ZusammenfassungIn diesem Artikel diskutieren wir Michel Foucaults Hauptwerke zum Thema „Wahnsinn und Psychiatrie“ von den Frühschriften bis in die siebziger Jahre. Zum einen rekonstruieren wir die globale theoretische und methodologische Entwicklung seiner Positionen im Lauf der verschiedenen Werkperioden. Zum anderen arbeiten wir Foucaults philosophische Überlegungen zum Gegenstand seiner Untersuchungen heraus. Nach der einleitenden Problemstellung zeigen wir entsprechend der neueren Forschung, inwiefern Foucaults frühe Positionen von 1954 (in der Einführung zu Binswangers Traum und Existenz sowie in Geisteskrankheit und Persönlichkeit) das spätere (...) Werk durch eine phänomenologische Deskription des Gegenstands und einen historisch-kritischen Anspruch vorbereitete. Davon ausgehend thematisieren wir die zentralen inhaltlichen und methodologischen Prämissen in Foucaults Wahnsinn und Gesellschaft von 1961. Seine Thesen zur „Abwesenheit des Wahnsinns“ in der Moderne verstehen wir als einen in sich widersprüchlichen Versuch, den Gegenstand der Untersuchung von gängigen Vorannahmen zu befreien. Anschließend situieren wir Foucaults Vorlesungen Die Macht der Psychiatrie von 1973/74 im Kontext seiner machtanalytischen Werkphase und betonen seinen erneuten Standpunktwechsel in den Annahmen zur „Produktivität“ des Wahnsinns als Machteffekt. Abschließend resümieren wir unsere Kritik im Zusammenhang mit der Rezeptionsgeschichte der dargestellten Studien und fragen nach der möglichen Bedeutung dieser Werke für die philosophische und historische Reflexion des psychiatrischen Gegenstandsfeldes. (shrink)

This article investigates how much influence consumers could have in the GDR during the 1960s by means of a case study of a patient striving towards an apparently reasonable psychiatric treatment through his actions in- and outside the clinic. The patient tried to obtain an effective therapy by referring to his model socialist work and life. The former patient also subsequently acted as a consumer via different activities, both within the GDR and abroad. Finally, against the background of different theories (...) of patient and consumer history, this article will discuss how consumer historical approaches can be useful for studying a socialist state. (shrink)

This paper argues that the newspaper Notre Journal enshrined the importance of narrative in the revolutionary psychiatry of its founder and editor, Frantz Fanon. Anchoring my analysis in the interdisciplinarity of the medical humanities, I demonstrate how care at Hôpital Blida-Joinville in colonial Algeria was mediated by the written word. I examine Fanon’s physician writing and editorial texts detailing the use of narrative approaches in the clinic. As an object of care, Notre Journal’s promotion of psychic healing, social actions, and (...) engaged professional practice shaped the interactions and experiences of patients and staff. Printed and distributed to the wider institution, the newspaper created community—during an oppressive French Occupation and at the outset of the War of Independence—in addition to nurturing creativity, curiosity, solidarity, and accountability. Still, Fanon would come to recognize the limits of narrative methods amidst cultural oral traditions, illiteracy, and divergent attitudes about narrating the self. (shrink)

Nineteenth-century psychiatrists ascribed to a model of health that was predicated on the existence of objective and strictly defined laws of nature. The allegedly “natural” rules governing the production of consumption of food, however, were structured by a set of distinctively bourgeois moral values that demonized over-indulgence and intemperance, encouraged self-discipline and productivity, and treated gentility as an index of social worth. Accordingly, the asylum acted not only as a therapeutic instrument but also as a moral machine that was designed (...) to remake lazy, indolent transgressors into useful, “decorous” citizens. Because the theory and mechanics underlying this machine seemed straightforward and self-evident to psychiatrists, they were confounded when the asylum failed to translate its ideals into reality. While psychiatrists tended to blame this failure on the intractable immorality and weakness of individual patients, particularly paupers and immigrants, a review of the various meanings and uses of food in the hospital reveals the fault lines that ran through the asylum’s ideological structure. (shrink)

