The Internationalisation of American Psychiatry, an Historical Case Study (1909 – 1973)

Regardless of how much one attempts to divorce it from them, the histories of psychiatry and mental health care can only be understood in their social, political and cultural contexts. In practice, there are three methods historians can employ for ventures such as these. Firstly, and typically, studies can be restricted by historians to individual nations, or clusters of nations selected to fulfil the purpose of a pre-ordained argument. Alternatively, one can opt for launching a study that compares national psychiatric cultures across borders. Comparative international studies can be engaging and fruitful, especially in relation to health care as concepts of health care differ wildly across nations, but encounter issues over the availability of viable sources for research purposes.[1] Historians in this instance are faced with the issue of locating sources which meet the specific criteria they are researching, which may not have been prominent in one nation at the time while being prominent in the other. The final methodological approach historians can use, the method this study will utilise, is assessing an aspect of a ‘host nation’ before an influx of new ideas and assessing how said aspect changes as a result.[2] In relation to psychiatry a prime candidate for such a study presents itself in the form of the internationalisation, or globalisation, of the world before, during, and after the Second World War and the effect it had on American psychiatry.[3] The selection of America is self-evident through historical reality. America’s geography and strength played to its advantage during the twentieth century and as a result waves of intellectual refugees came to its shores to escape the rise of Nazis and fascists in Europe. Among these intellectuals were psychiatrists, psychoanalysts and other mental health professionals who would use their European learning and more importantly personal experiences to fundamentally change American psychiatry.[4] The pertinent analogy of  Sanford Gifford bears meaning throughout this case study: ‘American analysts may be compared to the ancient Romans, pouring their energies into building a vast empire, represented by the massive edifice of the American Psychiatric Association, but they remained dependant on refugees for their theoretical nourishment’.[5]

Freud

Sigmund Freud (1909)

Given the tumultuous events of the twentieth century it is odd that the first European intellectual to introduce Americans to the concept of psychoanalysis did so in peace time. In 1909 the founder of psychoanalysis, Sigmund Freud, travelled to America from Austria to deliver a series of five lectures about treating psychopathology through patient and psychoanalyst interaction; the crux of psychoanalysis. The five lectures from Freud at Clark University in 1909 serve as a logical starting point for the transition American psychiatry would undertake in this century. Specifically, they were a crucial moment in the history of psychoanalysis, marking the most ambitious step in its missionary-like conversion efforts to that date. More importantly still, the lectures also marked a turning point in the struggle amongst various professional groups grappling for control over the treatment of mental illnesses; psychiatrists, mental hygienists and psychoanalysts all.[6] These struggles revolved around the ethics of Galtonian-Davenport inspired eugenic policies such as compulsory sterilisation and mass incarceration of the insane: policies of isolation rather than treatment.[7] As a concept and in practice eugenics is very difficult to divorce from any form of study on American psychiatry as much of the medical discourse of the time, let alone contemporary events and their eugenically charged undertones, inevitably lead one to some line of eugenic thought when addressing sources. The eugenicist debate is ultimately one that reflects on the entirety of psychiatry in the early-to-mid twentieth century certainly, and the transition from one paradigm of psychiatry to another revolves around it.

