Keywords: coprolalia, feral child, J. M. G. Itard, movement disorder, National tic, Tourette Syndrome

Itard's 1825 paper, written while he was Chief Physician at the National Institute for Deaf-Mutes in Paris, demonstrates his empiricist approach to medicine. That is, Itard founded his medical practice on sense and experience rather than on surgery and medication. If all knowledge came through the senses, Itard reasoned, those lacking knowledge or social abilities could be improved by appropriate sensory stimulation. This concern with senses and society, along with his different approaches to men and women, his references to contemporary cures and his comparisons between humans and animals, document early nineteenth-century medical and psychological attitudes and t r e a t m e n t s. Itard's paper also contains what was later recognized as the first clinical observation of Gilles de la Tourette Syndrome (TS).

Introduction and biography

Jean-Marc Gaspard Itard (1775Itard ( -1838) ) is perhaps best known as the physician who attempted to civilize 'the wild child of Aveyron'. Those efforts, interesting in and of themselves, belong to and typify a more productive life, one dedicated to the improvement of the mental and physical health of his fellow humans, particularly those less well-endowed intellectually or physically. In this, his work also typifies a moment in Western culture when the desire to understand human nature becomes the object of the new scientific method. Itard's 1825 paper, translated here for the first time, not only represents an Enlightenment perspective on medical practices but also contains what was later recognized as the first clinical observation of Gilles de la Tourette Syndrome (TS).

Born on 24 April 1775 in Oraison in the Basses-Alpes, Itard was educated to be a banker, but, by chance, became a physician. To avoid conscription d u r i n g the French Revolution, he sought work at a military hospital in Toulon and was assigned as an assistant surgeon. With this training and some apparent talent, Itard was awarded a surgical internship in a Parisian hospital in 1796. In 1800, again by chance, he became Chief Physician at the newly founded National Institute for Deaf-Mutes in Paris, a position he held for the rest of his career [START_REF] Lane | The Wild Boy of Aveyron[END_REF][START_REF] Malson | Wolf Children and the Problem of Human Nature[END_REF].

Early in his tenure at the National Institute (and eager to impress), Itard took on the task of teaching Victor, an apparently feral child, captured in 1798 in a remote part of southern France. We will never know with certainty if the boy was retarded, autistic, or delayed in some other way, nor how he came to live in the woods. More certain, however, is that Victor was aged 11-13 at the time of his capture, that he had been a local scavenger for several years in Aveyron, and that he completely lacked the trappings of any social experiences.

Victor's haunting story has been discussed extensively in word and image, based largely on Itard's two reports (Itard, 1801(Itard, , 1801[START_REF] Itard | The Wild Boy of Aveyron[END_REF][START_REF] Itard | à s.e. le Ministre de l'Interieur sur nouvaux developpements et l'état actuel du sauvage de l'Aveyron[END_REF][START_REF] Lane | The Wild Boy of Aveyron[END_REF][START_REF] Malson | Wolf Children and the Problem of Human Nature[END_REF]Shattuck, 1980Shattuck, /1994;;[START_REF] Truffaut | The Wild Child/L'Enfant Sauvage [Motion picture[END_REF]. 1 It is relevant here because the boy's presence at the Institute allowed the young and ambitious Itard to develop his empirical medical practices. His overall approach, based on observation, training and education rather than on medication or surgery, was the legacy of his teacher, Philippe Pinel, the socalled founder of modern psychiatry [START_REF] Ball | Itard, Seguin, and Kephardt: Sensory Education -A Learning Interpretation[END_REF][START_REF] Lane | The Wild Boy of Aveyron[END_REF]. From Pinel, Itard also learned to recognize the limits of his own knowledge and intelligence, to be sensitive towards the mentally or physically ill, and to be sceptical about all scientific inquiry [START_REF] Malson | Wolf Children and the Problem of Human Nature[END_REF].

In philosophical terms, Itard was influenced by Étienne de Condillac and, to a lesser extent, John Locke. Generally, eighteenth-century thinkers were concerned with understanding how humans know. Condillac and Locke granted priority to the senses in knowledge acquisition rather than to abstract disembodied thought, as Rene Descartes did. Condillac, in particular, argued that humans learn when their senses are appropriately stimulated. Because, he also argued, such stimulation was best gained through varied social interactions, being part of society was a key to being fully human. This perspective allowed that humans could improve their lot in life. But, it also meant that some people were higher than others in the hierarchy of words and deeds, the abilities that made humans unique among all species of animal. Emmanuel Kant and Jean Jacques Rousseau took yet a different approach. They believed the existence of social problems proved the opposite: humans became more fallible as they became more civilized. Thus, socialized people had much to learn from individuals in their natural state. Given the different characters of these perspectives, it is not surprising that the anthropological and evolutionary sciences developed at this time, disciplines which addressed the question of human nature from various ends of a spectrum, ranging from the most superior forms of humans at one end to the lowest of animals at the other. According to some classifications, feral man belonged somewhere in between [START_REF] Lane | The Wild Boy of Aveyron[END_REF].

Against this background, Victor was not only a general curiosity but also a perfect object for scientific examination. A wild child -part human, part animal, unsocialized and mute -might well provide insights into innate thoughts, human speech and the relationship between humans and other animals. Both the title of Itard's first report and its opening statement reflect his immersion in these issues. Thus, An historical account of the discovery and education of A SAVAGE MAN, or of the developments, physical and moral, of THE YOUNG SAVAGE caught in the woods near Aveyron, in the year 1798 begins:

Cast upon this globe without physical strength or innate ideas, incapable in himself of obeying the fundamental laws of his nature which call him to the supreme place in the universe, it is only in the heart of society that man can attain the preeminent position which is his natural destiny. Without the aid of civilization he would be one of the feeblest and least intelligent of animals -a statement which has been many times repeated, it is true, but has never been strictly proven. [START_REF] Lane | The Wild Boy of Aveyron[END_REF] Following Condillac and Pinel, Itard founded his medical practice on sense and experience. If all knowledge came through the senses, Itard reasoned, those lacking knowledge or social abilities could be improved by appropriate sensory stimulation. According to prevailing sentiment, the boy would remain little more than an animal; even Pinel deemed Victor incurably retarded (Itard, 1801[START_REF] Itard | The Wild Boy of Aveyron[END_REF]. For Itard, as indicated above, Victor's savage nature was not necessarily permanent. Having suffered extensive sensory deprivation in the wild, he was developmentally delayed. To rectify the delay, Itard exposed Victor to a five-step series of sensory experiences, gradually stimulating him to reach the developmental level of boys his age. In this way, and with much repetition, Itard attempted to integrate Victor into society (Itard, 1801[START_REF] Itard | The Wild Boy of Aveyron[END_REF]).

Itard's attitude and approach challenged contemporary thinking on matters of heredity, intelligence and learning. He not only held that an individual's intelligence depended on nature a n d nurture [START_REF] Ball | Itard, Seguin, and Kephardt: Sensory Education -A Learning Interpretation[END_REF]), but his perspective, indebted to Pinel, led to new ways to classify human behaviour. Before 1800, individuals were either normal or insane, and the latter had no hope of improving themselves, let alone functioning in society. For Itard and likeminded physicians, some people were mentally retarded. Though limited intellectually, the retarded could at the least be helped (granted, the concept is not without its own serious flaws).

Itard failed to socialize Victor and to resolve any of the dilemmas his existence seemed to pose. The boy did respond at times to the kindness of his caretaker; he uttered noises and cries, and apparently understood some of what others said to him, but he was never able to speak or belong in society. Sadly, Victor remained in the Institute until his death in 1828 -a man, or child, in his 40s. Many wonder if he might have been better off in the wild, to where he always wanted to return (Shattuck, 1980(Shattuck, /1994)).

If Itard did not improve Victor's life, the experience helped him establish specific practices for teaching other individuals with varying intellect [START_REF] Kanner | Medicine in the history of mental retardation[END_REF][START_REF] Malson | Wolf Children and the Problem of Human Nature[END_REF]. In particular, Itard pioneered sensory, deaf and special educations. He was among those, for example, who participated in debates over the relative value of lip-reading and sign language for the deaf [START_REF] Lane | The Wild Boy of Aveyron[END_REF][START_REF] Malson | Wolf Children and the Problem of Human Nature[END_REF]. Based on Itard's work, Eduard Seguin designed non-verbal intelligence tests. In turn, these ideas influenced Sequin's student, Maria Montessori, whose sensory teaching method is still practised worldwide [START_REF] Ball | Itard, Seguin, and Kephardt: Sensory Education -A Learning Interpretation[END_REF]Itard, 1801[START_REF] Itard | The Wild Boy of Aveyron[END_REF][START_REF] Kanner | Medicine in the history of mental retardation[END_REF]. Finally, in his role as chief physician at the Institute, Itard forged new ground in the diagnosis and treatment of ear diseases. He founded otorhynolaryngology, developed the Eustachian tube catheter, or Itard's catheter, and wrote the first modern book on ear diseases [START_REF] Itard | Traité sur des maladies d'oreille et de l'audition[END_REF]. His many books and articles also take up dropsy, mutism and stuttering, and he edited various journals: 1816, coeditor of Journal Universal des Sciences Médicales; 1832, editor of the Revue Médicale; 1832, editor of the Dictionnaire de Médicine ou Répertoire Générale des Sciences Médicales sous le Rapport Théorique et Pratique.

