06 May 2012

TTT Redux


The conference began with three papers that gave an architecture to the imbricate nature of psychology, psychiatry, and neurology/neurosurgery. Cutting across all of these talks were medical and scientific concerns about the status and technique of psychotherapy. Thus in Jeremy’s talk, the quixotic émigré figure of Hugo Münsterberg – then American’s pre-eminent psychologist - introduced us to not only his particular form of psychotherapy but located that form within the shifting status of psychology as an applied subject.  Jeremy reminded us, however, to look beyond the ivory tower’s wall andthe cloistered space of the clinic to see the wider setting of psychology, which included in his talk a rather provocative map featuring the Emmanuel Church and the Church of Christian Science adopting a seeming tactical position against Harvard psychology: the huns were literary at the ivory tower’s gates.

Similarly Katja’s paper centered upon the question of engagement between psychoanalysis and neurology. Katja called our attention to the intriguing figure of Paul Schilder. Trained in the Meynert-Wernicke tradition of neuropsychiatry, Schilder clearly had, as she put it, an “ambivalent relationship to psychoanalysis”.  In her case study of his theories of body image, Schilder seems to have deviated from the psychoanalytic tradition of interpreting and making manifest patient responses and moreover committed the heresy of taking the patient at her word. Such a view placed Schilder on the margins, and perhaps it was for this reason that Katja infers that he moved to America. In America, Schilder found Adolf Meyer, who emerges in her story as also conflicted about the limits of psychoanalysis. The subtly of Katja’s story – it seems to me – was in its revealing of the tensions between and within the psychoanalytic tradition and its slippages in the somatic traditions of neurology/neurosurgery.

Susan’s paper took us further into the world of Baltimore psychiatry and investigated those slippages still further. Susan described Adolf Meyer as America’s preminent psychiatrist. She noted that Meyer’s psychobiology drew heavily upon a deeply biologized account of the human nervous system.  The figures of John Hughlings Jackson, and thus Charles Darwin and Herbert Spencer were not far away. And yet there was a thread of American pragamaticism too, of common sense, throughout Meyer’s paradigm and therapeutic commitments. Susan showed us how both were eventuated within the Phipps Clinic – a world in which patients (and it seems also Meyer himself) were obsessively observed, recorded, analyzed, and then when possible intervened upon. It was as though Meyer created a miniature world of everyday things and habits, a world in which he was embedded with literally a stenographer peering over his own shoulder – all of which functioned as a result of a huge administrative apparatus for organizing, filing and categorizing the paper trail left in the wake of the Meyer project.

In many respects, Meyer’s world anticipated the world of medicine we encountered in Nicholas' paper. Nick’s story of fainting, of blood, of personality, of donar psychology – these were all predicated upon the structure of state medicine, a medicine in some sense only possible in the context of total war. The fascinating feature of Nick’s paper was that it showed how blood is always the forgotten tissue in the story of brainhood. Is blood part of the brain? Is the barrier between the blood and brain truly a barrier – or as seemingly innocuous chemical things permeate that barrier is it possible that more serious things like personality also accompany it. Whatever the case, blood and blood transfusions are crucial to the story of the emergence of not only neurosurgery and neurology but also in a chemical way, blood literally makes the neurochemical self a possibility too. But unlike the brain – blood is most definitely not fixed. Or if it is, then the body and the brain are in serious danger, and selfhood itself is in doubt.

We also encountered selfhood in Jesse’s remarks on transgenic mice and Alzheimer’s disease. Leaving to one side the question of whether the mice do represent a model of AD, what’s clear is that mouse models emerged in a very peculiar epoch – post the Bayh-Dole Act – such mice conjure up questions of public good and private concerns and thus the ways in the last three decades that the university has changed as a site of knowledge. Jesse, moreover, pushed us to think about how these mice have constructed human identity.  It seems clear, at least to me, that at the core of such questions is the problem of postmodern science’s ever increasing desire to hype and – as scholar Mark Robinson calls it – its tendency to speculate on the future returns of technology or novel therapies.

I can’t help but see then in Jess’s talk a cultural structure that also underpins Tobias' subtle enthography, which increasingly seemed to me to be as much an ethnography of the historians of the mind and brain sciences as it was an ethnography of the neuro-practitioners .  Tobias called our attention to the way in which a certain formulation – one that privileges the idea of fixed brain – has become a dominant presupposition of historiography. In this way, he charged us to look closely at the ways in which our own histories – which, yes, are “critical,” “rigorous,” etc – sometimes accidently continue the project of making the – as Fabio de Sio terms it – “leviathan subject of the leviathan brain.”