Laughlin

Harry Laughlin

America’s affair with eugenics as a means of addressing psychiatric questions would persist despite a steadily growing opposition to the practice following the introduction of Freudian ideas. Psychoanalysts who sought to overthrow eugenic practices lacked the political capital, let alone recognition from their fellow professionals, to affect policy change. At the time, this was perhaps best demonstrated by the American government passing the Immigration Act of 1924 on eugenic grounds.[8] The medical basis for this came from the champion of American sterilisation laws, Harry Laughlin. Laughlin was commissioned by the Coolidge administration to carry out studies to show ‘the high rate of feeblemindednesses’ among ethnic groups to imply that psychiatric conditions were genetically determined, also implying that the reduction of immigrants reduced the risk of American mental degradation.[9] However, the story of American psychiatry is a story of transition, of distinct paradigm shifts and one would begin two years later in 1926 when St. Elizabeth’s Hospital, previously and unceremoniously known as the Government Hospital for the Insane, began teaching psychoanalysis to upcoming mental health professionals. As historian Joseph Schwartz depicts, St. Elizabeth’s Hospital was the leading institution in America for the treatment of psychoses with psychoanalysis, for the research into the prevention of mental disease rather than its quarantine, for its professional publications rather than obscure here-say, for its specialised training of staff and for its use of non-medically trained professionals.[10] This divergence from the existing paradigm was met with considerable ire from the psychiatrists that still made up the majority of the professional community. The issue that psychiatrists had with psychoanalysts was that psychiatry as a profession had laboured to gain recognition as a legitimate branch of medical science and, seeing psychoanalysts employing distinctly non-medical methodologies, saw their theories as an affront to the progression of psychiatric science. Despite its winding road it had to travel, psychoanalysis was taking root in America before the beginning of the wave of European immigration wave in 1930 and would have continued to grow albeit at a much slower rate. Freud only delivering one series of lectures is not enough to account for the emergence, or rather the adoption and adaptation, of an entire mental health ideology.

This leads one to contemplate whether it is always necessary to transport men to transfer their doctrine.[11] In America’s case one can make the sound argument that this is indeed true. American eugenic thought was imported from the British statistician Francis Galton, cousin of the renowned naturalist Charles Darwin, before it was adopted by Charles Davenport; who makes no secret of his influence from Galton, literally referencing him on the first page of his 1911 work Hereditary in Relation to Eugenics.[12] Although eugenic ideas indeed began in British intellectual circles there was a clear distinction between their application in Britain and in America. Randall Hansen and Desmond King point out that despite the fact ‘eugenic ideas garnered extensive support and were similar in both countries’, application of said ideas differed wildly.[13] American politicians, buoyed by an enthusiastic eugenic lobby pushed through an array of policies like the aforementioned Immigration Act in 1924 and continued propagation of forced sterilisation laws. Most sterilisation laws were directly targeted at the inhabitants of state-run mental health institutions, as they were in Virginia when a 1924 act not only made the practice legal but also made it mandatory. The passage from the act itself reads as follows: ‘it is for the best interests of the patient and of society that any inmate of the institution under his [superintendent] should be sexually sterilized, such superintendent is hereby authorized to perform – the operation of sterilization on any such patient confined in such an institution afflicted with hereditary forms of insanity that are recurrent, idiocy, imbecility, feeble-mindedness or epilepsy’.[14] On the other hand, there is absolutely no parallel for events such as these in British history.[15] Certainly, while The Mental Deficiency Act of 1913 was ratified by the British houses of parliament what the act achieved was the transfer of, once again, ‘the feeble-minded’ into healthcare institutions run by local authorities in order to segregate such people from wider society where they were deemed not only a risk to others but at risk themselves.[16] Identifying similar ideologies but observing different applications of the same begs the question of historical context. Britain’s eugenics movement was driven by the promotion of positive eugenics, which was the process of selective breeding and social engineering to promote traits and hereditary deemed positive. America’s brand of eugenics however was based on the enforcement of negative eugenics, which was the process of erasing negative or undesirable traits from the gene pool – completely bypassing and supplanting the cycle of natural selection with a state-run alternative.[17] The historical origin of America’s affair with this brand of negative eugenics can be pinpointed to the influx of European immigrants, specifically southern European immigrants which did not come from the desirable gene pool of Saxon-Nordic descent, during the late nineteenth century.[18] It’s zeal thus comes from the desire to keep the indigenous population homogenic not only in body but in mind as well. Britain on the other hand was relatively more accustomed to diversity, being part of a union of nations and being the metropole of a global empire, therefore the idea of negative eugenics was never truly embraced as emigration from Britain to colonies alleviated any concerns over racial or mental purity.

