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MENTAL HEALTH IN HISTORICAL PERSPECTIVE
Hungarian Psychiatry,
Society and Politics
in the Long
Nineteenth Century
Emese Lafferton
Mental Health in Historical Perspective
Series Editors
Catharine Coleborne, School of Humanities and Social Science,
University of Newcastle, Callaghan, NSW, Australia
Matthew Smith, Centre for the Social History of Health and Healthcare,
University of Strathclyde, Glasgow, UK
Covering all historical periods and geographical contexts, the series
explores how mental illness has been understood, experienced, diagnosed,
treated and contested. It will publish works that engage actively with
contemporary debates related to mental health and, as such, will be
of interest not only to historians, but also mental health professionals,
patients and policy makers. With its focus on mental health, rather than
just psychiatry, the series will endeavour to provide more patient-centred
histories. Although this has long been an aim of health historians, it has
not been realised, and this series aims to change that.
The scope of the series is kept as broad as possible to attract good
quality proposals about all aspects of the history of mental health from
all periods. The series emphasises interdisciplinary approaches to the field
of study, and encourages short titles, longer works, collections, and titles
which stretch the boundaries of academic publishing in new ways.
Hungarian Psychiatry,
Society and Politics
in the Long
Nineteenth Century
Emese Lafferton
Department of History
Central European University
Vienna, Austria
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer
Nature Switzerland AG 2022
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To Lili and Beni, the centres of my universe, without whom this book would
have appeared a decade earlier.
To my Mother and Father, with the deepest gratitude.
Acknowledgements
vii
viii ACKNOWLEDGEMENTS
Katalin Kapronczay and László András Magyar for their warm and helpful
attitude and great knowledge they were willing to share.
I am grateful to my current colleagues at the Central European
University for a wonderful environment to work in, but especially Nadia
Al-Bagdadi, Matthias Riedl, László Kontler, Gábor Klaniczay and Balázs
Trencsényi, who trusted and supported me at crucial moments in my
career. I owe many thanks to Ádám Mézes who helped with the notes,
text, images and bibliography of the manuscript with his soothing calm-
ness and offered company at the lonely and tiresome last phase of clearing
it.
I feel fortunate to have a wonderful group of friends who have
provided unceasing support, inspiration and camaraderie over decades by
now. Ágnes Csonka, Sarah Dry, Tatjana Buklijas and Gayle Davis have
remained great friends and comrades as well as examples of successful
female scholars or intellectuals with families and children. I am indebted
to Simon Schaffer for his inspiration, encouragement and help over many
years. As people who know him can tell, history and research are much
more fun if one can share it with him. Finally, I am deeply grateful to
Viktor Karády, the most generous person I know both as a scholar and as
a friend, for his time, helpfulness, wisdom and invaluable pieces of advice
on both text and life. It is beyond my capacity to ever return his help.
At last, I wish to thank my family, my brother Zsolt Lafferton and
my sister-in-law, Barbara Ottó for their support and patience. I dedicate
this book to my two young children, Lili and Beni, who had to suffer an
often-stressful mother over the past months but who will hopefully one
day appreciate this work. And to my parents, who raised me in the most
caring and safe environment and who let me go far, freely, to find my own
path, never stopping supporting me. I am grateful for their love.
Two articles and a book chapter were formerly published from this
project. For shorter versions of Chapters 7 and 8, see: “What the Files
Reveal. The Social Make-Up of Public Mental Asylums in Hungary,
1860s–1910s,” in ‘Moderne’ Anstaltspsychiatrie im 19. und 20. Jahrhun-
dert - Legitimation und Kritik (Medizin, Gesellschaft und Geschichte—
Beiheft 26). Ed. by Heiner Fangerau and Karen Nolte, 83–103. Stuttgart:
Franz Steiner Verlag, 2006, and “The Hygiene of Everyday Life and
the Politics of Turn-of-the-Century Psychiatric Expertise in Hungary” in:
Psychology and Politics: Intersections of Science and Ideology in the History
x ACKNOWLEDGEMENTS
1 Introduction 1
2 Histories of Psychiatry and the Hungarian Model 19
The Self-Image of Late-Nineteenth-Century Psychiatry 19
Histories of European Psychiatry 23
The World Without Psychiatry 23
Therapeutic Asylums and Moral Treatment 28
Academic Research and Biological Psychiatry 33
The Hungarian Model 35
Care for the Insane in Hungary from the Late-Eighteenth
to the Middle of the Nineteenth Century 37
Medical Teaching and Professional Forums 47
Boom in Psychiatric and Medical Institutions
(1860s–1920) 58
Modern Scientific Research and Professionalisation
(1870s–1920) 67
3 The Bourgeois Family World of the Private Asylum:
The Schwartzer Enterprise from 1850 101
The Schwartzer Dynasty 102
The Private Asylum 104
Pólya’s Asylum 104
Schwartzer’s Asylum 105
xi
xii CONTENTS
Bibliography 385
Index 423
List of Figures
xv
List of Tables
xvii
xviii LIST OF TABLES
Introduction
The beginning of the breakdown of our old political world, among other
things also of the Globus Hungaricus, is deeply injuring our narcissism. It
is a good thing that one has a Jewish and a psychoanalytic ego along with
the Hungarian, which remain untouched by these events.
