'The poetry of psychiatry': existential analysis and the politics of psychopathology in Franco's Spain

This article examines the presence and influence of the work of Swiss psychiatrist Ludwig Binswanger and existential analysis (Daseinsanalyse) in Spanish psychiatry in the central decades of the 20th century. First, and drawing on various printed and archival sources, it reconstructs the important personal and professional ties that Binswanger maintained with numerous Spanish colleagues and describes the notable dissemination of his work in Spain through bibliographical reviews, scientific events, academic reports, university lectures and translations. Next, it reviews the incorporation of the postulates of existential analysis into the discourse of Spanish psychiatrists and assesses their most elaborate and original contributions to the foundations of 'anthropological-existential' psychiatry or the 'existential-analytical' interpretation of certain disorders or clinical conditions. And, finally, it tries to clarify the assessment according to which the (inevitable) instrumentalisation of existential analysis in the context of Franco's Spain first compromised the critical recognition of its true possibilities (and limits) and later contributed to the discrediting of psychopathological research among Spanish psychiatrists.

From mental hygiene to mental health: ideology, discourses and practices in Franco's Spain (1939-75)

Based on an analysis of the discourses, the ideological appropriation and the practical influence of mental hygiene in Spanish psychiatry during the early years of the Francoist regime, this article examines its decline and subsequent replacement by the new concept of mental health promoted by the World Health Organization and other international bodies from the mid-twentieth century. The old approach, essentially focused on the prophylaxis of insanity within the framework of a set of interventionist policies of social defence, was thus transformed from the beginning of the 1960s into a much more ambitious and comprehensive project which sought to promote the psychosocial balance and performance of individuals in the context of increasingly socialized health-related discourses and networks of care.

Travel and professional networks in the origins of Spanish psychiatry

This article examines the importance of travel and professional networks in the origins of Spanish psychiatry. After reviewing the early alienists' Enlightenment predecessors and their therapeutic and professional trajectories, it describes the trips to foreign psychiatric institutions made during the second third of the nineteenth century by a group of exiled Spanish doctors, commissioners and pioneers. Later, as they became more socially, institutionally and professionally established, some figures of Spanish psychological medicine cultivated their connections and international profile by organizing or attending conferences and other scientific events. This case illustrates the important role of international relations and scientific and professional networks in the spread of psychiatric discourses and practices.

[The clinics of subjectivity]

This article reviews the project of capturing, describing and cataloging subjective experiences as the constitutive and founding event of psychiatric knowledge. To substantiate this view, it provides first a look at the origins (and problems) of psychiatric semiology in the pioneering work of Philippe Pinel. Afterwards, it describes some of the resources used by his successors in order to gain access to the madman's inner world, expose the folds of his intimacy and enhance the scope of the psychopathological gaze and the semiological repertoire of psychological medicine. And finally it discusses the contraposition between the practice of the gaze and the practice of listening carried out by psychiatrists as a significant correlate of an epistemic culture obsessed with gaze, but whose very eagerness to take the human being as an object of inquiry in its double physical and moral condition doomed it to cultivate listening.

Identidades inestables: el síndrome borderline y la condición postmoderna

Partiendo de un análisis de las profundas transformaciones sociales y culturales que justifican lo que se describe como la nueva subjetividad expresiva propia de la modernidad tardía, el presente ensayo trata de mostrar su afinidad constitutiva con la patología de la identidad que numerosos autores consideran central no solo en el síndrome borderline o narcisista, sino también en buena parte de los trastornos mentales más frecuentes y representativos de nuestro tiempo.

[Suicide and cultural criticism in 19th century Spanish medicine]

This paper explores the major role of suicide in the cultural criticism deployed by 19th century Spanish doctors by analysing the most important theoretical models that inspired their contributions to its aetiology. In the first half of the century, the most commonly debated causal factor was the passions, which were thought to stand in a permanent tension with a free, reflexive and conscious self, in accordance with the spiritualist doctrine that was then dominant. In the context of a growing somatisation of moral and intellectual phenomena, the notion of suicide as an act of free will was later modified, and it became considered the consequence of certain organic disturbances. However, this process did not alter the central role of suicidal behaviour within 19th-century cultural criticism, because the advent of degeneration theory meant that doctors finally had a doctrine that allowed them to combine biological determinism with the extended perception of a moral and social crisis threatening the stability and achievements of bourgeois society.

Alexandre Brierre de Boismont and the origins of the Spanish psychiatric profession

This article examines the influence of the French alienist Alexandre Brierre de Boismont in the first development of the Spanish psychiatric profession during the third quarter of the 19th century. As an outstanding figure of French psychological medicine, Brierre enjoyed great scientific prestige among Spanish doctors, but he also took an active part in promoting and legitimizing the cause of alienism in Spain. For instance, he was involved in projects for the reform or creation of new mental hospitals, supported the admission of some Spanish colleagues into the Société Médico-Psychologique and made a decisive contribution to the social recognition of the professional and medico-legal expertise of alienists in Spain. His case is thus an excellent example of the important role played by international relations and the scientific and professional networks of European alienism in spreading the discourses and practices of the emerging psychological medicine.

Mental health care and the politics of inclusion: a social systems account of psychiatric deinstitutionalization

This paper provides an interpretation, based on the social systems theory of German sociologist Niklas Luhmann, of the recent paradigmatic shift of mental health care from an asylum-based model to a community-oriented network of services. The observed shift is described as the development of psychiatry as a function system of modern society and whose operative goal has moved from the medical and social management of a lower and marginalized group to the specialized medical and psychological care of the whole population. From this theoretical viewpoint, the wider deployment of the modern social order as a functionally differentiated system may be considered to be a consistent driving force for this process; it has made asylum psychiatry overly incompatible with prevailing social values (particularly with the normative and regulative principle of inclusion of all individuals in the different functional spheres of society and with the common patterns of participation in modern function systems) and has, in turn, required the availability of psychiatric care for a growing number of individuals. After presenting this account, some major challenges for the future of mental health care provision, such as the overburdening of services or the overt exclusion of a significant group of potential users, are identified and briefly discussed.

[The politics of the self: psychological science and bourgeois subjectivity in 19th century Spain.]

This paper offers an analysis of the process of institutionalization of psychological knowledge in Spain following the educative reforms implemented during the second third of the 19th century, which prescribed its inclusion in the curricular program of the new secondary education. After a detailed examination of the theoretical orientation, the ideological assumptions and the socio-political connections of the contents transmitted to the students throughout the century, its militant spiritualism is interpreted as a highly significant attempt on the part of the liberal elites to articulate a pedagogy of subjectivity intended to counteract the trends toward reduction, naturalization and fragmentation of psychic life inherent to the development of modern science.

Theoretical accounts on deinstitutionalization and the reform of mental health services: a critical review

This article offers a comprehensive critical review of the most popular theoretical accounts on the recent processes of deinstitutionalization and reform of mental health services and their possible underlying factors, focusing in the sharp contrast between the straightforward ideas and models maintained by mainstream psychiatry and the different interpretations delivered by authors coming from the social sciences or applying conceptual tools stemming from diverse social theories. Since all these appraisals tend to illuminate only some aspects of the process while obscuring others, or do not fit at all with some important points of the actual changes, it is concluded that the quest for an adequate explanation is far from having been completed. Finally, some methodological and conceptual strategies for a renewed theoretical understanding of these significant transformations are also briefly discussed, including a comprehensive empirical evaluation of the facts, the consideration of the shifting social values and needs involved in mental health care provision and the historical analysis of deinstitutionalization policies within the framework of the broader social and cultural trends of the decades following World War II.