Social Psychiatry in Germany in the Twentieth Century: Ideas and Models

Abstract

In the first decades of the twentieth century, German-language papers were published which included the term “soziale Psychiatrie” in their titles. At the same time modern concepts of extramural psychiatric care were being developed. Yet, the meaning of “sozial” (“social” in English) varied widely. This was partly due to its ambiguity. “Social” can be used in the sense of small communities or the wider public; it refers to interpersonal relationships, or to relationships between individuals and social groups or other communities. According to this latter meaning, “social” can emphasize the interests of social groups rather than those of the individual. This is how the term was used at the end of the 1920s and during the National Socialist era. On the other hand, “social” may indicate a friendly and humane intention, a philanthropic approach. It was in this sense that the term was widely used in the 1970s when philanthropic psychiatrists and others called for psychiatric reform and the closure or downsizing of asylums for the mentally ill. Moreover, in association with psychiatry, it can mean both the social dimension of mental illness (including the aetiology) that is assumed to lie in human relationships and in social circumstances, and the social and economic effects of mental illness. In parallel with these shifting meanings of the term “social”, the established models of twentieth-century ambulant psychiatric care also showed a variety of structural characteristics.

“Dictating the Suitable Way of Life”: Mental Hygiene for Children and Workers in Socialist Mexico, 1934–1940

“…In this regard, Edouard Toulouse, who set in motion reforms in psychiatric treatment in France, pointed out that mental hygiene was a new way of referring to actions that in his country had been undertaken since the end of the nineteenth century (Thomson, , p. 288). At the same time, other countries were also taking the same paths: this movement in England was known as “mental welfare,” in France as “mental prophylaxis,” in the Soviet Union as “psychohygiene” (Thomson, , p. 300), and in Germany and the Netherlands as “social psychiatry” (Oosterhuis, ; Schmiedebach & Priebe, ).…”

Mental Health Reform Not Always Beneficial

“…Nevertheless, they served the purpose of re-integrating patients back into their families and communities and offering services on an "out-patient" basis. The impetus probably also came from the ambitions of the relatively new psychiatric profession (psychiatry only became an official medical specialty in Germany in 1901 although the beginnings of professionalization can be traced back to the start of the nineteenth century) hoping to expand its authority and influence beyond the narrow walls of institutions into the larger community (Schmiedebach & Priebe, 2004).…”

“…Other self-employed tradesmen profited as well. Family care saved money and was, at the same time, therapeutic (Beddies & Shmiedebach, 2001;Schmiedebach & Priebe, 2004).…”

Mental Health Care in the Aftermath of Deinstitutionalization: A Retrospective and Prospective View

“…Although interest in the social aspects of mental illness and alternatives to institutional care are as old as psychiatry itself [6,52], it was only in the post-war period when, on the background of a pervasive crisis of the asylum as a social and therapeutic institution, they began to exert a remarkable influence and became a prevailing trend in psychiatric theory and practice. The focus on the social and environmental dimension of mental health stimulated by the lessons of war psychiatry and the then-at least in the USA-dominant position of psychoanalysis converged with the assumption that psychiatric patients should not be confined in the large, undifferentiated and isolated mental hospitals, but had to be actively treated and supported 'in' the community [4,26,30,57]. Coupled with a strong emphasis on prevention and rehabilitation issues and a declared concern for the social integration of the mentally ill, 'community care'-so ambiguous the term might be-was from the mid 1950es on the goal to reach for psychiatry.…”