The essays in this topical issue illustrate the changing cultural form and function of the biopsyche disciplines – disciplines that are both sciences and technologies of selfhood. To varying degrees, each essay actively engages Paul Forman's thesis on modern and postmodern cultural valuations of science and technology. Forman invites those who read his work to view the cultural space framing science and technology in new ways (Forman Reference Forman2007; idem 2010).

I want to draw attention to several questions Forman's essays raise, not least because I think they help elaborate links among the essays in this issue. The first question relates to Forman's notion of entrepreneurial selfhood that he considers to be the ideal of postmodern neoliberalism. In important respects, this ideal appears to hark back to a century earlier when technological development likewise engendered a rising sense of confidence. Following the emergence of the mercantile-professional classes, one of the archetypal heroes of Victorian society was the entrepreneur-engineer. Recall all those spectacular bridges, rail lines, and sea-going vessels of Brunel and Stephenson – built by teams boasting practical know-how rather than scientific credentials and curious minds. While the semi-professional enclaves of science were governed by gentlemanly codes of self-erasure and trust, the instrumental power of their work had far wider currency. It was a staple of the popular shows and exhibitions of the era such as the Great Exhibition of 1851, and it was epitomized by the way scientists like Michael Faraday made the “practical wonders of electricity” educational entertainment for the masses. These were the prevailing images of the Victorian era – celebrated then, and re-celebrated now in a consonant age.Footnote ¹ They were hardly less pragmatic in the New World where the most prominent aspirational figures of American life were the storied arch-capitalists such as Carnegie and Rockefeller ruthlessly pursuing their own interests. The relevant heroes of the period were technologist-inventors such as Bell and Edison, rather than the extant trained scientists.Footnote ²

Nineteenth-century notions of selfhood were framed by the contesting discourses of liberalism, church, and state. Even so, self-fashioning was positioned as an essentially private task on both sides of the Atlantic, with self-surveillance the moral key. As Patrick Joyce has argued, making sense of a life required making it into a story (Joyce Reference Joyce1994). Narrative was central to assembling the fragmented elements of lived experience and social imagination. Diaries and letters, the fountain pen and the printing press, were all crucial practices and tools, animated by tropes of hope, providence, and liberty that gave a life a sense of purpose and direction. The ideal of the productive, self-made man began to displace that of the uniquely gifted individual. Towards the end of the century, new mathematical procedures for mapping populations and partitioning developmental influences – accompanied by Darwinian fears of the unfit and degenerate – demonstrated ways in which the individual had come to be seen as a variable, composite entity. The self was now a scientific and political project, the site of a range of sponsored interventions. The new century saw increasingly deterministic notions of self-development articulated by disciplines such as psychiatry, psychology, and anthropology that connected the individual to the state in more inclusive ways. Political and economic upheaval, and both world wars, would contribute to the further dismantling of liberalism. Modern selfhood became a partnership of the individual, science, and the state (Eghigian et al. Reference Eghigian, Killen and Leuenberger2007).

While I am painting with a rather broad brush, I think there are insights to be gained in the wash-up of perspectives. The cultural valorizations of science and technology that Forman links to modernity arguably represent an interregnum between two periods of self-directed, technologically enabled individualism, an interregnum most coherently represented in postwar America. Having inherited the role of unambiguous Western leadership, higher-order values reached a premium in the land of the free. Much was poured into this deferential trust well: enhanced institutional arrangements and new forms of oversight geared up Big Science. While much of this research was military-backed, the pure science ideal attained an historic cultural apogee. The way men such as Einstein, Teller, and Pauling became iconic figures spoke of science positioned as the most authoritative arbiter of public knowledge and warranted belief. Entrenched in hierarchical structures of knowledge and expertise, authority and power, the enjoined quest for ultimate answers became a key part of the narrative of progress of this distinctly apprehensive era.

Only Andrew Scull's magisterial career coda in this volume covers the full chronological sweep of these changes. Scull identifies three largely incommensurate eras in US psychiatry, marked by distinctly different institutional bases, understandings of “mental illness” and favored treatment modalities. While Scull's narrative may be at odds with “March of Progress” rhetoric, it shows that psychiatry went from institutional recluse, far from the mainstream of medicine, to a degree of integrated respectability and a provisional seat at the high table of cultural influence. It is the story of a discipline with a penchant for reinvention. The arrival of the landmark Diagnostic and Statistical Manual (DSM) III in 1980 and the subsequent re-assertion of bio-pharmacological approaches dovetails nicely with the onset of Forman's version of postmodernity.

