Loss of Innocence: Albert Moll, Sigmund Freud and the Invention of Childhood Sexuality Around 1900

This paper analyses how, prior to the work of Sigmund Freud, an understanding of infant and childhood sexuality emerged during the nineteenth century. Key contributors to the debate were Albert Moll, Max Dessoir and others, as fin-de-siècle artists and writers celebrated a sexualised image of the child. By the beginning of the twentieth century, most paediatricians, sexologists, psychologists, psychiatrists, psychoanalysts and pedagogues agreed that sexuality formed part of a child’s ‘normal’ development. This paper argues that the main disagreements in discourses about childhood sexuality related to different interpretations of children’s sexual experiences. On the one hand stood an explanation that argued for a homology between children’s and adults’ sexual experiences, on the other hand was an understanding that suggested that adults and children had distinct and different experiences. Whereas the homological interpretation was favoured by the majority of commentators, including Moll, Freud, and to some extent also by C.G. Jung, the heterological interpretation was supported by a minority, including childhood psychologist Charlotte Bühler.     

Childhood long-term conditions in primary care: a qualitative study of practitioners’ views

Background

Improving child health and wellbeing in England was the key focus of the Chief Medical Officer’s Annual Report 2012, which recommended that all children with long-term conditions (LTCs) have a named GP responsible for their care. Little is known, however, about practitioners’ views and experiences of supporting children with LTCs in primary care.

Aim

To explore practitioners’ views of supporting children with LTCs and their families in primary care.

Design and setting

Qualitative interview study in primary care settings in South Yorkshire, England.

Method

Interviews explored practitioners’ views and experiences of supporting children with asthma, cystic fibrosis, type 1 diabetes, and epilepsy. Interviews were audiotaped, transcribed verbatim, and analysed using the framework approach.

Results

Nineteen practitioners were interviewed: 10 GPs, five practice nurses, and four nurse practitioners. The GPs’ clinical roles included prescribing and concurrent illness management; nurse practitioners held minor illness clinics; and practice nurses conduct asthma clinics and administer immunisations. GPs were coordinators of care and provided a holistic service to the family. GPs were often unsure of their role with children with LTCs, and did not feel they had overall responsibility for these patients. Confidence was dependent on experience; however, knowledge of GPs’ own limits and accessing help were felt to be more important than knowledge of the condition.

Conclusion

Primary care has a valuable role in the care of children with LTCs and their families. This study suggests that improving communication between services would clarify roles and help improve the confidence of primary care practitioners.     

The History of Mental Health Services in Modern England: Practitioner Memories and the Direction of Future Research

Writing the recent history of mental health services requires a conscious departure from the historiographical tropes of the nineteenth and twentieth centuries which have emphasised the experience of those identified (and legally defined) as lunatics and the social, cultural, political, medical and institutional context of their treatment. A historical narrative structured around rights (to health and liberty) is now complicated by the rise of new organising categories such as ‘costs’, ‘risks’, ‘needs’ and ‘values’. This paper, drawing on insights from a series of witness seminars attended by historians, clinicians and policymakers, proposes a programme of research to place modern mental health services in England and Wales in a richer historical context. Historians should recognise the fragmentation of the concepts of mental illness and mental health need, acknowledge the relationship between critiques of psychiatry and developments in other intellectual spheres, place the experience of the service user in the context of wider socio-economic and political change, understand the impacts of the social perception of ‘risk’ and of moral panic on mental health policy, relate the politics of mental health policy and resources to the general determinants of institutional change in British central and local government, and explore the sociological and institutional complexity of the evolving mental health professions and their relationships with each other and with their clients. While this is no small challenge, it is perhaps the only way to avoid the perpetuation of ‘single-issue mythologies’ in describing and accounting for change.     

What happens when doctors are patients? Qualitative study of GPs

Background

Current evidence about the experiences of doctors who are unwell is limited to poor quality data.

Aim

To investigate GPs'' experiences of significant illness, and how this affects their own subsequent practice.

Design of study

Qualitative study using interpretative phenomenological analysis to conduct and analyse semi-structured interviews with GPs who have experienced significant illness.

Setting

Two primary care trusts in the West of England.

Method

A total of 17 GPs were recruited to take part in semi-structured interviews which were conducted and analysed using interpretative phenomenological analysis

Results

Four main categories emerged from the data. The category, ‘Who cares when doctors are ill?’ embodies the tension between perceptions of medicine as a ‘caring profession’ and as a ‘system’. ‘Being a doctor–patient’ covers the role ambiguity experienced by doctors who experience significant illness. The category ‘Treating doctor–patients’ reveals the fragility of negotiating shared medical care. ‘Impact on practice’ highlights ways in which personal illness can inform GPs'' understanding of being a patient and their own consultation style.

