Jews and the Criminalization of Madness

Distinctions between delinquency and illness were ill-defined and problematic, as we have seen in the case of the masturbator Johann A. And it was precisely in this vague grey zone between the two that psychiatry was able to insert itself in defining a new mental pathology. The problem of deciphering the difference between delinquency/criminality and madness was further complicated and given a unique twist in the cases of Jewish patients, whose Jewishness (in the eyes of the asylum) was by definition a kind of criminality and immorality. Jewishness, in other words, represented a category of interpretation distinct from illness, one which, in turn, had become highly politicized in the debates about Jewish emancipation since the eighteenth century. Therefore, when race was used to interpret patient behavior, it constituted a form of thinking outside of the medical domain in the strictest sense. In this way, it was potentially at odds with the medical process, and could, as I will show in two case studies, function to prevent the asylum staff from seeing and treating patients as ill. This chapter thus examines the limits of the medicalization of deviancy— the points where, in contrast to the “illnesses” discussed heretofore (male masturbation, nymphomania, and religious madness), medicine pulled back, seeking explanations for the person in a framework outside of the terms of medicine. That extramedical framework drew from long-standing stereotypes of Jews as immoral and criminal; but it also had a more immediate source in a contemporary trope that united Jewishness and criminality in a social type: the jüdischer Gauner (Jewish crook). Such images of Jews had in turn become part of the political arsenal of those opposing Jewish emancipation on the grounds of an incorrigible Jewish “character.” My argument here runs counter to the few historical works on Jews and insanity, which, consistent with the medicalization thesis, have focused exclusively on the conflation of Jewishness and illness in medical theories. In part, this approach derives from their focus on the second half of the nineteenth century, where the conflation was indeed overwhelming, psychiatry and medicine (as well as other human sciences) having become saturated with racial and degeneration theories.

The Duchy of Nassau and the Eberbach Asylum

Eberbach’s founding in 1815 coincided with the lunacy reform movement that swept Europe and North America in the first half of the century. That movement in Germany took peculiar shape in the central role played from the start by the state. Unlike England and France, the primary initiative for the lunacy reforms in Germany came from above, by enlightened state bureaucrats under the tutelage of the German neoabsolutist states. If the (apocryphal) founding image of French psychiatry is the alienist Phillip Pinel famously striking the chains off the inmates of the Bicêtre during the French Revolution, its (real) German counterpart is that of the Prussian Minister Karl August von Hardenburg charging J. G. Langermann (medical officer, later privy councillor and head of Prussian medical affairs) in 1803 with the responsibility of turning the Bayreuth madhouse into Germany’s first mental hospital. Other states and areas of Germany followed suit in the decades after the Napoleonic wars. Eberbach was no exception to the German pattern, where new, enlightened ideas about insanity, concerns of state security with respect to the deviant poor, and the desire to keep abreast of the most progressive trends united to lead even the small and impoverished state of Nassau to embark on costly lunacy reforms. Further, in Nassau both the founding and functioning of the asylum were closely tied to state-building, that is, to the consolidation of state power, the political integration of the population, and the extensive administrative reforms that this entailed—in the penal system, medicine, local government, education, religion, and so forth. State reforms in the area of culture (religion and education) will be discussed in chapter 3. The following section focuses on the penal, medical, and (local) governmental reforms, which formed the broader institutional context of the asylum. The duchy of Nassau, which achieved its final form in 1816 (bounded by the Rhine, Main, Sieg, and Lahn rivers), was one of the new Mittelstaaten (medium sized states) to emerge out of the Napoleonic wars and the Congress of Vienna.