(Sándor Ferenczi to Sigmund Freud, 4 October 1918)
of modern lifestyle and the exhaustion of one’s vital powers, written for
an audience much broader than the medical profession. They also gave
popular science talks and participated in popular movements concerning
public health issues, such as eugenics or the temperance movement.
Parallel to this development, psychiatry also gradually invaded the private
sphere of healthy people by constructing what a healthy mental, phys-
ical, spiritual and sexual life consists of, laying emphasis on prophylaxis.
As a result, psychiatry attained a cultural monopoly over the “hygiene
of everyday life” as well as the factors contributing to the “health” of
society by the first decades of the twentieth century. This shift in the
role of psychiatry is discussed in the rich cultural and social context of
fin-de-siècle Budapest and the Austro-Hungarian Dual Monarchy.
Therefore, beyond contributing to psychiatric history by exploring
complex longue durée developments in a hitherto unstudied region, this
book connects and enriches other areas of study as well. These include the
cultural and social studies of fin-de-siècle modernity in Central Europe
and the wider scholarship on the Austro-Hungarian Empire (Habsburg
studies). Studying turn-of-the-century Hungarian psychiatry in the wider
social, cultural, scientific and political context of the Austro-Hungarian
Dual Monarchy invites an alternative to the genealogy of Central Euro-
pean modernism offered by Carl Schorske in his influential Fin-de-Siècle
Vienna: Politics and Culture.3 Schorske’s discussion of psychoanalysis in
the context of Viennese art, literature and culture at the time of the crit-
ical reformulations and subversive transformations of Austrian traditions
explained the fin-de-siècle preoccupation with the psyche and the bour-
geois cultivation of the self. The concentration on the psychological and
the aesthetic was the result of the intelligentsia’s move away from politics
marked by a decline of Austrian liberalism and rationalism and the rise
of right-wing ideologies. Viennese modernism thus meant a retreat from
the political, into the psychological realm, decadence and introspection.
This provided the context for psychoanalysis to develop and become the
theoretical or conceptual basis of modernism. Schorske used the image of
the “garden” for this Vienna, both as a real blossoming garden of the city
space and as the metaphorical garden of the psyche, both of which needed
cultivation and provided shelter or refuge from the disturbing public and
outer forces.
In his book The Garden and the Workshop,4 Péter Hanák already argued
for a need to extend this limited focus on Vienna to other cities of the
Dual Monarchy when discussing Central European modernism, above all
4 E. LAFFERTON
∗ ∗ ∗
impenetrability of mental processes, but also in the hard facts of the high
mortality and dismissal rate of “uncured” patients from lunatic asylums, or
in the not negligible condition that psychiatry was still largely marginal in
both the medical and social spheres in the nineteenth century compared
to the social status and influence it gradually acquired by the early decades
of the twentieth century. The book thus reconstructs the early history of
Hungarian psychiatry fraught with tensions over progress and therapeutic
failure, over great institutional designs and financial constraints, and over
the claimed mission and actual force of the psychiatric profession.
The main, traditional hub of current Hungarian medical history7 is the
Hungarian Society of Medical History 8 located at theSemmelweis Museum,
Library and Archive 9 in Budapest. Their main publication outlet is the
journal Orvostörténeti Közlemények [Communicationes de Historia Artis
Medicinae]. The major strength of the journal is the publication of
historical data and primary sources: places, dates, names and documents
related to the biographies of famous as well as lesser-known medical prac-
titioners, teachers and researchers and to medical institutions, such as
hospitals, university faculties and learned societies. Needless to say, these
contributions are extremely useful for further research. In general, the
studies of the journal are overwhelmingly descriptive and less oriented
towards analysis and methodological considerations. Critical reflections
on the challenges that have emerged in the social sciences as well as in
science studies since the 1970s are especially lacking. Analyses situating
the history of medicine within social and economic history, investigating
the history of the body or the construction of medical knowledge feature
much less prominently as compared to approaches of a longer-standing
tradition, such as more narrowly focused “biographies” of “great heroes,”
institutions and modern disciplines.
