The literature of madness and how it shaped modern psychiatry

IN 1890, THE RUSSIAN PHYSICIAN and writer Anton Chekhov traveled across Siberia to document the lives of prisoners sentenced to a remote penal colony on Sakhalin Island. The visit inspired not only a nonfiction exposé but also several works of fiction, including a famous short story, “Ward Number Six,” about the ill-fated friendship of a doctor and a paranoiac patient in a rural Russian institution.

Science and medicine often provide the inspiration for literature, but graduate student Cate Reilly notes that the reverse also can be true. In an effort to establish psychiatry as a legitimate medical science, German physicians in the period from the 1890s to the late 1920s created a standardized terminology, one that eventually formed the basis of our present-day diagnostic manual of mental illness. Reilly, a doctoral student in comparative literature, is exploring how the literary descriptions of mental disorders by Russian and German-language fiction writers contributed to the science of mental illness in ways that stay with us today.

“The story that hasn’t been told is about the birth of these terms and how literature influenced the development of our current international classification system for mental disorders,” Reilly said. “This was all happening at a time of tremendous exchanges between psychiatrists in Germany and Russia. Those nations’ creative writers, some of whom were doctor-physicians like Chekhov, were involved in and contributed to this classification system.”

Reilly was inspired to explore this interdisciplinary area in part by modern debates over the extent to which definitions of pathologies are shaped by culture. At one time, mental illnesses included homosexuality and “indigenous psychopathology,” a diagnosis given by French physicians to native Algerians to justify their subjugation. “Once you have the standardization of these terms, then you start to see their abuse for purposes of power,” Reilly said.

Reilly explores how psychiatry and literature influenced each other during this critical time by citing works by Chekhov, Russian playwright Nikolai Evreinov, and German-language authors Rainer Maria Rilke and Alfred Döblin. For example, Evreinov’s dramas drew themes from German psychology and the anatomical-imaging technologies available during the 1880s and 1890s. Döblin’s 1924 “true-crime” novella, Two Girlfriends Commit Murder by Poisoning, about a court case involving lesbians who plotted to kill their husbands, featured pages of pseudoscientific diagrams to explain the women’s mental states.

“When creative writers influence what happens in psychiatry, it is not so much the case of a specific work of literature influencing a single term or definition, but the opening of a space for experimentation in how mental illness is characterized,” Reilly said. –By Catherine Zandonella