[Historical aspects of ethics in psychiatry : From the end of humanitarianism up to the Human Rights Convention]. / Historisches zur Ethik in der Psychiatrie : Vom Ende der Humanität zur Menschenrechtskonvention.

The establishment of academic psychiatry was completed around 1900. Simultaneously, in view of the societal crisis phenomenon the professional self-concept of the psychiatrist was shifted to a self-image, according to which psychiatry had to place its expertise at the service of the people and the country. This was particularly expressed in World War I in the brutal dealing with the so-called war neurotics. In association with the so-called death by starvation of ca. 70,000 institution inmates, in the post-war period Karl Bonhoeffer debated a transformation of the term humanitarianism. The worst consequence of the rejection of humanitarian thoughts are the murders of invalids under National Socialism; however, legitimization of such crimes by alluding to collective ethics, as attempted by Karl Brandt, seems to be less than convincing. The reform of psychiatry initiated in the 1960s and the United Nations Convention on the Rights of Persons with Disabilities, which came into force in 2008, have achieved prerequisites for a supportive psychiatry with reduced coercion, whereby many questions also in the legal and social systems must still be clarified.

[Historical comments on ethics in psychiatry : Challenges in the 19th century]. / Historische Anmerkungen zur Ethik in der Psychiatrie : Herausforderungen im 19. Jahrhundert.

With the emergence of an early psychiatry around 1800, a number of questions arose on dealing with a group of persons whose "alien", irritating and disruptive behavior was considered to be a phenomenon of being sick. In the context of the growing importance of human rights, the term humanitarianism attained a high relevance as the reference for early psychiatrists. Based on historical sources it is shown that despite a multitude of psychiatric beliefs on humanitarianism the established psychiatric practice was dominated by patriarchal order regimes up to the first decade of the twentieth century, later superimposed by the challenges of somatophysiological and experimental research as well as perceptions of biological racism. The associated new ethical questions were partially addressed within psychiatry but did not prevent an increase in the assessment of the mentally ill as "inferior".

["Medicine is a social science" - the 200th birthday of Salomon Neumann]. / "Die Medizin ist eine soziale Wissenschaft" ­ zum 200. Geburtstag von Salomon Neumann.

Salomon Neumann (1819-1908) is one of the outstanding representatives of 19th century social medicine. As a medical reformer, statistician and city councilor, he made a significant contribution to improving social and hygienic conditions in Berlin. His most famous work was published in 1847 under the title "Die oeffentliche Gesundheitspflege und das Eigenthum" [Public Health and Property]. From 1859 to 1905, Neumann was active in the Berlin City Council for the improvement of the living conditions of the population. He was involved in the construction of municipal hospitals, supported the modernisation of sewage disposal, organised the Berlin censuses of 1861 and 1864 and was active in the field of health and social statistics. Not only was Neumann exposed to anti-Semitic reprisals during his lifetime, a foundation he founded to promote the science of Judaism was dissolved by the National Socialists in 1940. On the occasion of his 200th birthday, this article commemorates the life and work of the democratically minded and socially committed doctor and health politician. Salomon Neumann has rendered great services to social medicine in Germany.

German wine in an American bottle: the spread of modern psychiatry in China, 1898-1949.

Modern psychiatry was first introduced to mainland China around 1900 by Western missionaries. By 1949 the field had developed gradually as a result of contact with Western psychiatry and especially its American practitioners. This paper analyses the role played by key individuals and events in this process in the years prior to 1949. It argues that modern psychiatry was introduced to China through a process of cultural adaptation in which the USA served as a bridge for German thought.

[Madness and malaria--intersections and boundary blurring between psychiatry and tropical medicine in Hamburg]. / Wahnsinn und Malaria--Schnittpunkte und Grenzverwischungen zwischen Psychiatrie und Tropenmedizin in Hamburg (1900-1925).