Apart from a few influential historians of an older generation, many
of the practitioners of this more traditional style of medical history
are archivists or come from a medical background. Promisingly, a new,
younger generation of scholars is now also emerging who are able to
combine primary source-based research with a more self-reflective and
critical approach. They are not numerous and are institutionally scattered,
working at different university departments, for instance, the Depart-
ment of Philosophy and History of Science at the Budapest University
of Technology and Economics or the departments of history at Central
European University (recently moved to Vienna, but still with sizable
cohort of Hungarian students) and the ELTE University. Nevertheless,
1 INTRODUCTION 7
∗ ∗ ∗
medicine and church relief, home cures and unorthodox healers. It exam-
ines attempts by the churches to monopolise care for the insane, early
forms of state custodial care and the patterns of private provision for “the
mad.” It then summarises the chief tendencies in psychiatric institution-
alisation and knowledge production in the second part of the nineteenth
century that form a framework for the specific institutions, psychiatrists
and practices discussed in detail in the following chapters of the book.
These main trends are placed in the context of various models of Euro-
pean psychiatric history offered by an abundant scholarship in the past
decades.
Crucially, the Hungarian model of psychiatric institutionalisation
suggests idiosyncratic features concerning timing, periodisation and
magnitude. Custodialism (the provision of custodial, rather than
medical/therapeutic care in different institutions) marking the prehistory
of psychiatry appeared on a small scale in Hungary until the middle of the
nineteenth century, while the early custodial lunatic asylum phase char-
acteristic in Western countries is clearly non-existent in the Hungarian
Kingdom. The first viable mad house appeared at a time when the reform
of the custodial asylum was largely over and the therapeutic asylum already
had an almost one-half century history in Italy, France, England and some
German states. This is not simply a delay, but rather a complete lack of a
phase compared to general European trends of psychiatric institutionalisa-
tion. Despite initiatives by the centralised state, concerning the quality of
care in a country with few healing institutions and little access to physi-
cians, care for the insane was primarily the responsibility of the family
and the local village or parish community until the middle of the nine-
teenth century (and even beyond). In addition, sources suggest that in
Hungary, unlike in other national contexts, one cannot speak about a
monopolisation of the care for the insane by the church either, and the
private provision for the insane in mental institutions also did not become
a significant pattern until 1900 and beyond.
In the following three chapters, I study distinct types of institu-
tions: the small private madhouse, the large public asylum and the
university psychiatric clinic, together with their operational and thera-
peutic/research practices and underlying ideological discourse. I show
how these separate institutions embodied distinct forms of life and cogni-
tive universes. Marked by different conceptions of space and time, healing
10 E. LAFFERTON
and other practices, and views of the psychiatrist’s function, these institu-
tions framed different perceptions of mental illness and reflected different
ideas of doctor-patient relationship.
Chapter 3, The Bourgeois Family World of the Private Asylum. The
Schwartzer Enterprise from 1850 explores the intellectual climate of early
Hungarian psychiatry and the everyday world of Ferencz Schwartzer’s
private lunatic asylum. Initiated at the time of political repression
following the Hungarian war of independence in 1849, Schwartzer’s
private psychiatric enterprise is placed in the context of the therapeutic
asylum and moral treatment. His comprehensive theory of mental illness
(presented in the first Hungarian book of its kind) demonstrates an expert
knowledge informed by different medical, neurological and psychological
traditions, including a form of humoral pathology embraced at the time
in both Viennese and Pest16 medical circles, elements of Enlightenment
dynamic-vitalism and neurology and of Romantic psychiatry. With an
idiosyncratic combination of these traditions, Schwartzer came up with a
remarkably holistic view of the human being complemented with a refined
psychology and managed to conciliate the oppositions between organicist
and psychic approaches as well as to claim special expertise within the
medical community for the alienist trained in mental pathology.
