Posted on

Emotions and Device-Oriented Psychiatry in the Early Twentieth Century

In July, 1907, the Swiss psychiatrist Carl Gustav Jung and American neurologist Frederick Peterson published the results of their investigations into the galvanometer and the pneumograph in BRAIN, the journal of neurology. The pair had subjected various people to these instruments—people they had identified as “normal” and “insane”—in an attempt to record and quantify certain “emotional” and “psychical changes” in their moods “in connection with sensory and psychical stimuli.” At this time, only a few years into the twentieth century, these scientists—and many others like them—were eager to develop a systematic means of measuring emotion. They sought to demystify and provide a scientific explanation for the enigmatic interface between the body’s nervous system (both the peripheral and central nervous systems) and the presentation of varied human emotions. To this end, instruments such as the galvanometer and pneumograph, then understood as effective “measurer[s] of the emotional tone,” promised to illuminate the physical meanings, mechanisms and perhaps even causes of what they called the “emotional complexes.”

Among the most extreme of the “emotional complexes” was the category of dementia praecox. This was a condition whose “chief characteristic” was, as George H. Kirby noted, “a particular disturbance of the emotions.” Kirby was the first American to develop a classification of psychoses, and his system was later adopted by the American Psychiatry Association in something of a precursor the Diagnostic Statistical Manual of Mental Disorders, the authoritative diagnostic manual used by psychiatrists today. But Kirby was not the first twentieth-century psychiatrist to undertake a modern classification of the psychoses. That honour belonged to Eugen Bleuler, the Swiss psychiatrist under whose supervision Jung and Peterson had conducted their work on the galvanometer and the pneumograph. In fact, Jung and Peterson undertook their research in Bleuler’s laboratory, within the huge University Clinic for Psychiatry at Zurich known as Burghölzli (fig. 1), a building that was idyllically depicted in 1917 by swiss painter Max Gubler (fig. 2), who would tragically later move and die there. In Burghölzli, Jung and Peterson also used Bleuler’s apparatuses—his galvanometer and the pneumograph—to produce their study of the relations between the nerves and emotions. Jung had been awarded his PhD in 1902 based on Bleuler’s reports, and the tense relationship between the two men has been a subject of some scholarly interest.

Figure 1. The Burghölzli psychiatric clinic in Switzerland (1880s). Image: Public Domain.

Figure 2. Max Gluber, Winterlandschaft Burghölzli [Winter Lanscape at Burghölzli] (1917). Courtesy of the Eduard, Ernst and Max Gubler Foundation.
In 1911, only four years after the publication of Jung and Peterson’s investigation, Bleuler would coin the term schizophrenia, proposing that it should replace “dementia praecox.” That older term had been coined by the French physician or “alienist” Phillippe Pinel in the early nineteenth century, and popularised by the influential German psychiatrist Emil Kraeplin in his 1896 textbook Psychiatrie. In Bleuler’s 1911 monograph, titled Dementia Praecox or the Group of Schizophrenias, the Swiss psychiatrist would argue that the earlier term was misleading for practitioners, conveying as it did two deceptive associations. The term, he said, suggested that schizophrenia had something to do with the disease of dementia, as well as with the concept of “precocity,” when in fact it had nothing to do with either. Moreover, Bleuler argued that it was impossible to express the phrase “dementia praecox” as an adjective, which made writing about the disorder nearly impossible.

Despite the fact that Jung and Peterson worked in Bleuler’s laboratory, the way in which these scientists described mental disorders differed markedly, at least in one respect. Strikingly, Bleuler’s paradigmatic psychiatric work of 1911, translated into English from the original German in 1950, almost entirely omits the word “emotion” or “emotional complex.” By contrast, Jung and Peterson’s study of 1907 uses the term “emotion” or “emotional” some 108 times (in a study of roughly 18,000 words). Of course, this is not to say that emotions are altogether excluded from Bleuler’s understanding of schizophrenia. On the contrary, emotions lie at the heart of his symptomatological description of the disorder. At one point in his monograph, Bleuler writes that “many schizophrenic symptoms originate from emotionally charged complexes” and that the “symptomatology is determined by the emotionally charged complex which, in turn, is often dependent on the Anlage [predisposition].” As such, the omission of the word emotion and the general concept of emotionality in Bleuler’s text is puzzling. Of course, it might be explained by the fact that there is no easy German equivalent to the word, and that the text would presumably employ the word “gefühl” (meaning feeling) or “affekt” (meaning affect) to denote the same concept.