Kanner

Leo Kanner

When the Nazi party came to power in 1933 the exodus of psychoanalysts from continental Europe began in earnest, and by 1942 the movement’s entire centre of gravity had shifted to America.[19] Countless intellectuals made the journey from continental Europe to safer havens across the world, with some opting to stay in Great Britain while some made the Atlantic crossing to America if they had the fortune of securing a visa. Among these men and women this study draws attention to three mental health professionals: Leo Kanner, Bruno Bettelheim and Thomas Szasz. Kanner was an Austrian immigrant and came to America in 1924, spending the first decade of his new life in America in relative obscurity before rising to notoriety.[20] Kanner is best known for his work on autism in children but the source this study assesses is a colourful debate, hosted by the American Journal of Psychiatry, between himself and the American neurologist Foster Kennedy.[21] Kennedy, the recipient of an honorary degree from the University of Heidelberg, was in favour of euthanasia for feebleminded children while Kanner was vehemently opposed. Kennedy’s argument largely derived from a 1941 address he delivered to the American Psychiatric Association (APA) in a paper titled The Problem of Social Control of the Congenital Defective. In his paper, Kennedy claimed that ‘The idiot and the imbecile seem to me unresponsive to the care put upon them. They are not capable of being educated; nor can such defective products ever be made to be so. Good breeding begets good brains; with no good brains there can be no good mind. I am in favour of euthanasia of those hopeless ones who should never have been born – Nature’s mistakes’.[22] While one would understandably be shocked by Kennedy’s views by modern standards and sensitivities his views were not a minority in the historical context he lived within. Kanner’s counter argument, featured in his article Exoneration of the Feebleminded, retains composure but to his contemporaries he may have been seen to be appealing to emotion: ‘Psychiatry is, and should forever be, a science dunked in the milk of human kindness. Shall we psychiatrists take our cue from the Nazi Gestapo? Does anyone really think that the German nation is in any way improved, ennobled, made more civilized by inflicting what they cynically choose to call “mercy deaths” on the feebleminded?’.[23] This exchange is an instance of psychiatric cultures clashing at a pivotal point in the history of psychology. Both participants in the debate were based within one nation, although Kanner was foreign, but international events evidently played a role in shaping the course of the debate. Although the atrocities of the Nazis were not yet common knowledge, despite Kanner evidently being made aware of them by the waves of refugees arriving on American shores, the fact that elements of the American medical community persisted with ideologies like those of a nation they were at war with is remarkable. Medical professionals of Kennedy’s ilk fell out of favour in spectacular fashion following the revelations of the war but more-so when Nazi defendants at the Nuremberg Trials compared Holocaust planning and practice with American eugenic programs.[24] For many, that comparison hit far too close to home and all semblance of psychiatric euthanasia ceased in America in the post-war period. America’s affair with eugenics and especially its history of sterilising psychiatric patients, even flirting with the idea of exterminating them, is a legacy it struggles to come to terms with even to this day.[25]