Everyday asylum life and the institute’s operational machinery are
recaptured through arresting case studies of patients. The whole idea of
the asylum as a therapeutic tool, together with moral (psychic) and phys-
ical treatment, was aimed at the systematic re-education and reorientation
of the individual back to his or her family and society at large. Framed as
a family, the madhouse community mirrored the family hierarchy so cher-
ished by bourgeois society. The doctor posed as a patriarchal figure while
the patient was seen as a child into whose life the doctor (re)introduced
order and discipline. Mental illness was understood as a childlike state, and
the doctor’s art consisted of a masterful control over the deluded childish
psyche and the manipulation of fear. With most subsequent professionals
trained by his textbook and in his private asylum, Schwartzer’s influence
cannot be underestimated at the birth of Hungarian psychiatry.
Chapter 4 entitled The Kingdom in Miniature. Public Asylums from the
1860s reconstructs the life and everyday practices and treatment in public
asylums and discusses their legal, financial and managerial arrangements.
Opened just a year after the 1867 Compromise between Hungary and
Austria, the establishment of Lipótmező Royal National Lunatic Asylum
in Buda was strongly connected to the recent constitutional triumph of
1 INTRODUCTION 11
divergent theories on war neurosis and therapies and how this involve-
ment with war neurosis helped psychiatry to further its social function
through healing but also providing expert knowledge in areas of national
concern: curing troubled soldiers and returning them to the battlefield as
well as deciding who was a malingerer, a pension-seeker, etc. Shell-shock
also allows us to discuss Sándor Ferenczi’s contribution to the matter
and emphasise the short-lived, triumphant period of psychoanalysis with
a centre in Budapest in 1918–1919.
The final, concluding chapter summarises the complex developments in
Hungarian psychiatry from the private asylum to a heterogeneous insti-
tutional landscape and from healing the mind of the insane to healing
the ills of society. It recapitulates how—after the appearance of the first
lunatic asylums and the clarification of the first concerns (treating mental
patients isolated in asylums with professional care)—psychiatry went
through growth and fragmentation that brought about multiple institu-
tional forms, alternative therapeutic choices and psychiatric practices, and
manifold professional roles in society. This multiplication and fragmen-
tation, the crystallisation of distinct approaches and interests within the
expanding professional community, went hand in hand with a growing
sense of cohesion of the psychiatric profession at large. It resulted in the
extension of psychiatric expertise to social areas and the appropriation
of cultural monopoly over a number of issues related to the hygiene of
everyday life as well as a “healthy” society.
Notes
1. See Ernest Gellner, Language and Solitude: Wittgenstein, Mali-
nowski, and the Habsburg Dilemma (Cambridge: Cambridge
University Press, 1998).
2. From the Compromise in 1867 till its dissolution in 1918, the
Austro-Hungarian Monarchy (or Dual Monarchy) comprised both
Austria and the Hungarian Kingdom as two parts of the dualist
state. It is also often referred to as the Habsburg Monarchy or the
Habsburg Empire.
3. Carl E. Schorske, Fin-de-Siècle Vienna: Politics and Culture
(Vintage Books, 1979).
4. Péter Hanák, The Garden and the Workshop (Princeton University
Press, 1998).
16 E. LAFFERTON
The Self-Image
of Late-Nineteenth-Century Psychiatry
Born at the end of the last century, psychiatry slowly gained strength and
cast the different philosophical and ethicoreligious doctrines out; organised
itself on the firm foundations of the natural sciences, and showed a new
direction in therapeutics which began in the 1830s with the elimination
of the coercive tools and resulted in a number of new, monumental insti-
tutions furnished comfortably and with all the scientific equipments which
brought about the unforeseen development of psychiatry.1
Hungarian crown (as if “it were the seat of the country’s highest polit-
ical authority”12 ). The national lunatic asylum itself became a national
symbol.
The only thing that many could consider a flaw, according to Oláh,
was the German name of the institution’s first director, Emil Schnirch,
who was “nonetheless of Hungarian origin and feeling.” Oláh’s anecdotal
story of Schnirch’s first visit to Béla Wenckheim, the Minister of Inte-
rior, is telling about the national sentiment and meaning attached to the
asylum. When Schnirch introduced himself, Wenckheim allegedly replied
that such a German-sounding name was not so fortunate at the head of
the country’s greatest institution and advised Schnirch to “magyarize” it.
Schnirch’s bold and self-conscious response was that “In this question, I
will regard your Excellency as an example to be followed!”,13 which Oláh
explained with Schnirch’s intoxication with his new prestigious position.
