Psychiatry in the Long Nineteenth Century

by

Eric J. Engstrom

• LAST MODIFIED: 17 April 2025
• DOI: 10.1093/obo/9780197768723-0038

Introduction

Although much recent historical scholarship has turned its attention to latter 20th-century topics, the “long nineteenth century” remains the bedrock—whether acknowledged or not—of much psychiatric historiography. And for good reason. For this era, dating roughly from the American and French Revolutions to the outbreak of World War One, brought profound transformations in the understanding, treatment, and experience of mental suffering. It witnessed the rise of psychiatry as a profession and a medical discipline (professionalization, medicalization). It accompanied a marked shift in the locus of care from the family to the asylum, cultivating a deep faith in the therapeutic efficacy and humanity of institutional solutions to the problem of madness (institutionalization). It also generated and nourished the roots of dominant 20th-century paradigms, such as Darwinian theory and the nature/nurture dichotomy, the formulation of the principles of Mendelian inheritance, the rise of statistics and the positivist ethos underpinning quantitative research methods, the “discovery” of a dynamic subconscious and the rise of Freudian psychoanalysis, and the taxonomic delineation of major psychiatric disorders, like schizophrenia and manic-depressive illness. Given the nineteenth century’s seminal importance for later developments, its historiography has often been—for better or worse—hotly contested. The questions historians have asked have often been framed by current disputes about scientific progress, anti-psychiatry, deinstitutionalization, patient rights, or the rise of biological psychiatry. The historiography has evolved from older hagiographic “Whiggish” accounts of great men, scientific progress, and humanitarian prowess, to revisionist critiques that tell stories of social control, incarceration, and patient abuse, to post-revisionist and post-Foucauldian reevaluations that shun sweeping generalizations and rely instead on empirically grounded comparative and micro-studies. Much recent scholarship has acquired a greater appreciation of the complexity and contingency of the historical evidence that earlier historians had overlooked. The use of new kinds of sources and new ways of reading old sources have enhanced our dialogue with the nineteenth century and are ensuring that the era will remain an important, albeit contested space for the articulation of contemporary concerns. This article represents an introduction to key pieces of scholarship along the fifty-year span of this historiographic arc. The works cited are, with but few exceptions, English-language scholarly monographs. In forthcoming iterations, more foreign-language literature will be added.

General Overviews

Many of the general historical overviews, like Dörner 1981, Scull 1979, and Busfield 2015, have relied on sociological frameworks in crafting their narratives. The anthropological and archaeological methods used in Foucault 2006 shifted historians’ attention to disciplinary strategies that targeted the body and generated new subjectivities. Unlike these earlier synthetic analyses, and not withstanding a few exceptions (Porter 2002, Pietikainen 2015), most overviews have been collaborative efforts. An early collection of essays, Bynum, et al. 1985–1988, mapped out much of the landscape that revisionist historians have explored. Many of the results of this burgeoning scholarship have been captured in two recent large essay collections, Eghigian 2017 and McCallum and Engstrom 2022.

• Barham, P., D. Wright, E. J. Engstrom, et al. “History of Psychiatry.” In The Palgrave Handbook of the History of Human Sciences. Vol. 2. Edited by D. McCallum and E. J. Engstrom, 1221–1450. Singapore: Springer Nature, 2022.

  A collection of essays on major themes in the history of psychiatry by leading scholars.

• Busfield, J. Managing Madness: Changing Ideas and Practice. 2d ed. London: Routledge, 2015.

  Originally published in 1986. An enormously influential and recently republished study of the “liberal-scientific conception of psychiatry” (pp. 16–22). The first half delves into core concepts about mental illness and the character of psychiatric work, whereafter the second half turns to an overview of key historical changes in psychiatric theorizing and practice.

• Bynum, W. F., R. Porter, and M. Shepherd. The Anatomy of Madness: Essays in the History of Psychiatry. 3 vols. London: Tavistock, 1985–1988.

  A groundbreaking collection of thirty-five essays in the emerging revisionist tradition, divided into volumes on People and Ideas (Volume 1), Institutions and Society (Volume 2), and The Asylum and its Psychiatry (Volume 3).

• Dörner, K. Madmen and the Bourgeoisie: A Social History of Insanity and Psychiatry. Oxford: Basil Blackwell, 1981.

  A comparative and sociologically informed study that straddles the turn of the eighteenth century. Analyzes developments in Great Britain, France, and Germany before and after the French Revolution, framing the emergence of psychiatry in the context of expanding bourgeois norms and of the socioeconomic transformations that the Industrial Revolution wrought in capitalist economies.

• Eghigian, G., ed. The Routledge History of Madness and Mental Health. Abingdon, UK, and New York: Routledge, 2017.

  A chronologically and geographically wide selection of articles on the history of madness and its treatment.

• Foucault, M. Psychiatric Power: Lectures at the Collège de France, 1973–1974. Basingstoke, UK: Palgrave Macmillan, 2006.

  DOI: 10.1057/9780230245068

  A transformative study of the “micro-physics” of psychiatric power. Foucault’s analysis proceeds from the “proto-psychiatric” spaces of police and family to the disciplinary apparatuses of alienist practice, the techniques of truth production and classification, and the emergence of the “neurological body” in the late nineteenth century.

• Pietikainen, P. Madness: A History. New York: Routledge, 2015.

  DOI: 10.4324/9781315708966

  Part 2 of this survey contains four chapters that deal with the medicalization of madness in the long nineteenth century.

• Porter, R. Madness: A Brief History. Oxford: Oxford University Press, 2002.

  A cursory survey containing a chapter on the rise of psychiatry in the nineteenth century.

• Scull, A. T. Museums of Madness: The Social Organization of Insanity in Nineteenth-Century England. New York: St. Martin’s, 1979.

  A watershed publication of revisionist psychiatric historiography. Embeds the emergence of asylums in bourgeois norms of productivity: asylums became receptacles for anyone unable to function in the new, industrializing capitalist economy. Interprets alienists as “moral entrepreneurs” and the whole notion of curative asylums as a “chimera.”