Skip to main content

Assembling Adjustment: Parergasia, Paper Technologies, and the Revision of Recovery

Abstract

Drawing from research on ‘paper technologies’ conducted by medical historians Volker Hess and Andrew Mendelsohn, among others, this article explores how Adolf Meyer (1866–1950) and his staff at the Phipps Psychiatric Clinic used customized punch cards to develop an alternative conceptualization of schizophrenia: ‘parergasia.’ It begins by examining ‘dementia praecox,’ the conceptual precursor to both schizophrenia and parergasia, to explain how earlier paper technologies used to track patients transferred to asylums generated prognostic assumptions that precluded deinstitutionalization and community-based care. It then describes how Meyer's staff modified these technologies to define parergasia in opposition to dementia praecox and other diagnoses that resulted in prolonged hospitalization, primarily by conducting follow-up studies on discharged patients that correlated outcomes with various social factors. After demonstrating how the standardized forms used in these studies limited the possible metrics of recovery, it concludes by suggesting how Meyer's research influenced leaders of the community mental health movement, and prefigured later trends in psychiatric services.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

References

  1. Braslow, Joel T. 2013 The Manufacture of Recovery. Annual Review of Clinical Psychology 9: 782–785

    Article  Google Scholar 

  2. Drake, Robert E., Ellen R. Meara, and Gary R. Bond 2020 Policy Issues regarding Employment for People with Serious Mental Illness. In The Palgrave Handbook of American Mental Health Policy Howard H. Goldman, Richard G. Frank, and Joseph P. Morrissey, eds., Cham: Palgrave MacMillan.

    Chapter  Google Scholar 

  3. Engstrom, Eric J. 2003 Clinical Psychiatry in Imperial Germany: A History of Psychiatric Practice (Ithaca and London: Cornell University Press, 2003), 135–44

  4. Grob, Gerald N. 1966 The State and the Mentally Ill: A History of Worcester State Hospital in Massachusetts, 1830–1920 p 1966 Chapel Hill: The University of North Carolina Press

    Google Scholar 

  5. Grob, Gerald N. 1991 From Asylum to Community: Mental Health Policy in Modern America Princeton: Princeton University Press.

  6. Hess, Volker, and J. Andrew Mendelsohn 2010 Case and Series: Medical Knowledge and Paper Technology, 1600–1900. History of Science 48(3): 287–314

    Article  Google Scholar 

  7. Kasanin, J. 1939 Review of Analysis of Parergasia, by Gladys C. Terry and Thomas A.C. Rennie. American Journal of Orthopsychiatry 9(4): 817–818

    Article  Google Scholar 

  8. Klein, Ursula 2001 Paper Tools in Experimental Cultures. Studies in History and Philosophy of Science 32(2): 265–302

    Article  Google Scholar 

  9. Kraepelin, Emil. 1987 “Dementia Praecox.” In The Clinical Roots of the Schizophrenia Concept: Translations of Seminal European Contributions on Schizophrenia, translated and edited by John Cutting and Michael Shepherd, 13–24. Cambridge, New York, and Melbourne: Cambridge University Press. First published 1896.

  10. Lamb, Susan D. 2014 Pathologist of the Mind: Adolf Meyer and the Origins of American Psychiatry Baltimore: Johns Hopkins University Press

    Google Scholar 

  11. Lamb, Susan D. 2019 Neuroplasticity: A Century-Old Idea Championed by Adolf Meyer. Canadian Medical Association Journal 191(49): E1359–E1361

    Article  Google Scholar 

  12. Latour, Bruno. 1990. “Drawing Things Together.” In Representation in Scientific Practice, edited by Michael Lynch and Steve Woolgar, 19–68. Cambridge, MA: MIT Press, 1990.

  13. Leighton, Alexander H. 1952. Introduction to Mental Hygiene, xiii-xxviii. Vol. 4 of The Collected Papers of Adolf Meyer, edited by Eunice E. Winters. Baltimore: The Johns Hopkins Press.

  14. Leys, Ruth 1991 Types of One: Adolf Meyer’s Life Chart and the Representation of Individuality. Representations 34: 1–28

    Article  Google Scholar 

  15. Lidz, Theodore 1966 Adolf Meyer and the Development of American Psychiatry. The American Journal of Psychiatry 123(3): 320–332

    Article  Google Scholar 

  16. Logan, Cheryl 2005 The Legacy of Adolf Meyer’s Comparative Approach: Worcester Rats and the Strange Birth of the Animal Model. Integrative Physiological and Behavioral Science 40(4): 169–181

    Article  Google Scholar 

  17. Meyer, Adolf 1896 Review of Psychiatrie: Ein Lehrbuch Für Studirende Und Aertze, by Emil Kraepelin. American Journal of Insanity 53(2): 298–302

    Google Scholar 

  18. Meyer, Adolf 1898 Critical Review of the Data and General Methods and Deductions of Modern Neurology. Journal of Comparative Neurology 8(3): 113–148

    Article  Google Scholar 

  19. Meyer, Adolf. 1905. “Report of the State Pathological Institute for the Year Ending September 30, 1904.” In State Commission in Lunacy, Sixteenth Annual Report, 1903–1904. Albany, State of New York.

