Making a Case for the Geel Model: The American Experience with Family Care for Mental Patients

The historic colony for the mentally afflicted in Geel, Belgium is often cited as a unique example of integrating patients into the community. However, scholarly work on Geel largely ignores the history of similar programs that existed in the United States. This study will look into the practice of family care modeled after the Geel program in the 19th and 20th century U.S. The importance of this research is twofold: it shows that the program is not new for the American context while at the same time it informs about the logistics involved in initiating and running family care programs in the U.S. milieu.Nana Tuntiya is affiliated with the Department of Sociology, University of South Florida, FL 33620-5550, USA.     

Who was Deborah Kallikak?

The Kallikak Family was, along with The Jukes: A Study in Crime, Pauperism, Disease, and Heredity, one of the most visible eugenic family narratives published in the early 20th century. Published in 1912 and authored by psychologist Henry Herbert Goddard, director of the psychological laboratory at the Vineland Training School for Feebleminded Children in Vineland, New Jersey, The Kallikak Family told the tale of a supposedly "degenerate" family from rural New Jersey, beginning with Deborah, one of the inmates at the Training School. Like most publications in the genre, this pseudoscientific treatise described generations of illiterate, poor, and purportedly immoral Kallikak family members who were chronically unemployed, supposedly feebleminded, criminal, and, in general, perceived as threats to "racial hygiene." Presented as a "natural experiment" in human heredity, this text served to support eugenic activities through much of the first half of the 20th century. This article reviews the story of Deborah Kallikak, including her true identity, and provides evidence that Goddard's treatise was incorrect.     

Familial Alzheimer disease: a large, multigeneration German kindred

A German family with 21 members affected by Alzheimer disease (AD) was studied clinically and genetically. The diagnosis was histologically verified in three affected family members. Ancestors were traced through seven generations to a couple residing in East-Westfalia during the middle of the 19th century. Dementia was often accompanied by extrapyramidal features and myoclonus. No cases of Down syndrome or hematologic malignancy occurred in this family. Clinical manifestations, temporal progression, neurological testing, and neuropathological features do not differ from the more common sporadic form of AD. The inheritance pattern is most consistent with autosomal-dominant transmission.     

"Depressive pseudodementia" or "Melancholic dementia": a 19th century view.

Nineteenth century views on the interaction between dementia, depressive illness, general paralysis and brain localisation are discussed in the context of a book by A Mairet entitled: Melancholic Dementia. It is shown that by 1883 there was already awareness of the fact that severe affective disorder could lead to cognitive impairment. General paralysis was the commonest diagnosis put forward to account for patients with depression who went on to develop dementia. Patients so diagnosed, however, often recovered and clinical and statistical analysis of Mairet's case histories suggests that some were in fact suffering from depressive pseudodementia. Evidence is marshalled to show that during the 19th century there was wide disagreement concerning the clinical domain, course and even histopathology of general paralysis. This casts doubt on the traditional view that this condition served as "a paradigm" for other psychiatric diseases during this period. It is shown that by the turn of the century these difficulties led to a redefinition of the concept of dementia and to a marked narrowing of the clinical bounds of general paralysis.     

Familial occurrence of amyotrophic lateral sclerosis, parkinsonism, and dementia

We report here on a 59-year-old man from southwest Germany who died after a 14-year course of an illness characterized by progressive dementia, parkinsonism, and amyotrophic lateral sclerosis. Postmortem examination revealed Alzheimer's neurofibrillary tangles in the substantia nigra, innominata, locus ceruleus, parahippocampal gyrus, and less frequently in the hippocampus and the cerebral cortex. Investigation of the patient's pedigree back to the 17th century revealed nine additional family members who had exhibited signs of amyotrophic lateral sclerosis or parkinsonism-dementia or both. The pedigree suggests that a recessive trait with genetic epistasis is responsible for the disorder.     