Masturbatory Insanity and Delinquency

As argued in chapter 4, masturbatory insanity was closely linked to male identity and contemporary notions of masculinity. An additional factor contributing to the obsessive focus of medical practitioners on masturbation was the usefulness of the concept of masturbatory illness to the professional interests and aspirations of medicine and of alienists in particular, a group who embraced the notion of masturbatory illness with special fervor. According to Gilbert, the masturbation diagnosis partly derived from a gap between the “prestige and skill level” of the medical profession. This disjuncture drove doctors “to explain diseases of which they had inadequate knowledge in terms of the moral feelings of their patients.” The issue for psychiatry, this chapter argues, was not so much a gap between prestige and knowledge as the use of a new type of knowledge to enhance the prestige of mental medicine. For it is surely not 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 specialty. The notion of masturbatory illness was also, as Foucault has pointed out, connected with the power relationships of nineteenth-century institutions, such as the school, the army, and the insane asylum. The following case study of Johann A., a single, thirty-five-year-old farm laborer and former soldier, shows the role played by the institutions of the army and the insane asylum in masturbatory insanity. It also suggests how masturbation could play a crucial role in the expansion and legitimation of psychiatric expertise through the insertion of a discourse of sexual pathology into areas of behavior long viewed and treated as disciplinary or criminal matters. It did this by providing the scientific basis for the diagnosis of illness in ambiguous cases, where distinctions between delinquency and illness were unclear. The use of the masturbation diagnosis for disciplining male delinquency varied, both institutionally and culturally, by social class. The second part of the chapter explores the different ways that male masturbatory insanity was coded in, and experienced by, lower- and middle-class men.

Doctors and Patients: The Practice(s) of Nymphomania

The peasant Margaretha D., noted the asylum log, “often suffers from hysterical attacks, with which she wants to be treated like a distinguished lady . . . She raises herself above her social position and demands great attention and care.” This patient, in other words, though considered mad by the Eberbach asylum, was not a true hysteric: she rather “played” the hysterical lady. Two important issues suggest themselves from this description of feigned illness. The first has to do with the connection between class, gender, and the representation of illness. Madness, it seems, had its class and gender codes. Certain symptoms of hysteria—which in the eighteenth century had become a fashionable illness of privileged women, signifying the pathologies accompanying luxury, leisure, and “civilization”—appeared suspicious in a poor, peasant woman. Secondly, the “playing” of illness suggests (inadvertently) a subtext, normally buried and only implicit in the asylum notes: of illness as strategic behavior on the part of the patient within the social dynamics of the asylum. Margaretha’s symptoms were at least in part the result of a self-presentation to her keepers, a communicative act, with its own aims—attention, better care, and so forth. Both of these issues—the link between class, gender, and illness, on the one hand, and the strategic nature of symptoms, on the other—are at the core of the following analysis of nymphomania. Nineteenth-century physicians interpreted the behavior of nymphomaniacal women as a function of an internal state of being—as pathologically excited genitals—and in this way, they contributed to the construction of a modern conception of sexuality as an innate essence of personality. While no longer a clinical entity in post-Freudian psychiatry, the image of the out-of-control, sex-obsessed nymphomaniac remains very much alive in popular culture and continues to be grounded in a conception of sexuality as inner essence and “drive.” This analysis, by contrast, looks at nymphomania as acts and attitudes, which took place within very specific social contexts: the power dynamics of the asylum and the doctor-patient relationship.

Medical Representations of Sexual Madness: Nymphomania and Masturbatory Insanity

Nineteenth-century science played a critical role in the formulation and legitimation of modern gender norms and the subordination of women through naturalizing gender difference—representing as “scientific” and universal in the supposedly biological makeup of the sexes what were in fact social and prescriptive beliefs. Feminist studies in the history of psychiatry and on the hysteria diagnosis in particular have been groundbreaking in opening up this line of analysis. In stark contrast to the topic of hysteria, nymphomania has received almost no attention in the historiography. It played no role in the creation of famous psychiatric careers, as did hysteria in the work of Jean-Martin Charcot and Sigmund Freud. Rather, nymphomania was one of those vague, allen compassing, but all the more ubiquitous, terms for female sexual deviancy that floated in both medical and popular culture. Yet, in the Eberbach case histories, it was nymphomania, not hysteria, that predominated in medical representations of female sexual maladies, its symptoms or diagnosis appearing in the case files of almost one-third of the female patients. Its prominence in these cases, as I shall argue, was related in complex ways to the primarily rural and lower-class social background of these patients, a group which, while typical of early–nineteenth-century asylums, has received no systematic treatment in the study of gender and madness. This class dimension is probably one reason for the paucity of studies on nymphomania: hysteria was classically, though by no means exclusively, an illness of precisely those elite Victorian women on whom the historiography of hysteria and madness has hitherto focused. Gender, as feminist scholarship has shown, is a “symbolic system” that “signif[ies] relationships of power.” Gender categories are also relational: definitions of femininity are developed in opposition to those of masculinity. These elements of gender are important for understanding the medical construction of sexual pathology in the Eberbach files. Nymphomania had its male counterpart, masturbatory insanity, and both these “illnesses” can only be understood properly in relationship to each other, as two gendered sides to the coin of sexual pathology.