  20. Meyer, Adolf 1910 The Dynamic Interpretation of Dementia Præcox. American Journal of Psychology 21(3): 385–403

    Article  Google Scholar 

  21. Meyer, Adolf 1915 Organizing the Community for the Protection of Its Mental Life. The Survey 34: 557–560

    Google Scholar 

  22. Meyer, Adolf 1917 The Aims and Meaning of Psychiatric Diagnosis. American Journal of Insanity 74(2): 163–168

    Google Scholar 

  23. Meyer, Adolf 1957 Psychobiology: A Science of Man Springfield: Thomas Books

    Google Scholar 

  24. Morrissey, Joseph P., and Howard H. Goldman 1984 Cycles of Reform in the Care of the Chronically Mentally Ill. Hospital and Community Psychiatry 35(8): 785–793

    Google Scholar 

  25. Moure, La., and T. Charles 1915 A Study of the Statistics of the New York State Hospitals for 1913, with Special Regard to Statistics regarding Dementia Praecox. Boston Medical and Surgical Journal 173(20): 744–745

    Article  Google Scholar 

  26. Morrissey, Joseph P., and Howard H. Goldman 2020 Division of Labor: Function Shifts and Realigned Responsibilities in the Evolving Mental Health Services System. In The Palgrave Handbook of American Mental Health Policy Howard H. Goldman, Richard G. Frank, and Joseph P. Morrissey, eds., Cham: Palgrave MacMillan.

    Chapter  Google Scholar 

  27. Morrow, Marina 2013 Recovery: Progressive Paradigm or Neoliberal Smokescreen? In Mad Matters: A Critical Reader in Canadian Mad Studies Brenda LeFrançois, Robert Menzies, and Geoffrey Reaume, eds., Toronto, Ontario: Canadian Scholars’ Press.

    Google Scholar 

  28. Muncie, Wendell. 1939. Psychobiology and Psychiatry: A Textbook of Normal and Abnormal Human Behavior. St. Louis: The C.V. Mosby Company.

  29. Myers, Neely Laurenzo 2010 Culture, Stress and Recovery from Schizophrenia: Lessons from the Field for Global Mental Health. Culture, Medicine, and Psychiatry 34: 500–528

    Article  Google Scholar 

  30. Myers, Neely Laurenzo 2015 Recovery’s Edge: an Ethnography of Mental Health Care and Moral Agency Nashville: Vanderbilt University Press

    Book  Google Scholar 

  31. Noll, Richard 2011 American Madness: the Rise and Fall of Dementia Praecox Cambridge and London: Harvard University Press

    Book  Google Scholar 

  32. Padwa, Howard, Marcia Meldrum, Jack R. Friedman, and Joel T. Braslow 2016 A Mental Health System in Recovery: the Era of Deinstitutionalisation in California. In Deinstitutionalisation and after: Post-War Psychiatry in the Western World Despo Kritsotaki, Vicky Long, and Matthew Smith, eds., Basingstoke: Palgrave Macmillan.

    Chapter  Google Scholar 

  33. Porter, Theodore 2018 Genetics in the Madhouse: the Unknown History of Human Heredity Princeton and Oxford: Princeton University Press

    Book  Google Scholar 

  34. Pressman, Jack D. 1998. Last Resort: Psychosurgery and the Limits of Medicine. Cambridge, New York, and Melbourne: Cambridge University Press.

  35. Raz, Mical 2013 The Lobotomy Letters: the Making of American Psychosurgery p 2013 Rochester: University of Rochester Press

    Google Scholar 

  36. Rennie, Thomas A.C.. 1939 Follow-up Study of Five Hundred Patients with Schizophrenia Admitted to the Hospital from 1913 to 1923. Archives of Neurology and Psychiatry 42: 877–891

    Article  Google Scholar 

  37. Rennie, Thomas A.C.. 1943 Adolf Meyer and Psychobiology: the Man, His Methodology, and Its Relation to Therapy. In Papers from the Second American Conference on General Semantics Marjorie Kendig, ed., Chicago: Institute of General Semantics.

    Google Scholar 

  38. Rennie, Thomas A.C.., Temple Burling, and Luther E. Woodward 1950 Vocational Rehabilitation of Psychiatric Patients London: Oxford University Press

    Google Scholar 

  39. Richards, Esther L. 1941. Introduction to Psychobiology and Psychiatry: A Textbook for Nurses St. Louis: The C.V. Mosby Company.

  40. Rowe, Michael, and Allison N. Ponce 2020 How Shall We Promote Citizenship and Social Participation? In The Palgrave Handbook of American Mental Health Policy Howard H. Goldman, Richard G. Frank, and Joseph P. Morrissey, eds., Cham: Palgrave MacMillan.

    Chapter  Google Scholar 

  41. Sparks, Walter M. 1939. Review of Analysis of Parergasia, by Gladys C. Terry and Thomas A.C. Rennie. American Journal of Psychology 52 (3): 490–2.