Bettelheim

Bruno Bettelheim

As the psychiatrist Bradley Lewis claims, ‘the story of American psychiatry in the latter half of the twentieth century is a story of transition and paradigm shift’.[26] Lewis’s claim has validity as, if the former half of the twentieth century had been a gradual shift in transition, the latter half was nothing short of tectonic. After the Second World War, and by way of contrast, the very idea of mental health hospitals was perceived as icons of a bygone age. The globalisation, or the internationalisation of the latter part of the twentieth century brought about a struggle of ideas as what to replace the previous paradigm with. This struggle has been divided, by historians and medical professionals alike, into two camps. One camp is that of the status quo, of institutionalisation on a reduced scale, which was characterised at the time by professionals like the Austrian-born psychoanalyst Bruno Bettelheim.[27] The other is the camp of de-institutionalisation which sought a community-based policy of liberation. These intellectuals were characterised by the Hungarian-American psychiatrist Thomas Szasz.[28] Bettelheim was a figure whose career was marked by a successive string of controversies ranging from the alleged falsification of credentials to the propagation of previously discarded theories.[29] He had come to America in 1939 following a brief stint in Dachau concentration camp and was eventually made a professor of psychology at the University of Chicago. Bettelheim’s endorsement for institutionalisation came from his 1967 work The Empty Fortress where he declared that ‘during many years of work with schizophrenic children I had learned how an institutional setting designed especially for their treatment produced unexpectedly favourable results’.[30] Bettelheim was partially responsible for the propagation of the ‘refrigerator mother theory’ which supposed autism was a direct result of indifferent parenting causing emotional retardation. This theory began with Kanner in his 1935 work Child Psychiatry but Kanner soon distanced himself from his own case following the revelation of new information.[31] The issue with Bettelheim’s theories were that they were not based in empirical science or historical fact, they were instead based on personal observation and ignored the revisions Kanner had made to his original theories. As such, Bettelheim has not withstood the test of time.

Szasz

Thomas Szasz

If the de-institutionalisation movement and the desire to completely divorce American psychiatry from its sketchy history could be embodied by one man that man would likely be Thomas Szasz. Szasz had fled to America during the waves of refugees in the 1930s due to his Jewish heritage putting him at odds with the Nazi Reich.[32] Even to psychiatric laymen Szasz’s writings are gripping to say the least. Szasz’s belief, the crux of de-institutionalisation, was that there was no such thing as true mental illness beyond empirically proven diseases such as Alzheimer’s. While patients exhibited symptoms characteristic of autism, schizophrenia or manic depression the enthusiasm of psychiatrists to label them as mentally ill set a dangerous precedent. Szasz explains his stance in his 1961 work The Myth of Mental Illness:no science, however, can be better than its linguistic apparatus allows it to be. The language of psychiatry (and psychoanalysis) is fundamentally unfaithful to its own subject: in it, imitating medicine comes before telling the truth. We shall not, however, be able to hold on to the morally judgmental and socially manipulative character of our traditional psychiatric and psychoanalytic vocabulary without paying a price for it. Indeed, we are well along the road of having purchased superiority and power over patients at the cost of scientific self-sterilisation and imminent professional self-destruction’.[33] Fundamentally, Szasz was a humanist and vehemently opposed to the commitment of his fellow humans to insane asylums, a stance he explains in his 1973 work Ideology and Insanity; ‘for some time now I have maintained that commitment – that is, the detention of persons in mental institutions against their will – is a form of imprisonment; that such deprivation of liberty is contrary to the moral principles embodied in the Declaration of Independence and the Constitution of the United States; and that it is a crass violation of contemporary concepts of fundamental human rights. The practice of sane men incarcerating their insane fellow men in mental hospitals can be compared to that of white men enslaving black men. In short, I consider commitment a crime against humanity’.[34] While Szasz’s views on his own profession come across as anarchical, and they did to many in the psychiatric field at the time, it is important to emphasise that Szasz was in favour of interpersonal treatment between a patient and their psychiatrist; he was just adamant that large-scale, state-run programs were abhorrent. Given the attitude to institutionalisation in the post-war period the traction Szasz’s beliefs achieved is unsurprising. Szasz, and the de-institutionalisation movement, were instrumental in shifting American, if not international psychiatry from its early modern paradigm to its modern and contemporary one.[35]In conclusion, the internationalisation of the twentieth century affected American psychiatry in profound ways. The paradigm shift away from pre-modern eugenic assertions about mental health and healthcare was made possible by the introduction of European-based psychoanalysis. The ideas of Galton and Freud demonstrated that ideas can be introduced to a foreign nation and fundamentally affect its course even if the progenitors of the same ideas are not present to oversee their implementation. Indeed, the Freudian doctrine had engendered American interest in psychoanalysis and the concept had taken root in the nation even before the arrival of intellectual refugees in the 1930s. Among these refugees were men who would later become revisionists in the field, fuelled by the desire to prevent future miss-use of mental health policy – having been made all-too-aware of its effects on their homelands. Alternatively, psychoanalysis may have remained on the fringes of recognised science, as it was in the 1920s; accepted by a minority but frowned upon by a majority that saw institutionalised psychiatry achieving results – morbid results but results nonetheless. The arrival of European professionals conferred upon psychoanalysis a standing that it had lacked before, raised its status in the public eye, gave it a new appeal to upcoming professionals and greatly contributed to its evolution and expansion. Ultimately, while it is evident that psychoanalysis was growing in America before internationalisation and evident that it would have continued to grow in the absence of the same there is little disputing that the outcome could have been radically different had the discipline not been steered towards a more humane course by international forces.[36]