Conclusion

Challenging the culture of immunity to illness among GPs may require interventions at both individual and organisational levels. Training and development of doctors should include opportunities to consider personal health issues as well as how to cope with role ambiguity when being a patient and when treating doctor–patients. Guidelines about being and treating doctor–patients need to be developed, and GPs need easy access to an occupational health service.     

Venereology at the Polyclinic: Postgraduate Medical Education Among General Practitioners in England, 1899–1914

In 1899 the British Medical Journal enthusiastically announced that a new postgraduate teaching college was to open in London. The aim of the Medical Graduates’ College and Polyclinic (MGC) was to provide continuing education to general practitioners. It drew upon emerging specialisms and in so doing built upon the generalist training received at an undergraduate level. Courses were intended to refresh knowledge and to introduce general practitioners to new knowledge claims and clinical practices. The establishment of postgraduate institutions such as the MGC marked an important stage in the development of medical education in England. Yet these institutions, and the emergence of postgraduate medical education more broadly, have been largely overlooked by historians. Moreover the history of venereological training among medical undergraduates and postgraduates alike has been overlooked. The study of such special subjects characterised postgraduate study. This article examines the dissemination of venereological knowledge among subscribers to MGC as an important case study for the development of institutionalised postgraduate medical education in England at the turn of the twentieth century.     

‘The Solution to his Own Enigma’: Connecting the Life of Montague David Eder (1865–1936), Socialist,Psychoanalyst, Zionist and Modern Saint

This article examines the career of pioneer British psychoanalyst David Eder (1865–1936). Credited by Freud as the first practising psychoanalyst in England, active in early British socialism and then a significant figure in Zionism in post-war Palestine, and in between an adventurer in South America, a pioneer in the field of school medicine, and a writer on shell-shock, Eder is a strangely neglected figure in existing historiography. The connections between his interest in medicine, psychoanalysis, socialism and Zionism are also explored. In doing so, this article contributes to our developing understanding of the psychoanalytic culture of early twentieth-century Britain, pointing to its shifting relationship to broader ideology and the practical social and political challenges of the period. The article also reflects on the challenges for both Eder’s contemporaries and his biographers in making sense of such a life.     

A framework of Afrocentric hope: Rural South African children's conceptualizations of hope

There is a growing need to explore and understand indigenous knowledge and subjective experiences around hope from children raised in rural African communities. This engagement sought to address the question: What are rural South African primary school children's conceptualizations of hope? A visual participatory methodology (using collage‐making, drawing, Mmogo method, and photovoice) enabled an exploration of hope with 12 children (9‐13 years) attending an aftercare center in rural QwaQwa region of South Africa. Using evidence generated from the study, and drawing on Scioli's theory of integrated hope, this article posits a framework of Afrocentric hope that develops along four interdependent and interrelated levels: contextual, personal, relational, and collective. These interactions are mediated by the spiritual/cultural worldview dimension. Understanding rural South African children's perspectives of hope contributes toward engagements aimed at nurturing, shaping, and strengthening hope in collective‐oriented communities.     

Building the ship of death: part I

This is the first in a series of two consecutive articles, both of which present the results of original research from a team of music-thanatology musician-clinicians working in Spokane, Washington. This article presents not only an overview of the music-thanatology narration style (through direct excerpts from clinical narratives), it also describes the interconnected physical, emotional, and spiritual needs of 11 dying persons and their families as they occur in a hospital setting. Core to narrative medicine practice, in the first article, we welcome these excerpts from patient, provider, and caregiver experiences to stand on their own, in their own voice, without interpretation. The second article will be published in the following issue and will focus on the clinical practice of music-thanatology, as well as the documentation of the palliation it offers to meet the complex physical, emotional, and spiritual needs described below.     

The Medicines of Katherine,Duchess of Norfolk, 1463–71

This article discusses the medicinal remedies consumed at the court of the Yorkist kings of England in the light of a lawsuit in the court of common pleas (edited in an appendix) between John Clerk, king’s apothecary to Edward IV, and Katherine Neville, Duchess of Norfolk, over the partial non-payment of the apothecary’s bills. It argues that the consumption of apothecaries’ wares in large quantities was not merely a direct result of the excessive diet of the late medieval aristocracy, but in itself represented a facet of the conspicuous consumption inherent in the lifestyle of this particular social class. The remedies supplied by Clerk over a period of several years and listed in the legal record are set in the context of contemporary collections of medical recipes, particularly a ‘dispensary’ in the British Library’s Harleian collection generally attributed to the king’s apothecary.     

