archives@tulane.edu / 1 / Elena Llinas

Since it was first included in the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980, post-traumatic stress disorder (PTSD) has become a medical and cultural phenomenon. Moreover, it has led to the belief that PTSD is a universal aspect of human experience. Traumatic Formations and Psychiatric Codifications: A Rhetorical History of Post-traumatic Stress Disorder challenges this view by examining the rhetorical processes by which PTSD and its predecessor diagnoses were codified. Using critical techniques taken from rhetorical studies, Science and Technology in Society studies, and historiography, this dissertation examines the social, medical, and institutional formations that created the need for psychological trauma to be codified as an actionable psychiatric diagnosis at four specific historical moments, beginning in Victorian England and culminating with the offical codification of PTSD in 1980. By attending to the rhetorical processes of codifying unique post-traumatic illnesses over the course of 150 years, this dissertation argues that post-traumatic illnesses are better understood as dynamic entities that respond to specific social problems. Furthermore, it finds that the diagnoses themselves must conform to the constraints of their day as determined by the institutions (government, military, or disciplinary) that call upon psychiatric medicine to intervene in social problems. Traumatic Formations presents four historical case studies: railway spine in Victorian England, shell shock in World War I, post-Vietnam syndrome in the 1970s, and PTSD in 1980. After introducing the project in the first chapter, Chapter 2 examines how British legal courts in the late ninteenth century called upon physicians to determine whether train accident survivors were entitled to monetary compensation for their psychological injuries. To make psychological trauma legible to legal courts, British physicians codified railway spine as a psychological effect of a physical injury, thus connecting victims' mental problems to the accidents they survived. Chapter 3 analyzes how the shell shock epidemic in World War I ushered in a shift in theoretical understandings of psychological trauma. When psychiatrists located near the frontlines of combat demonstrated that soldiers did not need to be exposed to exploding munitions to manifest the symptoms associated with shell shock, medical professionals and the British military came to understand shell shock as a psychological problem rather than a physical malady. Chapter 4 examines how a small group of antiwar psychiatrists advocated for military veterans who had trouble readjusting to civilian life after fighting in the Vietnam War. They persuaded the American public, the federal government, and mental health clinicians that the veterans' adjustment problems were the result of a new psychological illness called post-Vietnam syndrome. Chapter 5 analyzes how post-Vietnam syndrome become PTSD. In the process of convincing the APA to include PTSD in the 1980 edition of the DSM, many of the unique features of post-Vietnam syndrome were compromised so that the PTSD diagnosis could be applied to people who were traumatized by events other than war. / Ph. D. / <i>Traumatic Formations and Psychiatric Codifications: A Rhetorical History of PTSD</i> takes a historical case study approach to understanding post-traumatic stress disorder (PTSD) as a medical and cultural phenomenon. Working from the rhetorical tradition, as well as intersecting traditions of historiography, medical and scientific rhetorics, and Science and Technology in Society studies, it investigates how disciplinary medical science intervenes in social problems and codifies them as post-traumatic diagnoses in order to meet the needs of other institutions, like legal courts, the military, and the American Psychiatric Association. This project begins in Victorian England with railway spine, then examines shell shock in World War I, post-Vietnam syndrome in the 1970s, and culminates in a case study of PTSD in 1980. For each case study, I conduct a rhetorical analysis of a large corpus of documents, including archival medical sources, government documents, and cultural texts. By analyzing post-traumatic diagnoses over the course of 150 years, I demonstrate that psychiatric diagnoses are rhetorical repositories of historical social problems and institutional goals.