Les études sur le corps du siècle des Lumières se sont longtemps appuyées sur les traités de médecine, reprenant ainsi les représentations médicales plutôt que celles des malades. Les écrits ordinaires, parmi lesquels on peut compter les consultations épistolaires, permettent toutefois d’appréhender les perceptions corporelles des femmes du xviiie siècle. Ces lettres, envoyées par les malades à leur médecin, forment de véritables biographies médicales et constituent des sources d’une grande richesse pour explorer les écritures féminines du corps. On peut ainsi (...) mettre en évidence des manières spécifiques d’écrire le corps au féminin tout en soulignant les points communs avec les écritures masculines. (shrink)

What Ivan Illich regarded in his Medical Nemesis as the ‘expropriation of health’ takes place on the surfaces and in the spaces of the screens all around us, including our cell phones but also the patient monitors and (increasingly) the iPads that intervene between nurse and patient. To explore what Illich called the ‘age of the show’, this essay uses film examples, like Creed and the controversial documentary Vaxxed, and the television series Nurse Jackie. Rocky’s cancer in his last film (...) (submitting to chemo to ‘fight’ cancer) highlights what Illich along with Petr Skrabanek called the ‘expropriation of death’. In contrast to what Illich denotes as ‘Umsonstigkeit’ – i.e., a free gift, given undeservedly, i.e., gratuitously – medical science tends to be tempted by what Illich terms scientistic ‘black magic’, taking over (expropriating) the life and the death of the patient in increasingly technological ways, a point underscored in the concluding section on the commercial prospects of xenotransplants using factory farm or mass-produced (and already for some time) human-pig mosaics or chimeras. (shrink)

The historiography of pandemics and inequality can be characterized by two distinct but often overlapping traditions. One centers structural and political analysis, the other a race-critical approach to the production of human difference. This bibliographic essay reviews historical scholarship in these traditions spanning the past hundred years, with a focus on Anglophone literature in the history of medicine in the United States over the past half century. Early writing on the history of epidemics celebrated the conquest of disease through the (...) application of laboratory research. Insights from social history and environmental history came to inform new analyses of epidemic inequalities, drawing questions of race, class, and empire into the frame during the 1960s and 1970s. The AIDS pandemic of the 1980s further oriented scholarship toward reckoning with stigma, identity, and human experiences of inequality while also troubling the relationship between medicine and the state. In more recent decades, the scholarship on race, social inequality, and pandemics has become deep and broad, remedying longstanding biases toward elite scientific actors and the metropolitan centers of Europe and the East Coast of the United States. In expanding their vision, historians also have engaged in more nuanced analyses of racialization as a social, environmental, and ideological process of embodying difference. Further, where earlier scholarship often relied on mortality data, there has been growing awareness of how numbers shape narratives and are shaped by them in turn. In its conclusion, the essay highlights emerging themes in race and inequality with particular attention to themes that have become prominent amid the global devastation wrought by the COVID-19 pandemic. (shrink)

Extensive scholarship has described the historical and ethical imperatives shaping the emergence of the brain death criteria in the 1960s and 1970s. This essay explores the longer intellectual history that shaped theories of neurological consciousness from the late-nineteenth century to that period, and argues that a significant transformation occurred in the elaboration of those theories in the 1960s and after, the period when various disturbances of consciousness were discovered or thoroughly elaborated. Numerous historical conditions can be identified and attributed to (...) the production of the new theories that emerged from that period-on, not least in the broader social and cultural transformations that occurred with decolonialization, pro-democracy movements, and civil and disability rights advocacy, all contexts which exerted pressures on the institutions and professions of medicine. In this telling, the discovery of the locked-in patient is thus the exploration of a transformed vision of medical patients – one that moved them from a liminal indefinite space into a firmly grounded epistemological existence – in a backdrop in which medical professionals in particular and society in general was beginning to see the body differently. With this new vision, came a relational theory of consciousness to, a reading of a body and it signs, that shifted consciousness from an internally-derived state into a relationally-constructed object. The ontology of consciousness, whatever it was, thereby became entangled with the social condition of consciousness, one that bridged the worlds of close relationship with the social movements and anxieties about personhood that emanated out of that fraught period. (shrink)

The authors conducted a qualitative analysis of thirty-seven issues of The DDU Review, a newsletter produced by residents of the Dual Diagnosis Unit, a residential unit for people who had diagnoses of developmental disability and serious mental illness in the Central State Hospital. The analysis of the newsletters produced between September 1988 and June 1992 revealed three major themes: 1) the mundane; 2) good behavior; and 3) advocacy. Contrary to the authors’ expectations, the discourse of medicalization—such as relations with physicians, (...) diagnoses, and medications—receive little attention. Instead, the patient-journalists focus on prosaic aspects of institutional life. The patients used their writing as a form self-definition and advocacy. The authors argue that even though it is tempting to consider the patients’ emphasis on good behavior as evidence of institutional control, internalized discipline, and medicalization, a more nuanced interpretation, which focuses on how the patients’ understood their own experiences, is warranted. Researchers must also recognize the ways in which The DDU Review reveals the patient-journalists’ experience of an institutional life that includes non-medical staff, varied social relationships among patients, and negotiated freedoms. (shrink)