The object of this article is to point out and to discuss the significant intersections and boundary blurring between psychiatry and tropical medicine while treating malaria in the German "colonial metropolis" Hamburg. The focus of this study is the Hamburg asylum at Friedrichsberg and the Institute for Maritime and Tropical Diseases (Hamburg Tropical Institute). Under analysis are two groups of patients as well as the means with which their doctors treated them: 1. patients who have been sent back from the German colonies in Africa after mental disorders had been diagnosed, and 2. patients suffering from general paralysis and treated in Friedrichsberg after 1919 using the then newly developed malaria fever therapy (according to Wagner-Jauregg). The implementation of this latter led to an intensification of the cooperation between psychiatry and tropical medicine in Hamburg which prior to this had been only very sporadic.

The reputation of psychiatry in the first half of the twentieth century.

The article evaluates the arguments used by German psychiatrists in the first half of the twentieth century to raise their professional reputation. The arguments, which were used in Wilhelmine Germany and in the 1920s, changed with the establishment of the NS-regime. While psychiatrists claimed for open care systems and for more transparency of psychiatric practice to the public in the first decades of the twentieth century, psychiatry became a crucial part of NS-health policies after 1933. The psychiatrist's participation in the largest systematic action to kill mentally ill patients known in history forced them to search for ways to legitimatize the murder program and to integrate it into a therapeutical view of future psychiatry by trying to avoid arbitrariness and assigning research a central importance.

[Psychological events--organic interpretations: concepts of trauma in German psychiatry since 1889]. / Psychische Ereignisse--organische Interpretationen: Traumakonzepte in der deutschen Psychiatrie seit 1889.

This paper examines the debate on psychological trauma in German psychiatry since 1889. A content analysis of five leading German psychiatric journals between 1889 and 2005 is realised. An organic concept of psychological trauma has been prominent in the professional debate until today. Psychiatrists frequently referred to physical traumatisation, constitutional factors and genetic predisposition, exogenous reaction types according to Bonhoeffer, and to biological markers in the context of the PTSD concept. The biological tradition in German psychiatry resulted in a specific adoption of concepts on psychological trauma. However, integrating various models of psychological trauma into a psychiatric tradition focusing on a biological model proved to be difficult and inconsistent.

[Trauma and psychosis in german psychiatry - a historical analysis]. / Trauma und Psychose in der deutschen Psychiatrie - Eine historische Analyse.

OBJECTIVE: The paper reports an historical analysis of the debate on trauma and psychosis in German psychiatry. METHODS: Content analysis of five leading German psychiatric journals between 1889 and 2005. RESULTS: A substantial number of publications until the late 1960s addressed different aspects of potential links between trauma and subsequent psychosis. Papers exclusively focused on traumatic experience in adulthood. Most papers showed a negative attitude towards the idea of traumatic experiences causing psychosis. CONCLUSIONS: The debate on psychological trauma and psychosis refers to a long tradition in German psychiatry. Whilst the discussion contributed significantly to concepts and classifications of psychotic illnesses, it did not generate a coherent model for the potential association of trauma and subsequent psychotic disorder.

[Dis/arranged medical histories à la Friedrichsberg. Explorations of foreign patients by multilingual fellow patients in a German asylum about 1900]. / Verlrückte Anamnesen à la Friedrichsberg. Explorationen ausländischer Patienten durch mehrsprachige Mitpatienten in einer deutschen Irrenanstalt um 1900.

This paper deals with two examples of a particular patient's activity at the Friedrichsberg Asylum in Hamburg in the beginning of the 20th century. Two multilingual patients assumed the function of interpreters in each case for a foreign fellow patient. They were involved to a great extent in the documentation of the medical histories. Conversations and interrogations carried out by them and recorded by their own hand are passed down in the medical files of their foreign-language fellow patients. After some preliminary remarks about the Friedrichsberg Asylum and its patients, the various activities of patients in the psychiatric institution and the importance of the patients' manner of speaking for the psychiatric diagnosis, the two cases are described in detail. The patient-interpreters were perceived as border-crossers, as "Figures of the Third".

["The communication is of course very difficult." The "insane re-migrants" from America in the Hamburg Asylum Friedrichsberg 1909]. / "Die sprachliche Verständigung ist selbstverständlich recht schwierig." Die "geisteskranken Rückwanderer" aus Amerika in der Hamburger Irrenanstalt Friedrichsberg 1909.