Introduction

In 1838, an indigent tailor arrived at the Eberbach asylum terrified, dazed, and repeatedly crossing himself. At home before his committal, Martin M. had become violent and been bound and beaten. He had experienced, as he later explained, “an irresistable urge to spit in people’s faces and hit them.” Now, during his eleven-month incarceration, he incessantly begged for “mercy” from the asylum physicians. Rituals of authority and submission were built-in features of doctor-patient relations in an institution where doctors wielded almost absolute power and where acts of submission were a necessity for any patient who wanted to leave the place. Curiously, Martin M. understood this fact in a language foreign to the medical designs of the asylum—a language (“mercy”) of the prisoner or penitent, of criminal justice or the church, not that of the patient. Martin M., it seems, felt he needed either divine salvation or judicial clemency, not medical treatment. The treatment of Martin M. in an insane asylum was an innovation of the nineteenth century. Just twenty-five years earlier, such a man would have been left at home to face the punishments of family and community or placed in one of the multifunctional work-, poor-, and madhouses that housed the castoffs of society—beggars, petty criminals, prostitutes, orphans, the insane, and the infirm. In contrast to these detention institutions, the new asylums of the nineteenth century contained only the mentally ill, with the aim of medically treating and rehabilitating them through methods that affected the mind. The birth of a new medical specialty and a new set of experts—the alienists, later known as psychiatrists—thus accompanied the founding of modern insane asylums in a movement that spread throughout Europe and North America beginning in the late eighteenth and early nineteenth centuries. As a result of these changes, masses of deviant and mentally ill people in the nineteenth century came to be incarcerated and subjected to new kinds of medical and psychological treatment (although their numbers remained limited in the first part of the century). We know that most of these people came from the lower classes; certainly such people made up the overwhelming majority of patients in public asylums.

Conclusion

Almost unknown before the 1970s, multiple personality disorder (M.P.D.) has become an epidemic in the last twenty years. One estimate puts the incidence of new cases between 1985 and 1995 at forty thousand. The patients are overwhelmingly “white, female, and North American.” The New Yorker tells of one such case: Elizabeth Carlson, a suburban housewife, who began psychiatric treatment in 1989 for depression. Within a year she had discovered more than two dozen personalities inhabiting her mind and had recovered horrifying memories of childhood sexual molestation at the hands of a satanic ritual cult. The psychiatrist, Diane Humenansky, had supplied her patient with a M.P.D. illness script— books, videotapes, and leading questions— which Carlson faithfully internalized and made her own. It was a dangerous script. Before long, Carlson’s condition was deteriorating: she no longer left her bedroom and her marriage was falling apart; she became suicidal, and felt she was going crazy. M.P.D. is not a disease entity. Not the tools of the psychiatrist, but those of the historian, social psychologist, and sociologist are best suited to explain its epidemiology and symptomatology. The illness script Humenansky and other psychiatrists made believable to their patients drew from a number of political, social, and cultural currents: the child-protection movement of the 1970s, the later recovered-memory movement, and the involvement of an unlikely alliance of feminists and Christian fundamentalists. M.P.D. became a psychiatric growth industry, which promoted the illness from new institutional bases: a professional organization (I.S.S.M.P.&D.: International Society for the Study of Multiple Personality and Dissociation), annual conferences, specialized units within hospitals, and publications. Finally, the media spread the word through magazine, talk show, and news coverage (one program featuring a “star [M.P.D.] patient who switched personalities [on cue] for the camera”). On the other hand, it is not accurate to make M.P.D. alone responsible for mental disorder in these women and the medicalization of otherwise purely social problems. Like Carlson, most of these women had long been troubled in mind and “already spent [on average] seven years in the mental—health system” before undergoing M.P.D. therapy.