Mental health care became the “measure of a country’s state of civil-
isation”: “the more developed a country’s culture was,” “the more
numerous are the arrangements with which state and society together
attempt to take care of its mental patients.” In this respect, as Epstein
proudly concludes, “our nation has not only displayed a sense for culture,
but also gave proof of its ability to develop culture from its own
resources.”14
This enthusiastic and rather optimistic picture of the emergence of
Hungarian psychiatry, of course, tells more about how psychiatrists saw
themselves than about anything else. Their claims are, however, perti-
nent to the story of the emergence of psychiatry, as they reflect a proud
nationalist concern connecting the development of psychiatry with the
formation and modernisation of the nation state. At the same time, they
also testify to the historical process during which early practitioners had
to compete with myriads of traditions and self-appointed specialists in
interpreting and treating madness. Bodies of knowledge, roles and prac-
tices had to be appropriated by an emerging group of professionals from
philosophers who speculated about the relationship of the mind, the
soul and the body, from the general medical community that produced
rival frameworks for explaining madness, from clergymen who tradition-
ally administered to matters of the soul, and from individuals of various
standing, eager to alleviate the sufferings of the insane with alternative
practices (“quacks,” wise women, holy men, herbalists, etc.). All of these
were crucial in the formation of a profession that could eventually claim
2 HISTORIES OF PSYCHIATRY AND THE HUNGARIAN MODEL 23
expertise and exclusive right to interpreting and tending to the mind and
the psyche.
In order to reach a more realistic and historically reliable narrative
about the emergence of Hungarian psychiatry than the one offered in
the self-image of psychiatrists in the period, this chapter draws the map
of various historical contexts for the process. First, I briefly outline some
main trends in the prehistory and early phase of psychiatry in different
European countries based on the scholarship produced in the field of
psychiatric history during the last decades. Then an outline of Hungarian
psychiatric history is presented with reference to the main institutions,
psychiatrists and practices that will be more amply discussed in the rest
of the book. In the present chapter, I lay more emphasis on a number of
closely related issues that are not dwelt upon later in the book but might
be useful as a background for the reader uninitiated in Hungarian medical
history (such as the organisation of public health care, the availability of
healing institutions, the development of medical teaching, to name a few).
built in the outskirts of Vienna in 1819 was, according to Erna Lesky, the
first private hospital specialising in the insane in Austria.45
We can conclude that early custodial institutionalisation neither
reached great magnitude, nor was characterised by therapeutic intent.
These institutions neither helped to mark the dividing line between the
mentally ill and other poor inmates, nor used practices that would later
be introduced in psychiatric institutions.
Orders were issued that the landing of troops from the warships
which had appeared off Kinchou should be stoutly resisted.
On the 7th of the Moon His Majesty sacrificed at the Temple of
Confucius, but on the next morning he was afraid to come into the
city from the Summer Palace, although he wished to sacrifice to the
tutelary deities and inform them of his intended departure. Early on
the following day Prince Kung was appointed Plenipotentiary in the
place of Prince Yi (Tsai Yüan) and the Emperor, despite the brave
wording of his Decree, fled from the capital, after making obeisance
to the God of War in a small temple of the Palace grounds. In the
Decree announcing his departure, the flight was described as an
“autumn tour of inspection.”[3]
The Court started in utter confusion, but proceeded only some
eighteen miles on the road northwards from Peking, stopping for the
first night in a small temple. Here a Decree was issued calling upon
all the Manchurian troops to hasten to Jehol for the protection of the
Court. On the evening of the following day a Memorial was received
from Prince Kung, reporting on the latest doings of the barbarians,
but His Majesty ordered him, in reply, to take whatever steps he
might think fit to deal with the situation. It was out of the question,
said the Rescript, for the Emperor to decide on any course of action
at a distance: in other words, the Throne divested itself of further
responsibility.
On the 11th, the Court lay at the Imperial hunting lodge north of
Mi-Yun hsien. The Chinese chronicler records that the Emperor was
too sick to receive the Grand Council, and delegated his duties to
Yehonala, who thereupon issued the following Decree:—
At the Court’s halting place at Pa-Ko shih, close to the Great Wall,
a Memorial came in from Prince Seng Ko Lin Ch’in, stating that small
scouting parties of the barbarian troops had been seen in the
neighbourhood of Peking, but that as yet there had been no general
bombardment. A Rescript was issued as follows:—