O objetivo deste estudo foi investigar a criação do Hospital Santa Teresa de Ribeirão Preto, no Estado de São Paulo, na década de 40 do século XX. Partiu-se do pressuposto de que a criação deste Hospital não se deveu apenas ao desafogamento do Hospital de Juqueri em São Paulo, mas muito mais marcantemente por questões político-econômicas e sociais locais. O marco teórico foi a história nova por razões dos problemas, objetos e abordagens possibilitados por essa escrita da história, ou seja, a busca pelos interstícios "por acaso" silenciados na história oficial. Os instrumentos de investigação foram três: 1) consulta aos livros de registro dos pacientes dos primeiros cinco anos de funcionamento do Hospital (1944-1948); 2) consulta aos jornais locais disponíveis no Arquivo Público – Casa da Memória de Ribeirão Preto de 1937 a 1946; 3) entrevistas semi-estruturadas aos sujeitos ou familiares, no caso do óbito dos primeiros, envolvidos no processo de criação do Hospital Santa Teresa. Portanto, o corte histórico visitado foi, no caso dos jornais, os anos de 1937 a 1946, e, com relação ao registro dos pacientes internados naquele Hospital, os anos de 1944 a 1948. No ato da criação do Hospital Santa Teresa de Ribeirão Preto, verificou-se a presença do dado irrefutável do fenômeno de desafogamento de Juqueri, ou seja, o Hospital abriu com pacientes vindos de lá, tendo inclusive esses pacientes grande contribuição na construção/efetivação do Hospital. Mas os resultados, deste estudo, evidenciam que dois aspectos podem ser acrescentados, por um lado a existência de uma demanda reprimida no que tange à assistência psiquiátrica no município de Ribeirão Preto e região, e por outro lado uma premência sócioeconômica e política, ou em outras palavras, a criação de um Hospital de Alienados em Ribeirão Preto em 1944, foi uma questão eminentemente política, empreendimento do interventor federal do Estado Ademar de Barros e dos resquícios do que na República Velha (1889-1930) tinha sido o eminente Partido Republicano Paulista, porta-voz da política agroexportadora predominante no país. / This study aimed at investigating the creation of Ribeirão Preto Santa Teresa Hospital, in São Paulo State, in the decade of 40, century XX. It was presupposed that the creation of this Hospital occurred because of the relief of the Juqueri Hospital in São Paulo but much more remarkably for social, economic and political reasons. The theoretical mark was the new history for reasons of the problems, objects and boardings enabled by this written history, or either, the search for the interstices “by chance" silenced in the official history. There were three instruments of investigation: 1) consultation to the patient register books on first five years of working of the Hospital (1944-1948); 2) consultation to the available local newspaper in the Public Archive – Memory House of Ribeirão Preto from 1937 to 1946; 3) semi-structured interviews to the subjects or relatives, in case of death of the first ones, who were involved in the process of the Santa Teresa Hospital creation. Therefore, the historical cut visited was , in the newspapers case, from 1937 to 1946, and in respect to the register of the interned patients in that Hospital, from 1944 to 1948. In the act of Ribeirão Preto Santa Teresa Hospital creation, the presence of the irrefutable data of the Juqueri relief phenomenon was observed, or either, the Hospital opened with patients from Juqueri, who also brought a great contribution in the construction / effectuation of the Hospital. But the results of this study evidence that two aspects can be added, one of these aspects is the existence of a restrained demand in what refers to the psychiatric assistance in Ribeirão Preto city and region, and the other aspect is a political and socioeconomic pressure, or in other words, the creation of a Hospital of Insane in Ribeirão Preto in 1944 was eminently a politics question, the federal interventor of the Ademar de Barros State and the Old Republican remainders (1889-1930) enterprise, which was the eminent São Paulo Republican Party, spokesman of the agroexporter politics predominant in the country.