The origin of mental hospital in Japan and its typological classification]

Before the beginning of the Modernization in 1868, there were no psychiatric hospitals in the sense of Modern-Western in Japan. Instead of them, as far as I ascertained, altogether 30 asylums are existed in the whole country. They are mainly buddhistic temples and shrines, where psychotic patients and their families are treated by monks in various way. The ways of treatment are quite different, so that the typological classification of asylums is possible according to this point: 1. treatment by waterfall or water, 2. treatment with old Chinese herbal medicine, 3. treatment with collaborative conjuration associated musical instrument (drum). From the historical standpoint of view the Type 1 has oldest tradition. In the late of 11th century a daughter of the emperor was psychotic and sent into the temple Iwakura-Daiunji in northern suburb in Kyoto-City. She was treated successfully with holly waterfall and water and after this legend many psychotic patients gathered there. From the end of 14th century the Temple Juninji near the City of Okazaki began treatment with Chinese herb for the psychotics. Compared to Daiunji which belongs to Mikkyo-sect in the national Buddhism Juninji belongs to Jodoshin-sect in the frame of the reformed Buddhism. Altogether 4 temples of Type 2 are belonging to this new sect without exception and after the Modernization (Meiji-Restoration in 1868) became psychiatric hospitals. The all temples belonging to Type 3 are Nichiren-sect also in the reformed Buddhism and began the conjuration-treatment after 17th. century. The typology of asylums before the Modernization brings us necessary to the question on the origin of the ways and methods in psychiatric treatments in the history.     

Roots in Jewish and Christian Soil: A Portrait of the Holocaust Researcher as an Involved Person

Abstract

Having grown up in a postwar Germany characterized by a social climate of unmourned losses and crimes, the author traces his family roots through its two distinct lineages: the Catholic maternal and the Jewish paternal family (which, however, had converted to Protestantism in the late 19th century). He reflects on his early adolescent experience of digging into this history, covered by collective silence, and connects it to his later decision to become a psychoanalyst and a Holocaust researcher.     

A Brief History of Psychiatry: Millennia Past and Present—Part III

Release of emotion through a variety of means has often been seen as healing. Throughout the centuries many cultures dealt with stress by bringing relief through methods like dancing, ritual, or confession. The idea of discovering not always conscious emotions and their release through talking became important in 19th-century psychological treatments. The 20th century has seen a flowering of psychoanalytical, behavioral, cognitive behavioral, and many other psychotherapies. These have been used in individual, group, or martial/family settings, inpatient and outpatient. There have been disagreements between and among the various schools of psychotherapy. As we approach the next century, therapists of all schools are discussing ways in which each therapy contributes to helping patients and are defining common threads that link all the approaches to psychotherapy.     

Alzheimer's disease: a model from the quantitative study of a large kindred.

In an Italian kindred (family N), early onset Alzheimer's disease has been transmitted in a Mendelian autosomal fashion since the early 18th century. The age at death of affected members of the family varies widely, and was taken as an index of the age of expression, a measure of phenotypic variability. Either a gamma or a log-normal algorithm provides the best fit for the age at death distribution. Subsets of family N widely different as to time and place have the same age at death of patients: Environment appears to play a negligible role in the expression of disease. Pairwise correlation between an affected parent and child is zero: The disease is monogenic (no major expression gene). The same stochastic distribution of age of expression, but with late onset, and after correction for death from other causes, is compatible with the epidemiology of Alzheimer's disease in general. Mendelian genetics is a possible model for Alzheimer's disease etiology.     