  42. Srole, Leo, Thomas S. Langer, Stanley T. Michael, Marvin K. Opler, and Thomas A.C. Rennie. 1962. Mental Health in the Metropolis: The Midtown Manhattan Study, ed. Leo Srole and Anita Kassen Fischer. New York, Toronto, and London: McGraw Hill Book Company.

  43. te Heesen, Anke 2003 The Notebook: A Paper Technology. In Making Things Public: Atmospheres of Democracy Bruno Latour, and Peter Weibel, eds., Cambridge, MA: MIT Press.

    Google Scholar 

  44. Terry, Gladys C. 1933. “Genetic-Dynamic Aspects of Schizophrenic Reaction Patterns.” Henry C. Phipps Psychiatric Clinic, Baltimore, Maryland. Lecture. AMC XII/23/126.

  45. Terry, Gladys C., and Thomas A.C.. Rennie 1938 Analysis of Parergasia New York: Nervous and Mental Disease Monographs

    Google Scholar 

  46. The Johns Hopkins University School of Medicine 1929 The Johns Hopkins University Circular: Catalogue and Announcement for 1928–1929 of the School of Medicine Baltimore: The Johns Hopkins Press

    Google Scholar 

  47. The Johns Hopkins University School of Medicine 1931 The Johns Hopkins University Circular: Catalogue and Announcement for 1931–1932 of the School of Medicine Baltimore: The Johns Hopkins Press

    Google Scholar 

  48. Weber, Matthias M., and Eric J. Engstrom 1997 Kraepelin’s ‘diagnostic Cards’: the Confluence of Clinical Research and Preconceived Categories. History of Psychiatry 8: 375–385

    Article  Google Scholar 

  49. Wells, William D. 1956 The Use of McBee Keysort in Content Analysis. American Psychologist 11(1): 53

    Article  Google Scholar 

Download references

Acknowledgements

Access to archival materials and permission to include the images in Figures 1, 2, 4, and 5 was granted by the Alan Mason Chesney Archives of the Johns Hopkins Medical Institutions, while authorization to analyze protected health information was obtained by the Privacy Board of the Johns Hopkins Medical Institutions. The contents of this article are solely the responsibility of the author, however, and do not represent the opinions of the aforementioned entities. The author would like to specifically acknowledge the following: (i) Jeremy Greene, Graham Mooney, Angus Burgin and Mical Raz, for advising this project; (ii) the faculty and students at the Johns Hopkins University Department of the History of Medicine, for offering feedback on various iterations of this project; (iii) Marjorie Kehoe, Phoebe Letocha, and the staff and volunteers at Chesney, for supporting this archival research; and (iv) Anne Kveim Lie and the Biomedicalization from the Inside Out Project, for providing various opportunities to present and discuss this project.

Funding

The archival research upon which this article is based was funded by the Hugh Hawkins Research Fellowship for the Study of Hopkins History.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Michael N. Healey.

Ethics declarations

Conflict of interest

The corresponding author states that there is no conflict of interest.

Note Concerning Archival Sources

Sources obtained from the Adolf Meyer Collection (AMC) from the Alan Mason Chesney Medical Archives are cited using the three-part catalogue codes outlined in the finding aid (https://medicalarchives.jhmi.edu:8443/sgml/amg-d.htm). These numbers represent the ‘series’ (i.e. topical grouping), ‘unit’ (i.e. section within the series, when relevant), and the folder or box in which these materials were located. To consult these documents, please contact the Alan Mason Chesney Medical Archives, Johns Hopkins Medical Institutions, Baltimore, Maryland.

Note Concerning Protected Health Information

Unpublished documents containing protected health information (including medical records, transcripts from staff conferences, correspondences with patients and family members, reports from social services, and data from keysorter cards) are cited using numeric IDs, followed by brief descriptions of the type of source. These IDs were generated by the author and bear no relation to the record numbers generated at the time of admission or during subsequent research projects. The catalogue code described above was added to sources collected from the AMC, with folder numbers being omitted to protect the identity of each patient. Patients discussed in the main text are referred to by pseudonyms designated by the author. To consult these documents, please contact the Privacy Board, Johns Hopkins Medical Institutions, Baltimore, Maryland.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is the product of original research and has not been published elsewhere. Another essay based on similar archival materials has been submitted by the author to DIVISION/Review, a publication of the American Psychological Association's Society for Psychoanalysis and Psycho-analytic Psychology, but it discusses other cases and makes different arguments.

Appendix

Appendix

See Figs. 4 and 5.

Fig. 4
figure4

Front of keysorter (AMC XV, box 500,659)

Fig. 5
figure5

Back of keysorter (AMC XV, box 500,659)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Healey, M.N. Assembling Adjustment: Parergasia, Paper Technologies, and the Revision of Recovery. Cult Med Psychiatry 45, 405–428 (2021). https://doi.org/10.1007/s11013-021-09732-7

Download citation

Keywords

  • History
  • Mental health
  • Recovery
  • Schizophrenia
  • Paper technology