This article investigates how much influence consumers could have in the GDR during the 1960s by means of a case study of a patient striving towards an apparently reasonable psychiatric treatment through his actions in- and outside the clinic. The patient tried to obtain an effective therapy by referring to his model socialist work and life. The former patient also subsequently acted as a consumer via different activities, both within the GDR and abroad. Finally, against the background of different theories (...) of patient and consumer history, this article will discuss how consumer historical approaches can be useful for studying a socialist state. (shrink)

The aim of this article is to understand an important passage in the history of the sciences of the psyche: starting from the psychiatric problematization — and the consequent emergence — of the concept and the object called ‘sexuality’ in the second half of the 19th century, it attempts to show a series of continuities and discontinuities between this kind of reasoning and the birth of psychoanalysis in the first years of the 20th century. The particular focus is therefore directed (...) on two texts: Krafft-Ebing’s Psychopathia Sexualis and Freud’s Three Essays on the Theory of Sexuality. The argument runs along three intertwined axes: (1) an historico-epistemological analysis of the concepts and their transformations in the field of the science of sexuality; (2) an analysis of the power relationships between patients and physicians; and (3) an account of the psychiatric technologies of the self that have as an effect the emergence of new forms of ‘objective’ knowledge of the subject. The broader goal is to trace a map of the simultaneous and correlate coming into being and transformations both of new forms of objects and of new forms of subjects through the mediation of scientific concepts and techniques. (shrink)

During the Italian campaigns of the French Revolutionary Wars (1796–1801), several epidemic outbreaks sparked acrimonious aetiological debates: were the fevers spread by soldiers and prisoners of war, or produced by environmental factors? This debate was not only a scientific issue, but also a political one, for causation was linked to accountability. Looking at a series of medical investigations written by French military practitioners, this paper argues that theories of contagion were used by civilians to accuse the army of spreading disease, (...) in what I describe as an “aetiology of blame.” Likewise, military officials attempted to absolve themselves of responsibility for the spread of disease by focusing on unwholesome environments, depicting diseases as unavoidable fatalities. Military doctors thus supported French imperial endeavours by obscuring the army's responsibility for the spread of diseases, putting forward aetiologies of fate and blaming individual behaviour. Even when they did not radically dismiss contagionist perspectives, military practitioners insisted on a wide range of pathogenic causes. Their discourses were in line with medical theories of the time, but they downplayed the responsibility of the army for the spread of diseases, which they depicted as a factor among others. Military doctors were thus not always involved in the direct and deliberate production of ignorance, but they did sustain controversies and uncertainty. (shrink)

This article uses a reading of John Wesley's Primitive Physic, or An Easy and Natural Method of Curing Most Diseases (1747) to resist the common rejection—often as "quackery"—of Wesley's treatments for common maladies. We engage Wesley not because he was right but because his approach offers useful moments of pause in light of contemporary medical epistemology. Wesley's recommendations were primarily oriented towards the categories of personal responsibility and capability, but he also sought to empower individuals—especially the poor—with the knowledge to (...) safely and affordably treat maladies of their own. We leverage Primitive Physic to rethink contemporary medical knowledge production, especially as sanctioned by randomized clinical trials and legitimate views of experience and contemporary institutions such as the AMA. Ultimately, we suggest that the medical humanities has a key role to play in mining the discarded and dismissed for what they can tell scholars about medical knowledge. (shrink)

The article considers the history of electroshock therapy as a history of medical technology, professional cooperation and business competition. A variation of a history from below is intended; though not from the patients’ perspective (Porter, Theory Soc 14:175–198, 1985), but with a focus on electrodes, circuitry and patents. Such a ‘material history’ of electroshock therapy reveals that the technical make-up of electroshock devices and what they were used for was relative to the changing interests of physicians, industrial companies and mental (...) health politics; it makes an intriguing case for the Social Construction of Technology theory (Bijker et al., The social construction of technological systems: new directions in the sociology and history of technology. MIT Press, Cambridge, MA, 1987). (shrink)