Between 1900 and 1914 many so-called "insane re-migrants" were admitted to the Hamburg Asylum in Friedrichsberg. These patients were mainly East European emigrants who had left Europe via Hamburg and who had been classified as insane and sent back by the US-authorities. About 450 relevant medical files are available, exactly 100 for the year 1909. Based on a quantitative examination of these files this paper provides a profile of these patients. It analyses how these patients were perceived and how physicians and authorities in Hamburg dealt with them. Furthermore several case histories and different circumstances of deportation from the USA will be discussed. The article shows a particular formation of madness in the context of transatlantic migration. Most of the patients spoke little or no German. Minders or fellow patients often acted as interpreters.

["Querulousness", anti-psychiatry, and the public around 1900]. / "Querulantenwahnsinn", Psychiatriekritik und Offentlichkeit um 1900.

The querulent and the paranoid litigant as specific types of modern insanity partly owe their psychiatric genesis to an ambivalent legal-political development in 19th-century Germany. One the one hand the legal system had been opened up to the recognition of civil rights, on the other hand the extensive use of these new rights raised many problems. Open court proceedings and the daily press provided opportunities of information for the general public. The critical anti-psychiatry movement, which developed from the 1880s, used these opportunities rigorously with regard to psychiatric statements made in court. The public played a major role in the conflict with the psychiatrists, including the dispute about "querulousness" and its definition. This paper discusses how psychiatrists and medical laypersons confronted each other in their struggle over expert knowledge versus "common sense" regarding "pathological querulents".

["Zerquälte Ergebnisse einer Dichterseele"--literary critiques on psychiatry around 1900]. / "Zerquälte Ergebnisse einer Dichterseele"--Literarische Kritik, Psychiatrie und Offentlichkeit um 1900.

In the last decade of the 19th century dozens of "mad" people from the respectable bourgoisie went public with most stigmatizing details of their private lives. The authors told about healthy people branded as insane, and incarcerated in insane asylums. They took their cases to the "court of public opinion". These stories became the stuff of public scandals and also the basis of an organized "lunatics' rights" movement, which was a protest movement against the power and competency of psychiatric expertise. Inspired by this movement some authors and playwriters took up the criticism towards psychiatry and wrote novels and stage plays in which they told frightening and desparate stories of restrained people who had to suffer from arbitrary decisions of psychiatrists. The paper deals with three novels and stage plays written between 1908 and 1917 by Heinrich Mann, Frederik van Eeden, and Waldemar Müller-Eberhart. It analyses the gloomy picture of the asylum and the practice and attitudes of the asylum doctors painted by the three authors. I argue that the narratives had an impact on the public as well as the professional discourse on the problem of psychiatric arbitrariness, and that the authors not only conveyed citicism but also pointed out a concept of a humaine interaction between "normal" and "abnormal" people.

[Psychological trauma in psychiatric textbooks published in german - the dominating view of psychiatrists between 1945 and 2002]. / Psychisches Trauma in deutschsprachigen Lehrbüchern der Nachkriegszeit -- die psychiatrische "Lehrmeinung" zwischen 1945 und 2002.

AIM: The study investigates the concepts of psychological trauma and their changes over time in psychiatric textbooks published in German between 1945 and 2002, assuming that textbooks reflect the established and dominating views of their time. METHOD: [corrected] In psychiatric textbooks, the terminology, concepts of illness, and recommendations for assessment and treatment concerning psychological trauma were analysed. RESULTS: The concept of psychological trauma that had existed since 1916 continued to dominate textbooks up until the 1960s. Findings on holocaust survivors entered textbooks not before the mid 1970s. Since the mid 1990s, the concept of Post-Traumatic Stress Disorder has been widely established in textbooks. CONCLUSION: Changes of dominating views on this issue in textbooks appear to have been extremely slow and occurred with significant delays in the past. The change of the dominating view in the 1970s was linked to the establishment of a new generation of leading psychiatrists. Since the introduction of PTSD, psychiatric textbooks have given up a previously negative attitude towards patients suffering from psychological trauma.

Psychological injury in the two World Wars: changing concepts and terms in German psychiatry.