The paper translated here was part of his efforts at the National Institute to improve his patients' health by means of observation and therapeutic interventions. In particular, Itard discusses ten individuals, seven men and three women, who presented with uncontrolled movements of their legs, hands and vocal chords. As he states at the paper's conclusion, his goal was to examine the symptoms, origins and treatment of these spastic convulsions rather than to name a new disease. Ironically, he may have done the latter, since Itard's last observation was later appropriated as the first clinical description of TS. It is important to focus for a minute on this observation. It considers the Marquise de Dampierre, a distinguished member of polite society and a sufferer of coprolalia, or uncontrolled swearing. Given her social prominence, she was (like Victor) a curiosity to the general public and an opportunity for scientists to examine the human condition. Accordingly, the case appears in various nineteenth-(and twentieth-) century medical sources associated with the nascent field of neurology. In fact, after 1825, subsequent references to the Marquise were copied nearly verbatim from Itard's paper. None of the physicians observed her clinically, although they may have seen the well-known woman in Paris [START_REF] Kushner | A Cursing Brain? The Histories of Tourette Syndrome[END_REF]. For these reasons, it is important to make the complete text available. The disorder, after it appeared in George Gilles de la Tourette's 1885 paper about involuntary movements, acquired his name, no doubt with the support of his mentor, J. M. Charcot of Salpêtrière Hospital in Paris (Goetz, 1987;[START_REF] Yorston | Study of a nervous disorder characterized by motor incoordination with echolalia and coprolalia. The introduction and case studies of Gilles de la Tourette's 1885 paper[END_REF].

Read in its entirety and in its historical context, Itard's paper complements his work with Victor. In this case, Itard applies his empiricist method to individuals with normal intellect. Why, Itard asks implicitly, would otherwise normal people (i.e., of normal intelligence, of appropriate education and breeding) move and/or speak in socially inappropriate, inconvenient or dangerous ways against their own better judgement?

According to Itard's evaluation, the convulsions are due to brain lesions. But, this responsibility differs along gender lines. In the men, the lesions are the sole cause of their convulsions, gesturing and feverish pacing. Thus, their brain function has been co-opted but their will remains intact. Although lesions affect the women, too, they are responsible only in part. Their physical and vocal convulsions also depend on stressful circumstances in the women's lives, circumstances involving puberty, marriage and childbirth. As a result, Itard believes the women have some control over their inappropriate movements and statements. To help to develop this control, he espouses various cures including bleeding, leeching, bathing, herbal medications. Itard also refers to moral medicine, an extremely popular nineteenth-century cure which attempted to improve health by means of lifestyle changes involving fresh air, healthy food and exercise [START_REF] Goldstein | Console and Classify: The French Psychiatric Profession in the Nineteenth Century[END_REF]).

Itard's different approaches to men and women, his references to contemporary cures and his comparisons between humans and animals document early nineteenth-century medical and psychological attitudes and treatments. In the end, Itard exhibits the personal sensitivity with which he defended the mentally deficient, as well as a cultural insensitivity which equated weakness of will to animalistic subhuman behaviour, evident especially in women. And again, Itard's sympathy with the afflicted individuals he observes is unusual for the time, and also characterizes their problems within the framework of cure rather than acceptance.

During his career, Itard saw wealthy patients in his private, residential practice and other patients at the Institute. By all accounts, he was hardworking, dedicated, not especially gregarious, and a perfectionist. His many carefully written works pay testimony to the care with which he thought out and practised his craft. According to contemporary reports, he resembled Henri IV [START_REF] Malson | Wolf Children and the Problem of Human Nature[END_REF] and avoided social gatherings, but was generous with both time and money to students, colleagues and worthy causes. Increasingly incapacitated by a painful illness, he grew more insular and taciturn in his final years. He moved to Passy to be more comfortable where, never married and with few relations kin and close friends, he enjoyed solitary pastimes such as woodworking and walking in nature, as he had with Victor. He died on 5 July 1838 at his home; he had been a medical success with no formal degree or education (Itard, 1801[START_REF] Itard | The Wild Boy of Aveyron[END_REF][START_REF] Lane | The Wild Boy of Aveyron[END_REF]Shattuck, 1980/94).

Style of the translated text

In the translation which follows, every effort has been made to preserve the style of the original French rather than to render it in more contemporary English. The original footnotes are retained. All italics are Itard's own. When necessary, I give a clarification in square brackets. In these ways, I hope to remain as close as possible to the original meaning, and to capture the historical context in which the document appeared. Although this means that today's reader must accept Itard's penchant for comas and semicolons, he or she will gain a sense of the concerns and materials with which Itard grappled.

Classic Text No. 67 'Study of several involuntary functions of the apparatus of movement, gripping, and voice' by Jean-Marc Gaspard Itard (1825)*

When the muscles which animate our lives are no longer controlled by the will, because a morbid stimulus provokes contractions and produces convulsions, these violent and repetitive movements are especially disorganized, tumultuous, and nonfunctional. Yet, there are numerous anomalies of the nervous system which exemplify the contrary. Thus, it is not impossible that in the midst of the free exercise of its other functions, the brain would suddenly be deprived of its control over some of the muscular apparatuses, apparatuses entirely subject to the brain; those functions which serve in their place, such as we see in ordinary convulsions, alternate rapidly between contractions and relaxations; they begin to perform more or less regular movements which replace some of the functions they are supposed to execute under the exclusive influence of the will. Such conversion of our voluntary actions into automatic movements cannot be a very rare phenomenon; examples include stretching, yawning, laughing when we are * Itard, J. M. G. (1825) Mémoire sur quelques fonctions involontaires des appareils de la locomotion, de la préhension et de la voix. Archives Generales de Médecine,8,

  , 17(3): 333-351 Copyright © 2006 SAGE Publications (London, Thousand Oaks, CA and New Delhi) www.sagepublications.com [200609] DOI: 10.1177/0957154X06067668

Note

1. To read Itard's account of Victor in translation, see Itard (1801[START_REF] Itard | The Wild Boy of Aveyron[END_REF] and [START_REF] Malson | Wolf Children and the Problem of Human Nature[END_REF];

for background and interpretation, see Harlan (1976) and Shattuck (1980Shattuck ( /1994)). All these publications provide extensive bibliographies.


Jeffrey R. Watt (ed.). From Sin to Insanity: Suicide in Early Modern Europe. Ithaca, NY: Cornell University Press, 2004. Pp. 240. ISBN 0-8014-4278-8 (cloth).

DOI: 10.1177/0957154X06069568

Western society has experienced eras of passive tolerance and active antipathy towards suicide. Roman Law was relatively lenient, even towards those who suicided after having been charged with other crimes. For the Romans, the crime (and the punishment) died with the criminal. Everything changed with Augustine, who, in the fifth century, articulated a harsh new interpretation of suicide as contrary to the 6th Biblical commandment that one shall not kill. Suicide was a double crime: murdering oneself and killing the 'image of god'. Thereafter, legal traditions in Europe denied canonical rights, desecrated the suicider's body and imposed penalties on his family. Such social practices sought to enforce ecclesiastical hegemony and deter future acts of self-murder. By the fifteenth century, however, change was afoot. European jurisprudence slowly began to incorporate notions of intentionality: only those who knowingly committed suicide would be subject to religious, social and legal penalties. Thereafter, the principle of felo de se (self-murder) became distinguished from the conclusion of non compos mentis (lunacy). This, in effect, introduced the insanity clause to suicide verdicts; those who committed suicide in a state of unsound mind would be absolved of all of the harsher punishments. There still might be a quiet burial in the corner of a cemetery, but families were spared the public displays of humiliation and private forfeiture of property. Needless to say, the decision as to whether the person was or was not of sound mind was a contested one over the course of the sixteenth and seventeenth centuries. Moreover, it appears to have been applied inconsistently: gentlemen were more likely to have been considered to have committed the ultimate sin in a 'fit of distraction' than their pauper compatriots. Nevertheless, the non compos mentis option gave magistrates and juries a legal avenue through which to express softening attitudes towards this disturbingly common act.

Laws in most European jurisdictions compelled public investigations of suspicious, sudden or 'unnatural' deaths. In the case of suicides, decisions over whether the suicide occurred willingly, or under mental duress, were

Book Reviews

History of Psychiatry, 17(3): 353-362 Copyright © 2006 SAGE Publications (London, Thousand Oaks, CA and New Delhi) www.sagepublications.com [200609] made either by magistrates or lay juries. Depositions were taken; witnesses were interviewed; juries deliberated. The records extant from such inquests constitute the primary sources upon which many historians construct their quantitative and qualitative research. Where complete sets of records exist, some scholars have even taken a stab at reconstituting the historical demography of suicide. Here the data suggest a rise in suicide rates from the eighteenth century onwards, and the now all-too-familiar gender gap in completed suicides (men in almost every society and time period outnumber women by three or four to one). Such rising rates of self-murder would ultimately captivate the attention of Durkheim and others in the nineteenth century -authors who would suggest that, along with madness, suicide was one of the prices societies paid for advanced civilization.