Making Modern Migraine Medieval: Men of Science,Hildegard of Bingen and the Life of a Retrospective Diagnosis

Charles Singer’s retrospective diagnosis of Hildegard of Bingen as a migraine sufferer, first made in 1913, has become commonly accepted. This article uses Hildegard as a case study to shift our focus from a polarised debate about the merits or otherwise of retrospective diagnosis, to examine instead what happens when diagnoses take on lives of their own. It argues that simply championing or rejecting retrospective diagnosis is not enough; that we need instead to appreciate how, at the moment of creation, a diagnosis reflects the significance of particular medical signs and theories in historical context and how, when and why such diagnoses can come to do meaningful work when subsequently mobilised as scientific ‘fact’. This article first traces the emergence of a new formulation of migraine in the nineteenth century, then shows how this context enabled Singer to retrospectively diagnose Hildegard’s migraine and finally examines some of the ways in which this idea has gained popular and academic currency in the second half of the twentieth century. The case of Hildegard’s migraine reminds us of the need to historicise scientific evidence just as rigorously as we historicise our other material and it exposes the cumulative methodological problems that can occur when historians use science, and scientists use history on a casual basis.     

A qualitative study exploring genetic counsellors' experiences of counselling children

The identification of healthy carriers by newborn screening programmes raises questions about how and when the carrier results will be conveyed to child. There is currently a lack of information concerning how best to convey carrier information to children. This is a serious gap in the literature and practice. This study examined genetic counsellors'' experiences of counselling children to explore how to support and inform children about their carrier result. Practising members of the United Kingdom (UK) Association of Genetic Nurses and Counsellors took part in semi-structured telephone interviews. Respondents described the communication process and identified barriers and facilitators of communication. Age, illness experience and maturity were variously discussed as facilitators; all of which are integral to psychological theories of children''s understanding of illness. Adaptive family communication, school tuition and educational materials were also seen as influencing counselling efficacy. Relevant materials that children could keep were also seen as important to enhance children''s autonomy. Yet, such resources were rare, constituting a barrier to communication. Counsellors reported communication was further impeded by maladaptive family communication and resistance from children to engaging in counselling. By exploring the facilitators and barriers inherent in communicating genetic information to children, guidance can be offered to counsellors, researchers and parents. This study indicates that some factors (eg illness experiences) previously identified by psychological theories may act in complex ways within this setting. Importantly, the factors identified as being most influential when communicating with children about genetics are amenable to change through interventions, support and training.     

Support for mothers and their families after life-threatening illness in pregnancy and childbirth: a qualitative study in primary care

Background

One in 100 women who give birth in the UK develop life-threatening illnesses during childbirth. Without urgent medical attention these illnesses could lead to the mother’s death. Little is known about how the experience of severe illness in childbirth affects the mother, baby, and family.

Aim

As part of the UK National Maternal Near-miss Surveillance Programme, this study explored the experiences of women and their partners of life-threatening illnesses in childbirth, to identify the long-term impact on women and their families.

Design and setting

Qualitative study based on semi-structured narrative interviews. Interviews were conducted in patients’ homes in England and Scotland from 2010 to 2014.

Method

An in-depth interview study was conducted with 36 women and 11 partners. A maximum variation sample was sought and interviews transcribed for thematic analysis with constant comparison.

Results

Women’s birth-related illnesses often had long-lasting effects on their mental as well as physical health, including anxiety, panic attacks, and post-traumatic stress disorder. In some cases the partner’s mental health was also affected. Women often described feeling isolated. Their experiences can have a profound impact on their relationships, family life, career, and future fertility. While some women described receiving good support from their GP, others felt there was little support available for them or their families after discharge from hospital.

Conclusion

A near-miss event can have long-lasting and major effects on women and their families. Support in primary care, including watchful waiting for mental health impacts, can play a valuable role in helping these families come to terms with their emergency experience. The findings highlight the importance of communication between primary and secondary care.     

‘No “Sane” Person Would Have Any Idea’: Patients’ Involvement in Late Nineteenth-century British Asylum?Psychiatry

In his 1895 textbook, Mental Physiology, Bethlem Royal Hospital physician Theo Hyslop acknowledged the assistance of three fellow hospital residents. One was a junior colleague. The other two were both patients: Walter Abraham Haigh and Henry Francis Harding. Haigh was also thanked in former superintendent George Savage’s book Insanity and Allied Neuroses (1884). In neither instance were the patients identified as such. This begs the question: what role did Haigh and Harding play in asylum theory and practice? And how did these two men interpret their experiences, both within and outside the asylum? By focusing on Haigh and Harding’s unusual status, this paper argues that the notion of nineteenth-century ‘asylum patient’ needs to be investigated by paying close attention to specific national and institutional circumstances. Exploring Haigh and Harding’s active engagement with their physicians provides insight into this lesser-known aspect of psychiatry’s history. Their experience suggests that, in some instances, representations of madness at that period were the product of a two-way process of negotiation between alienist and patient. Patients, in other words, were not always mere victims of ‘psychiatric power’; they participated in the construction and circulation of medical notions by serving as active intermediaries between medical and lay perceptions of madness.     