What do we make of the initial asylum-based period of American psychiatry punctuated by what now looks like reckless somatic experimentation? When considered in light of these adjustments to Forman's thesis, the three-act structure of Scull's essay makes sense. If psychiatry was a formatively modernist discipline, then its backwater status had made it inherently insular and conservative. Early twentieth-century therapeutics – such as they were – involved all sorts of devices and contraptions that doused and shook patients, only to be replaced by a range of new techniques that sedated or shocked them. Trenton asylum superintendent Henry Cotton and Chicago physician and surgeon Bayard Holmes could be considered pioneering psychiatric entrepreneurs, holdovers in a country still struggling to upgrade its higher education and medical research sectors. They were driven into action by the do-nothing malaise they saw as blighting their psychiatric brethren. They followed the example of laboratory medicine the only way they could, by taking ideas imported from the Continent and turning them to their own ends (Scull Reference Scull2007; Noll Reference Noll2011). Like the psychosurgeons Freeman and Watts who followed them, these medical showmen emphasized the transformatory power of their breathtaking forms of surgical intervention. Despite their excesses, and some behind-the-scenes reservations about their actual results, these men were lavishly praised by contemporary disciplinary leaders as examples of what psychiatry should aspire to. The impulse to intervene in this fashion was reprised in a very different context several decades later, as Brian Casey shows, with both familiar and divergent consequences.

One aspect of US psychiatry's history that still intrigues is the mid-century transformation from asylum-based custodial practice to outpatient consultative practice, catalyzed by the astonishing ascendency of psychoanalysis. Both world wars had functioned as the laboratory incubus for Freudian therapeutics, one a dress rehearsal for the next. The difference the second time around was that analytically-inclined American psychiatrists were well-positioned to mount a disciplinary takeover. While fully credentialed analysts never amounted to more than 10 per cent of the profession in the US, they held a disproportionate influence in the immediate postwar years. Analysts headed a majority of the university psychiatry departments and dominated the executive of the American Psychiatric Association (APA). They wrote the textbooks, helped fashion the cursory diagnostic schemes of the period, and tended to represent the public face of the discipline.

The psychoanalytic turn in American psychiatry makes sympathetic contextual accounting a challenge, and indeed makes it tempting to asymmetrically dismiss it as a grave error, a disastrous cul-de-sac. Yet for many bright young medical graduates in 1950s America, psychoanalysis had an overwhelming appeal; it made psychiatry one of the specialties of choice at the time.Footnote ³ Psychoanalysis, it seems, pointed towards therapeutic progress. Sourced in the first instance to the charisma of one man, it had internationalist foundations and an immersive, insular epistemology sharply at odds with materialist medicine. It may well have offered a distinct body of knowledge oriented to treatment in comfortable offices rather than bleak institutions. However, it was only “medical” by fiat, courtesy of the context it was inserted into rather than its content. It was indeed an odd fit, as Scull remarks, built upon what now looks like inherently unstable foundations.

There were also some distinctly modern aspects to the appeal of psychoanalysis. In its classical “analysis interminable” form it represented a proceduralist zenith, ends totally subordinated to proper means. Such a model of therapeutic practice could only be indulged in an era sympathetic to such values. It also possessed an oracular mystique, and US psychiatrists heightened this by instituting some of the tightest guild controls over training and practice anywhere in the world. Psychoanalysis became a prized boundary object, with an intellectual cachet intensified by its exclusivity. It also promised ultimate answers. As Jason Miller suggests in his essay on Henry Murray and the Thematic Apperception Test (TAT), psychoanalysis could be positioned as the universal key to the underlying Ur-narrative of selfhood. Psychoanalysis suggested hidden depths, inaccessible and unintelligible to the untrained. It rendered the injunction “know thyself” necessarily expert-assisted, a hugely empowering motif for those deemed expert in delivering this kind of almost incommunicable, elite knowledge.