The clinical concept of epilepsy

This article reviews the history of clinical concepts of epilepsy and its classification, especially in the last 100 years. Throughout its recorded history of 3 to 4 millennia, epilepsy has always been defined by its most dramatic symptoms, for example, falling, motor activity or loss of consciousness, but separation from other causes of the same paroxysmal symptoms has always proved challenging. For over a century there has been some semantic confusion whether to call the various paroxysms fits, convulsions, seizures, or epilepsies. Since the middle of the 19th century a great unresolved debate has continued about whether recurrent seizures or epilepsy should be viewed as a separable symptom of underlying brain disease or as one or more idiopathic diseases or syndromes, with an inherent age-related natural history; or indeed viewed as both a symptom and a disease. A major advance in the 20th century is that vascular theories of epilepsy, which reached their peak with Turner in 1907, have been replaced by electromagnetic discharges, based especially on the work of Todd, Jackson, Berger, Lennox, and the Gibbs, culminating eventually in new ILAE classifications of seizures (1981) and epilepsy syndromes (1989). However 21st century uncertainties about symptomatic versus idiopathic or cross-sectional (seizures) versus longitudinal (epilepsy) approaches to the problem very much reflect similar divergences of view a century ago. More attention is now being directed at interseizure events and processes which may lead either to remission or intractability with associated cognitive and psychosocial consequences. The search for the elusive essence, diathesis or predisposition to epilepsy, including seizure threshold, continues.     

Family dynamics, adolescent delinquency, and adult criminality.

Family and offending is probably the theme most researched in criminology. A comprehensive array of characteristics of family life have been linked to offending since the beginning of this century. This theme has been approached from two directions: a bivariable point of view, in which one characteristic of the family is related to a measure of offending, and a multivariate point of view, in which some family characteristics are used to explain offending. The literature is dominated by bivariable studies and although there are a few multivariate studies no specific theoretical perspective is proposed. In this paper we choose a control theory perspective and a comprehensive set of family variables to answer the following question: Can the explanation of offending be improved by a dynamic system family control theory? Additionally, the literature is principally focused on adolescent delinquency; in consequence we will study the following question: Are the family characteristics that explain most efficiently juvenile delinquency the same ones for the explanation of adult criminality?     

Publicity and purism in the history of psychiatry

Psychiatry has always been influenced by the "Zeitgeist" of the epoch. Due to the supernatural aura surrounding mental disease, the lack of a sufficient biological basis, and the capacity to reduce civil rights of individuals, psychiatry occupies a special position among the medical disciplines. The dependence of psychiatry on the dominating ideas of epochs are analysed for the 18th century and the Nationalsocialist era in Germany 1933-1945. Both epochs are characterised by strictly defined ideologies. It can be demonstrated that puristic ideologies tend to be inhumane. Psychiatry needs constant public control; wherever this is not possible, for political reasons, human right of the mentally ill are not preserved. During the 17th and 18th century, English psychiatry on the whole was leading in respect to humane methods of treatment, because there was parlamentary and public control. Public resistance, especially by the churches, forced Hitler to halt the so-called euthanasy programme. Even under the conditions of dictatorial rule, control was effective to some extent.     

Psychosocial aspects of women's lives: work, family, and life cycle issues.

Over the past century and continuing to evolve into the twenty-first century, there have been dramatic changes in work and personal/family lives within the United States. These changes, though strongly affecting men and children, have impacted most dramatically on women's lives, particularly white, middle-class women. Psychiatrists and other mental health clinicians need to be aware of the scope and nature of these changes and to recognize that their own personal experiences and values might differ from those of women of different generations as well as different socioeconomic and cultural backgrounds.     

Changing care for the mentally ill in the "house of the poor insane in Lübeck" from the 17th to the early 19th century

Until quite recently the history of the "House of the Poor Insane" in the Hanseatic City of Lübeck has only been studied selectively. Our study comprises an overall view of the comprehensive historical documents concerning this institution during the 17th and 18th century; the period of the following 40 years in another new constructed house is outlined likewise. Not only the journal, into which the principals of the institution wrote down the minutes, but foremost the cassa-books without omissions were used to describe the social history as well as the range of activities. Thus historical windows into the daily routine of the inmates are opened. - During the greater part of 17th century, the institution rather resembled a prison for the mentally ill, though in the end of the 17th and during the 18th century an important early phase of reform is to be recognized, followed, however, by a period of repression and "containment" towards the end of the century and in the beginning of the 19th century. Then again, this time initiated by the medical profession, the reform was revived. - The Lübeck findings are not only compared with the historical development of inpatient treatment in institutions elsewhere, but it is also discussed, which influences were the decisive factors for the public care in the city of Lübeck.