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


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.

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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.


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

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Correspondence to Michael N. Healey.

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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 ( 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.

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

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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.



See Figs. 4 and 5.

Fig. 4

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

Fig. 5

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

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Healey, M.N. Assembling Adjustment: Parergasia, Paper Technologies, and the Revision of Recovery. Cult Med Psychiatry 45, 405–428 (2021).

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