Rachel then helped us think about technique – as seen from a broad historical and philosophical view. Rachel pointed out that no single view of technique adequately captures it meanings for different disciplines and in different periods. Indeed, Rachel described how technique in music, for example, could be seen as a rather ambivalent idea; she alerted us to the view that sometimes scholars argued that too much faith was placed in the powers of technique – suggesting that in at least a meritocratic world, in a world where careers are open to talent, technique – which can be acquired – may not be adequate to the task of competing with genius. I think we were left with the impression that “technique” could teach competence but not necessarily promise success, and could be in some cases as much as slander as a compliment.

In some sense, Heidi’s paper on the stereoscope enlarged upon these ideas about technique, expanding through several encounters with science, applied science, leisure, technology, and nascent consumer culture. In Heidi’s paper, technique emerged as many-sided thing: there was the technique of transmitting natural knowledge through teaching people the proper usage of the stereoscope; then there was the technique of teaching people to see ‘the real’; there was the technique of setting scenes within the photographs; and there were the techniques of developing the photographs themselves. Heidi’s paper recalls and at the same time also contextualizes in important ways Hugo Münsterberg’s psychotechniks. It also recalls the commonsense world of Adolf Meyer’s Phipps Clinic in which habits in everyday things had to be taught and reinforced.  All of these papers capture in a rather unique way a transnational Atlantic culture  - I’m thinking Daniel Rogers here – of progressive and modernist ideals and actions, as well as the pragmatic uses and limits of technology in an age of mass industrialization.

Freud, of course, was a product of that culture; and among Freud’s admirers was the figure of Otto Pötzl, introduced by Scott. Pötzl, as we encountered him in Scott’s paper, emerged as something of illusionist who could on one hand read the minds of the blind and see in their dreams what they had not seen in their waking states, and on the other he produced his readings from photographs which he had doctored to accord with the realities of patient’s dreams. In his studies of neurological patients with traumatic brain injuries, Pötzl analyzed the novel condition “anosognosia,” i.e. an unawareness of disability. Scott’s paper recalled the figure of Paul Schilder too; both appear to have expressed a Husserl-ian faith in the truthfulness of patients’ self-reports. For Schilder, this was a heresy within orthodox psychoanalysis; for Pötzl it seems to have functioned as a mechanism for crystallizing the ‘whole’ visual experiences of even blinded patients. Perhaps what distinguished that continental tradition of neurology and neuropsychiatry – and the psychoanalytical tradition too – from that in Britain, was this faith in the report of the patient. Although the psychoanalyst was supposed to interpret, and Schilder and Pötzl appear to have broken somewhat with this ideal, British neurologists and psychiatrists seemingly saw patient reports as merely a means of furthering the cause of diagnostics. There is some discrepancy between the Anglo and the Continental tradition that appears fruitful here.

Part of what makes those differences challenging to spot was the existence of a broader modernist and literary culture. Joe’s paper and his poem directed attention to whole variety of figures – from Henry James and T. S. Elliot to William Carlos Williams and Robert Lowell. The confessional poem, a style which Joe unpacked for us, recalled for many of the historians in the room the famous stories of engagement between physicians of the mind and brain and poets like Robert Nichols and Siegfried Sassoon, or artists or Ernst Kirchner’s self-portrait as a shell shocked handless soldier juxtaposed to his comparatively realist portrait of his neurologist. Joe’s poem, moreover, invited the question of how much the literary and artistic sensibility of modernism influenced the ways in which the science and medicine of the mind and brain was constructed in the same period. Did literary techniques spill into scientific and clinical ones? Did artistic depictions of affect and sensibility determine the status of psychiatric and psychological interpretations of the norm? It is difficult to not think of Muybridge or Marey and the neurology of motion without recalling Benjamin’s later essay on mechanical reproduction, Münsterberg’s engagement with cinematography, or the seemingly repressive urge to teach people to see as exemplified by Oliver Wendell Holmes’ evangelism for the stereoscope.

Somehow encephalitis lethargic seemed to me to be located in between Pötzl and poetry.  Kenton and Francisco unpacked the myriad of receptions, the scale of the literature, and disciplinary formations that arose out of the epidemic disease. Itself called many names – e.g. epidemic encephalitis and encephalitis lethargic – the disease was evidently neurological in nature. But not all who saw it regarded it as so, or at least expressed curiosity about it. It should have been discipline making, but instead it became many things. In London, neurologists never wholly adopted it as their own; in New York it became a mainstay of specialization. Meanwhile, at an international level, epidemiologists, bacteriologists, histo-pathologists, as Kenton and Francisco say in their paper, “stripped epidemic encephalitis of its significance for clinical neurology” and indeed neurologists largely ignored the condition – as they did with many others, including stroke, or as Jess showed, Alzheimer’s dementia. And perhaps this was because no condition was ever self-evidently neurological ? Neurology and psychiatry seemingly possessed this protean characteristic – everything is neurological and psychiatric and thus perhaps no area of disease and illness qualifies as their special and exclusive domain solely.  