From Sin to Insanity promotes itself as the 'broadest treatment yet of suicide in Europe during the period 1500-1800'. Ten essays drawn from s c h o l a r s working on various aspects of European history from the Renaissance to Napoleon explore social, cultural and legal perspectives on the history of 'this rash act'. The essays span a good part of central, western and northern Europe, including chapters on Scandinavia, Hungary, France, northern Germany, England, Switzerland, Spain and Amsterdam. During this period, the turgid editorial introduction affirms, Western society witnessed the 'birth of modern suicide', by which is meant a decriminalized, secularized and mostly medicalized act that increased in apparent frequency. Suicide was no l o n g e r the province of the Church; it became a controversial social phenomenon that engaged the sociologist, the alienist and the lay public. Religious denunciations of suicide did not diminish necessarily; they were merely crowded out by more tolerant and sympathetic views from within and without the Church.

Although they work on disparate regions, the contributors reach similar conclusions. All reaffirm that, over the course of the early modern period, there was a gradual secularization of suicide, by which they mean diabolical explanations of suicide were gradually replaced by suspicions of mental maladies. Concurrent to this, magistrates and juries became reluctant to impose penalties on suiciders (and their families) through the traditional means of refusing Christian burials, desecrating bodies and/or penalizing estates. This evolution in social values predated the articulation of new treatises by the eighteenth-century p h i l o s o p h es; rather than breaking new ground these Enlightenment intellectuals gave articulate voice to ideas in currency at the popular level. By the late eighteenth century a 'modern' conception and treatment of suicide had come to dominate Europe, paving the way for the medicalization of suicide in the nineteenth and twentieth centuries.

The act of suicide highlighted and aggravated tensions throughout earlymodern European society. The suicider's body, as several chapters attest, was a 'site of conflict', the consequences of suicide a test of the relative powers of secular and ecclesiastical authority. In some national cultures, such as that of Hungary, suicide would also emerge as an important trope within an ascendant national identity -a self-sacrifice for country and civil society that could be both honourable and noble. In other instances, as in the shocking suicide of the British Whig MP Sir Samuel Romilly, it might occasion a deep national discussion as to the social effects of rapid social and political change in early industrial society. Indeed, the perceived rise of suicide rates in most European communities in the eighteenth century provided fodder for those who felt that liberal thinking was leading inevitably to social anarchy.

Although individual chapters provide commentary on themes familiar to historians of suicide, there are also some unusual aspects of this history t h a t have received less scholarly attention. More than one author, for example, examines the phenomenon of 'suicidal murderers'. These individuals, who were mostly women, were so fearful of God's wrath (if they killed themselves) that they purposefully murdered others. This resulted in their own execution for premeditated murder. Since their own death (their ultimate goal) would be achieved by an executioner's hands, they would be spared eternal damnation. Children were often the chosen target of this tragic gambit, since, without sin, the victims would be guaranteed an entry into heaven. Those of less nerve might falsely confess to other murders or to beastiality, or recklessly expose themselves to danger. Early modern suicide, it would seem, occasioned a surprising degree of inventiveness.

Although the contributors to this book tend to reaffirm existing historiographical themes rather than to pose any radical new interpretations, the reach of authors rarely exceeds their grasp. Detailed archival work coupled with elegant writing reflects well on the editor, the contributors and Cornell University Press. Furthermore, the high quality of the scholarship legitimizes the value of adding historical perspectives to this troubling social phenomenon. While mental health professionals wrestle with the guilt of having done very little to dent suicide rates in the twentieth-century West, they can at least take some solace in historical perspectives on the subject, which suggest that suicide is a long-standing and robust phenomenon, seemingly impervious to most types of religious prohibition and medical intervention. In this ambitious study Chris Philo reinvigorates a Foucauldian perspective on the history of provision for the mad. Philo's chief concern is to reconsider the central arguments in Foucault's Historie de la Folie / Madness and Civilization


an ascendant national identity -a self-sacrifice for country and civil society that could be both honourable and noble. In other instances, as in the shocking suicide of the British Whig MP Sir Samuel Romilly, it might occasion a deep national discussion as to the social effects of rapid social and political change in early industrial society. Indeed, the perceived rise of suicide rates in most European communities in the eighteenth century provided fodder for those who felt that liberal thinking was leading inevitably to social anarchy.

Although individual chapters provide commentary on themes familiar to historians of suicide, there are also some unusual aspects of this history t h a t have received less scholarly attention. More than one author, for example, examines the phenomenon of 'suicidal murderers'. These individuals, who were mostly women, were so fearful of God's wrath (if they killed themselves) that they purposefully murdered others. This resulted in their own execution for premeditated murder. Since their own death (their ultimate goal) would be achieved by an executioner's hands, they would be spared eternal damnation. Children were often the chosen target of this tragic gambit, since, without sin, the victims would be guaranteed an entry into heaven. Those of less nerve might falsely confess to other murders or to beastiality, or recklessly expose themselves to danger. Early modern suicide, it would seem, occasioned a surprising degree of inventiveness.

Although the contributors to this book tend to reaffirm existing historiographical themes rather than to pose any radical new interpretations, the reach of authors rarely exceeds their grasp. Detailed archival work coupled with elegant writing reflects well on the editor, the contributors and Cornell University Press. Furthermore, the high quality of the scholarship legitimizes the value of adding historical perspectives to this troubling social phenomenon. While mental health professionals wrestle with the guilt of having done very little to dent suicide rates in the twentieth-century West, they can at least take some solace in historical perspectives on the subject, which suggest that suicide is a long-standing and robust phenomenon, seemingly impervious to most types of religious prohibition and medical intervention.

DAVID In this ambitious study Chris Philo reinvigorates a Foucauldian perspective on the history of provision for the mad. Philo's chief concern is to reconsider the central arguments in Foucault's Historie de la Folie / Madness and Civilization through a careful reading of an immense corpus of primary and secondary material, much of which was not considered by Foucault himself. The result is an impressive, and certainly at times brilliant, contribution to the history of madness and psychiatry that defends, nuances and extends those aspects of Foucault's work which, in Philo's view, remain compelling to our understanding of 'the space[s] reserved for insanity'. I would argue that Philo, in fact, need not feel as indebted to Foucault as he rather humbly indicates, for there are some major insights in Philo's geo-historical reconsideration of the subject which, though they may be Foucault-inspired, are more 'Philodian' than 'Foucauldian' per se.

Central to this book is Philo's thoughtful reinterpretation of Foucault's classic and controversial text. For Philo, there are three enduring insights brought to the debate on madness by Foucault's work: his recovery of an historical turn in the juxtaposition of reason and unreason; his deployment of a theoretical eclecticism with which to better understand this major turn; and his geographical approach to the study of madness. Philo stresses that for F o u c a u l t it is the broader 'Reason-Madness nexus' (p. 36) that is essential to under-standing Western engagements with madness, and not merely how those considered mad were understood and treated (though this too becomes an essential aspect of the much larger argument). Philo reminds us that Foucault's original claim was that reason and unreason were in a state of relatively free exchange during much of the medieval period, but that the Renaissance and the Enlightenment brought to reason increasing claims over madness which culminated in a sealing off of the one from the other. Part of this process included the linguistic layering-up of reason (including an increasingly thick medical layer), which, by the nineteenth century, had effectively silenced and subsumed madness. Philo sees Foucault's use of a cocktail of theoretical approaches as an advantage to his articulation of this reason/unreason nexus. Historical materialism accounts for how a wide range of unreasonable behaviour, including madness, was brought into servitude by the economic imperatives of capitalism, while post-structuralism explains, culturally, the discursive process by which reason became disentangled and increasingly 'estranged' from unreason (p. 37). These insights, argues Philo, owe much to Foucault's 'alertness to spatial relations in the history of the madbusiness' (p. 42), something that has subsequently been lost by the bulk of revisionist historians of madness whose work suffers from the 'suppression of space by time' (p. 21).

This having been said, Philo does point out that Foucault's work, though benefiting from a consideration of the geographies of madness, needs to be considerably nuanced through 'areal differentiation', that is, by a more solid geographical grounding of understandings and responses to madness. This, then, constitutes the major goal of Philo's own work -a careful siting and reevaluation of the spaces reserved for madness in England and Wales from medieval times to the 1860s.

So, what is revealed by Philo's massive 'close' geographical study of madness in England and Wales as it relates to the more salient aspects of Foucault's 'deep' thinking about the subject? First, Philo's historical geography of mad spaces from the 1100s to the late 1600s does indeed appear to indicate that an 'untidy geography' of 'chaotic space' dominated provision for the mad. For Philo, this is significant because it buttresses Foucault's argument that there existed a more open dialogue between madness and reason during this time. Equally important, Philo's study of holy wells, holy shrines, monasteries, hospitals and retreats effectively demonstrates a diversity of responses to madness that defies earlier historians' depictions of this period as one of unmitigated harsh treatment of the mad. This is an empirical contribution that all historians of psychiatry, regardless of intellectual orientation, will appreciate.

Second, in chapters four through seven, Philo reconstructs the overlapping temporal and geographical spaces reserved for madness during the eighteenth and nineteenth centuries. He organizes these chapters by 'type' of confinement: secure places (including gaols, houses of correction, poorhouses and workhouses), private madhouses, charitable lunatic hospitals and public asylums. Certainly this massive gathering of primary material on confinement enables Philo to revisit the most contentious of claims by Foucault -that of a 'great confinement' of mad people in the Early Modern period. While perhaps not indicating that the confinement was as widespread as Foucault alleges, the careful mapping of mad spaces in Philo's work does create a picture which could perhaps upgrade Akihito Suzuki's notion of a 'small confinement' to a 'medium', or perhaps even 'large' confinement.

