Dear Editor,
McNally believes that my attempt to transcribe 19th-century descriptions of mental illness into modern diagnostic categories is ‘misguided’. The basis of his objection rests on what he calls ‘presentism’. This, to a non-historian, represents the retrospective analysis of past political or other events by present-day scholars according to their own biases, prejudices or preconceptions. But what is at issue here is my attempt to re-categorise the classification of signs and symptoms of psychotic mental illness devised by 19th-century psychiatrists. They arrived at their classifications through the identification of the same signs and symptoms of psychotic illness that patients exhibit today. Thus, thought disorder, delusions, hallucinations and other stigmata of psychotic illness have been clearly and unambiguously described for at least two centuries in the precise form we encounter today. This is apparent in the writings of, to take one example, the French school of psychiatry. Thus, Pinel, Esquirol and Georget as early as the 1820s described psychotic symptoms and arranged them in classifications that, to a large extent, determined those used in the Reports of the Inspectors of Lunacy of the famine years.
It is to these symptom groups that I applied the modern diagnostic concept of schizophrenia with the limitations that such an exercise involves and which I acknowledged. Nineteenth-century psychiatrists were preoccupied with nosology in a search for causes and treatments just as we today employ newer technology, such as genomics, to the same end. And in the light of these initiatives, our classifications of today may evolve further. An example of this is the increasing scepticism of a dichotomy between schizophrenia and other ‘functional’ psychotic illnesses. But as of today, in the sense in which I used it, schizophrenia endures.
Psychiatry as an interest of historians in any comprehensive fashion is of recent provenance (Goldstein, Reference Goldstein1987) but does not invalidate the attempts of psychiatrists and others to adapt the evolving technology of contemporary classification, with all its shortcomings, to 19th-century concepts of psychotic mental disorder. ‘Presentism’ might equally critically be applied to art historians in their application of newer investigative technologies, such as infra-red reflexography and dendrochronology, as complementaries to archival reappraisal in the re-attribution of authorship of pictures of the Renaissance.
That historians and psychiatrists can cross professional boundaries to mutual benefit is nicely illustrated in Pauline Price's recent volume of the history of the evolution of mental health care in Ireland (Prior, Reference Prior2012).
