The Psychiatric Persuasion: Knowledge, Gender, and Power in Modern America.

Historians have interpreted the influence of twentieth-century psychiatry as either the triumph of reason over superstition, or as the hoodwinking of innocent populations by plotters intent on social control. Elizabeth Lunbeck challenges both these paradigms in her brilliant new study, The Psychiatric Persuasion. Drawing upon detailed analysis of eight hundred psychiatric and one hundred psychoanalytic case studies from the Boston Psychopathic Hospital's first decade (1912-1922), Lunbeck meticulously reconstructs the turf battles, the epistemological dilemmas, the daring assertions as well as the petty ambitions of the Boston Psychopathic Hospital's first generation of psychiatrists and social workers. She describes how these professionals' skirmishes with their patients and with each other resulted in the emergence of the modern "psychiatric persuasion" - the idea of an elusive "normality" that moderns seek through subjecting their most private thoughts and experiences to self-analysis and to psychiatric scrutiny.

Lunbeck's study has three sections. The first, "Insanity to Normality," explains how psychiatry evolved from a relatively low-prestige superintendence of the chronically insane to its modern incarnation as the profession entrusted to heal broken families, dysfunctional sexualities, public misbehaviors and private miseries. This enormous expansion of the psychiatric domain emerged haphazardly, as enterprising young psychiatrists exploited all opportunities to expand the scope of their expertise. Psychiatrists drew upon new medical treatments of syphilis, for example, to justify their claim that the most private sexual behaviors were within their professional sphere. Amalgamating the disease paradigm of syphilis and the metric paradigm undergirding mental testing, psychiatrists constructed "psychopathy" as a disease-like entity that only psychiatrists could measure. The category of the "psychopathic personality" made normality and insanity, not polar opposites, but positions on a continuum. This continuum implied, as one early psychiatrist explained, that "practically the entire world" could be legitimately placed under psychiatric authority. (p. 48)

In part two, "Institutional Practices," Lunbeck describes how the intense surveillance characteristic of modern psychiatric hospitals resulted from psychiatrists' eagerness to prove their modernity. By keeping patients in constant view, psychiatrists of the 1910s sought to demonstrate the distance they had travelled from their origins as asylum-keepers - a disreputable past symbolized in the public mind by the image of manacled patients left to decay in closed off rooms. Yet this move from seclusion to constant visibility also resulted in a new regime of power, based not on physical restraints but on the constant surveillance of patients whose most intimate thoughts were casually exposed to public view by psychiatrists.

The third section, "Psychopathologies of Everyday Life," is perhaps the most fascinating. Here Lunbeck analyzes psychiatrists' and social workers' encounters with "hypersexual" women, female hysterics, "psychopathic" men, and lesbian women. The result is a graphic portrayal of how ordinary people - women struggling to assert their sexual desires or their right to be free from male sexual aggression, men tom between the pulls of "dissolute" and "respectable" ideals of manhood, and couples seeking to negotiate their sometimes violently opposed ideals of money and marriage - were subject to the often misguided intervention of psychiatrists and social workers. Lunbeck shows how psychiatrists' claims to iconoclasm and modernity foundered when confronted by these patients, whose dilemmas aroused the psychiatrists' own insecurities and desires.

One of the most compelling aspects of Lunbeck's study is her demonstration of the gap between psychiatrists' rhetoric and their practice. She shows us self-proclaimed sexual modernists stunned into silence by the assertiveness of their "hypersexual" women patients, "enlightened" psychiatrists bullying men and women committed against their will, and psychiatric champions of womanhood belittling the abused wives of male clients.

This review cannot do justice to the scope of Lunbeck's study. The Psychiatric Persuasion analyzes the entirety of psychiatric practice. The history of diagnostic categories, the politics of hospital attendants, the evolution of commitment laws, the rituals of patient interrogations, the conflicts of social workers struggling with the mutually exclusive goals of aiding women and preserving families, and the roles of families in policing their members are all subject to Lunbeck's incisive analysis.

I have three criticisms of this volume. First, the book is organized and edited somewhat poorly. Key themes, such as the role of psychiatry in the construction of sexual modernity, lack adequate emphasis, sentences are often repeated, and key figures are introduced half-way through chapters on apparently unrelated topics. Second, Lunbeck never admits that her study, which is based exclusively on sources dating from 1912-1922, is about the 1910s and not "the turn of the century" or "modern America." Consequently, Lunbeck does not sufficiently bring the historical context of the 1910s into her study. Instead, her depictions often have an oddly hermetic character, as if her subjects existed in a sphere sealed off from the heated political and cultural battles of that tumultuous decade. Finally, Lunbeck too often depicts her subjects' clashes as battles between competing narratives. Lunbeck sometimes uses the language of "competing narratives" not merely to clarify the limits of her subjects' worldviews, but as an explanatory paradigm. For example, Lunbeck explains that women who felt oppressed by the sexual demands of their husbands suffered because "they did not have the materials at hand" to construct an alternative narrative encoding a different sexual politics. (p. 273) This interpretation slights the fact that numerous "narratives" or critiques circulated in the 1910s. Furthermore, Lunbeck's reliance on the language of narrative sometimes gives the struggles she recounts a bloodless and depoliticized feel.

The loose organization of Lunbeck's book makes her study a bit less accessible than it ought to be. Still, her study richly rewards its readers. Lunbeck's The Psychiatric Persuasion is a stunning and ambitious study of major importance, and should be read by all who are interested in the history of medicine, social work and psychiatry, in the formation of modern paradigms of manhood and womanhood, and in the daily struggles of ordinary Americans caught in the transition from a Victorian to a modern American culture.

Beryl Satter Rutgers University, Newark