More importantly, in these four chapters, Philo brilliantly assesses the complex geographical and historical overlapping of discourses on madness that were embedded in each mode of confinement. In essence, Philo argues persuasively that the siting of mad spaces was very much the product of the conceptualizations of madness that informed their location. Multiple forms of mad space overlapped in the eighteenth and nineteenth centuries, and these spaces embodied competing discourses over the proper management and understanding of madness and of the mad. For example, Philo observes that charitable lunatic hospitals, though not numerous, had an 'urban bias' and a medical orientation which contributed to the separation of the mad from other confined groups, while also emphasizing the medical nature of their plight. This partly set the stage for the crucial battles between medical and moral geographies of madness -ones that underscored the rhetorical battles between William Battie and John Monro, or that differentiated the spatial and institutional constituents of the urban and medical St Luke's Hospital from the rural and moral York Retreat. Philo sees a kind of medical/moral 'fault line' emerging by the nineteenth century, one that gave way to the 'moral locational discourse' of the county public asylum and an attendant uneasy alliance of medical and moral explanations of madness. Although this is only a fraction of the insight Philo offers in his book (it is, after all, 678 pages long!), it gives some idea of its great potential for reevaluating madness over the long durée in England and Wales.

One important aspect of the history of madness that fits rather awkwardly in this book is home or domestic confinement. At one point Philo acknowledges that his focus might 'underplay the extent to which [the mad] . . . were left in the charge of family, friends and neighbours ' (p. 178). At another point, engaging with Roy Porter's claim that most mad people were not institutionalized at all during the supposed 'great confinement', Philo suggests that 'such "domestic confinement", wherein mad people commonly ended up chained alone in attics or cellars, could be seen as an element within, not as opposed to, the sequestered geography envisaged by Foucault' (p. 186). I would suggest that the very long history of domestic confinement and care of the mad, and the understudied nature of its multiple forms, make these claims difficult to sustain. While it must be said that this is not a focus of Philo's work, his challenging analysis of the spaces reserved for insanity will no doubt encourage others to consider how the emerging literature on domestic/family confinement and care fits into a geographical history of madness. What is needed is an approach to the domestic geography of madness similar to that offered by Philo for institutional provision. The historical development of institutional care for mentally disordered people continues to engage the attentions of historians. That it remains a fertile field for research is amply demonstrated in this new collection of articles. Although the asylum is still the central reference point, it is no l o n g e r the sole focus of scholarly attention, as reflected in several of the chapters. Even in the nineteenth century, other institutions such as workhouses were providing a significant alternative option for many people deemed insane or otherwise mentally disordered, as Elaine Murphy's contribution carefully illustrates. In the twentieth century various newer types of institutional facilities emerged, and part of this collection represents the beginnings of an appraisal of their relative historical significance. The book contains much to interest both historians of psychiatry and of learning disabilities. Most of the individual contributions appear to be part of

JAMES E. MORAN

A Geographical History of Institutional Provision for the Insane from Medieval Times to the 1860s in England and Wales: The Space Reserved for Insanity. Lewiston

	WRIGHT
	McMaster University
	Chris Philo. , NY: The Edwin Mellen
	Press, 2004. Pp. 678. ISBN 0-7734-6509-X.
	DOI: 10.1177/0957154X06069569

Mental Illness and Learning Disability Since 1850: Finding a Place for Mental Disorder in the United Kingdom. Abingdon

  University of Prince Edward IslandPamela Dale and Joseph Melling (eds).

	and New York: Routledge, 2006. Pp. xii + 234.
	ISBN 0-415-36491-4.

DOI: 10.1177/0957154X06069570


after all, 678 pages long!), it gives some idea of its great potential for reevaluating madness over the long durée in England and Wales.

One important aspect of the history of madness that fits rather awkwardly in this book is home or domestic confinement. At one point Philo acknowledges that his focus might 'underplay the extent to which [the mad] . . . were left in the charge of family, friends and neighbours ' (p. 178). At another point, engaging with Roy Porter's claim that most mad people were not institutionalized at all during the supposed 'great confinement', Philo suggests that 'such "domestic confinement", wherein mad people commonly ended up chained alone in attics or cellars, could be seen as an element within, not as opposed to, the sequestered geography envisaged by Foucault' (p. 186). I would suggest that the very long history of domestic confinement and care of the mad, and the understudied nature of its multiple forms, make these claims difficult to sustain. While it must be said that this is not a focus of Philo's work, his challenging analysis of the spaces reserved for insanity will no doubt encourage others to consider how the emerging literature on domestic/family confinement and care fits into a geographical history of madness. What is needed is an approach to the domestic geography of madness similar to that offered by Philo for institutional provision.

JAMES E. MORAN University of Prince Edward Island

Pamela Dale and Joseph Melling (eds). Mental Illness and Learning

Disability Since 1850: Finding a Place for Mental Disorder in the United Kingdom. Abingdon and New York: Routledge, 2006. Pp. xii + 234. ISBN 0-415-36491-4.

DOI: 10.1177/0957154X06069570
The historical development of institutional care for mentally disordered people continues to engage the attentions of historians. That it remains a fertile field for research is amply demonstrated in this new collection of articles. Although the asylum is still the central reference point, it is no l o n g e r the sole focus of scholarly attention, as reflected in several of the chapters. Even in the nineteenth century, other institutions such as workhouses were providing a significant alternative option for many people deemed insane or otherwise mentally disordered, as Elaine Murphy's contribution carefully illustrates. In the twentieth century various newer types of institutional facilities emerged, and part of this collection represents the beginnings of an appraisal of their relative historical significance.

The book contains much to interest both historians of psychiatry and of learning disabilities. Most of the individual contributions appear to be part of wider research studies, and all are of a high quality. Although there are some common themes, there is a striking diversity in the chapters. Several break new ground, notably Louise Westwood's study of two pioneering female psychiatrists in the first half of the twentieth century, which also highlights significant developments occurring outside the institutional mainstream. Vicky Long's chapter on the role of psychiatric social workers in facilitating the return of mentally ill people to paid employment, in the post-war period, serves both to underscore the increasingly important role of non-medical professionals and to demonstrate the changing nature of the emphasis on work as a therapeutic and rehabilitative agent. John Welshman's preliminary analysis of the rise of hostels, both for the mentally ill and for those with learning disabilities, points to an almost virgin field for comprehensive historical research as it passes out of the realms of contemporary study.

In several instances the authors have based their work on the compilation of an extensive and elaborate database, utilizing the voluminous records kept by asylum superintendents. Frank Crompton, in his study of the Worcester Asylum in the nineteenth century, has skilfully marshalled this material to demonstrate the linkages between diagnosis, behavioural presentation, and the techniques of patient management within the asylum. Similar methods have been employed by David Pearce in using the admission records of the Devon Asylum to consider how the 1930 Mental Treatment Act, with its introduction of voluntary admissions, impacted on the gender and social class composition of the in-patient population. Joseph Melling has taken the methodology a stage further, by combining his occupational analysis of the earlier Devon Asylum records with a linkage of individual inmates through census data. In constructing a more rounded picture of one particular group of patients, governesses in this case, he has delineated new possibilities in the development of a far richer social history of psychiatry.

Although the majority of the studies relate primarily to mental illness, there are two chapters that specifically cover mental deficiency. Matt Egan's work on Scotland provocatively argues that the apparent significant increase in the numbers of mental defectives in the early twentieth century was largely the consequence of changing definitions, and the concerns of professionals to raise educational standards by removing problematic children from the general school system. Pamela Dale similarly demonstrates the undue influences that could be wielded by often competing professional groups in determining policies and practices. She shows how apparently complex and chaotic the management of services could become as a consequence.

Dale and Melling have put together a valuable collection comprising much important new material, which successfully widens our understanding of the history. Several of the contributions leave the reader wanting more, and there can hardly be a stronger recommendation.

LEONARD SMITH University of Birmingham


Alexander Crichton

G E Berrios

'Mind in general' by Sir

Keywords: Alexander Crichton, historicism, history, John Augustus Unzer

The history of the 'philosophies of psychiatry' can be defined as the contextualized study of past theoretical views on the nature, understanding and management of madness and related notions. The application of an hermeneutic apparatus to past psychiatric narratives gives rise to the history of psychiatry; its application to current narrative gives origin to the philosophy of psychiatry. If the latter employs off-the-shelf, ready-made, external philosophies, it follows a centripetal approach; if it starts from the inside of psychiatry and generates its own tools and meta-language, it follows a centrifugal approach.

Psychiatry is burdened by intrinsic and extrinsic philosophical problems. The former result from its hybrid nature, i.e., from the fact that psychiatry unsteadily straddles the natural and human sciences. The latter are borrowed from the conceptual frames into which psychiatry has been inscribed since the 19th century.

The philosophy of psychiatry may anticipate or follow empirical research. The ante rem mode is based on the idea that empirical research requires conceptual supervision, audit and guidance, for it is always ideology-and theory-laden. The post rem mode is based on the view that science is the only way to 'truth' and hence all that the philosophy of psychiatry can (or should) do is facilitate, interpret, justify, defend or glorify empirical findings.