Psychoanalysis conveyed deeply paternalistic values in a deeply paternalistic age. Technologies and interpretative approaches that drew on it mirrored those values, as was the case with the TAT. It seems hardly accidental that Murray, a product of East Coast privilege, educated in medicine and besotted with the power of Jungian intuition, should have turned out an assessment device that gave the psychologist-tester the first and final word. It was a role Murray modeled on his own sense of omniscience, as Miller makes plain. Murray was American psychology's very own patrician seer, doctor of the soul. While his TAT was stripped of its pre-modern narrative elements after the Second World War and given a quantitative basis to universalize its purview, it retained this interpretative conceit – the two worlds of tester and testee that structured the exchange between them. According to Rebecca Schilling and Stephen Casper, the Minnesota Multiphasic Personality Inventory (MMPI) underwent a similar transformation, but from a very different starting point. Ingeniously conceived by “backyard inventor” Starke Hathaway as a practical aid to psychiatric diagnosis, the MMPI metamorphosed after the war as a complete test of personality (Buchanan Reference Buchanan1997).

There were limits and tension to the modernist indulgences of psychiatry that would eventually reach crisis point. In its classical form, psychoanalysis emphasized the atavistic otherness of untrammeled desire; it represented a cautionary tale rationalizing the need for self-mastery to adjust to social arrangements as they stood. American psychiatrists and psychologists felt compelled to refashion its antagonistic elements – ego psychology was a prime example – and give it a more optimistic, directed spin wherein pathology was conceived as a failure of individuation rather than sexual renunciation. A more pervasive tension was psychoanalysis's apparent inability to conform to any acceptable model of science. After all, the most telling form of critique in the postwar period came from a philosophy of science perspective (e.g., Popper, Nagel, Cioffi) and focused on the non-scientific nature of psychoanalytic methodology rather than any lack of clinical efficacy. As Scull so clearly demonstrates, analytic indifference to quantifiable therapeutic outcomes, accessorized by all-important research grants and publications, was a corollary that would eventually prove costly.

As the paradigm exemplar of talk therapies, psychoanalysis helped fashion a demand for psychotherapy that inevitably invited interlopers – especially psychologists bearing contrasting, ends-oriented alternatives.Footnote ⁴ Therapists of all persuasions would founder on the rocks of 1960s counter-cultural critiques that cast them as paternalistic disciplinarians rather than empathetic healers. While some suggest that the affirmative “re-narrativizing” of Seligman's movement represents an overly prescriptive doctrine of self-improvement, it does illustrate a shift in both the object and style of postmodern interventions in the US and UK – now organized around the ideas of depression and happiness rather than anxiety and security (Held Reference Held2002; Brinkman Reference Brinkmann2008; Hayward Reference Hayward, Taylor and Alexander2012b).Footnote ⁵

Psychoanalysts found it especially difficult to recast their mode of delivery in less paternalistic ways. As a cultural force, psychoanalysis had helped bring psychiatry in from the cold. Many radical intellectuals, among them Marxists and anti-psychiatrists, had also sensed a liberatorary potential in the analytic corpus. Somewhat ironically, it played a minor enabling role in the revolts against entrenched forms of authority that froze out its practitioners.

Despite the public protests over its use in the 1960s, the MMPI survived these crises and remained a psychologists’ test. Unlike user-oriented assessment devices that emerged as joint exercises in de-pathologized, self-understanding (the Myers-Briggs Type Indicator is a good example), the training, access, and use of the MMPI remained under relatively tight regulatory control. The MMPI's rationale has remained true to the mantra Hathaway intoned in the face of charges of invasion of privacy and social control concerns: “professional use by professional people.” MMPI users have maintained their disinterestedness of its ends, despite its socially normative, quantitative means. A measured form of adaptation has allowed successive revisions of the MMPI to span eras. It retained its place as an adjunct tool in clinical practice (and as an important research device) by toning down some of its inquisitive content and moderating the sense of imposition it conveyed (Buchanan Reference Buchanan2002).