The Moral Career of ‘Outmates’: Towards a History of Manufactured Mental Disorders in Post-Socialist?China

This study focuses on ‘manufactured mentally ill’ (bei jingshenbing, 被精神病) individuals in post-socialist China. In Chinese society, bei jingshenbing is a neologistic catchphrase that refers to someone who has been misidentified as exhibiting symptoms of mental illness and has been admitted to a mental hospital. Specifically, it refers to those individuals who were subjected to unnecessary psychiatric treatment during the first decade of the twenty-first century. Based on archival analysis and ethnographic fieldwork, this study addresses the ways in which the voices of bei jingshenbing victims and those who support them reveal China’s experiences with psychiatric modernity. It also discusses the active role of these individuals in knowledge production, medical policymaking, and the implications for reforming the psychiatric and mental health systems in post-socialist China.     

Making sense of chronic disease using Emotional Freedom Techniques (EFT): An existential view of illness

ObjectiveThis article explores chronic disease patients’ personal symbolic meanings of their diseases, as emergent from their experience of Emotional Freedom Techniques (EFT) therapy. The present study is part of a larger study that explored chronic disease patients’ and EFT practitioners’ experiences of using EFT to support chronic disease healthcare.DesignEight chronic disease patients who had received EFT were interviewed for this study. Semi-structured interviews were conducted face to face, or via telephone, or the online videoconferencing platform, Zoom. Interviews were transcribed verbatim and data was analysed using Interpretative Phenomenological Analysis methodology.ResultsThree themes emerged, namely ‘illness as an embodiment of unresolved emotional issues’, ‘illness as body's call for time-out and attention’, and ‘illness as a boundary from other people’.ConclusionEFT offers promise as a suitable therapeutic approach to help chronic disease patients make sense of their life stories and lived experiences, and consequently, symbolic meanings of diseases. The exploration of illness symbology and meaning-making may offer therapeutic value to patients, from both an existential and a health behaviors perspective.     

Manny's legacy: paying forward my personal therapy

The lessons of childhood will often last a lifetime. Two lessons that I learned early in life were that loss can occur quickly, unexpectedly, and have monumental consequences such as when my father died when I was 9 years old. I also learned that losses can be assuaged or mitigated in many ways, not the least of which would be the replacement of my father with a father figure, who filled the needs of an adolescent and later an adult with a role model, keen insights, and emotional support. This article traces my experiences with personal therapy and addresses how lessons learned can be used and passed on to succeeding generations comprised of one's children and, in my case, my patients and students for the past 45 years.     

Animal Magnetism,Psychiatry and Subjective Experience in Nineteenth-Century Germany: Friedrich Krau? and his Nothschrei

Friedrich Krauß (1791–1868) is the author of Nothschrei eines Magnetisch-Vergifteten [Cry of Distress by a Victim of Magnetic Poisoning] (1852), which has been considered one of the most comprehensive self-narratives of madness published in the German language. In this 1018-page work Krauß documents his acute fears of ‘mesmerist’ influence and persecution, his detainment in an Antwerp asylum and his encounter with various illustrious physicians across Europe. Though in many ways comparable to other prominent nineteenth-century first-person accounts (eg. John Thomas Perceval’s 1838 Narrative of the Treatment Experienced by a Gentleman or Daniel Paul Schreber’s 1903 Memoirs of my Nervous Illness), Krauß’s story has received comparatively little scholarly attention. This is especially the case in the English-speaking world. In this article I reconstruct Krauß’s biography by emphasising his relationship with physicians and his under-explored stay at the asylum. I then investigate the ways in which Krauß appropriated nascent theories about ‘animal magnetism’ to cope with his disturbing experiences. Finally, I address Krauß’s recently discovered calligraphic oeuvre, which bears traces of his typical fears all the while showcasing his artistic skills. By moving away from the predominantly clinical perspective that has characterised earlier studies, this article reveals how Friedrich Krauß sought to make sense of his experience by selectively appropriating both orthodox and non-orthodox forms of medical knowledge. In so doing, it highlights the mutual interaction of discourses ‘from above’ and ‘from below’ as well as the influence of broader cultural forces on conceptions of self and illness during that seminal period.