The Classic Text that follows was written by Sir Alexander Crichton at the end of the 18th century, and is a good example of the centripetal mode of philosophy-making.

INTRODUCTION: THE PHILOSOPHIES OF PSYCHIATRY -A CONCEPTUAL HISTORY

Throughout history, the phenomena of madness have attracted philosophical reflection both on account of their extraordinariness and of the fact that their (putative) irrationality has been perceived as a threat to the epistemological validity of man's perception or conception of the world. 1 When collated, such reflections amount to a veritable 'philosophy of psychiatry'. Their contextualized analysis is the task of what is called here the 'history of the philosophies of psychiatry'.

Defining psychiatry

In its present form, the discipline of 'Psychiatry' was constructed during the nineteenth century to deal with the u n d e r s t a n d i n g and m a n a g e m e n t of categories of behaviour and experience then deemed deviant, abnormal or 'diseased'. Some of these categories were created anew, others were a legacy. Selecting and describing such forms of behaviour also required the construction of a technical language (descriptive psychopathology). During the nineteenth century, the act of understanding 2 abnormal behaviour was considered as tantamount to identifying a link between the said behaviour and an anomaly of the body. 3 Although in most cases the link amounted to no more than an observation of contiguity, it was boldly considered as 'causal'. 4 The act of management included interventions of a social, moral and scientific nature addressed at changing target behaviours [START_REF] Berrios | press) The history of psychiatric treatments[END_REF].

The construction of psychiatry during the nineteenth century occurred under the aegis of medicine. 5 Because of the complexities exhibited by the phenomena of madness, the conceptual structure of psychiatry and its epistemological handles were (rather hastily) made out of fragments taken from contemporary natural and human sciences. Ever since, the former have informed psychiatry of how the target behaviours may be inscribed in the body (currently research is focused on the brain); and the latter have provided the criteria for their very selection and configuration. The natural sciences by themselves cannot create new categories of 'mental disorder', nor can any somatic footprint be sufficient to define a mental disorder. This means that the human sciences have epistemological primacy. In other words, a mental disorder cannot be formally ascertained by studying the brain of the patient but by the enactment of the social act of 'diagnosis' which is the outcome of an emotional and epistemological partnership between helper 6 and sufferer. After a private negotiation between two persons, experiences and behaviours will get selected, named, and thereby made real.

On account of the above, diagnosing in psychiatry is far more than the act of 'recognizing' by means of a checklist some pre-existing, autonomous object (as ontologically stable as a tumour or a pimple). Diagnosis consists in the construction of 'mental symptoms' by the unique act of attaching meaning to certain experiences and behaviours and (ideally) getting the patient to go along with it. 7 'Seeing things which are not out there' is a report which remains ontologically empty until an act of diagnosis takes place. It is only when the reported 'experience' is integrated into the life of the sufferer that it becomes an official token of what is now called a 'hallucination'. This is why proxy devices 8 such as checklists, psychiatric instruments and putative 'biological markers' (e.g., neuroimages, biochemical tests, physiological changes) cannot confer meaning or effect the transformation described above. That they appear to have the power to confer meaning results from their parasitical nature, from the fact that they depend (usually via a 'significant' correlation) on an earlier primary social act of diagnosis.

In psychiatry, there is an additional problem, namely, that correlations are made finite by the fact that their correlates are transient: that is, both the social criteria for selecting abnormal behaviours and the brain inscriptions identified for them do change with time. This means that there is no transhistorical object of inquiry (i.e., an eternal mental disorder) which the psychiatry of today may expect to share with the disciplines that managed the 'phenomena of madness' before the nineteenth century or might share with disciplines that will be constructed in the future to manage them.

In this sense, each historical period constructs its own ('psychiatric') object of inquiry, and over the centuries a variety of such has accumulated. When trying to compare them, the historian may find that objects from different historical periods are named the same, 9 or that throughout time the same object has been named differently. 10 Comparisons of these variegated objects of inquiry are, in fact, extremely difficult to undertake for they require that the historian has, for each, adequate knowledge of: (1) structure, function, social meaning and role; and (2) putative biological inscriptions [START_REF] Berrios | Historiography of mental symptoms and diseases[END_REF]. An important point to remember is that within each historical period behaviours that have been selected as 'abnormal' or 'deviant' tend to 'correlate' well, i.e., be coherent with, putative bodily inscriptions (which have been linked to all manner of organs such as the stomach, hypochondria, liver, brain, etc.) and with therapeutic success. 11 Local coherence is then used by 'experts' to make truth claims about their own theories, and to found their right to draw professional and deontological rules for the psychiatric community at large. 12 The meaning and evidential power of such internal coherence, however, is localized, and it remains unclear whether coherences from different historical periods can be compared (i.e., whether they are incommensurable). 13 A crucial consequence of the definitions proposed above is that it will not ever be possible for psychiatry to jettison the human sciences, i.e., to kick away its Wittgensteinian ladder 14 solely to rely on the 'invariant' objects' 15 offered it by the natural sciences. Without the social sciences the process of periodically redefining mental disorder or constructing 'new' disorders would come to a halt, and the (weak) biological markers available to psychiatry would soon lose calibration.

It also follows from the above that the history of psychiatry should conceive of its subject as the set of narratives and practices 1 6 that have been constructed to describe and/or control behaviours which are deemed 'unacceptable', 'disturbing' or 'diseased' (three concepts which are not necessarily overlapping). During the nineteenth century these practices included the creation of a language of description (descriptive psychopathology; [START_REF] Berrios | Descriptive psychopathology: Conceptual and historical aspects[END_REF][START_REF] Berrios | History of Mental Symptoms[END_REF].

Aspects of the philosophy of psychiatry are regularly chronicled by historians of psychiatry, but no dedicated historiography has yet been developed for it. This introduction to the Classic Text wishes to justify the need for one. Such specification needs to be based on a preliminary agreement on what the history of psychiatry [START_REF] Berrios | Descriptive psychopathology: Conceptual and historical aspects[END_REF][START_REF] Berrios | Historiography of mental symptoms and diseases[END_REF]Micale and Porter, 1994) and the history of philosophy are (or should be).

The history of the philosophies of psychiatry

The history of the philosophies of psychiatry can be defined as the contextualized analysis of the origins and vicissitudes of views developed (in the Western world) to make sense of the diverse phenomena of 'mental disorder' (sensu lato), the focus of such analysis being on their conceptual structure, social appurtenances and aesthetic and moral warrants rather than on any 'empirical' claims that have been made in regard to their nature and origins. A number of historiographical options are available to this end. 17

The history of philosophy Books dedicated to the general history of philosophy started to appear during the seventeenth century; 18 by the time of the Enlightenment, major historical works 19 and a journal 20 had become available. The historiographical rivalries adumbrated by these writings were sharpened during the nineteenth century when histories of philosophy became a genre in their own right [START_REF] Geldsetzer | Philosophiegeschichte[END_REF][START_REF] Schneider | A bibliography of nineteenth-century histories of philosophy in German, English, and French (1810-1899)[END_REF]. In his magisterial history of the histories of philosophy, [START_REF] Braun | Histoire de l'histoire de la philosophie[END_REF] identified naïve, erudite, pragmatic, progressive, critical and romantic historiographical approaches to philosophy. A variety of other typologies and taxonomies are also available [START_REF] Piaia | Brucker versus Rorty? On the 'Models of the Historiography of Philosophy[END_REF].

Representative of what Braun called the naïve genre are 'doxographies', 21 that of Diogenes [START_REF] Laertius | Lives of Eminent Philosophers[END_REF] being the best example. The concept of history as the linear unfolding of a divine truth [START_REF] Markus | Saeculum: History and Society in the Theology of St. Augustine[END_REF] was introduced by Christianity and has influenced the writing of history ever since. 22 Secularized during the nineteenth century, 23 the linear approach inspired writings purporting to show that the natural sciences and philosophy were themselves processes unfolding towards a form of 'lay' truth.

Others have proposed the existence of a fixed set of philosophical questions (i.e., a philosophia perennis) to which each historical period would give its own answers. When placed in chronological order, such answers may or may not show a relationship: in other words, philosophia perennis may be accommodated by either a linear or a cyclical (Viconian) conception of history. 24 During the nineteenth century, the view became predominant that the understanding of man and the world required knowledge of their origin and development [START_REF] Wright | History and historicism[END_REF]. Called 'historicism' or 'historism', this trend culminated in the work of Dilthey, Windelband and others, and during the first half of the twentieth century it provided a new frame for the writing of the history of philosophy [START_REF] Bambach | Heidegger, Dilthey, and the Crisis of Historicism[END_REF][START_REF] D'amico | Historicism and Knowledge[END_REF][START_REF] Engel-Janosi | The Growth of German Historicism[END_REF][START_REF] Morris | Toward a New Historicism[END_REF][START_REF] Riesterer | Karl Löwith's View of History: A Critical Appraisal of Historicism[END_REF]. During the second half of that century, versions of historicism also inspired the so-called 'sociologies of knowledge', i.e., the view that philosophical systems are fully the product of history and culture [START_REF] Bloor | Knowledge and Social Imagery[END_REF][START_REF] Gieryn | Cultural Boundaries of Science[END_REF][START_REF] Golinski | Making Natural Knowledge[END_REF][START_REF] Kusch | Psychologism. A Case Study in the Sociology of Philosophical Knowledge[END_REF]. Variations and combinations of the approaches listed above can often be found, and the assumptions made by authors of well known 'histories of philosophy' are not always easy to disentangle [START_REF] Collins | The Sociology of Philosophies[END_REF].