During the last decades, medical historiography has undergone considerable changes. This review attempts an outline of the developments since 1945. The first section sketches the institutional background of the discipline focusing on the characteristic features which emerged in different national traditions. The following sections—essentially restricted to the German speaking context—describe the development of the fields in research and teaching, ranging from the history of ideas to the social history of medicine, from philogical and editorial work to the philosophy and sociology (...) of medical knowledge. (shrink)

Patient history has enriched medical history since about the 1980s. But there are still research gaps in certain periods and themes, especially in topics related to the medical history of West Germany. This paper deals with the efforts of patients, lay persons, and medical advisors (diabetologists) to enable diabetics to secure employment as civil servants (Verbeamtung). Attention will be payed to the fact that this success relied on the activities of mediators, who translated and conveyed the patients’ interests to society (...) at large. This victory was concordant with similar initiatives in other fields of the diabetic life, including sexuality and lifestyle management. Therefore, efforts to achieve civil servant employment for diabetic patients were constitutive of a broader initiative that changed the image of the disease and promoted the integration of diabetic patients into West German society. (shrink)

ZusammenfassungWiewohl die Patientengeschichte seit Mitte der 1980er Jahre die Medizingeschichte stark bereichert hat, finden sich noch starke Forschungsdesiderate, so beispielsweise im Rahmen der Forschung zur Medizingeschichte der frühen Bundesrepublik. Der Beitrag behandelt die Bemühungen von Diabeteskranken auf der einen Seite sowie Laienhelfern und Mediziner_innen, d. h. Diabetologen, auf der anderen Seite, um einen Zugang zur Verbeamtung von Patient_innen. Es wird herausgearbeitet, dass die Erfolge auf der Arbeit von Mediatoren beruhte, welche die Bedürfnisse der Diabeteskranken mit der Gesellschaft aushandelten. Diese Erfolge (...) gingen einher mit ähnlichen Bemühungen auf anderen Gebieten der diabetischen Lebensführung (Sexualität, Diskussionen zum Lebenssinn des Diabeteskranken). Damit trug der Einsatz für die Verbeamtung von Diabeteskranken dazu bei, das Image der Krankheit zu verändern und eine Integration in die westdeutsche Gesellschaft zu fördern. (shrink)

The article considers the history of electroshock therapy as a history of medical technology, professional cooperation and business competition. A variation of a history from below is intended; though not from the patients’ perspective (Porter, Theory Soc 14:175–198, 1985), but with a focus on electrodes, circuitry and patents. Such a ‘material history’ of electroshock therapy reveals that the technical make-up of electroshock devices and what they were used for was relative to the changing interests of physicians, industrial companies and mental (...) health politics; it makes an intriguing case for the Social Construction of Technology theory (Bijker et al., The social construction of technological systems: new directions in the sociology and history of technology. MIT Press, Cambridge, MA, 1987). (shrink)

Mallory Smith’s posthumously published book, Salt in My Soul: An Unfinished Life, is an insightful and moving account of one young woman’s experience living with a chronic, often invisible, illness.1 Mallory was diagnosed with cystic fibrosis (CF) at age three and began writing in a journal when she was 15. According to those close to her, Mallory wrote consistently over the span of 10 years, until shortly before she died at age 25 from complications related to a double lung transplant. (...) Much of what Mallory included in her journal was too difficult for her to share with family and friends while she was alive, yet she hoped that her writing would one day “offer insight for people living with, or loving someone with, chronic illness.” (page x) As Mallory explained, “I want to create a piece so moving that people are in disbelief. And I want it to be like handing people a pair of glasses, giving them a way of seeing something they didn’t even realize they weren’t seeing.” (page 291) Shortly before Mallory died, she shared the password to her 2,500-page journal with her mother, along with instructions for how to select excerpts for what would become Salt in My Soul. (shrink)

