Sex, Religion, and the Making of Modem Madness: The Eberbach Asylum and German Society, 1815-1849.

Sex, Religion, and the Making of Modem Madness: The Eberbach Asylum and German Society, 1815-1849. By Ann Goldberg (New York: Oxford University Press, 1999. x plus 236pp. $35.00).

In the rapidly growing field of psychiatric history, the study of asylum records and patient charts has established itself as perhaps the most promising new departure. The work is highly demanding, going over hundreds of patient records for clues to deeper themes, then putting one's particular microstudy in larger context with the aid of psychiatry textbooks, administrative records, and information about the careers of the asylum staff. Yet the technique is able to bring the power of Annales-school type scholarship to the conventional history of medicine.

Ann Goldberg has examined 463 patient records (out of a total of 758) from the Eberbach Asylum in the small German state of Nassau from 1815, when the hospital was founded, until 1849. She comes to the work informed by the opinions of Michel Foucault and full of questions about the social shaping of insanity, offering us "a social history of insanity that explores how ... madness and personal distress were shaped by social experience." (5) Indeed, the material cries out for social analysis, for the patients' charts are filled with such diagnoses as 'masturbatory insanity," "nymphomania," and "religious madness." The main chapters of the book march through the chief illness-labels and social groups that Goldberg is interested in: the extent to which the diagnosis of religious madness gave asylum physicians an excuse (she argues) for extending their power and prestige; how "nymphomania," meaning public displays of "raving" sexuality, represented a means of righting the balance in marital strife; and the extent to which deeper undercurrents of anti-Semitism are visible in the physicians' stereotyping of the behavior of their Jewish patients.

Goldberg's analyses of sexual relations in particular produce some interesting new insights from this material which takes us into the deepest recesses of the personality: what patients cry out in the grips of psychotic illness. Goldberg argues that, "These women used sex--their own and their husband's--as a public language of accusation, demand, and punishment. We see women intentionally making a public spectacle of sex at the time of extreme marital tensions." (130)

How curious, she comments, that men in the grips of masturbatory insanity were encouraged by the doctors to free-up energy and strength; women by contrast in nymphomania are ordered to heighten self-control and repression. All of this is attributable, Goldberg says, to capitalism's need for "a new normative ideal of gender based on separate spheres." (95)

But the analysis itself has a kind of archaic quality, as though we were still back in the 1970s, our ears ringing with earnest indictments of male society and "the bourgeoisie." For Goldberg, capitalism and the middle classes are ultimately responsible for just about everything nasty that happens to these rural patients. The middle-class physicians are unrelentingly demonized by the author. And when the evidence doesn't suffice for a shattering indictment of capitalism, Goldberg has no reluctance to import material from far-distant sites. Thus the book begins with a blood-curdling review of the inhumane and authoritarian physical therapies sometimes used in asylums, despite the absence of evidence that any of these were actually employed in Eberbach. And the visual material on wheels supposedly designed to break the resistance of patients and fiendish devices for restraint comes from the Wellcome Institute for the History of Medicine in London and the archives of the American Psychiatric Association in Wash ington.

This reviewer's disappointment with the monograph concerns more what Goldberg chose not to do rather than what she did. In using patient records, one really has a choice: one can employ them to illumine the attitudes of the treating physicians and "society," or to study the patients and their actual illnesses. Now, Goldberg's work is very much in the former tradition, and she gratefully acknowledges such specialists in this as Jan Goldstein and Elizabeth Lunbeck as her predecessors. She has no interest in retrospective diagnosis, in trying to determine what illnesses (if any) the patients might actually have been suffering from, in order to chart the still tenebrous course of the big diagnoses in psychiatry over the decades and centuries, such as depression, schizophrenia, delirium, neurosyphilis, and the like. A number of psychiatric historians using patient records have undertaken quite innovative studies with precisely this goal in mind: studying the history of patients and their illnesses.

Goldberg has no curiosity about any of this. She does not even mention these major illness entities in psychiatry, and their epidemiology (though capable of being illumined by a potentially quantitative study of this nature) interests her not at all. Her work is resolutely non-quantitative. Statements such as "lower-class religious fanatics" predominated over middle-class fanatics (52) are left undocumented, and periodic discoveries such as her announcement that, "Nymphomania was diagnosed disproportionately in lower-class women" are left without the kind of statistical demonstration that such assertions require. (103)

Instead, what really hooks Goldberg is the idea of using this kind of asylum evidence to get the goods on "capitalism" and the efforts of the "bourgeoisie" to have psychiatrists (as the agents of capitalism) pull the lower orders into line by pathologizing their behavior, "The emergence of the asylum worked to turn the depressed, disturbed, lazy, superstitious, and sexually deviant into medical cases that were diagnosed accordingly." (184) All of this is pure Michel Foucault, with a sort of feminist spin.

All the while the psychiatrists are struggling to establish themselves illegitimately as a medical specialty. Goldberg: "It is surely nor coincidental that the frenzy over masturbatory insanity coincided with the period in which a nascent psychiatry was struggling to establish itself as a legitimate medical speciality." (149) This sounds like some limp residue of the antipsychiatry movement of the 1960s that, enmeshed in Marxist ruminations about the "bourgeoisie," has somehow staggered into the 1990s. This book began life as a UCLA doctoral dissertation in 1992. One wonders what they could possibly have been teaching their graduate students in that department.