History of Psychiatry

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History of psychiatry in Switzerland

Angela Graf-Nold
History of Psychiatry 1991; 2; 321
DOI: 10.1177/0957154X9100200709
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History of Psychiatry, ii (1991),321

321-328. Pnnted In England

History of psychiatry in Switzerland

ANGELA GRAF-NOLD*

August

Forel (1848-1913) and Eugen Bleuler (1857-1939), who both led Swiss
psychiatry to a world-wide reputation, felt themselves to be pioneers in their
disciplines. When Bleuler published his famous book on schizophrenia in 1911,
he complained in the preface about the embryonic state of our psychology; and
with great success he created the names and terms for the new psychological
findings which came to birth at that time. In addition to the term
schizophrenia, he also coined the terms ambivalency, autism and, last but
not least, depth psychology (Tiefenpsychologie), a broadened conception of
psychoanalysis which included the ideas of his esteemed colleague Sigmund
Freud as well as those of his former pupil and assistant, C. G. Jung, and the
findings of Alfred Adler.
The impression of having opened a new area distracts from the interest in its
history.
So it is not surprising that, in Switzerland, it took some time before psychiatry
and mental health care became the subjects of systematic historical inquiry.
Indeed it was not until 1957, more than forty years after Bleulers standard
work, that the director of the newly founded Zurich Institute for Medical
History, Erwin H. Ackerknecht (1906-1988), published A Short History of
Psychiatry[ 1 ] . And it may also not be surprising that Ackerknecht was not Swiss.
Ackerknecht was a real cosmopolitan with a wide personal and scientific
background. Born in Germany (Stettin), he studied medicine in Freiburg i.Br.,
Berlin, Vienna and, finally, Leipzig. As an active member of the communist
Party and an opponent of the Nazi regime, he emigrated to Paris in 1933. There
he studied ethnology, and finished with a diploma from Sorbonne in 1939. After
imprisonment and allied military service, he escaped to the USA, where he
obtained a post as fellow in medical history, thanks to his former teacher, Henry
E. Sigerist. Sigerist had already sponsored his doctoral dissertation in Leipzig

* Address for correspondence: Dr phil. Angela Graf-Nold, Hochstrasse 63, 8044 Zurich,
Switzerland.
1

Bleuler, E., op. cit

., XV.

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322
and since then had become Provost of Johns Hopkins University, Baltimore.
After a year as assistant curator of anthropology at the American Museum of
Natural History in 1947 Ackerknecht was appointed to the Chair of Medical
History at the University of Madison (Wisconsin). Ten years later, in 1957, he
returned to Europe as director of the newly founded Medical History Institute at
the University of Ziirich.22
His Short History of Psychiatry, which appeared in the same year, was soon also
published in English, Spanish and Japanese. It is still in print today (more than
30 years after its first appearance) and still is studied in Switzerland and
Germany as the standard text.

preface of his book, Ackerknecht describes the history of psychiatry as

ungrateful subject, because one cannot speak of significant progress in
treatment as in other disciplines of medicine. There were still resentments
against the mentally ill and the persons treating them, and there remained the
most difficult medical-physiological problem, the mind-body problem, which is
In the

an

still unsolved. As in internal medicine in earlier times, there existed many schools of
psychiatry, mostly dogmatic, which made the subject difficult to study.
Though Ackerknecht is known as one of those who helped to establish
medical ethnology, and although he dedicated his book to the memory of the
ethnologist Ruth Benedict, and begins with an ethnological preliminary note
about the relativity of psychiatric symptoms with respect to different cultures
and different times, his Short History of Psychiatry seems to me on the whole
rather like a sprint through the history of ideas without much regard to the social
conditions that generated the symptoms. For example, he devotes only one
sentence to the officially tolerated homicide of some hundreds of thousands of
mentally ill and mentally retarded people during the Nazi regime. He confines
his work to the psychiatry of medical doctors, excluding the psychiatry of the
philosophers, for - so he says - philosophical psychiatry was not much help to
practical psychiatry (S. VII f).
Also characteristic of Ackerknechts work is the great attention he pays to the
French school of psychiatry of the early nineteenth century, to Pinel and
Esquirol, both of whom, because (in his view) of their humanistic and
enlightened ideas, laid the basis for the newer psychiatry. (In this spirit he later
edited a new publication of Esquirols book Folie, and, in 1967, he published
Medicine at the Paris Hospital, 1794-1848, in which he coined the term Paris
clinical school, a term that still inspires research today.)
In the context of his admiration for the French tradition of psychiatry

2
Walser, H. H., Zum Hinschied von Erwin K. Ackerknecht, Gesnerus, xlv (1988), 309. See also,
Temkin, O., In memoriam Erwin H. Ackerknecht, Bulletin of the History ,
of Medicine (1989), 273-75;
and Cranefield, P., Erwin H. Ackerknecht (1906-1988). Some memories, Journal of the History of
, xlv (1990), 45-49.
Medicine