As the number of medical and health humanities degree programs in the United States rapidly increases, it is especially timely to consider the range of specific disciplinary perspectives that might benefit students enrolled in these programs. This paper discusses the inclusion of one such perspective from the field of Science and Technology Studies The author asserts that STS benefits students in the medical and health humanities in four particular ways, by: challenging the “progress narrative” around the advancement of biomedicine as (...) scientific practice, evaluating the meaning of technology, especially in how technology orients us towards sickness and how health technology is in turn shaped by social and cultural values, assessing the plurality of biomedical epistemologies, rather than assuming biomedicine is one, cohesive body of knowledge that does not differ across contexts, and critiquing bias in biomedical practice and science, especially in the marginalization of women’s voices and in the racial and postcolonial trajectories of contemporary biomedicine. The paper discusses the theoretical importance of these four trajectories to the medical and health humanities, as well as the venues for inclusion of STS within coursework and programming at Case Western Reserve University. The paper also comments on how programming at other institutions might be adapted to incorporate STS scholarship. By drawing on numerous examples of research in the anthropology, sociology, history, and the philosophy of science, this article seeks to open a conversation about the value of science and technology studies to health humanities pedagogy. (shrink)

The patient empowerment process that took place in France during the 20th century can, artificially, be divided into three major periods, marked by the principles of solidarity, agency, and authority. This tripartition makes it possible to better understand the challenges of this movement and to see how the advent of health democracy, which took place at the beginning of the 21st century, led, through its depoliticization of autonomy issues, to the dismissal of patients towards a form of subalternity. Paradoxically, the (...) new figures of the patient, the expert, or the partner bear witness to this subalternity. (shrink)

Existing accounts of the early history of Alzheimer’s disease have focused on Alois Alzheimer’s (1864–1915) publications of two ‘peculiar cases’ of middle-aged patients who showed symptoms associated with senile dementia, and Emil Kraepelin’s (1856–1926) discussion of these and a few other cases under the newly introduced name of ‘Alzheimer’s disease’ in his Textbook of Psychiatry. This article questions the underpinnings of these accounts that rely mainly on publications and describe ‘presenility’ as a defining characteristic of the disease. Drawing on archival (...) research in the Munich psychiatric clinic, in which Alzheimer and Kraepelin practised, this article looks at the use of the category as a diagnostic label in practice. It argues that the first cases only got their exemplary status as key referents of Alzheimer’s disease in later readings of the original publications. In the 1900s, the published cases rather functioned as material to think about the limits of the category of senile dementia. The examination of paper technologies in the Munich psychiatric clinic reveals that the use of the clinical diagnosis of Alzheimer’s disease was not limited to patients of a certain age and did not exclude ‘senile’ cases. Moreover, the archival records reflect that many diagnoses of Alzheimer’s disease were noted in the medical records as suspicions rather than conclusions. Against this background, the article argues that in theory and practice, Alzheimer’s disease was not treated as a well-defined disease entity in the Munich clinic, but as an exploratory category for the clinical and histopathological investigation of varieties of organic brain diseases. (shrink)

Few diseases are extensively diffused as influenza, but though flu pandemics occur with regularity throughout history the bibliography is dominated by the 1918-1919 “Spanish influenza” pandemic. This review argues that this preoccupation is largely a product of historical epidemiology and retrospective statistical analysis which has made the Spanish flu the reference point against which other modern respiratory pandemics, including COVID-19, are measured—hence the Spanish flu’s importance for the 21st century pandemic imaginary. The review identifies six distinct thematic areas within the (...) historiography of H1N1 Spanish influenza. These include medical writings which attempt to read the history of the Spanish flu backwards to “learn” public health “lessons” for the mitigation of future pandemics, and ecological writings in which influenza is seen as the paradigm of an emerging infectious disease and a model for the genesis of epidemics and pandemics from zoonotic reservoirs. Scholarship since 1997 also reflects a growing interdisciplinarity, one in which bioarchaeology and molecular dating techniques have furnished new insights into the history of influenza and the Spanish flu’s evolutionary origins, bringing the life sciences into closer dialogue with the medical and environmental humanities. These scientific insights have spurred both academic and popular writings on the Spanish flu, rendering its characterization as the “forgotten pandemic” something of an oxymoron. Indeed, if anything, the centenary of the Spanish flu in 2018 and the 2019-2023 COVID pandemic have provoked renewed interest in several of the themes identified in this review: including, most particularly, the writings of social historians of medicine, cultural historians, and disease demographers. (shrink)

