After the First World War, psychiatrists captured the imagination of the public. Two of the eponymous villains of early Weimar cinemaâs most successful and iconic films were mad doctors as much as mad-doctors. In the 1920 movie, a nameless alienist-turned-lunatic styles himself as the early-modern showman Caligari and uses his suggestive abilities to force a patient into becoming his tool for murder. Soon after, the demonic Dr. Mabuse, a physician and psychoanalyst, appeared as the main figure in the film adaption of the recent best-seller. Amidst the post-war commotion, he employs his hypnotic powers to subtly influence his surroundings, to gamble, spy, and to manipulate the stock market. The mastermind behind an enormous criminal conspiracy, his aim is to create and rule a utopian community in the South American jungles. Both films mark the beginning of a cinematic occupation with an uncanny image of the psychiatrist that continued through the twentieth century.1
In his influential analysis of Weimar cinema, Siegfried Kracauer argued that the figure of the hypnotic psychiatrist symbolically foreshadowed transformations in the exercise of political power that Germany would experience with the rise of Nazism.2 However, as film historian Anton Kaes has more recently shown, the doctors Caligari and Mabuse also related to the actual history of psychiatry during and after the war.3 On first sight, the real psychiatrists of 1918 had little in common with these caricatures of malevolent quacksâalthough, about two decades later, a number of them would turn into more gruesome murderers than early Weimar film-makers would have been able to imagine. But there was more to psychiatristsâ depiction in these films than only the evocative narrative of madness affecting those who promised to cure it. Older tales of patient abuse and fears of wrongful confinement in madhouses merged with more recent reports of the brutal treatment of âhystericalâ soldiers and mass starvation in psychiatric asylums during the war.
Like other âmad scientistsâ in popular culture, post-war cinemaâs psychiatrists reflected an ambivalence about the threats and promises of modern science. The fascination with progress was mixed with fears that representatives of a discipline claiming a privileged insight into the deepest layers of the functioning of the human mind could use this knowledge to manipulate individuals and collectives.4 And in fact, while psychiatrists in 1918 were neither delusional killers nor megalomaniac criminals, many of them firmly believed in shifting the boundaries of their professional authority further into society and politics, targeting not only the insane but also the apparently normal, and in restructuring society on the basis of their scientific insights. Often these calls for socio-medical interventions translated directly into visions of psychiatrists transcending their traditional role as physicians and becoming guides and leaders of the nation on the way towards âmental reconstructionâ.5
The shrillest of these voices faded into silence during the political and economic consolidation of the early 1920s. Nonetheless, in the following decades psychiatristsâ attempts to bring diagnosis and treatment outside the asylum and the clinic continued in different shapes. Many of the ideas discussed in this context were not entirely new. Throughout the nineteenth century, psychiatrists had drawn political conclusions from clinical observations and had framed their diagnoses of perceived social and political problems in medical terms.6 After all, psychiatry both as a science and as a practice was, from the onset, concerned with social norms and the maintenance of social order and thus always had one foot in the political sphere. Only after the First World War, however, did psychiatristsâ socio-political ideas grow into systematic programmes and became institutionalised as associations and societies.
This book examines the radical reformulation of psychiatristsâ role in society in the period between the First World War and the Second World War. Out of a vast range of possible stories that could be told, I focus on three attempts to redefine psychiatryâs relation to society and politics: the psycho-political diagnoses of the defeat and the revolution in 1918/1919, âapplied psychiatryâ, and mental hygiene. While the larger trend of an increasing presence of experts from the psy-ences in all fields of political, social, and cultural life beginning in the inter-war period has been noted by scholars from different perspectives, we know less about the specific historical configurations shaping this process. As I show, psychiatryâs âneed for expansionâ, which was already observed by contemporaries, was far from monolithic.7 It sprung from very different motives and circumstances and happened at the intersection of the larger lines of political history with intra-psychiatric and intra-medical developments and against the background of growing competition with other actors in the differentiating field of the psy-ences. My main goal is to examine psychiatryâs move out of the asylum and the clinic and into society and politics in both detail and context. I ask about continuities and discontinuities to pre-war psycho-political thinking, and how the experience of the First World War and the political turmoil that followed it accelerated and shaped the redefinition of psychiatristsâ self-understanding in the inter-war period. Furthermore, I also take a close look at the interplay, competition, and conflict between different actors in the scientific field, both inside the psychiatric discipline, in the wider realm of the psy-ences, and beyond.