Bibliography

Anonymous, Virginia Sterilization Act of 03/20/1924 (Virginia, 1924), p.589. Available At: https://www.dnalc.org/view/11213-Virginia-Sterilization-Act-of-3-20-1924.html

Bashford, Alison; Levine, Philippa, The Oxford Handbook on the History of Eugenics (Oxford University Press, 2010).

Baynton, Douglas, Defectives in the Land: Disability and Immigration in the Age of Eugenics (University of Chicago Press, 2016).

Black, Edwin, War Against the Weak: Eugenics and America’s Campaign to Create a Master Race (New York, 2004).

Buchanan-Parker, P.; Barker, P., ‘The Convenient Myth of Thomas Szasz’, Journal of Psychiatric and Mental Health Nursing, Vol.16 (June 2008).

Bettelheim, Bruno, The Empty Fortress (New York, 1967).

Davenport, Charles Benedict, Hereditary in Relation to Eugenics (New York, 1911).

Ernst, Waltraud, Mueller, Thomas, Transnational Psychiatries: Social and Cultural Histories of Psychology in Comparative Perspective c.1800-2000 (Newcastle Upon Tyne, 2000).

Fermi, Laura, Illustrious Immigrants: The Intellectual Migration from Europe, 1930-41 (University of Chicago Press, 1968).

Gifford, Sanford, ‘The Psychoanalytic Movement in the United States, 1906-1946’ in John Gach; Edwin Wallace, History of Psychiatry and Medical Psychology (New York, 2008).

Gijswijt-Hofstra, Marijke; Oosterhuis, Harry; Vijselaar, Joost; Freeman, Hugh (Editors), Psychiatric Cultures Compared: Psychiatry and Mental Health Care in the Twentieth Century (Amsterdam University Press, 2005).

Grossman, Ron, ‘Genius or Fraud? Bettelheim’s biographers can’t seem to decide’, Chicago Tribune (23rd January, 1997). Available At: http://articles.chicagotribune.com/1997-01-23/features/9701230196_1_orthogenic-school-bruno-bettelheim-pollak

Hale, Nathan, The Rise and Crisis of Psychoanalysis in the United States (Oxford University Press, 1995).

Hansen, Randall; King, Desmond, ‘Eugenic Ideas, Political Interest, and Policy Variance: Immigration and Sterilization Policy in Britain and the U.S’, World Politics, Vol. 53, No. 2 (January, 2011).

Joseph, Jay, ‘The 1942 euthanasia debate in the American Journal of Psychiatry’, History of Psychiatry, Vol.16, No.2 (April, 2005).

Kanner, Leo, Child Psychiatry (Illinois, 1935).

Kanner, Leo, ‘Exoneration of the Feebleminded’, American Journal of Psychiatry, Vol. 99, Issue 1 (July, 1942). Available At: http://ajp.psychiatryonline.org/doi/pdf/10.1176/ajp.99.1.17

Kennedy, Foster, ‘The Problem of Social Control of the Congenital Defective: Education, Sterilization, Euthanasia’, American Journal of Psychiatry, Vol. 99, Issue 1 (July, 1942). Available At: http://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.99.1.13

Lewis, Bradley, Moving Beyond Prozac, DSM, and the new Psychiatry: The Birth of Postpsychiatry (University of Michigan Press, 2006).