To date, studies of the relationship between technology and its consumers have used the constructs of traditional paradigms of production and consumption as the foundation for analysis. These studies have served to reinforce traditional concepts of gender and hierarchy in the nursing–technology dichotomy. To propose a new and more relevant framework for analysing the technology–nursing relationship, the analysis of gender within the methodology of the social history of technology will be used. Healthcare will be viewed as a technologic network, and (...) within that network multiple knowledge domains reside and interact. These domains, in turn, are socially constructed and historically contingent. This paper operationalizes this argument by examining the domain of the early nurse practitioner movement of the 1960s as part of a gendered technologic system. The findings of this study illuminate the agency of nurses in the shaping of traditionally male knowledge domains and as a crucial factor for understanding the evolution of not only the particularities of the nurse–technology relationship, but also the generalities of the gendered ways of knowing within the healthcare–technology relationship. Perhaps most importantly, different sets of questions can be formulated to analyse the history of the nurse practitioner movement from a technologic perspective that will provide new standpoints for the nursing‐technology dichotomy in the millennium. (shrink)

The scope and mission of the history of science have been constant objects of reflection and debate within the profession. Recently, Lorraine Daston has called for a shift of focus: from the history of science to the history of knowledge. Such a move is an attempt at broadening the field and ridding it of the contradictions deriving from its modernist myth of origin and principle of demarcation. Taking the move from a pluralistic concept of medicine, the present paper explores the (...) actual and possible contributions that a history of knowledge can offer to the history of medicine in particular. As we will argue, the history of medicine has always been a history of knowledge, but for good reasons has always stuck to the concept of medicine as its object and problem throughout the ages, including the modern, scientific one. We argue that, in the history of medicine, the demarcation between scientific and non‐scientific represents an accident, but is not foundational as in the case of natural science. Furthermore, the history of medicine programmatically played a role in at least two academic domains (history proper and medical education), adjusting historical narratives of medical knowledge to its audience. Accordingly, we underscore that the history of both science and medicine, as traditionally defined, already provides room for almost the whole spectrum of approaches to history. Moreover, their different myths of origin can, and indeed must, be included in the reflexivity of the historical gaze. We argue that the position towards a history of science, medicine, or knowledge is not a question of narrative or theory, rather, it is a question of relevance and awareness of extant contexts. (shrink)

Depuis les années 1980, l’histoire de la médecine a connu un très fort renouvellement de ses approches, de ses objets et de sa mise en récit. L’histoire des femmes, du genre et des sexualités, en plein essor depuis ces mêmes années, a contribué de manière non négligeable à ce renouvellement en s’emparant de sources médicales délaissées par l’histoire de la médecine traditionnelle. En effet, durablement imprégnées par l’héritage positiviste du xixe siècle, l’histoire de la médecine et plus lar...

Histories of psychoanalysis largely respect the boundaries drawn by the psychoanalytic profession, suggesting that the development of psychoanalytic theories and techniques has been the exclusive remit of professionally trained analysts. In this article, I offer an historical example that poses a challenge to this orthodoxy. Based on extensive archival material, I show how British psychiatric social workers, a little-studied group of specialist mental hygiene workers, advanced key organisational, observational, and theoretical insights that shaped mid-century British psychoanalysis. In their daily work (...) compiling patient histories, conducting home visits, and interviewing the parents of ‘maladjusted’ children, psychiatric social workers were uniquely positioned to expose the importance of family relationships in the development of childhood neuroses. As this article details, their analytic attention to these dynamics not only influenced, but fundamentally constituted the innovative research on maternal-child relationships and family therapy pioneered by eminent psychoanalyst John Bowlby. In addition, psychiatric social workers produced and published independent psychoanalytic research, and fiercely debated the limitations of analytic concepts such as transference. In presenting the relationship between British psychiatric social work and psychoanalysis, this article suggests a new way of telling the history of both. (shrink)

Is mental illness an object of knowledge? The history of psychiatry teaches us to doubt it, by emphasizing the infinitely variable and fluctuating character of psychiatric entities. Mental illness is not simply ‘out there’, waiting to be described and theorized by psychiatrists; it interacts with psychiatric theories, clinical entities waxing and waning in accordance with diagnostic fashions, institutional practices and methods of treatment. This should be a warning to psychiatrists and therapists: their intervention is part of the ‘etiological equation’ of (...) the syndromes that they claim to observe from the outside. But this should also be a warning to historians of psychiatry, who can no longer be content with writing the history of ready-made syndromes and psychiatric theories. They must, if they want to remain faithful to their improbable ‘object’, study the complex interactions from which those syndromes and those theories emerge, somewhere between the doctors, the patients and the society that surrounds them. In short, they must study the making of psychiatric history, and understand that they participate in it. (shrink)