Indeed, as psychiatry developed in the following decades, the concept of “feeling” and specifically of the “praecox gefühl”—the praecox feeling—would become one of the most important in the diagnosis of the psychoses. First named by the Dutch psychiatrist H. C. Rümke in the 1940s, the praecox feeling described the way in which the diagnostician would, in some circumstances, need to rely on intuitive reasoning—on their highly attuned and sensitive emotional senses, refined as they were by clinical experience—to reach a diagnosis of schizophrenia. It would be necessary to use this method when a patient was, for reasons related to their pathology, “fundamentally inaccessible,” such as when, because the basic structure of their “being-in-the-world” had altered, the practitioner could identify something about them that was hard to describe in words but “definitely incomprehensible.”

Perhaps one of the reasons that Bleuler’s work so rarely refers to emotions and emotional states, whereas Jung and Peterson’s study describes “emotions” so often, is due to the divergent aims of and influences on their authors. Despite presenting itself as a work of psychiatry, Bleuler’s study inherits much from psychoanalysis and Freud, routinely referring to such Freudian concepts as symbolisation, resistance, and the Oedipus complex, among others. Jung and Peterson’s study, by contrast, focuses almost entirely on the quantification of emotions by means of their instruments; it is less a study in taxonomy than an attempt to break away from those symbolic concepts that Freud had introduced only six years earlier. Using instruments and devices, Jung and Peterson seek to bring these disorders of the mind out of the realm of the “invisible” and into the clear light of day. This, as Jeffrey Lieberman notes, was precisely what distinguished the work of neurologists from psychiatrists: “Physicians who specialized in disorders with an observable neural stamp became known as neurologists,” he writes, whereas “those who dealt with the invisible disorders of the mind became known as psychiatrists.”

Historians and philosophers of science have identified the rise of a “device paradigm” in psychiatry from the mid-twentieth century and onward. They point to the invention of electroconvulsive therapy (ECT), the emergence of repetitive transcranial magnetic stimulation (rTMS) and, from the mid-1950s, the use of psychopharmacological drugs, as evidence of this newly device-oriented science of the mind. However, Jung and Peterson’s investigations—together with some similar, though more controversial, experiments with x-rays in chiropractic medicine—illustrate an earlier turn towards devices. In fact, not only was the shift toward devices well underway in the first decade of the twentieth century, but devices were, at this time, central to the study of emotion. Before psychiatrists such as Bleuler and Kirby established psychiatry’s classification systems, subsuming “emotional complexes” into their systematic taxonomies, measuring human emotions by means of physical tests had been a central object of neurological enquiry.

Figure 3. The most recent version of the E-Meter (courtesy Scientology.org).

Ironically, Jung and Peterson’s methods would be revived in the 1950s, when, after attending a lecture delivered by L. Ron Hubbard, an American inventor named Volney Mathison patented a new device that he described as a “bio-electronic instrument which registers human dynamic emotion in a more accurate and sensitive manner than has been possible with any previous device of comparable simplicity.” Hubbard quickly embraced the device, which is now known as the E-meter (fig. 3, above), and a modified version of this same galvanometer today forms part of the Church of Scientology’s official practices, used to “audit” the emotional complexes of the Church’s adherents.

Posted on

The Goldwater rule prevents psychiatrists diagnosing Trump from afar but some say there’s too much at stake

This article was originally published on The Conversation, here. I have altered the styling slightly.

In the late nineteenth century, Sigmund Freud’s colleague Wilhelm Fleiss successfully diagnosed an illness in one of Freud’s relatives, without even having met them. Freud was so impressed by Fleiss’s “diagnostic acumen” that he went on to advocate the method in certain circumstances. Freud would write that diagnosing someone without personally examining them was acceptable where the features of certain disorders, such as paranoid schizophrenia (then known as dementia paranoides), made the interview process counterproductive. Here, Freud noted that “a written report or a printed case history can take the place of personal acquaintance with the patient.”

Now, a controversial debate about the ethics of diagnosis at a distance or long-distance diagnosis has arisen in the US. It has come about as commentators have proposed that President Donald Trump suffers from narcissistic personality disorder (NPD) and attention deficit hyperactivity disorder (ADHD), among other conditions. Health professionals have weighed in as well. Psychotherapist and former assistant professor of psychiatry John D. Gartner has been particularly vehement in his assessment of the President. Gartner asserts that Trump suffers from malignant narcissism, a specific manifestation of NPD.