This paper describes how German psychiatrists in two World Wars treated psychologically injured soldiers, and the concepts of related illnesses which they developed. The literature is reviewed, and symptomatolgy of patients and therapeutic practice in the wars are compared. By 1916 German psychiatrists had already established a concept of illness that continued to be used until World War II and beyond, albeit with a changing terminology. The vague term 'war neurosis' was commonly used, but covered different, partly overlapping concepts. Psychiatrists considered the disorder as a psychogenetic reaction based on an individual predisposition and denied a causal link between the experience of war and subsequent psychopathology. It may be concluded that psychiatrists developed theoretical models and practical treatment methods in a manner that met the social and military requirements of the time.

["Euthanasia"--victims and test subjects. The fate of diseased, disabled children in Berlin during World War II]. / "Euthanasie"--Opfer und Versuchsobjekte. Kranke und behinderte Kinder in Berlin während des Zweiten Weltkriegs.

This article shows, through a study of the Berlin-Brandenburg region, that children and juveniles who were subjected to the killings of diseased and disabled, or mentally retarded, persons during the Third Reich did not only fall victim to the operations of the "Reichsausschuss" ("Reich Commission for Registration of Severe Disorders in Childhood"). Many were also included in the gas chamber killings of the "T4"-action and in various decentralized killing actions. Furthermore, the co-operation of various medical disciplines in the misuse of children for scientific research is demonstrated by looking into the research on a tuberculosis vaccine. It can be shown that the purpose of the killings was not the painless ending of individual suffering, but that they constituted a means of freeing the public from so-called "ballast existences", whose lives were only prolonged if they could be of scientific use.

[Housing and work as criteria of the "Social Integration" of the mentally ill - development in Germany between 1900 and 2000]. / Wohnen und Arbeit als Kriterien einer "sozialen Integration" psychisch Kranker - Entwicklungen in Deutschland von 1900 bis 2000.

AIM: This paper analyses, in what way psychiatrists considered housing and work as criteria of social integration of mentally ill people and what models of care were suggested in Germany throughout the 20th century. METHOD: Publications in 29 German professional and scientific psychiatric journals through the complete period from 1900 to 2000 and monographs were searched for papers on the above issues. RESULTS: Until the second half of the century, integrative initiatives related to housing and work generated in asylums without the aim of a full social integration of the patients. In the activistic concept of NS-psychiatry, work became an obligation for patients and a criterion for selection that decided on life and death. Not until the late 1950s, there again was an orientation towards integration in psychiatric care in both German states. Whilst already in 1963 the "Rodewisch Theses" outlined recommendations for the rehabilitation of the mentally ill already in the GDR (East Germany), a similar mark of reform ideas was published in the "enquete" in the FRG (West Germany) in 1975. In the GDR initiatives were limited to a small number of locations. In the FRG and the re-unified Germany various forms of sheltered housing and work were established - also with significant regional variation. However, a clear discussion of underlying aims and implications for the structure of mental health care was not found in the psychiatric literature. CONCLUSIONS: In the 20th century a tradition of psychiatric ideas related to housing and work did not develop in Germany. Particularly, there were only sporadic contributions from university psychiatry. Work was more frequently explicit subject of discussions than housing. Both areas were - slowly and in discontinuity - established as criteria of integration of people with mental illnesses, which was increasingly accepted as an aim of mental health care.

[Trauma and Psyche in German Psychiatry since 1889]. / Trauma und Psyche in der deutschen Psychiatrie seit 1889.

AIM: This paper summarises the psychiatric concepts on trauma in Germany since 1889. METHOD: Literature review and historical analysis. RESULTS: Based on the notion that traumatic experience may lead to mental disorders Oppenheim described the traumatic neurosis in 1889. Subsequently, there was an intensive discussion on different concepts until 1918. Since then, the history of psychiatric concepts of trauma in Germany has been characterised by change, repitition and discontinuity. After 1945, mental disorders following traumatic experience hardly featured in textbooks with the exception of the vaguely defined survivor syndrome. In the last 10 years, the concept of posttraumatic stress disorder as originated in the USA became dominant. CONCLUSIONS: Psychiatry in Germany has a long and inconsistent tradition of theories and concepts on trauma. The historical view may enrich the current debate in which the concept of posttraumatic stress disorder has been increasingly criticized.