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323

Ackerknecht took a very critical view of Freud and psychoanalysis. In his view,
Freud indeed gave to the French school of psychiatry that closed intellectual
form which was necessary if these ideas were to become the basis of an
international movement; on the other hand, by never referring to his real
predecessors, Freud created a closed system and founded a para-religious church
with all its symbols having the appearance of exercitia (teaching exercises).
It was the Swiss-Canadian psychiatrist Henry F. Ellenberger (*1905) who, in
his monumental study The Discovery of the Unconscious, wrote the history of the
different schools of depth psychology. He pointed out the private and historical
social, political and cultural - conditions which led the protagonists, Freud,
Jung and Adler, to their several theories and determined their impact [9].
In the preface of the second edition, Ackerknecht refers to a critical argument
which he had read several times and to which he had given considerable thought;
that history of psychiatry should be written by psychiatrists. Since when, he
-

asks,
does one have to be politician to write political, military or war history, since
when does one have to be an artist to write about the history of the arts ?3

Nevertheless, the earlier as well as the later work in the history of psychiatry in
Switzerland has, until now, been carried out exclusively by psychiatrists.
A great deal of the material for the historiography of psychiatry in Switzerland
is contributed by the directors of the psychiatric hospitals who wrote their
memoirs or, at least, the histories of the institutions which they directed. For
example, Auguste Forel, director of the Psychiatric Hospital of Zurich
Burgh61zli from 1879-1898, published his memoirs in 1935 [17]. Manfred
Bleuler, who soon followed his father, Eugen Bleuler, as director of Burgh6lzli
(after a short interregnum of H. W. Meier) and remained there for 32 years until
1967, published a history of this institution [7, 8]. C. G. Jung, who after 1910
developed his influential school of analytical psychology beyond the psychiatric
and academic institutions, shortly before his death dictated his memories to his
assistant Aniela Jaff6. She edited the book posthumously [19].
John Staehelin, director of the Psychiatric Hospital Friedmatt in Basel from
1929-1959 wrote a history of this hospital [22]. Furthermore, Staehelin indulged
his humanistic attitudes in several historical studies; for example, by publishing
papers about psychological and psychopathological treatments referred to in the
Annals of Tacitus, aphorisms by Hippocrates and about the history of psychiatry
in Islam [24, 22, 23].
Staehelins colleague, Max Miiller, director of the Psychiatric Hospital
Waldau in Bern, also left behind his memoirs [20]. He relates the difficulties of
his professional career, his encounters and friendships with several well-known
colleagues. In particular, Mtiller describes his activities and experiences during
3

Ackerknecht, op.

., IV.
cit

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324

period of The Second World War, when famous German colleagues

suddenly in fear of their lives and Switzerland became a haven for a number
of those persecuted. Besides this, the book gives a vivid example of the inner
dynamics of psychiatric institutions by showing how Muller, as a psychoanalytically-trained director, was able to integrate psychoanalytical treatment
with his emphasis for therapeutic methods like electric shocks, sleep cures and
especially insulin cures.
At the same time, the Basel psychiatrist and resident doctor Thomas Haenel
published a richly documented history of psychiatry with special emphasis on
the history of psychiatry in Basel. He specifically commemorates the influential
psychiatrists of the several psychiatric institutions in order to promote - as he
points out - the interest and understanding (of psychiatry) as a relatively newlyestablished discipline which has grown out of internal medicine and which has to
fight with prejudices and hostility. [op. cit., 18].
At the Institute for Medical History of the University of Ziirich, directed by
E. Ackerknecht until 1971, the psychoanalytical psychiatrist Hans H. Walser
(*1920) dedicated a great deal of his professional life to research into and the
teaching of the history of psychiatry. It is to his merit that he worked through
many of the local documents of history of psychiatric institutions, practical
psychiatry, and psychoanalysis. He particularly analysed the special conditions
of the Swiss school of psychiatry which was founded by Forel and Bleuler
between about 1880 and 1920 and which has spread around the world, thanks,
emphatically, to the efforts of their pupil Adolf Meyer (1866-1950). Walser also
pointed out a German Period (c.1850-1880) of the Swiss (i.e., Zurich)
psychiatric school: German psychiatrists, who escaped from the reactionary
politics of the German States to the newly founded universities of Zurich and
Berne - for example H. Ellinger, L. Binswanger (1820-1880), H. Cramer (18311893) A. Zinn (1825-1897) and especially W. Griesinger (1817-1868), who
planned the Zurich Psychiatric Hospital - set the stage of the Swiss school.
Their ideas - no restraint, employment for the patients, free days off and
holidays - laid the ground for the Zrich school as well as for the type of
institution that is still the basis of practical Swiss psychiatry today. Griesingers
later concept of 1868 - a more differentiated organization of mental health care,
including city hospitals for short term patients, rural hospitals for long term
patients, and foster families for recovering patients - worked as a ferment in
Bleuler and his followers and influenced the further development of Swiss
psychiatry into modern social psychiatry [29, 30].
Another distinct approach to the history of psychiatry at the Institute of Medical
History in Zurich under Ackerknecht was developed by the psychiatrist Esther
Fischer-Homberger (*1940) in the early seventies. In her monograph History of
Medicine (1975) she reflected on the several functions of medical history:
the dramatic