According to the DSM-5—the authoritative psychiatric manual—this condition is characterised by various “traits of antagonism”, including “manipulativeness, deceitfulness, [and] callousness.” Notably, the DSM-5 names the condition only once throughout its hundreds of pages; and some academic psychiatrists say the disorder is understudied and its features largely unsettled, with no treatment yet established.

Despite this, Gartner is convinced that the president’s conduct fulfils the criteria of malignant narcissism—even without having interviewed him:

We’ve seen enough public behaviour by Donald Trump now that we can make this diagnosis indisputably.

Recently, the American Psychoanalytic Association (APsaA) issued a memo to its more than 3,500 members, advising they were “free to comment about political figures as individuals”, and that the APsaA did not regard “political commentary by its individual members an ethical matter.”

By contrast, the American Psychiatric Association (APA) has long maintained a strict ethical stance on the open discussion of public figures’ mental states. Enshrined in the so-called Goldwater rule, the APA’s prescription cautions psychiatrists against diagnosis at a distance. As former APA President Herbert Sacks put it, psychiatrists should avoid engaging in “psychobabble,” especially when it comes to politicians. He said that, when “reported by the media,” such diagnostic speculation only “undermines psychiatry as a science.” Although the Goldwater rule is not enshrined in Australian law, a code of ethics provides guidance to Australian psychiatrists about their conduct in the media.

What is the Goldwater Rule?

The Goldwater rule is named after an incident involving Republican presidential nominee Barry Goldwater. Having been defeated in the 1964 US election, Goldwater sued the editor of the shortlived political magazine Fact for defamation. Just one month before the election, Fact’s front page had printed a controversial declaration:

1,189 psychiatrists say Goldwater is psychologically unfit to be president!

Fact had conducted a broad but clinically invalid survey, providing questionnaires to more than 12,000 psychiatrists whose details the magazine had obtained from the American Medical Association’s membership list. Of the 2,417 responses it received, some 1,189 psychiatrists asserted Goldwater was unfit for office.

In the feature article, Fact purported to quote many of the psychiatrists it had surveyed, and used their words to suggest that Goldwater was a “megalomaniac, paranoid, and grossly psychotic”, and even suffering from “schizophrenia.” In the trial that followed, Goldwater was awarded some US$75,000 in punitive damages—enough to ensure that Fact never published another issue. The ruling raised disturbing questions for the APA, threatening not only the reputation of the psychiatric profession, but the future livelihoods of practitioners. In slightly different circumstances, a psychiatrist might face similar civil action, whether “for invasion of privacy or defamation of character.”

In 1973, some four years after the trial, the Goldwater rule was first published in the APA’s professional ethical code. In the most recent 2013 edition, the rule reads as follows:

On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general.

However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.

The Rule in Dispute

Many academic psychiatrists disagree with the rule. Some have suggested that breaking the Goldwater rule is ethical when it’s necessary to diagnose “mass murderers” from afar, or when “the importance of the diagnosis of an individual … rise[s] to the level of a national threat.” Others have criticised the rule more generally, calling it “an excessive organisational response” to “an inflammatory and embarrassing moment for American psychiatry.” And one psychiatrist has recently described the prescription as “American society’s gag rule.” In February this year, the New York Times published a letter signed by some 33 psychiatrists who blamed the rule for silencing them at this “critical time”. They wrote that “too much [was] at stake to be silent any longer”, and that Donald Trump’s “emotional instability” had made him “incapable of serving safely as president.”

The tension between the APA and its members, and between the APA and the APsaA, partly reflects the history of the two disciplines. Since the 1940s, psychiatry has increasingly focused on medical interventions, while tending to neglect the “in-depth talk therapies” which, despite their general decline, remain central to the psychoanalytic method.

But the situation is still more complicated than this. After all, the methods of psychiatrists and psychoanalysts often overlap. In many practices, for instance, psychiatrists employ intuitive reasoning in the diagnostic process. For some diagnosticians, the so-called “Praecox-Gefühl” or “praecox feeling” remains at the “clinical core” of diagnosing schizophrenia, despite the method’s varied reliability. First described in the 1940s, the praecox feeling is a complex, emotionally charged intuitive sense that a psychiatrist sometimes gets when detecting the subtle symptoms of an emergent psychosis.