Women, Sex, and Rural Life

The making of nymphomaniacs occurred not only within the confines of the asylum walls, but in the wider social world that produced mental patients. Before incarceration, twenty-five of the nymphomania cases were already regarded as such (as nymphomaniacs or as sexually overexcited) in the commitment reports of medical officers, whose information was heavily dependent on family and community informants; in government reports; and even in the direct statements of community members. These women had become threats to their families and/or communities, and the latter, as a result, had desired their incarceration as much as any intrusive state or medical profession. Moreover, the sexual danger that medical science perceived in nymphomaniacs was not wholly fabricated. In many of the cases, the women were behaving in sexually aberrant and out-of-control ways, and these actions were not incidental to their communities’ perceptions of insanity and danger. Though redefining that experience, medicine worked in the first instance with the material of village conflicts, complaints, and interests in forming the nymphomania diagnosis. These interests could coincide with those of medicine and state, and it was in the cooperation of these parties (state, medicine, and community) that nymphomania initially evolved in the cases where it was diagnosed before commitment. To understand the origins of the nymphomania diagnosis, it is thus necessary to examine those communities, their norms of sexuality and mental health, and to look at the women themselves: who they were, their problems, and the language—in action and word—they used to articulate those problems. Statements of community members in three of the cases show that a popular version of the nymphomania concept did exist in rural society, a version covered by the term man-craziness (Mannstollheit or mannssüchtig). Its meaning, in fact, overlapped in some ways with that of the more technical, medical term. This similarity, it seems, reflected less the incorporation of medical ideas into popular culture than the reverse: the extent to which the science was saturated by and drew from nonscientific sexual mores and moral codes in the society at large.

Religious Madness in the Vormärz : Culture, Politics, and the Professionalization of Psychiatry

In 1849 Germany’s leading psychiatric journal reported a curious “illness” that, “like a plague,” had swept through a number of rural Swedish communities: young girls subject to an “involuntary drive to preach.” The “preaching illness” began with symptoms of a “strongly-felt awakening towards repentance and improvement,” headaches, and burning in the chest. It then progressed to “automatic convulsions” and visions, which the girls “imagine are the effects of God’s spirit.” In this state, they preached a message admonishing against sin—against dancing, drinking, card-playing, and other depraved behavior—and prophesied the coming destruction of the world. Whole communities had been infected, believing in the girls’ message and in their connection to God. Identifying new forms of religious “madness” (and other mental illnesses) was a learning process, and one important venue for this was the collegial exchange of case histories in professional journals. In a postscript to the article, Carl Friedrich Flemming (1799–1880), an editor of the journal and one of Germany’s leading asylum psychiatrists, appended his own recent treatment of a case in Prussia that remarkably matched the symptoms of the Swedish preaching illness. A young village girl took to falling into “epileptic fits” and, in a trance state, would admonish people in her community about their sins. She attained “great respect through her preachings and prophesying”; “listeners streamed” to hear her, even paying money for the privilege. A doctor was called in to examine her; she was ultimately removed to an asylum where, through Flemming’s successful cure, she “never again made the least attempt to preach,” and was able to be returned home without any further “public nuisance.” The preaching illness was but one variant of a larger epidemic of religious madness that physicians, asylum alienists, and others were convinced plagued their society. They saw patients troubled by anxiety, guilt, and terror over real or imagined sins; people who were bewitched or possessed by the devil; prophets and mystics whose diseased imaginations led them to believe themselves endowed with divine powers. This was the heyday of religious madness, an illness discussed at length in the professional literature and registered in asylum statistics across Europe and North America.