Schizophrenia must be another instance of this fact, and as Justin showed us in his paper, schizophrenia appears indispensible to both psychiatry and neurology. But no one knew, and no one knows what schizophrenia is.  In the mid-1970s, psychiatrists and neurologists argued for the dopamine hypothesis of the condition. They grounded this hypothesis in two facts – one was antipsychotics; the other was amphetamine psychosis. This idea had been first introduced in the 1950s, but in the 1960s, LSD intoxication was felt to be a better model of schizophrenia; yet Justin observed that LSD counter culture – communalist, ostensibly high-minded, and pure – collided with amphetamine culture – speed, individualism, violence, and hedonism. It was in this counter-amphetamine culture that amphetamine psychosis began to be accepted as model for schizophrenia. Where this idea of a model came from is perhaps worth thinking about more. Certainly transgenic models of mice for dementia were models; and so too were snail reflexes for memory. Whatever the case, Justin’s paper calls attention to the way that the chemical theory of the nervous system had become transcendent by the 1970s, and perhaps this was due to the rise of so-called “biological psychiatry.”

Brian’s paper explored the origins of this biological revolution from the perspective of the National Institutes for Mental Health. What was striking about NIMH polic in the seventies, as recounted by Brian, is not only that NIMH seized upon biology rhetoric, they were somehow in the vanguard of advancing and promulgating it as well. In particular, Brian’s paper recalled Tobias’s concerns about the way in which formations within historiography cast aside certain stories even as they claim inevitable the way in which psychiatry became biologized. Curiously other imperatives - ones that matched Jess’s story of mice – appear in the NIMH branding of psychiatry as biology. The idea that biology and technology would furnish the most fruitful approaches to mental health became a hegemonic one from which there appeared no evident escape route. Yet, as Kenton pointed out, there is too the reality that NIMH was promoting a particular biology. It is the rhetoric of a particular notion of biology that has subsumed mental health, but this also invites the question how has mental health shaped notions of biology. In our paper, we wondered if there had been sometime a blurring between psychiatry and neurology. It is a seeming article of faith that the neuro turn must influence theories of mental illness but why we wondered would we not also say that the practices surrounding mental health exerted an influence on neurology and neuroscience. To me, both Tobias and Brian raise this possibility in clear fashions and I would say also that in the rhetoric of fMRI we are witnessing the realization of those older aspirations on mental health, mental hygiene, and neurology.  

1 comment:

  1. First, thanks to Stephen for organizing such a stimulating workshop & to all the participants. From the perspective of someone outside the discipline(s) of History & indeed outside the Social Sciences, the scholarship on view was impressive: original, thoughtful & relevant. When the conference was over & I had finished up the final tasks of the semester (Grading!), I was casting about for a way to get a sense of perspective, or, to change metaphors, a way of digesting & understanding what I had heard over the course of the workshop. Experience has taught me to be sensitive to synchronicity, so when, standing in front of one of my bookshelves, my eye fell on Jerome Bruner's In Search of Mind: Essays in Autobiography (Harper & Row 1983), I pulled it off the shelf and began flipping through the pages. Honestly, I didn't remember much about the book, published in 1983, but I had clearly read it since I could see all my old underlinings & check marks, etc. I wandered off to a comfortable reading place & started at the beginning. I've recently been enjoying the genre of intellectual autobiography & that, perhaps, is what initially drew me again to this text, but as soon as I had read a few pages, I began to sense that Bruner's story was a perfect container for many of the papers & presentations & informal conversations I'd encountered over our weekend together.

    I'm not going to try to summarize the book here, but I will note a few connections to work being done by conference participants. But first, a bit of an overview: Bruner's text takes the reader through the history of the psychological disciplines during the middle part of the 20th century, from the pre-WW II period dominated by "psychophysics" derived from Wundt & other German researchers, to the emergence of "cognitive psychology" in the 1970s. Bruner was an experimentalist and an applied psychologist in many respects but at the same time a deeply committed humanist who took Wittgenstein seriously. He also knew everyone who was worth knowing in the Human Sciences: Jakobson, Luria, Piaget, Levi-Strauss, M. Mead, Chomsky, as well as J. Robert Oppenheimer & a host of scientists & literary figures who remain relevant in 21st century intellectual life.

    Bruner's project, as I understand it & as these "essays in autobiography" develop it, was, put very simply, to make the mind a respectable subject for psychological inquiry. In American psychology before the war & even in the decade after, taking that position was definitely swimming against the current. Reading this account, which takes one right up to the cusp of brain-imaging & the resulting reductionisms & materialisms it engendered, one is struck by the fact that technologies like fMRI did not so much establish a new way of thinking about cognition & consciousness as providing a convincing (if ersatz) "proof" of materialism.

    I've gone on at some length without making any explicit connections to papers presented in our workshop -- perhaps I'll leave that for a follow-up post or something on my own blog. But I strongly urge you all to read Bruner's book: it provides an immense amount of context for the neurosciences in a very compact & convenient form. You can pick up a clean used copy on Amazon for under $5.

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