My point of departure is the end of the First World War. Like for many other areas of politics, culture, and science, the first global and industrial war marked a significant caesura in the history of psychiatry as a medical speciality. The need to treat hundreds of thousands of âwar neuroticsâ had given psychiatry an important role in the conduct of war and brought the discipline into even closer proximity to the state.8 Following a rationale of efficiency and rationalisation, the mass treatment of war neuroses through a range of newly invented or re-discovered methods promised a therapeutic breakthrough. It presented psychiatry with the prospect of finally overcoming an era of âtherapeutic nihilismâ, in which important scientific advances had changed little about psychiatryâs notorious inability to heal its patients. For psychiatry as a âbelated scienceâ,9 this recently gained prestige and treatment success promised an opportunity to close up to more successful medical specialties such as bacteriology and surgery, which had experienced a most impressive development in the previous decades. With the military defeat of the Central Powers and the post-war turmoil, however, these war gains were threatening to unravel quickly. Public and patient protests and the dissolution of military hierarchies profoundly altered the relation between doctors and their patients and effectively abolished the foundations of psychiatryâs therapeutic success, which often had been based on the almost unconditional subordination of soldier-patients under their military physicians.10
Medical debates about the treatment of the war neurotics and the impact of the war on individual patients were accompanied and mirrored by a discourse transposing the issue from the individual to the level of the collective. Drawing on nineteenth-century psychologies of the collective such as French psychologie des foules and German Völkerpsychologie, prominent psychiatrists discussed how the war had created, affected, jolted, or united a ânational soulâ (Volksseele) and how collective psychology and psychopathology could explain the behaviour of the enemy. Oscillating between analogy, metaphor, and actual diagnosis, the concept of the Volksseele complemented the ubiquitous wartime talk of an organic body politic and allowed to discuss politics from a psychological and psychiatric perspective. In the wake of defeat and revolution, the concept of the Volksseele helped reframe the political, cultural, and medical crisis of the immediate post-war period as a crisis of a collective psyche. Against this backdrop, prominent right-wing psychiatrists radicalised their views of their role in society, shifting the focus from the mental health of the individual patient to that of the nation as a whole. They combined alarmist psycho-political diagnoses about collective mental âshocksâ and ânervous breakdownsâ with calls for far-reaching socio-medial programs, which only they themselves, invested with privileged insights into the medical and spiritual needs of the people, would be legitimised to lead.
The most ambitious and aggressive of these programmes was âapplied psychiatryâ, for which the Viennese psychiatrist Erwin Stransky (1877â1962) untiringly and stubbornly campaigned throughout the inter-war period. Introduced in 1918 as an expansive vision of âmedical imperialismâ of the psychiatric profession by the right-wing nationalist Stransky, and radicalised politically after the end of the war, its history took a surprising turn during the 1920s. Conflicted between cooperation and competition with the Vienna psychoanalysts and individual psychologists, applied psychiatry became a uniquely interdisciplinary forum, bringing together scholars from very different backgrounds using psychopathology to examine culture, society, and politics. It reached its zenith with a first international conference, when some of the greatest minds in psychiatry and its border areas gathered in Vienna in the summer of 1930. A projected second conference never took place, as the rise of Nazism and Austro-fascism severed the networks and forced key actors into exile for both âracialâ and political reasons. In the end, applied psychiatry yielded few palpable results, but its grandiose claims and the peculiar concurrence of aggressive disciplinary expansionism and interdisciplinary cooperation avant la lettre make it one of the most fascinating forgotten episodes in the history of the psy-ences.
As a movement, mental hygiene originally was a product of American pre-war philanthropism that entered the European stage in the mid-1920s. The founding of mental hygiene associations in Europe was the result of lobbying by protagonists of the vastly more successful movement in the United States. But the Europe associations directly built upon various pre-existing local reform programmes in psychiatry. Mental hygiene brought together different approaches to psychiatric reform and prophylaxis in common national frameworks and engaged them in the international âpolitics of comparisonâ.11 Simultaneously, reform-minded psychiatrists used the prestige of being part of an up-and-coming international movement to bolster their own position at home. Mental hygiene introduced an unprecedented degree of internationalism to the professional networks of reform-minded psychiatrists andâin the same year as applied psychiatryâreached its apogee in 1930 with a large international meeting in Washington, DC. In the following decade, and against the backdrop of rising political tensions, meetings of European mental hygienists continued. During this time, mental h...