What now for the Goldwater rule?

That psychoanalysts may wish to distinguish themselves from psychiatrists on the Goldwater rule, and vice versa, is unsurprising. In countless ways—more than can be named here—psychoanalysts and psychiatrists adopt different views of their roles in the diagnostic process. This is the result of their different training backgrounds, histories, and professional cultures.

Less expected, however, is the growing feeling among psychoanalysts and psychiatrists alike, that today, more than ever, the Goldwater rule should be set aside. While neither group may wish to admit it, the Trump era may have brought psychiatrists and psychoanalysts closer together—at least on this point.

Posted on

Emotions and Publishing

I assume that, on occasion, many early-career researchers are tempted, as I am, to reach for those kinds of books that offer a system or model for publishing success. After all, what better way to reassure oneself that an academic career is feasible than to learn about others’ achievements? Dean A. Shepherd’s The Aspiring Entrepreneurship Scholar offers ample straightforward advice to early-career scholars—indeed, the advice is sometimes so straightforward, and the book’s tone so informal, that one may even begin to suspect, as I did, that Shepherd had managed to somehow manipulate the review process to publish it (a sure sign of his scholarly aplomb). How else to explain the offhand equanimity, the conversational register, of some of the remarks? Chapter 2 opens with an exemplary line: “Okay, so maybe this is self-delusional, but I think of scholars, at least the good ones, as highly entrepreneurial.”

Despite a profusion of many such general statements in the book, statements with a wide application for would-be scholars of all types, what I discovered within a few moments’ reading—but which I had not, I admit, initially realised when I downloaded the book via my institution’s subscription—was that Shepherd’s manual is not for all scholars at all. It does not explicitly propose that we, in whatever fields of study, take an “entrepreneurial” approach to a scholarly career—and why would it? The book is not addressed to all scholars but is, rather—and of course!—a guide written for—quite literally—“entrepreneurship scholars.” Of course, as you might have guessed, I had somehow, no doubt frivolously, imagined that Shepherd’s title was a strange nominalisation of the phrase “entrepreneurial scholar,” and that his book therefore sought to advance a particularly “entrepreneurial” strategy for a “successful academic career,” whatever the field. How wrong I was. But, despite this, my own quite remarkable misprision, the book proved to grant a few noteworthy insights for all of us in academia.

But first a little more on the book’s tone. It should probably be noted regardfully that the book is published by Palgrave Pivot, an imprint of Palgrave Macmillan designed for scholars who wish to publish a work longer than a journal article but shorter than a monograph. These compact books are published as e-books, but perfect-bound volumes can be ordered on demand. And it seems that this Palgrave imprint facilitates—or, better, encourages—precisely the kind of informal, this expert-but-accessible, style of writing preferred by Shepherd; or, in fact, I should say that it facilitates this as well as many other kinds of idiosyncratic writing, since Palgrave Pivot is set up to allow authors to publish their works at their “natural lengths”—to save them the adversity of cutting a long work down to the standard 8,000-word article, and the hardship of elaborating a short book up to to the 80,000-word breadth of the monograph. The imprint is also, it seems, all for authors publishing works that do not bear the seriousness of the monograph, nor the epistemological rigour of the article. As such, you might even say that these books represent, in some ways, the formalisation of the academic blog. After all, they’re also very quickly produced, with a turnover publication time of only twelve weeks following peer review. Hence, I suppose, the name “pivot.” But just in case I am being unclear, I think these volumes represent a positive expansion of the academic publishing ecosystem.

And while I’m talking shop: one thing that I immediately noticed about this imprint’s productions were the books’ formatting details—clearly the ramifications of this new modality of academic publishing—such as the way the chapter title pages were organised. Like journal articles, each chapter title page had a selection of keywords, a copyright notice (stipulating that copyright in the work was held by the author), and a DOI number. It’s certainly a smart-looking series, typeset in the classically sleek but sharp ITC Galliard (the same font the Library of America uses in its books), as opposed to ITC Stone Serif, the usual fare in Palgrave’s non-Pivot series books; although it is also a curious hybrid, what with this strange chapter metadata in a text that is released digitally, as an e-book, but is yet-not-fully digitised, a “photographic” pdf rather than a “live” hypertext.

