Transnational history of medicine after 1950: framing and interrogation from psychiatric journals.

Communication amongst medical specialists helps display the tensions between localism and transnationalisation. Some quantitative sampling of psychiatric journals provides one framework for understanding the history of psychiatry and, to some extent, the history of medicine in general in the twentieth century. After World War II, extreme national isolation of psychiatric communities gave way to substantial transnationalisation, especially in the 1980s, when a remarkable switch to English-language communication became obvious. Various psychiatric communities used the new universal language, not so much as victims of Americanisation, as to gain general professional recognition and to participate in and adapt to modernisation.

The syndrome of accident proneness (Unfallneigung): why psychiatrists did not adopt and medicalize it.

In the World War I period, psychologists in Britain and Germany independently and simultaneously originated the idea of accident proneness (Unfallneigung). This distinctive syndrome of suffering a series of accidents was logically attractive for psychiatrists and psychoanalysts, especially as a pattern of unconsciously motivated deviant and self-destructive behaviour. Yet except for some mid-twentieth-century interest by psychosomatics specialists, psychiatrists did not systematically embrace the syndrome except occasionally as a symptom of other psychiatric conditions, thus showing that there were limits to the extent to which twentieth-century psychiatrists would medicalize patterns of behaviour.

A perfectly staged 'concerted action' against psychoanalysis: the 1913 congress of German psychiatrists.

An eyewitness account provides evidence of a significant clandestine effort to neutralize the legitimacy and authority of psychoanalysis. In a letter, the witness confirms the existence of a perfectly staged concerted action among German psychiatrists against Freud's influence in 1913. Their congress in Breslau was meant to present the united front of German psychiatrists, who were going on record as being against psychoanalysis and, in that context, to give Eugen Bleuler, a leading psychiatrist, whose (however half-hearted) support for psychoanalysis had alarmed his colleagues, a public opportunity for back-pedalling. The letter shows that Freud and his allies were not the only ones who tried to manage an intellectual movement by using informal networks and 'behind the scenes' manoeuvring.

A clinical alternative to the public health approach to mental illness: a forgotten social experiment.

In the last half of the 20th century, the community mental health movement, based on a public health model, came to dominate patterns of care for mental patients. In the process, brutal deinstitutionalization of very ill patients took place, at least in the United States. These events were not inevitable. In 1949, the Menningers of Topeka, Kansas, began administering Topeka State Hospital, which was in deplorable condition. By concentrating expenditures on clinical personnel, the Menningers humanely deinstitutionalized many patients before chlorpromazine, before the entitlement programs of the U.S. federal government such as Medicaid (1965), and before the community psychiatry movement got under way. Topeka State Hospital furnished a model of mental health care that centered a whole system on a last-resort, large, specialized state mental hospital. This inadvertent social experiment suggests that a clinical approach to mental health care offers a hard-headed alternative to present arrangements.

Unraveling the mystery of why there was no childhood lead poisoning.

Despite widespread use of leaded paints, classic life-threatening lead poisoning in small children began to be diagnosed as such only in the 1914-30 period. The diagnosis became suddenly more common in the 1950s and 1960s, but only in some areas of the United States. Experts focused on interior leaded paints as the source of the poison. Archival study of cases from Cincinnati and material from Denver, along with reevaluation of the medical literature, suggests that the problem should be reframed in terms of localized accident, not an epidemic. Very likely clinicians' reports accurately reflected social and material reality. Housing patterns hitherto not fully explored or understood explain why diagnoses were or were not reported. Moreover, evidence suggests the hypothesis that exterior (not interior) paint applied to middle-class houses (not mansions) may account for most cases not traced to repainted furniture and windowsills.