Psychiatric Experiences

by

Ketil Slagstad

• LAST MODIFIED: 17 April 2025
• DOI: 10.1093/obo/9780197768723-0041

Introduction

As epistemological framework, professional logic, cultural practice, scientific endeavor, and negotiator between the social and the political spheres, psychiatry has profoundly shaped the idea of madness and the boundaries between the normal and the pathological. Consolidating as a specialized medical field and practice in the nineteenth century, psychiatry has been positioned in the triangle between science, society, and politics. Its diagnostic procedures, therapeutic practices, social engagements, shifting hierarchies, architectural arrangements, and institutional routines have given rise to ways of conceptualizing, framing, defining, internalizing, approaching, governing, administering, and managing madness that can be broadly construed as psychiatric experiences. This entry is about the experiences of those who were classified as psychiatric patients and those who cared for them. Class, gender, race, and geographical and historical context have profoundly shaped psychiatric experience, as have institutional frames, disease concepts (nosology), and therapeutic practices. The scholarship listed in this entry highlights the influence of all these factors, but historiography is biased toward European and North American experiences.

The View from Below

Compared to the wealth of scholarship on the history of psychiatric institutions, theories, and practices, not to mention biographies of influential psychiatrists, historians for a long time ignored the experiences of those who psychiatry labeled as ill. Since the late 1980s, historians began to explore patient experiences in their own right, not just as a means for retrospective diagnosis. Porter 1987 argues that historians for too long had been “explaining away” what psychiatric patients said and encouraged historians to take what patients said at face value. “I wish simply and quite literally to see what they had to say,” the author writes (Porter 1987, p. 1), two years after the publication of a seminal article in which he made a plea for centering of “the patient’s view” in the history of medicine—a manifesto for a history “from below” (Porter 1985). “Experience,” as any other historical category, is subject to change, and a recurring methodological problem is how to approach experience as a historical phenomenon. As Scott 1991 notes, “Experience is at once always already an interpretation and something that needs to be interpreted.” According to Huertas 2013, moving the patient view to the center emphasizes that the bio in mental health is both biology and biography. In an introductory article to a special issue on patient experiences in psychiatry, Bacopoulos-Viau and Fauvel 2016 argues that a view from below not only sheds new light on the psychiatric past but is key for a “comprehensive picture of the field’s ongoing history.” Brückner, et al. 2019 provides a comprehensive overview of the reception and uptake of the “view from below” in the German historiography.

• Bacopoulos-Viau, Alexandra, and Aude Fauvel. “The Patient’s Turn Roy Porter and Psychiatry’s Tales, Thirty Years on.” In Special Issue: Tales from the Asylum. Patient Narratives and the (De)construction of Psychiatry Edited by Alexandra Bacopoulos-Viau, and Aude Fauvel. Medical History 60.1 (2016): 1–18.

  DOI: 10.1017/mdh.2015.65

  Overview of the “patient turn” in the historiography of psychiatry including a discussion of the differences between Porter’s and Foucault’s approaches to the history of psychiatry. Concludes that the patient’s voice should not be treated as an addendum to psychiatric history but included within other madness discourses.

• Brückner, Burkhart, Thomas Röske, Maike Rotzoll, and Thomas Müller. “Geschichte der Psychiatrie „von unten”—History of Psychiatry ‘from below’: Entwicklung und Stand der deutschsprachigen Forschung.” Medizinhistorisches Journal 54.4 (2019): 347–376.

  DOI: 10.25162/MHJ-2019-0010

  A review article of German scholarship on the history of psychiatry “from below.” Argues for the shift from a patient history to a history of people with experiences from psychiatry/psychiatry survivors which would imply participatory methods and community involvement.

• Huertas, Rafael. “Another History for Another Psychiatry. The Patient’s View.” Culture & History Digital Journal 2.1 (2013): e020.

  DOI: 10.3989/chdj.2013.021

  A historiographical essay of methodological approaches to the history of psychiatry since the 1960s with a section on patient perspectives.

• Porter, Roy. “The Patient’s View: Doing Medical History from Below.” Theory and Society 14.2 (1985): 175–198.

  DOI: 10.1007/BF00157532

  A pathbreaking article introducing a new program for medical historical analysis by centering the voices and perspectives of “sufferers” and a “people’s history of health.”

• Porter, Roy. A Social History of Madness: The World through the Eyes of the Insane. New York: Weidenfeld & Nicolson, 1987.

  A follow-up of the manifesto published two years earlier in which Porter attempts to present a social history of mental health based on autobiographical sources of people classified as mad primarily from the Anglo-Saxon culture.

• Scott, Joan W. “The Evidence of Experience.” Critical Inquiry 17.4 (1991): 773–797.

  DOI: 10.1086/448612

  An important historiographical contribution that argues for the historicization of experiences as a product of historical change and for the examination of their preconditions.