O objetivo deste estudo foi investigar a criação do Hospital Santa Teresa de Ribeirão Preto, no Estado de São Paulo, na década de 40 do século XX. Partiu-se do pressuposto de que a criação deste Hospital não se deveu apenas ao desafogamento do Hospital de Juqueri em São Paulo, mas muito mais marcantemente por questões político-econômicas e sociais locais. O marco teórico foi a história nova por razões dos problemas, objetos e abordagens possibilitados por essa escrita da história, ou seja, a busca pelos interstícios "por acaso" silenciados na história oficial. Os instrumentos de investigação foram três: 1) consulta aos livros de registro dos pacientes dos primeiros cinco anos de funcionamento do Hospital (1944-1948); 2) consulta aos jornais locais disponíveis no Arquivo Público – Casa da Memória de Ribeirão Preto de 1937 a 1946; 3) entrevistas semi-estruturadas aos sujeitos ou familiares, no caso do óbito dos primeiros, envolvidos no processo de criação do Hospital Santa Teresa. Portanto, o corte histórico visitado foi, no caso dos jornais, os anos de 1937 a 1946, e, com relação ao registro dos pacientes internados naquele Hospital, os anos de 1944 a 1948. No ato da criação do Hospital Santa Teresa de Ribeirão Preto, verificou-se a presença do dado irrefutável do fenômeno de desafogamento de Juqueri, ou seja, o Hospital abriu com pacientes vindos de lá, tendo inclusive esses pacientes grande contribuição na construção/efetivação do Hospital. Mas os resultados, deste estudo, evidenciam que dois aspectos podem ser acrescentados, por um lado a existência de uma demanda reprimida no que tange à assistência psiquiátrica no município de Ribeirão Preto e região, e por outro lado uma premência sócioeconômica e política, ou em outras palavras, a criação de um Hospital de Alienados em Ribeirão Preto em 1944, foi uma questão eminentemente política, empreendimento do interventor federal do Estado Ademar de Barros e dos resquícios do que na República Velha (1889-1930) tinha sido o eminente Partido Republicano Paulista, porta-voz da política agroexportadora predominante no país. / This study aimed at investigating the creation of Ribeirão Preto Santa Teresa Hospital, in São Paulo State, in the decade of 40, century XX. It was presupposed that the creation of this Hospital occurred because of the relief of the Juqueri Hospital in São Paulo but much more remarkably for social, economic and political reasons. The theoretical mark was the new history for reasons of the problems, objects and boardings enabled by this written history, or either, the search for the interstices “by chance” silenced in the official history. There were three instruments of investigation: 1) consultation to the patient register books on first five years of working of the Hospital (1944-1948); 2) consultation to the available local newspaper in the Public Archive – Memory House of Ribeirão Preto from 1937 to 1946; 3) semi-structured interviews to the subjects or relatives, in case of death of the first ones, who were involved in the process of the Santa Teresa Hospital creation. Therefore, the historical cut visited was , in the newspapers case, from 1937 to 1946, and in respect to the register of the interned patients in that Hospital, from 1944 to 1948. In the act of Ribeirão Preto Santa Teresa Hospital creation, the presence of the irrefutable data of the Juqueri relief phenomenon was observed, or either, the Hospital opened with patients from Juqueri, who also brought a great contribution in the construction / effectuation of the Hospital. But the results of this study evidence that two aspects can be added, one of these aspects is the existence of a restrained demand in what refers to the psychiatric assistance in Ribeirão Preto city and region, and the other aspect is a political and socioeconomic pressure, or in other words, the creation of a Hospital of Insane in Ribeirão Preto in 1944 was eminently a politics question, the federal interventor of the Ademar de Barros State and the Old Republican remainders (1889-1930) enterprise, which was the eminent São Paulo Republican Party, spokesman of the agroexporter politics predominant in the country.

In 1974 Random House published a popular and controversial book entitled Why Your Child is Hyperactive. The author, San Francisco allergist Ben F. Feingold, claimed that hyperactivity was caused by food additives and was best prevented and treated with a diet, subsequently dubbed the 'Feingold diet', free of such substances. Reaction to the idea was swift. The media and parents found Feingold's environmentally-based theory intriguing, as it provided an aetiological explanation for hyperactivity that was both sensible and topical. The medical community, in contrast, was suspicious and designed double-blind trials to test his theory. The dominant perception emerging out of these tests was that Feingold's hypothesis was incorrect and, soon after Feingold's death in 1982, medical and media attention faded away. Drawing on unpublished archival material, medical literature, popular media sources and oral history interviews, this thesis explores the rise and fall of the Feingold diet. It examines the origins of Feingold's idea, the manner in which his theory was disseminated to the medical community and the broader public, and analyses how physicians and patients evaluated whether or not Feingold's hypothesis was correct. Aiming to contribute to the histories of allergy, psychiatry and nutrition, the thesis contends that social factors, rather than scientific testing, were largely responsible for the fate of the Feingold diet. Some of these factors include Feingold's methods and approach to describing and promoting his diet, the professional and economic interests of medical practitioners and the food, chemical and pharmaceutical industries, and the difficulties inherent in following the diet. From a broader historiographical perspective, the history of the Feingold diet suggests that in order to understand how medical controversies are resolved it is essential to analyse the historical context within which they emerge.