During the twentieth century, there was a reaction against historicism, particularly from philosophies deriving from logical positivism, the Vienna circle, and the analytical school of the type practised in much of the Anglo-Saxon world. Representative of this view is Wittgenstein's claim (1979: 82e): 'what has history to do with me, mine is the first and only world'. (On Wittgenstein's views on history in general, see [START_REF] Glock | Wittgenstein and history[END_REF] Other philosophers approach history as a source of material to translate into current categories. It goes without saying that 'translating' views of earlier philosophers into current concepts does away with meaning, context and rhetorical force

The historian of the philosophies of psychiatry will have to choose what method to follow and what writers to study, for, in earlier times, not only philosophers but medics, theologians, moralists, poets, fiction writers, etc., pondered over the nature of madness, and their reflections should be considered as forms of philosophy of psychiatry. It is the job of the historian to seek the connection between such discourses, their historical context and the 'understanding and management of madness'. Such discourses can precede, interpret or follow ongoing views on mental disorder; indeed, often enough philosophy may just be used to 'interpret' or justify empirical research (on this, see more below).

Ways of doing philosophy of psychiatry

The philosophy of psychiatry can be undertaken in a centripetal or centrifugal fashion. To allow a fair comparison, it is assumed here that both are being carried out by competent thinkers. Those practising the centripetal style will make use of off-the-shelf philosophies to identify, configure, classify and resolve the problems of psychiatry. Animism and vitalism, 2 5 p h e n o m e n o l o g y , 2 6 logical empiricism, 27 analytical philosophy, 28 etc., have all been resorted to. Both professional philosophers and psychiatrists have tried their hand with varied degree of success. Although technically impeccable, the offerings of the former are often off the mark simply because they lack the knowledge by acquaintance with the phenomena of madness. The latter, on the other hand, rarely offer more than syncretistic 29 solutions (currently re-branded as ' p l u r a l i s m ' ) , 3 0 that is, mixtures of fragments taken from different philosophical systems. (Examples of centripetal philosophy can be found in: [START_REF] Ghaemi | The Concepts of Psychiatry[END_REF][START_REF] Kendler | Toward a philosophical structure for psychiatry[END_REF] The centrifugal way, on the other hand, starts at the very centre of psychiatry. It thinks its problems from the inside and, when required, composes a metalanguage to capture them. However, to be able to identify issues, formulate questions and draw boundaries, the thinker will need a first-hand familiarity with the subject-matter of psychiatry. Not all the problems generated by psychiatry are equal. Some -such as the definition of mind, the interaction between mind and body, the supervenience of new types of experience and behaviour, the distinction between causes versus reasons, etc. -will be extrinsic to psychiatry, and their analysis will share the same conceptual frames and methods as the philosophy of mind. Other problems, however, such as the concept of mental symptom, the semantics organization of mental disorder, 31 etc., will be intrinsic, that is sui generis to the task that psychiatry has set itself. Solutions to these problems do not exist ready-made. They must be original and fresh, and this makes them sometimes into veritable contributions to philosophy. Excellent works have made use of the centrifugal approach. 32 Whether centripetal or centrifugal, the philosophy of psychiatry can be undertaken ante rem, i.e., early in the process of becoming acquainted with the phenomena of madness, or post rem, i.e., as an exercise in justification 33 of whatever object has been created by empirical research. Those who practise the latter approach seem to assume that biological psychiatry (the current source of such empirical findings) is a non-ideological activity whose 'discoveries' are an exact picture of the world. 34 This assumption is unwarranted given that (as seen above) in psychiatry all 'empirical' findings are epistemologically dependent upon an object of inquiry which has been primarily and originally constructed in terms of social, moral and aesthetic criteria.

It is unlikely that the history of the philosophies of psychiatry will provide historians, philosophers or psychiatrists with a ready-made source of errors or hints for new ideas. The philosophical analysis of the views and practices of madness can only tell about conceptual moves and constraints. Such moves are governed by epistemic rules unique to each historical period. A historical comparison of different patterns of moves and constraints may help to work out what in the episteme itself determines such sets of rules, and whether a trans-epistemic taxonomy of conceptual moves can be identified.

For example, in each there should be legitimate and illegitimate moves, and among the former there should be silly, indifferent, prosaic and imaginative moves. Finding out what in a given cultural niche makes possible the development of original moves, and whether such conditions can be manipulated, is another important contribution of the history of the philosophies of psychiatry. Armed with this historical knowledge the philosopher can then work out the rules governing the conceptual moves in current psychiatry. This suggests that the same analytical apparatus is used by both the historian and the philosopher: when it is used on past narratives it becomes the history of psychiatry, when applied to the current narrative it is called the philosophy of psychiatry. A separation between the two disciplines is therefore likely to be artificial.

The Classic Text

An early text of the centripetal type (see above) has been chosen to illustrate the origins of drawbacks that still bedevil philosophy of psychiatry. 35 Entitled 'Mind in general', the text was included by A. Crichton in his book A n Inquiry into the Nature and Origin of Mental Derangement (1798). It deals mainly with the relationship between mind, body and disease.

The author

Sir Alexander Crichton (1763Crichton ( -1856) ) was born in Edinburgh and studied medicine at Edinburgh University [START_REF] Appleby | Oxford Dictionary of National Biography[END_REF]. He was apprenticed to both Alexander Wood and William Fordyce, obtained his MD from Leiden University, and studied further in Paris, Stuttgart, Vienna, Halle, Berlin and Göttingen. His long association with the Westminster Hospital started in 1794 and there he taught medicine, materia medica and chemistry. In 1792 Crichton translated Blumenbach's Essay on Generation, and his own A n Inquiry into the Nature and Origin of Mental Derangement appeared in 1798. He became a famous physician, chemist and mineralogist, contributing original work to all these fields. Between 1804 and 1819 he lived in Russia as a physician to the Imperial family. At the time he undertook original natural science research, and put together the core of his famous collections of biological and mineral specimens. He received many honours from the Russian government and was knighted by George IV in 1821. Crichton was not a mad-doctor, alienist or anything of the sort. Like Pinel, Reil, Chiarugi and other medical-men of his generation, he was a generalist who occasionally dabbled in the business of madness. Apart from this book, he did not publish any other work on mental derangement. 36

Its sources

The book in question is said to have influenced Pinel and Esquirol [START_REF] Weiner | Mind and body in the clinic: Phillip Pinel, Alexander Crichton, Dominique Esquirol, and the birth of the clinic[END_REF]. In the introduction to the first edition of his Traité, [START_REF] Pinel | Traité médico-philosophique sur l'alienation mentale, ou la manie[END_REF] found some of the books on madness published in England and Germany to be over-theoretical except Crichton's which he described as a 'profound work, resulting from new observations based on modern physiology' (p. xxi). Pinel was particularly impressed by the fact that Crichton used the concept of passion in a non-metaphysical, physiological way ('without any reference to morality or immorality', p. xxij). 37 Was Pinel right in talking about 'new observations' in this regard?

Crichton was no more than 30 years old when he started collecting information for his book. Until then he had had little experience in the diagnosis or management of madmen. If 'new' is understood as original or personal, there are no new clinical observations in his book. All the cases reported therein were borrowed from someone else. In fact, Crichton did acknowledge his main sources: Unzer's Physiologie and the Magazin zum Erfahrungsseelenkunde [START_REF] Förstl | Karl Philipp Moritz and the Journal of Empirical Psychology: an introductory note and a series of psychiatric case reports[END_REF] edited by Moritz and Maimon: in this work I found what I had not yet met with in any other publication, a number of well-authenticated cases of insane aberrations of mind, narrated in a full and satisfactory manner, without a view to any system whatever … (Crichton, 1798: v) Indeed, elsewhere Pinel (1801: 49) had already made a scathing comment:

One must admire Dr Crichton's courage for publishing two volumes on mania and melancholia without having other basis than some observations taken from a German journal, some clever interpretations of modern physiology, and a table of the psychological and physical effect of the human passion … 38 Pinel was not the last person to criticize the book. Thomas Laycock, 39 the translator of Unzer's Physiology (1851) also commented upon it. In his personal copy of Crichton's book, D. H. Tuke 40 (a disciple of Laycock) entered: 'Dr Laycock says that some of Crichton's principal merits are due to unacknowledged plagiarisms from Unzer's Physiology.' 41 Thus, in spite of his Scottish education and early training in Edinburgh, 4 2 and the fact that Scottish Philosophy of Common Sense [START_REF] Grave | The Scottish Philosophy of Common Sense[END_REF] was at the time also influential in Germany, 43 Crichton does not seem to have been much influenced by it.

J. A. Unzer

Born in Halle, Johann August Unzer (1727-99) graduated in medicine from the local university in 1748. Two years later, he left for Altona where he was to spend the rest of his life. At Halle, it is likely that he attended some of Hoffman's lectures who at 79 was still lecturing there. His main teacher, however, was Johann Juncker (1679-1759), a follower of G. E. Stahl (1660-1734) and author of a synopsis of Stahlian ideas on pathology [START_REF] Juncker | Conspectus Pathologiae: Ad Dogmata Stahliana Praecipve Adornatae Et Semeiologiae Potissimvm Hippocratico-Galenicae[END_REF]. From Juncker, Unzer learned about the metaphysics of vital actions.