Mukerjee, Siddhartha, The Gene: An Intimate History (London, 2016).

Nicosa, Francis, Huener, Jonathan, Medicine and Medical Ethics in Nazi Germany: Origins, Practices, Legacies (Oxford, 2008).

Roelcke, Volker; Weindling, Paul J.; Westwood, Louise (Editors), International Relations in Psychiatry: Britain, Germany and the United States to World War II (University of Rochester Press, 2010).

Szasz, Thomas, Ideology and Insanity: Essays on the Psychiatric Dehumanization of Man (New York, 1973).

Szasz, Thomas, The Myth of Mental Illness (New York, 1961).

Schaler, Jeffrey (Editor), Szasz Under Fire: The Psychiatric Abolitionist faces his Critics (Illinois, 2004).

Schwartz, Joesph, Cassandra’s Daughter: A History of Psychoanalysis (London, 2003).

Strand, Michael, ‘Where do classifications come from? The DSM-III, the transformation of American psychiatry, and the problem of origins in the sociology of knowledge’, Theory and Society, Vol. 40, No. 3 (May 2011).

Wilkinson, Stephen, ‘On the Distinction between Positive and Negative Eugenics’ in Matti Hayry, Arguments and Analysis in Bioethics (New York, 2010).


References

[1] Waltraud Ernst, Thomas Mueller, Transnational Psychiatries: Social and Cultural Histories of Psychology in Comparative Perspective c.1800-2000 (Newcastle Upon Tyne, 2000), p.8.

[2] Marijke Gijswijt-Hofstra, ‘Comparing National Cultures of Psychiatry’ in Marijke Gijswijt-Hofstra; Harry Oosterhuis; Joost Vijselaar; Hugh Freeman (Editors), Psychiatric Cultures Compared: Psychiatry and Mental Health Care in the Twentieth Century (Amsterdam University Press, 2005), p.17.

[3] Laura Fermi, Illustrious Immigrants: The Intellectual Migration from Europe, 1930-41 (University of Chicago Press, 1968), p.3.

[4] Sanford Gifford, ‘The Psychoanalytic Movement in the United States, 1906-1946’ in John Gach; Edwin Wallace, History of Psychiatry and Medical Psychology (New York, 2008), p.638.

[5] Ibid, p.653.

[6] Michael Strand, ‘Where do classifications come from? The DSM-III, the transformation of American psychiatry, and the problem of origins in the sociology of knowledge’, Theory and Society, Vol. 40, No. 3 (May 2011), p.275.

[7] Edwin Black, War Against the Weak: Eugenics and America’s Campaign to Create a Master Race (New York, 2004), pp.23-24.

[8] Douglas Baynton, Defectives in the Land: Disability and Immigration in the Age of Eugenics (University of Chicago Press, 2016), p.40.

[9] Garland Allen, ‘The Ideology of Elimination: American and German Eugenics, 1900-1945’ in Francis Nicosa, Jonathan Huener, Medicine and Medical Ethics in Nazi Germany: Origins, Practices, Legacies (Oxford, 2008), p.25.

[10] Joesph Schwartz, Cassandra’s Daughter: A History of Psychoanalysis (London, 2003), p.176.

[11] Fermi, Illustrious Immigrants, pp.141-42.

[12] Charles Benedict Davenport, Hereditary in Relation to Eugenics (New York, 1911), p.1.

[13] Randall Hansen; Desmond King, ‘Eugenic Ideas, Political Interest, and Policy Variance: Immigration and Sterilization Policy in Britain and the U.S’, World Politics, Vol. 53, No. 2 (January, 2011), p.237.