Master of Landscape Architecture / Department of Landscape Architecture/Regional and Community Planning / Anne Beamish / Human nature compels us to remember the past. A society’s collective memory creates meaning in our lives, establishing individual and group identity and contextualizing cultural values. Commemorative landscapes give physical form to loss and memory, providing a space for public awareness and remembrance while acting as a sanctuary for dealing with loss. Over time, memorials face a loss of relevance as generations pass and society evolves to embody different shared memories and values. At the same time, our environment directly affects our physical and psychological well-being. Restorative environments benefit the individual by reducing stress. If the well-being of the individual and his or her environment are directly linked, landscape architecture can be utilized to restore mental well-being. A commemorative space combining the characteristics of memorials and restorative environments will act as a “restorative memorial”. Beyond remembering the events, people, or circumstances that establish cultural identity and values, restorative memorials would improve mental well-being, reminding the individual of their cultural identity while reducing psychological stress. Synthesizing literature understanding the importance of memorials, restorative environments, loss, stress, and environmental psychology with experiential observations of memorials and restorative environments generated a set of design guidelines for restorative memorials. These design guidelines were applied to a design commemorating the legacy of the Menninger Clinic in Topeka, Kansas. The Menninger family formed the first group psychiatric practice in the country. They became world-renowned leaders in psychiatric and behavioral health treatments, believing a patient’s physical and social environment was instrumental to improve mental health. In 2003, the Menninger Clinic relocated to Houston, Texas, vacating a campus which played a great role in the history of Topeka, Kansas, and psychiatry. A restorative memorial commemorating the Menninger legacy could reconnect the citizens of Topeka with the history of the former campus and would pay homage to the ideals of the Menningers, using the designed environment to continue improving mental health. Restorative memorials can become landmarks in the urban fabric, providing an engaging built environment, imbued with meaning. They will transcend generational significance, serving the past, present, and future.

The purpose of this thesis is to describe and analyse the institutionalized Swedish Psychiatric practice during the period 1850 and 1970 - the era of the large mental hospitals - in terms of a modem disciplinary project. Point of departure relates to the meeting between the admitted patient and the educational work of the mental hospital and its everyday practice. The main sources of information for this study consists among other things of case sheets and texts closely related to the work of the mental hospitals. The study has two important aspects. The first deals with the normalized procedures in the practice of mental care, and draws the attention to the relation between social and cultural standards and the way the mental hospitals reviews, treats and handles the patient. The second aspect deals with the actual administration and the techniques of the hospital to correct the patient and his/her actions in a desirable direction. An overarching discussion deals with the relation between liberating and Controlling practitioners, and how the Controlling power of the hospital relates to the modem society's conception of a independent man. At the same time as the physical coercion of the mental hospital diminished, controlling methods were required which were not merely based on obedience and Submission, but also on the participation and will of the patient. Informal system of rewards, confession-techniques as well as various forms of a conditionalised and regulated freedom is combined with a more concealed potential of coercion of the institution. The compulsory work is being analysed as the most important educational therapy - both socially and ethically. Work is being described as a liberal Controlling technique. By connecting work to the system of rewards as well as increased physical freedom enables the hospital to exercise control and predictability without resorting to coercion. How the hospital looked upon and handled the sexual body, and how cultural conceptions regarding sexual normality dominated the practical care-taking is being analysed with the starting point in case sheets. The sexual behaviour, especially concerning women, resulted in a meeting of different opinions between restraining and testing practitioners where moral reliability was a condition for physical freedom. The thesis describes a movement over time towards increased physical freedoms for the patients of the mental hospitals. This did not imply that the control or the normalization decreased in intensity. But rather that the forms and the conditions for these processes changed. The freedom that was placed in sight was always connected with the well behaviour of the patient. / digitalisering@umu