Stahl's philosophy of medicine is complex and not easy to present without providing some context, particularly in regard to the meaning of terms such as anima, motion, substance and essence, which must be understood in their early eighteenth-century meaning, otherwise what he said would make little sense to the present-day reader. Stahl opposed the application to the mind (soul) and to the higher mental functions [START_REF] Rather | Stahl's psychological physiology[END_REF] of the mechanical philosophy developed in Europe at the end of the seventeenth century [START_REF] Boas | The establishment of the mechanical philosophy[END_REF]. He believed that, due to the fact that soul and body were essentially different, the former could activate the latter only indirectly. Stahl proposed that such activation took place via 'motion' which he conceived of as a third essence, independent and different from the soul and the body. Human action could then be explained as a causal cascade: the soul activated motion and motion imparted activity upon the body [START_REF] King | Stahl and Hoffman: a study in 18th century animism[END_REF]. This version of animism, acquired via Johann Juncker, Unzer was to build into his own views on the mind, and is a recurrent theme in his publications. Two years before his graduation he had already published three books (in German) of which his 'New Theory Regarding the Passions (Emotions)' (Unzer, 1746a) is of particular relevance to understanding Crichton's views. In this book Unzer sought to explain the emotions in terms of variations in the tension of the nerves. The other two books were 'Thoughts on the Influence of the Soul on its Body' (1746b), and 'Thoughts on Sleep and Dreams' (1746c) . However, the work which summarized Unzer's mature thoughts was Erste Gründe einer Physiologie der eigentlichen thierischen Natur thierischer Körper (The Principles of a Physiology of the Animal Nature Proper to Animal Organism; 1771).

Based on Unzer's physiology, Crichton argued against Joseph Priestley's materialistic monism, i.e., the view that mental phenomena can be fully reduced to physiological mechanisms [START_REF] Yolton | Thinking Matter: Materialism in Eighteenth Century Britain[END_REF]). Priestley's physiological ideas came from David Hartley whose work he had edited [START_REF] Allen | David Hartley on Human Nature[END_REF]. Further, Priestley believed that his monism was more in accordance with Biblical teaching than Cartesian dualism. Crichton was not the only one to oppose Priestley's materialism; another important opponent was Richard Price [START_REF] Thomas | The Honest Mind: The Thought and Work of Richard Price[END_REF].

Discussion and conclusions

Crichton's Classic Text which follows is a good example of the centripetal mode of doing the philosophy of psychiatry. A youthful work, it reflects his early conceptual interests as applied to the understanding of certain forms of madness. Although educated in Edinburgh, and then in continental universities, some of which were at the time (like Göttingen) influenced by the Scottish Philosophy of Common Sense, Crichton's style of formulating and resolving the problem is surprisingly Continental. It has been claimed that Crichton's work was influential on writers such as Pinel and Esquirol but the extent of such influence remains unclear.

The Classic Text has two recognizable sections: the first includes a general review of arguments in favour of a materialist view of the mind; the second is a sustained criticism of Priestley's reductionism as presented in his Disquisitions Relating to Matter and Spirit (1777). The arguments used by Crichton are animistic and vitalistic in tone and redolent of the Stahlian ideas that Unzer learned from Juncker at Göttingen.

By using an earlier version of the logic of double-dissociation, Crichton also argues in a less metaphysical way. As against Priestley's view that the integrity of the body is essential for the functioning of the mind, Crichton, on the one hand, quotes examples of elderly sages who continued producing major works in spite of the decrepit state of their bodies and, on the other, he refers to people who can be severely mentally impaired and yet their bodies are normal.

Notes

1. In the First Meditation, Descartes famously made use of 'delusions' to test the nature of perceived reality: 'And how could I deny that these hands and this body are mine, were it not perhaps that I compare myself to certain persons, devoid of sense [original Latin text: nescio quibus insanis], whose cerebella are so troubled and clouded by the violent vapour of black bile [cerebella tam contumax vapor ex atrâ bile labefactat] that they constantly assure us that they think they are kings when they are really quite poor, or that they are clothed in purple when they are really without covering …' (English text : Descartes, 1967: 145; Latin text: Descartes, 1996, 18-19). 2. On the complex history of the concept of 'Understanding' or Verstehen see: [START_REF] Eisler | Verstehen[END_REF]McCarthy, 1974. 3. The 'anomaly' was defined in terms of ascertainable anatomical, physiological or chemical change (see [START_REF] Canguilhem | Le Normal et le pathologique. 3rd edn[END_REF]. 4. With minor technical changes, this view still holds today: the observational link has been replaced by a 'statistical correlation', and its ascertainment is measured in terms of an arbitrarily defined statistical significance. 5. The view that this alliance seems now written in stone should not make the historian forget the fact that it is man-made and that if in the future society wished to manage the phenomena of madness differently (on grounds moral, economic, legal, aesthetic, etc.), it will see to it that the partnership is soon dissolved. Experts in post-hoc justifications will then have no difficulty in declaring the new arrangement superior. 6. The helper represents society and carries with him or her the primary (social, moral, aesthetic) definitions of mental disorder. On the social and epistemological complexities of the act of diagnosis see: [START_REF] Chertok | Les Empêcheurs de penser en rond)[END_REF][START_REF] Laín-Entralgo | Salvat)[END_REF], 1983. 7. The act of insight can be said to round off or complete the process of diagnosis in the sense that it makes the sufferer an active participant in the process (on the concept of insight, see [START_REF] Marková | Insight in Psychiatry[END_REF]. 8. On the concept of proxy, see Berrios & Marková, 2002. 9. For example, there is plenty of historical evidence to state that although the term melancholia has been in use for more than two millennia, the referent of the term has changed at various times to the point that so-called 'histories of melancholia from the Greeks to the present' are just histories of the use of the word and not of some perduring disease [START_REF] Berrios | Melancholia and depression during the 19th century. A conceptual history[END_REF]. 10. Such is the case of phrensy, delirium, acute confusional state, acute organic disorder, etc. [START_REF] Berrios | Delirium and confusion in the 19th century[END_REF](Berrios, , 1999a) 11. For an analysis of the differences, see [START_REF] Berrios | Biological psychiatry: conceptual issues[END_REF] 12. The case of the 'aural haematoma' is well known -a very coherent and scientific disorder during the 19th century (Berrios, 1999b). 13. On the issue of incommensurability of the theoretical content of different epistemes, see Sankey, 1994. 14. This philosophical locus communis refers to Wittgenstein's claim (1963), at the end of the Tractatus: 'My propositions serve as elucidations in the following way: anyone who understands me eventually recognizes them as nonsensical, when he has used them -as steps -to climb up beyond them. (He must, so to speak, throw away the ladder after he has climbed up it.) He must transcend these propositions, and then he will see the world aright.' (6.54) 15. By 'invariant' it is meant here an object which is considered autonomous, stable and transhistorical, that is, a token of a 'natural kind' [START_REF] Laporte | Natural Kinds and Conceptual Change[END_REF]. This ontological view of disease is favoured by current official psychiatry which conceives of mental disorder (be it schizophrenia, melancholia, Asperger's syndrome or Attention Deficit Hyperactivity Disorder) as a genetic condition expressed in a more or less fixed 'phenotype' that would be the same (with minor pathoplastic allowances) in all cultures and historical periods. So popular has this view become that in psychiatric parlance the term 'phenotype' is (rather stupidly) replacing those of 'clinical presentation', 'symptomatology', 'clinical profile', 'phenomenology', etc. 16. The histories of psychiatry and of art construct their objects of inquiry in similar ways.