[14] Anonymous, Virginia Sterilization Act of 03/20/1924 (Virginia, 1924), p.589. Available At: https://www.dnalc.org/view/11213-Virginia-Sterilization-Act-of-3-20-1924.html (Last Accessed: 27/03/2017).

[15] Hansen; King, Eugenic Ideas, p.240.

[16] Mathew Thomson, ‘Mental Hygiene in Britain’ in Volker Roelcke; Paul J. Weindling; Louise Westwood (Editors), International Relations in Psychiatry: Britain, Germany and the United States to World War II (University of Rochester Press, 2010), p.137.

[17] Stephen Wilkinson, ‘On the Distinction between Positive and Negative Eugenics’ in Matti Hayry, Arguments and Analysis in Bioethics (New York, 2010), pp.115-117.

[18] Siddhartha Mukherjee, The Gene: An Intimate History (London, 2016), pp.82-83.

[19] Nathan Hale, The Rise and Crisis of Psychoanalysis in the United States (Oxford University Press, 1995), p.115.

[20] Leo Kanner, Child Psychiatry (Illinois, 1953), p.6.

[21] Jay Joseph provides an overview of the debate, links to Kennedy and Kanner’s articles are provided below. Jay Joseph, ‘The 1942 euthanasia debate in the American Journal of Psychiatry’, History of Psychiatry, Vol.16, No.2 (April, 2005), pp.171-179.

[22] Foster Kennedy, ‘The Problem of Social Control of the Congenital Defective: Education, Sterilization, Euthanasia’, American Journal of Psychiatry, Vol. 99, Issue 1 (July, 1942), pp.13-14. Available At: http://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.99.1.13 (Last Accessed: 27/03/2017).

[23] Leo Kanner, ‘Exoneration of the Feebleminded’, American Journal of Psychiatry, Vol. 99, Issue 1 (July, 1942), p.19. Available At: http://ajp.psychiatryonline.org/doi/pdf/10.1176/ajp.99.1.17 (Last Accessed: 27/03/2017).

[24] Alison Bashford; Philippa Levine, The Oxford Handbook on the History of Eugenics (Oxford University Press, 2010), p.327.

[25] Joseph, The 1942 Euthanasia Debate, p.178.

[26] Bradley Lewis, Moving Beyond Prozac, DSM, and the new Psychiatry: The Birth of Postpsychiatry (University of Michigan Press, 2006), p.1.

[27] Gerald N. Grob, ‘The Transformation of Mental Health Policy in Twentieth Century America’ in Gijswijt-Hofstra; Oosterhuis; Vijselaar; Freeman, Psychiatric Cultures Compared, p.141.

[28] Ibid.

[29] Ron Grossman, ‘Genius or Fraud? Bettelheim’s biographers can’t seem to decide’, Chicago Tribune (23rd January, 1997), p.2.

http://articles.chicagotribune.com/1997-01-23/features/9701230196_1_orthogenic-school-bruno-bettelheim-pollak

[30] Bruno Bettelheim, The Empty Fortress (New York, 1967), p.6.

[31] Leo Kanner, Child Psychiatry (Illinois, 1935), p.720.

[32] Thomas Szasz, ‘Thomas Szasz: An Autobiographical Sketch’ in Jeffrey Schaler (Editor), Szasz Under Fire: The Psychiatric Abolitionist faces his Critics (Illinois, 2004), p.11.

[33] Thomas Szasz, The Myth of Mental Illness (New York, 1961), pp.4-5.

[34] Thomas Szasz, Ideology and Insanity: Essays on the Psychiatric Dehumanization of Man (New York, 1973), p.113.

[35] P. Buchanan-Parker; P. Barker, ‘The Convenient Myth of Thomas Szasz’, Journal of Psychiatric and Mental Health Nursing, Vol.16 (June, 2008), pp.87-95.

[36] Fermi, Illustrious Immigrants, p.145.

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