None of this has much to do with Shepherd’s writing, however. And, lest my earlier meaning be misread, none of my earlier comments were supposed to suggest that Shepherd’s informality, this aporetic self doubting (“Okay, so maybe this is self-delusional”), is threaded through the entirety of his book—far from it. Shepherd, I soon realised, writes not with the insouciance of the careless, and not with “informality” as such, but with the openness and directness of a guru. It is, of course, the appropriate tone for a guidebook, something of a Dale Carnegie or Carl Crow done gone academese. And I imagine that, as an “entrepreneurship scholar,” Shepherd’s “down-to-business” style of writing is an asset—and not uncommon in journals in the field of business entrepreneurship, such as the one of which Shepherd is himself the editor, the Journal of Business Venturing. But what I thought would make an interesting and productive addition to my notes, here, were the various references and allusions Shepherd makes to the emotional world of the aspiring scholar, and particularly to the emotional conflicts they face in their attempts to publish their research.

In the opening chapter, Shepherd discusses the unusually buoyant attitude he took to the revise-and-resubmit (“R&R”) decision letter while still a doctoral student: “Believe it or not,” he writes, “I was excited when I received a rejection letter,” excited “that three scholars had read my work, found something interesting in it, and provided me feedback.” And while Shepherd implies that he “no longer feels” as positive about receiving R&Rs as he did then, he does continue to feel more positively about them than most of his colleagues, one of whom, when they asked him “how to deal with the negative emotions associated with such a decision letter,” prompted incredulity on his part. But what Shepherd writes next about his process is worth quoting at length, if only because few scholars seem to have written as candidly as he does of their emotional reactions to R&R letters—that is, of the way in which they have learnt to manage their own emotions. But this long quotation will also allow me to quickly look at the tropological figures Shepherd produces to explain his emotional defences against the familiar melancholy of dejection:

Returning to the issue of excitement in receiving feedback on a rejected paper, I used that excitement to drop other work and immediately begin to interpret the letter and the spirit of the reviewers’ comment [sic] to improve the paper and resubmit it to another journal. I thought about a paper as having momentum and believed it was important to keep the momentum rolling. On the flipside, I felt that if a paper sat, it lost momentum and required more effort to “start the ball rolling” again. Fortunately, having peers as co-authors and choosing to work with people with similar values, I was able to quickly learn, enhance the quality of each paper, and put them “back in play” at journals. Speed came from energy and momentum, not from cutting corners.

Through speed and working with colleagues on papers out of our dissertations, my colleagues and I were able to generate a reasonable number of papers in the first couple of years post-dissertation. We believed that having a “reasonable” number of papers “in play” (i.e., at least three or four papers under review at top journals) was important for two primary reasons. First, we believed that the more papers we worked on, the more feedback we would receive. Feedback not only helped us improve the quality of the specific paper but also provided the basis for a deeper understanding of what reviewers were looking for and how to address these issues and follow their recommendations. Upon reflection, we were engaging in deliberate practice and hopefully building expertise. We certainly had many opportunities to learn from our failures, but fortunately, we also had some successes—some small wins—which allowed me to start to believe that maybe I could make a career as an entrepreneurship scholar.

While Shepherd magnanimously—and doubtless truthfully—attributes a degree of his success in turning papers over quickly and effectively to his helpful peers and colleagues, what is perhaps more notable about the above summary is Shepherd’s emphasis on “excitement,” “momentum” and “speed.” None of these three words is a one that we would first associate with the monastic labour of research. They better convey the personality of the explorer or adventurer—even the champion sportsperson.

Better still, these nouns remind me of Freud’s haughty, swaggering vision of himself as a “conquistador” in the letter of which I wrote in my last post. The year was 1900, and Freud, vainglorious, wrote of his personality thus: “I am by temperament nothing but a conquistador . . . with all the curiosity, daring, and tenacity of a man of this sort.” I suppose there are many ways to find success as a scholar; however, what strikes me as salient about Shepherd’s keywords and Freud’s self-portrait is the common emphasis they place on this constitutive tenacity, this positively “dopaminergic” sense of ferment, that seems required of the emotionally durable scholar. In different ways, both authors suggest the importance of maintaining, for want of a better idiom, something of a quickness of mind and spirit. Excitement and energy, it may be, then, are the emotional antinomies of dormancy, the affective defences to torpor, no less in academia than elsewhere. But then, of course, we already knew that.