During the first half of the 19th century institutions for the treatment of the insane were established throughout Europe and North America. These institutions were generally the result of government initiative and were founded on a belief that existed in the new psychiatric theories of treatment. Psychiatry was, at this time, an embryonic science, in which great conflict existed between different theoretical schools of thought, but in which a remarkable concensus existed regarding methods of treatment. Treatment was based on a view of the nature of man inspired by the philosophy of the Enlightenment, in which up-bringing was considered to be able to affect a person's entire character. In 1823, the Swedish Riksdag voted in favour of the etablishment of treatment hospitals. The background to this decision was the belief that it should be possible to diminish the costs of caring for the poor if mental illness could be treated. However, fears of a general increase in social unrest and philanthropic motives seem also to have been important factors. Sweden's first hospital for the treatment of the insane was established in Vadstena in 1826. Georg Engström (1 795-1 855) became the country's first full-time asylum doctor. Georg Engström was well-read in German, French and English psychiatric literature, but never himself formulated any psychiatric theory, neither did he write any articles of a principiai nature. His psychiatric activities may, however, be followed in his comprehensive medical journals and regular official reports. Engström saw the roots of mental illness in the existence of a surplus, a shortage, or an inbalance in the energy of the psyche. The cause of illness lay in the patients manner of living and, Engström stressed, in the importance of intense feelings and passions. The essence of treatment lay in the patient's being kept occupied and in his manner of living. Most of the recommendations for methods of treatment contained in the literature were tried out, a number of which — for example, being spun in a revolving chair — were quickly abandoned. The development of psychiatry and of the care and treatment of the mentally ill during the first half of the 19th century can be seen as a sign of the fact that science itself was developing and becoming paradigmatic. However, it is also possible the view developments from the perspective of the ideology of treatment and to focus on the way in which the philosophy of treatment and its concomitent optimism spread and reformed the old asylum system. Finally, it is also possible to observe developments from a pedagogical perspective, stressing the state's desire for control and order in a situation in which there were fears of an increasing social unrest. / <p>Behandlar huvudsakligen Georg Engström och förhållandena vid Vadstena hospital</p> / digitalisering@umu

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O período de reestruturação e reordenação da cidade do Rio de Janeiro ao princípio da história republicana do Brasil, que culmina na chamada Belle Époque Carioca, é analisado aqui sob a ótica higienista. Neste sentido, a política assume uma postura de adequação do cotidiano embasada na medicina social e na intervenção sobre os costumes considerados indevidos, degenerantes. Um campo de conhecimento importante neste processo de adequação e imposição de uma nova ordem é a psiquiatria. Renovada pelas proposições de Juliano Moreira, a ciência seria responsável pela conceituação de novos padrões de anormalidade, as chamadas personalidades psicopáticas, e pelo afastamento destes perturbadores da ordem em relação ao convívio com a sociedade. / The period of restructuring and reordering of the city of Rio de Janeiro at the beginning of Brazils republican history, which culminates at the so called Belle Époque Carioca, is analyzed here under the perspective of the hygienism. In that way, politics assumes a posture of adequacy of the everyday based on social medicine and on intervention over the manners considered improper, degenerating. An important field of knowledge in this process of adequacy and imposition of a new order is psychiatry. Renewed by the propositions of Juliano Moreira, that science would be responsible by the conceptualization of new standards of abnormality, the so called psychopathic personalities, and by the withdrawal of these disturbers of the order in relation to the interaction with society.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Este trabalho tem como objetivo analisar a estruturação do diagnóstico de Transtorno de Personalidade. Inicialmente, o trabalho percorre o território conceitual com o qual, desde sua origem na passagem do século XVIII para o XIX, a psiquiatria procurou nomear, explicar e compreender as personalidades consideradas anormais. Em seguida promove-se uma discussão acerca das concepções de personalidade, normalidade e patologia que circunscrevem a categoria, orientada a partir do estudo de seus diferentes modelos diagnósticos presentes no DSM-5. Por fim busca-se compreender a relevância atual do diagnóstico de transtorno de personalidade através da análise de alguns exemplos de seu uso em contextos médico, legal e literário. O objetivo é o de entrever o lugar ocupado por esse diagnóstico, especialmente o do tipo Antissocial, no imaginário cultural presente. / This work analyzes the processes through which the diagnosis of personality disorder has been structured. First, it covers the conceptual territory through which, from its origin in the passage of the eighteenth century to the nineteenth, psychiatry sought to name, to explain and to understand the so called abnormal personalities. This first step is followed by comments on the concepts of personality, normality and pathology that take part in the construction of this psychiatric category as it exists today. In order to do this, the structure of different diagnostic models present in the DSM-5 is analyzed. Finally, we seek to understand the current relevance of the diagnosis of personality disorder by taking into consideration examples of its use in medical, legal and literary contexts, in order to shed some light over the place occupied by this diagnosis, especially the anti-social type, in todays cultural landscape.