Psychoanalysis likewise survived far longer than many of its critics thought it would and should, partly as a result of its internationalist foundations and the independence of the training institutes. The professional usefulness of psychoanalysis as a boundary object and as a bridge to the community was exhausted by the 1970s. The fall of psychoanalysis seemed as over-determined as the rise of the DSM. Psychoanalysis finally departed the scene in the new millennium when changes in reimbursement policies saw US psychiatrists abandon almost all forms of talk therapy.

The “dissing” of disinterestedness in the 1960s and 1970s – the anti-test activists that Schilling and Casper cover, the anti-lobotomy protesters of Casey's essay – was symptom and perhaps cause of these changing times. American psychiatrists took the full brunt of these attacks from within and without. They reacted in some notably regressive ways, retreating to medical certitudes of biogenetic research and pharmacological treatment. The triumph of DSM III could partly be read in these defensive terms, as a means to ward off encroachment, as well as fulfill research needs and insurance industry imperatives. But it has had some unanticipated, ambiguously pro-active consequences. The way the DSM has been taken up by the public as a didactic technology facilitating the auto-critique of oneself and others goes beyond the “disease mongering” of psychiatrists and the “astroturfing” of syndromes by drug companies. In the age of agency, critical grief over the medicalization of normality should also factor in this sense of empowering consumer choice, however problematic it may seem. The public buys into testing, buys into diagnostic categories, to enlist support services and to shape and carry identities – turning these means to their own ends. The recent rise of patient and career movements of “post-psychiatry” has added to this impulse.

The preeminence of pills-for-all-ills exemplifies this commercial, ends-driven ethos, right down to the technical justifications themselves: the mechanism might be mysterious, only imputed effects matter. The license conceded to entrepreneurial Big Pharma is arguably the best exemplar of the instrumental postmodern disregard for scientific mores and methods, and moreover, occurs in the context of public demand and experimental self-medication, with many senior psychiatrists complaining that patients arrive on their doorstep demanding the quickest of pharmacological fixes. Feeling obliged to keep up, US psychologists have reluctantly pursued prescription privileges for over a decade.

Such observation raises a further question about these essays and their historiographic goals: can the layered structures of biomedicine really be accommodated by Forman's thesis, especially as we move toward the client-liaison complexities of clinical medicine? Forman could quite justifiably complain that his thesis was not meant to extend this far but the areas in which these essays transverse make it a relevant question. It is true that certain forms of medical disinterest have been destabilized in the last four decades. Public protests, counter-cultural critiques and a string of scandals have undermined medicine's imputed capacity to act according to patient interests and negotiate the collision between the scientific ethos and market forces. As a result, various forms of disciplinary autonomy – guild, administrative and clinical – have been reined back and restructured. Yet the chief means for doing so have been overwhelmingly procedural: from the organizational level of legislative oversight and managed service delivery to the clinical level of multi-disciplinary case handling, evidence-based protocols, and surgical theater safety checklists. In Forman's terms this is modernist medicine in a postmodern age, and it has not been without its tensions.

There are other interesting congruities, however. Those branches of biomedicine amenable to laboratory experimentation were able to reduce understandings of disease to pathological cells and processes. It was this means-oriented image – along with that of the paternal, saintly doctor – that resonated most in the modern era. But the discipline has now largely dispensed with the notion of embodied medical virtue, the singular healing figure wielding the ineffable methods of refined observation and experience-based intuition. And more or less on cue, biomedical reductionism has been complemented by the rise of the biopsychosocial model that emphasizes results in holistic terms. The patient has indeed reappeared to assert his or her priorities.

Indeed, perhaps the best case for Forman's thesis can be made for those biomedical sciences that hived off most completely from their parent discipline, but even then there are complications. Compare, for example, the contexts and values that framed Crick and Watson's supposedly “pure” and disinterested pursuit of a structural model of DNA to the decidedly mixed private and public means and ends in the race to map the genome four decades later. Justin Garson's essay points to the way physiologist Edgar Adrian's research shifted from the clinical-anatomical toward functionalist physics between the wars, framed by a pre-figurative (or premodern?) emphasis on technological possibilities and outcomes – a point ambiguously echoed in Jeremy Blatter's excellent study of Hugo Münsterberg. And Adrian did it using the vacuum tube, a piece of AV hardware that would play a ubiquitous role in the media-looping processes of twentieth-century subjectification.