Journal of Nervous and Mental Disease Commences Series of Historical Papers

Released: 29-Aug-2011 8:00 AM EDT
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1878 Call for Asylum Reform Still Has Echoes for Psychiatry Today

Newswise — Philadelphia, Pa. (August 29, 2011) – In the late nineteenth century, reform of insane asylums was a hotly debated topic that pitted two emerging medical specialties—psychiatry and neurology—against each other, according to a historical paper presented and discussed in the September issue of The Journal of Nervous and Mental Disease. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The historical article and accompanying commentaries are the first in a series commemorating the 200th volume of The Journal of Nervous and Mental Disease, America's oldest continuously published independent psychiatric journal. The series will reprint articles from each decade since JNMD began publication in 1874, along with expert commentaries setting the historical papers in a contemporary context. While some of the historical topics may seem "quaint and archaic," the issues they raise are still relevant today, according to Dr. John A. Talbott, Editor in Chief of JNMD.

Contentious Debate over 'Insane Asylum Reform'
The first paper in the special series was written by Dr. Edward C. Spitzka in 1878, amidst a tumultuous debate over the operation of insane asylums. "We may not call them asylums anymore but the reform of the public mental health system is as critical today as it was in 1878," writes Dr. Talbott in an introductory editorial.

Spitzka was a leading neurologist whose address to the New York Neurological Society was a furious attack on the country's insane asylums. At the time, the medical superintendents of insane asylums were psychiatrists—or, in the terminology of the day, "alienists." Spitzka accused the asylum superintendents of a wide range of malfeasances: from lack of accountability to sloppy recordkeeping to inhumane treatment of patients. The superintendents countered that the neurologists were ignorant of the nature of insanity and the practical challenges of operating an asylum.

A key objection was that the asylum superintendents were standing in the way of a scientific approach to understanding insanity—including the ability to perform autopsy examinations of the brains of insane patients after death. Spitzka urged a long list of reforms, including limited use of restraints, improved conditions for patients, and accurate recordkeeping.

More than a Century after Reforms, Psychiatry Still Faces Many of the Same Issues
Were Sptizka's charges against psychiatry justified? In a commentary, Dr. Jeffrey Geller of University of Massachusetts Medical School presents an overview of the state of psychiatry in 1878 to address that question. He concludes that, while there were major shortcomings in the infant science of psychiatry, the "alienists" of the era were well aware of them, and were "engaged in all manner of deliberations about important issues of the day relevant to the practice of psychiatry."

Sptizka's call for reform was far from the end of the controversy over insane asylums, or of the tensions between psychiatry and neurology. In an accompanying article, Dr. Kenneth J. Weiss of University of Pennsylvania Perelman School of Medicine discusses an 1894 address by famed neurologist Silas Weir Mitchell—who leveled many of the same charges against the insane asylums.

Mitchell's critique of the asylum and asylum doctors for their "isolationism and backward ways" is regarded as a landmark moment in the history of psychiatry. But from a historical perspective, Dr. Weiss believes that Mitchell's speech was more a reflection of changes that were already in the air. He writes, "Although Mitchell is often credited with delivering psychiatry a wake-up call, it is equally feasible that he was merely channeling the organic reforms from within the profession."

Dr. Geller notes that the issues with which alienists were grappling—such as competing interests of the patient and society, outside interference with psychiatric practice, lack of funding in the face of high demands for treatment, and stigma associated with psychiatry and psychiatric patients—were not that different from the problems facing psychiatry today. "In fact, to an absolutely remarkable degree, the issues of 1878 are the same as those of American psychiatry in the twenty-first century," Dr. Geller adds. "That might say much more about psychiatry than Spitzka could ever have known 133 years ago."

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About The Journal of Nervous and Mental Disease
Founded in 1874, The Journal of Nervous and Mental Disease is the world's oldest independent scientific monthly in the field of human behavior. Articles cover theory, etiology, therapy, social impact of illness, and research methods.

About Lippincott Williams & Wilkins
Lippincott Williams & Wilkins (LWW) is a leading international publisher for healthcare professionals and students with nearly 300 periodicals and 1,500 books in more than 100 disciplines publishing under the LWW brand, as well as content-based sites and online corporate and customer services.

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