From early times, the history of art was confronted with the epistemological question of how to define its object (e.g., [START_REF] Bazin | Histoire de l'histoire de l'art[END_REF]. The problem was not ontological, i.e., it was not due to the fact that the object of art is an elusive abstraction. The object of art, in fact, is ordinarily inscribed in tangible matter (stone, canvas, colour pigments, etc.). The issue was to decide: (1) what is object of art, and (2) whether its correlated pattern of material inscription can be used in the future to decide whether some other object is also an object of art. Nowadays, few experts will claim that such a decision can be taken on the basis of an analysis of a material substratum. In other words, the decision will continue to be taken in terms of social and aesthetic values unrelated to chemistry, physics, x-ray technology, etc. The same can be said of 'mental disorder', the object of inquiry of psychiatry. The issue is not whether or not mental disorder is inscribed in the brain. The issue is whether the decision that a particular behaviour constitutes mental disorder can be taken on the basis of an analysis of the brain alone. The answer is that it cannot. 17. For an overview and bibliography of the historiography of philosophy, see [START_REF] Walton | Bibliography of the historiography and philosophy of the history of philosophy[END_REF]. 18. For example, Thomas Stanley (1655) [START_REF] Brucker | [END_REF]-62), Tiedemann (1791-97) and Tennemann (1798Tennemann ( -1819)). There has recently been an interesting effort to show that Brucker's historiography was more refined and concept-aware than had been thought hitherto [START_REF] Piaia | Brucker versus Rorty? On the 'Models of the Historiography of Philosophy[END_REF]). 20. For example, C. E. Heumann's Acta philosophorum (1715-28). 21. The term 'doxography' names a work that lists summaries of philosophical views without analysing quality or context. Described (and criticized) with grace by [START_REF] Passmore | Philosophy, historiography of[END_REF], the doxographic approach became a bête noir for [START_REF] Rorty | The historiography of philosophy: four genres[END_REF]. 22. This model is well illustrated by the linear and progressive histories of philosophy published during the 17th century (e.g., [START_REF] Stanley | The History of Philosophy, Containing Those on Whom the Attribute of Wise was Conferred[END_REF]. 23. The social and cultural phenomenon of secularization can de described as the abandonment of religious, theological, divine, etc., explanatory hypotheses for the existence of the world. Interestingly enough it is not free from controversy. Some have argued, for example, that the concept is superficial and confused and assumes a false view of religion. By adapting to science and the new cultural practices, religion is in fact showing its vitality and significance (Hammond, 1985). 24. This refers to the concept of recurrent history re-developed by G. B. Vico during the 18th century [START_REF] Trabant | Neue Wissenschaft von alten Zeichen: Vicos Sematologie[END_REF]. The cyclical view of history has, however, a long tradition in the west [START_REF] Trompf | The Idea of Historical Recurrence in Western Thought. From Antiquity to the Reformation[END_REF]. 25. The Classic Text that follows is a good example of this. 26. For example, earlier in his life, Karl Jaspers resorted to a form of 'phenomenology' to analyse the problems of psychiatry. At the time, this philosophical movement was totally external to psychiatry [START_REF] Berrios | Phenomenology, psychopathology and Jaspers: a conceptual history[END_REF]. 27. In this regard, the efforts by [START_REF] Hempel | Fundamentals of taxonomy[END_REF] and [START_REF] Kendell | The Role of Diagnosis in Psychiatry[END_REF] are well known. 28. See, for example [START_REF] Fulford | Oxford Companion of Philosophy and Psychiatry[END_REF]Radden, 2004. 29. In philosophy, 'syncretism' refers to the mixing of fragments of doctrines and views without bothering about their contradicting each other (for a comparison of syncretism with 'analysis' and 'synthesis', see [START_REF] Renan | L'Avenir de la science[END_REF]. Comparing philosophia eclectica and philosophia syncretica, Brucker (1744, Vol. 4: 5) believed, was like comparing light and darkness (et lucem comparemus cum tenebris). 30. 'Pluralism' is an old philosophical term which has been rehashed of late to name complex states believed to be refractory to a unifying, unitary, homogeneous account, and which need to be resolved piecemeal by solutions taken from different philosophical systems [START_REF] Spinner | Pluralismus als Erkenntnismodell[END_REF]. Originally developed as a reaction against 19th-century monism, the pluralist movement included thinkers like Lotze, Wundt and Renouvier (Boex-Borel, 1909).

In the field of psychiatry pluralism is just another name for the old 'multi-model' solutions of the 1960s (when the issues involved were written about with more grace and scholarship; see, for example, [START_REF] Siegler | Models of Madness, Models of Medicine[END_REF]. The problem with the pluralistic approach is that it makes premature assumptions as to the nature of psychiatry and reflects (rather than analyses) a superficial Pax Romana that has been achieved by those practising psychiatry from medical, psychodynamic, behavioural, social, etc., perspectives.

However, the whole point of doing the philosophy of psychiatry is to cut through these arrangements in order to find out whether thinking anew about the fundamental concepts of psychiatry may identify/create a deeper conceptual unity. It is not the job of philosophy tamely to justify the professional parcelling of psychiatric practice but to throw light on its foundations. 31. For a recent example of this form of analysis, see [START_REF] Berrios | Symptoms -historical perspective and effect on diagnosis[END_REF]. 32. See: Blanc, 1998;[START_REF] Galimberti | Psiquiatria e fenomenologia[END_REF][START_REF] Lanteri-Laura | Psychiatrie et connaissance[END_REF], 1963;Laudan, 1983;[START_REF] Palmer | The Philosophy of Psychiatry[END_REF][START_REF] Reznek | The Philosophical Defence of Psychiatry[END_REF]Rigoli, 2001;Sass, 1992;[START_REF] Sauri | El naturalismo psiquiátrico[END_REF][START_REF] Spiegelberg | Phenomenology in Psychology and Psychiatry[END_REF]Taylor, 1979, etc. 33. For example, this was the thinking of Henry Wilde when in 1898 he endowed the 'Wilde Readership in Mental Philosophy' at Oxford with the provision that the incumbent should treat the 'subject in a non-experimental way'. The fact that the earlier incumbents were either psychiatrists or theoretical psychologists (Stout, McDougall, Brown, Farrell) did conceal the ideological bias built into these terms of reference. It became patent after the appointment to the (now) Wilde chair of professional philosophers (Evans, McGinn, Davies, Campbell, and Davies again) [START_REF] Oldfield | Psychology in Oxford 1898-1949[END_REF]. 34. For a criticism of this naïve view, see Bennett and Hacker, 2003. 35. Philosophizing on madness does of course start much earlier and can be found in, inter alia, Erasmus, Hobbes, Descartes, Spinoza, Locke, Hartley and Priestley. The specific issue about Crichton is that he was a physician who, while writing a book on mental derangement, decided to draw from it some philosophical implications. Chiarugi, Reil, Heinroth, Pinel, Esquirol, Royer-Collard, etc., did likewise. 36. He wrote a confidential report on the mental state of George III, but this was never published. 37. Here Pinel seems to be making a difference between the classical concept of passion which at the time was already on its way out and the new concept of 'emotions', a term which Brown was going to introduce for such non-cognitive phenomena in 1820 [START_REF] Dixon | From Passions to Emotions[END_REF]. 38. Here Pinel was quoting himself from a publication of 1798; see Gauchet and Swain, 1980: 347. 39. For information on Laycock see: [START_REF] James | The life and work of Thomas Laycock 1812-1876[END_REF][START_REF] Leff | Thomas Laycock and the cerebral reflex: a function arising from and pointing to the unity of nature[END_REF]. 40. On Tuke, see: Ireland, 1895;Renvoize, 1991. 41. Note appearing in page 5 of D. H. Tuke's copy of Crichton's book; deposited in the library of the Royal College of Psychiatrists, London, UK. 42. Upon graduating in 1784, Crichton became a member of the Royal Physical Society.

Founded in 1771 and chartered in 1788, this Society was dedicated to the natural and physical sciences; its membership included amateur naturalists some of whom were also moral philosophers. In that company, it is most unlikely that Crichton would not have heard of Reid or Stewart. The latter had started teaching moral philosophy in Edinburgh in 1778 when he was asked to stand in for Adam Ferguson who formed part of the British Delegation that visited the USA, following the British defeat at Saratoga. 43. In his important book on the influence of Scottish Common Sense philosophy in Germany, [START_REF] Kuehn | Scottish Common Sense in Germany 1768-1800[END_REF] states that Göttingen University (where Crichton spent some time studying) was one of its main German receptors, listing Feders and Meiners as examples of followers of the Scottish ideas. Indeed, one of the books that Crichton (1798: xxviii) mentions as having influenced him greatly is Feder's 'excellent work on the human will'. Johann Georg Heinrich Feder (1740-1821) was a Bavarian thinker who, following the Scottish Ideas, opposed Kant's philosophy [START_REF] Ziegenfuss | Philosophen-Lexikon. Handwörterbuch der Philosophie nach Personen[END_REF]. The book Crichton refers to is the Grundlehren [START_REF] Feder | Grundlehren zur Kenntnis des menschlichen Willens und der natürlichen Gesetze des Rechtverhaltens[END_REF]. Christoph Meiners (1747Meiners ( -1810) ) was the other follower of Scottish philosophy at Göttingen University. Also opposed to Kant, he published an important book on psychology based on associationism [START_REF] Meiners | Grundriss der Seelenlehre[END_REF] which is not mentioned by Crichton.

  , whose work went through various editions, concentrated mainly on Greek philosophy with a later volume on Chaldaic thought. Stanley identifies two types of history: 'one represents generall affairs of state; the other gives account of particular persons, whose lives have rendred them eminent …' (Preface, p. 1). 19. Suffice it to mention major works by

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The attempt to define the nature of the mind, or soul, is as vain and presumptuous an undertaking as it is to try to find out, by thought alone, the nature of the Almighty: or whether he existed before time, or had himself a beginning. We have no means of throwing any light on such subjects as these, inasmuch as we have neither any direct facts which explain them, nor have we even the most distant analogies to justify and direct speculation. Whether we elevate our thoughts to the heavens and consider the various constellations which enlighten the firmament, in the hope of discovering its wonderful fabric, or depress them to the globe which we inhabit, and analyze the many objects it presents to our senses; whether we take a grand and comprehensive view of the whole frame, and structure of the world, or examine with a curious and inquisitive eye, the minuter parts of which it is composed, we shall find on every hand certain boundaries, beyond which it is impossible to penetrate either with success or safety.

The limits of human reason are clearly marked, and may be easily discerned by every inquirer, with whatever ardor his researches be conducted, provided his judgment be not fascinated by the passion of pride, or not encumbered with the strange and irremovable prejudice, that the powers and perfection of man have no limits.

The conclusions, indeed, which are drawn concerning the more hidden secrets of nature, by some great luminaries of the present age, are done with so much apparent ease and quickness, as to shew that they have not run any