the distance is very great, miles wide, that he will never get to the other side, and connected to this is the referred-to feeling of anxiety, often accompanied by a general tremor. Turning toward the sides of the square [the Begrenzungen des Plätzes] the closer he comes to the buildings, the more his feeling of anxiety disappears. If he goes arm-in-arm with someone else or involved in conversation across the square [Platz], the feeling of anxiety is much less. A staff or an umbrella in his hand gives him no security. On the other hand it has often occurred that, occupied with his thoughts, he crossed a square [Platz] without noticing that he had done so. If a wagon is crossing the square [Platz], then he can cross with ease if he stays close to it; otherwise he would be entirely unable to, and would go around. He cannot go to Charlottenburg, through the zoological garden, because there are no buildings in the garden.

He is seized by the same feeling of anxiety when he is obliged to pass by walls or long buildings [Exerciserhaus in der Carlsstrausse, Artillerieschule unter den Linden; the gymnasium in Carlsstrasse, the artillery school in Unter den Linden] or along streets when the shops are closed (as on Sundays or Fridays or later in the evening and late night hours). In the evenings—he usually goes to restaurants in the evenings—he helps himself in Berlin in a singular fashion; either he waits until he sees someone start of in the direction of his home and follows closely behind that person, or he takes up with a lady of the night, engages in conversation with her and thus goes some distance until he finds another similar opportunity and so gradually reaches home.²

One of the first things to note in this English version is the translation of the term angst. The term has a very different semantic field in German than the term anxiety has in English. This is in part due to the interpretation of angst in nineteenth-century German philosophy and theology and its reverberations in German culture. Søren Kierkegaard (1813–1855), the Danish theologian, gave the term angst an ontological status, making it “the unavoidable companion of reflective consciousness in man.” Angst, for Kierkegaard, arises from the recognition that a state of nothingness is both thinkable and possible: “With every increase in the degree of consciousness,” Kierkegaard writes, “and in proportion to the increase, the intensity of despair increases: the more conscious, the more intense the despair.”³ Thus, the experience of angst, which would need to be rendered in English as some combination of anxiety and dread, is associated in various areas of German culture with a fundamental feature of the human condition, one that the twentieth century German philosopher Martin Heidegger—and other thinkers in what became known as existentialism—would privilege as an authentic mode of being in the world. Karl Jaspers, who developed a school of existential psychotherapy around the experience of angst (Daseinsanalyse, or “analysis of one's there being”), articulated anxiety's positive aspects and showed great suspicion toward psychiatry's attempts to remove it from everyday life. “Large numbers, particularly of modern people, seem to live fearlessly because they lack imagination,” Jaspers writes. “The freedom from angst is but the other side of a deeper loss of freedom.”⁴ Jaspers's work was particularly important in elaborating what came to be an important distinction in the phenomenology of anxiety that has had special meaning for the description of agoraphobia: the distinction between “free-foating” (freifottierende) and “object-related” (objektbezogene) anxiety—a distinction between contextless (unsituated) and contextual (situated) anxiety. I will come back to the significance of these important cultural infections in the vocabulary of anxiety in subsequent chapters. For now it is enough to note that angst is not the same as anxiety, if by that we mean the neurotic symptom. European languages have many terms to describe the experiences associated with the English word anxiety. In French, for example, there is anxiété, but this word does not cover the same semantic space as anxiety. Sometimes the word angoisse is proposed as a near synonym (likewise ansiedad and angustia in Spanish), but angoisse better describes the English anguish with emphasis on the bodily sensations of the emotion. So here we have the first obstacle to the translation of the nineteenth-century German experience of agoraphobia's Platzangst.

A second question we might ask about the 1991 edition of Westphal's classic nineteenth-century study concerns why this urtext on agoraphobia should resurface in an American psychiatric journal specializing in anxiety disorders at the end of the twentieth century. In the theoretical and review article titled “Westphal's Agoraphobia” that follows the 1991 translation, author Boyd answers our question, noting, “Professor Westphal, [in his] … classic clinical description of agoraphobia … is often said [to have] defined agoraphobia as a fear of public places … whereas for Westphal it was [in fact] a fear of open spaces, some of which were public places, some of which were not. … Westphal emphasizes large open spaces rather than public places, for example: a deserted town plaza, a broad empty boulevard, a theater, a church, the seashore, a small boat in open water.”⁵