were

the function of recycling old ideas and experiences

the function as monuments and tombs for some heroes

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325
-

the

apologetic function (defence and self-confirmation, history

history of progress)
the function as instrument for prognosis and oracle
the function of recovery and recreation from today
the function constituting justice, valuing and passing opinions
the function of clearing up terms and definitions
the function of mediating the consciousness of being a subject
history

as

of

E. Fischer-Hombergers main focus was upon the last three functions. She
began her scientific work in 1968 with a history of the term zirculdres Irresein
(circular insanity). Then she studied the metamorphosis of the terms hypochondria, melancholia and neurosis from antiquity to the present, pointing
out that these terms do not describe objective entities but, rather, constructions
and reflections of thinking and knowing and abstractions of social proceedings
[ 11 ] . Thus she came to the great factor of misogyny in the history of medicine.
Her book Krankheit: Frau (Disease: woman) ( 1979), became a classic feministic
work and made its way beyond the limits of medical history [ 15 ] .
Meanwhile, both Swiss historians of psychiatry, Walser and FischerHomberger, retired from their academic functions to private practice. Walser,
on reaching retirement age, expressed his disappointment at the lack of interest
in his subject amongst Zurich students and complained about their lack of
higher education and idealistic interests.4 The resignation of Fischer-Homberger
in 1983, after only a few years as director of the newly-founded institute for
medical history in Berne, was dramatic and the reasons for it were understood by
only few of her academic colleagues. She could not complain of a lack of interest
in her work, but based her resignation on her own personal increasing lack of
joy, humour and concentration for creative work in the academic structures
which she had to represent in her job. Her visit to the USA, as she wrote in her
letter of resignation, had also confirmed her opinion that medical history in
Switzerland would have to be institutionalized as an interdisciplinary subject:
this would mean more awareness of methods, more specialization, more
academization and management, rather than only just researching the foundations
of psychiatry, which was her first special and personal approachThus both
resignations show, each in its own way, that academic structures in the institutes
of medical history are not altogether satisfying for historians of psychiatry.
Medical history in Switzerland is the most marginal discipline of the medical

4
5

Walser, H. H., personal communication, March 1990.

E. Fischer-Homberger, Letter to friends and colleagues, December 1983. For the significance of the
resignation see also: Professorin kehrt der Universität den Rucken, Tages-Anzeiger, Zürich, 22.8.1984,
and: Letter to the editor from H. H. Walser: Aussteigen muss man sich leisten können, Tages-Anzeiger
,
Zürich, 29.8.84.

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326

faculty; in Ziirich, the director has only one assistant at his disposal, in Berne,
only half an assistant. Medical history is not a required subject of examination
for medical doctors, and so only a few of the overburdened medical students find
the time to attend lectures in medical history. For the directors of institutes, the
lack of assistant positions hinders the necessary broader specification as well as
the interdisciplinary and critically-reflected approach to basic problems of
physical and mental health.
Under these circumstances, there is almost no choice for the directors of the
(up to now) three young Swiss institutes of medical history (Zurich, Bern,
Lausanne) other than to focus either on the local documents of medical history
or on their own (medical) specializations.
In Zurich, for example, when Rttimann, a specialized orthopaedist, took
office at the begining of 1990 as director of the Medical History Institute, he had
first to visit more than forty new colleagues in the medical faculty. Even with a
staff as numerous as that of most of his colleagues, he could manage neither to
care for tombs and monuments of all the heroes and founders, nor to compile
the necessary critical essays about the significance and the social and scientific
implications of all the several medical disciplines. The history of psychiatry more than any other medical specialization - does not lend itself to a medicalonly approach. The history of psychiatry and mental health care cannot be
separated from the history of the human mind and conciousness, which includes
the history of philosophy as well as the history of society and politics.
Exactly this interdisciplinary approach to medical history has, until now, had
the longest tradition in Switzerland at the very university that still has no Chair
for medical history: the University of Geneva. In Geneva, Jean Starobinski
(*1920), trained in both letters and medicine, taught the history of ideas and
history of medicine until last year. With the tools of the Genevan scientific
traditions - (Saussurean) linguistics and the critical psychological implements of
the School of Geneva - he elaborated une histoire des id6es sans frontieres
with many contributions to the history of psychomedical concepts and practices
[25, 26, 27, 28]. One may presume that Starobinskis work will have a longlasting influence on the spirit of the Genevan medical history institute which will
be founded in near future.
But nevertheless, in Switzerland, the institutionalization of a systematic, wellstructured interdisciplinary history of science is, I think, still far away. In any
case, there is no pressure group, no political lobby, working in this direction. A
critical approach to science in general and (mental) health care in particular,
clearing up terms and definitions and confirming the awareness of subjectivity
and relativity of all ideas and meanings, does not promise that kind of scientific
progress which, until now, might be honoured by a Nobel Prize or large
economic profits. For scientists who nevertheless want to work in this way, there
remains no alternative except to be creative, not only in their scientific work but
also in establishing conditions that allow them to work. To this end, they all

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327

need the solidarity of their colleagues and the confirmation of their desire that
their work on mental health and mental health care should promote mental
health and in this way contribute to the further development of freedom, peace
and happiness in human society.

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