Immediately we see that Boyd wishes to correct a misreading of Westphal. According to Boyd, it is not “public” space that the agoraphobics in Westphal's study fear; rather, it is a sort of asocial, abstract space: “wide open spaces” as such. Thus, Boyd appears to be uninterested in the preponderance of public urban sites mentioned in Westphal's text where the public spaces outnumber the nonurban sites by far. The preponderance of dreaded public sites in Westphal's text would also elude the general English reader because many of these sites are actually removed from the text in the English translation. (I reinserted, for example, Exerciserhaus in der Carlsstrausse, Artillerieschule unter den Linden (the gymnasium in Carlsstrasse, the artillery school in Unter den Linden). By suggesting that the space feared by Westphal's patients is not related to a historical, built environment, Boyd reduces the spatial complexity of the agoraphobic disorder. The geometric common denominator of angst-provoking space thus becomes a generic sort of large, open, or empty space. By reducing what Westphal calls freie Plätze (large open squares) to “open space,” a space emptied of its public, historical, and social coordinates, Boyd abstracts the agoraphobic's experience of everyday life. This move is partially due to the mistranslation of the opening sentence of Westphal's original essay:

Seit mehreren Jahren haben sich wie derholt Kranke mit der eigent hümlichen Klage an mich gewandt, dass es ihnen nicht möglich sei, über freie Plätze und durch gewisse Strassen zu gehen und sie aus Furcht vor sochen Wegen in der Freiheit ihrer Bewegungen genirt würden.⁶

For several years patients have repeatedly come to me with the peculiar complaint that it is impossible for them to go into open spaces [freie Plätze] and down certain streets, and because of this fear their freedom of movement is disturbed.⁷

Freie Plätze are specifically open spaces in a city (the closest English equivalent to Plätze would be “squares” or “plazas”). In English, as in German, the words square or plaza would not be used to refer to an open space in the countryside. Thus the English translation is conveniently misleading and does not correspond to the overwhelming number of agoraphobic case histories from this period wherein the onset of the disorder is linked to specific metropolitan sites characterized interchangeably by their vastness, their crowdedness, and their emptiness. One might say that the translation Boyd uses to bring nineteenth-century agoraphobia into the purview of late-twentieth-century psychiatry involves a “retroactive homogenization” (or a retroactive abstraction) of the historic agoraphobic's fear-provoking site. City space, public space thus becomes mere space.

Recovering Public Space in the Urban World of Late-Nineteenth-Century Agoraphobia

The current trend among psychiatrists to retroactively homogenize or abstract the city space of the nineteenth-century agoraphobic is striking when one considers the enormous efforts of our contemporary new urbanists to undo the abstract openness of modernist public space in Euro-American city design. It is as if, on the one hand, urban planners had noticed that the abstract space of modernist design mattered negatively in the mental life of city dwellers while, on the other hand, urban psychologists were proclaiming that the specifics of public space do not matter in the metropolitan person's psychic state. So, what if we were to keep the historical landmarks of the nineteenth century urban trigger sites in our view as we probe into the complexity of the rise of agoraphobia in European cities? What would we see? We would see that these sites provide essential information for a consideration of agoraphobia as a disorder of modernity broadly speaking. This is precisely the period in which European capitals are dismantling their feudal cityscapes in exchange for the huge public squares and wide boulevards that befit great empires. The architectural gigantomania of this period, in fact, corresponds to the second wave of European imperialism t...

Table of contents

• Cover
• Title Page
• Copyright Page
• Table of Contents
• Preface
• Acknowledgments
• Introduction
• Chapter 1 The Disappearance of Public Space in Psychiatric Descriptions of Agoraphobia Dr. Westphal (1872) and Dr. Boyd (1991)
• Chapter 2 The Nineteenth-Century Urban Commons as a Spatial Puzzle
• Chapter 3 The Nineteenth-Century Urban Commons as a Gendered Puzzle
• Chapter 4 The Twentieth-Century Urban Commons The Urban Freeway
• Chapter 5 The Twentieth-Century Urban Commons The Shopping Center, Laboratory of Behaviorism
• Chapter 6 The Twentieth-Century Urban Commons Neoliberal Universes of Nonrecognition
• Chapter 7 Alternative Treatments for the Twenty-First-Century Urban Commons Horror Vacui, Solvitur Ambulando?
• Conclusion
• Notes
• Bibliography
• Index