Emese Lafferton's latest book is the first-ever comprehensive monograph concerning the history of psychiatry in Hungary. It is the result of decades of research, including the author's PhD dissertation, defended in 2003 at the Central European University. Considering the significant attention that historical aspects of mental health, mental disorders, and psychiatry have gained in recent decades, the availability of such work about the Hungarian case is a major development.
Some related fields have enjoyed extensive research interest, like the history of the Budapest School of Psychoanalysis or eugenics in Hungary, to which we will return later. Still, as is the case in other fields of Hungarian medical history, most of the previous literature on the history of Hungarian psychiatry focuses on biographies of doctors or histories of particular institutions. As Lafferton underlines, those works are rich sources of data, but they seldom exhibit methodical considerations (6).
The work's title suggests a scope of interest in the “long 19th century”; nevertheless, the main emphasis is roughly on the decades between 1850 and the end of World War I. The book follows a timeline, though the narrative is thematically as well as chronologically structured. Thus, the methodology is also diverse in terms of approaches: from institutional history to intellectual history, from legal history to statistical analysis, or the quantitative breakdown of thousands of case histories. Even microhistory is applied in chapters where the author discusses the daily life in the institutions by invoking fascinating, sometimes tragic and sometimes amusing, stories and anecdotes.
The nineteenth century saw dramatic changes in every discipline of Western medicine. Psychiatry was no exception; indeed, a new medical speciality was born. Thenceforth, “the mad” were considered to be patients who were supposed to be cared for and treated by specialist medical professionals in contrast to the harsh custodial measures of the earlier times. Naturally, these developments influenced those Hungarian doctors who treated mental disorders and reshaped their debates and professional identity. These changes also, however, coincided with the tectonic changes undergone by the country during those decades. Emerging capitalism, urbanization, and their consequences on society all affected the environment Hungarian psychiatrists were working in and triggered new mental health concerns or shed new light on old problems.
The important locations under study are the Schwarzer Private Asylum and the state Lipótmező National Lunatic Asylum. Other significant institutes discussed are the Budapest University Clinic, where the author details the emergence of scientific psychiatry in Hungary (193–244), and the Transylvanian regional institute of Nagyszeben (now Sibiu, Romania). The book also discusses numerous other special institutes and asylums.
The author recounts the reception and influence of various intellectual trends and scientific developments—and their attendant discourses—in detail. Lafferton outlines a wide intellectual landscape of new paradigms, from biological psychiatry to psychoanalysis, from the ethical considerations regarding treating people with mental health conditions—like the controversy over physical restraint—to legal aspects or the ideas and implementations of alternative methods, for example, family care and colonies (254–63). It is worth noting that Lafferton not only shows the perception and adaptation of thoughts from abroad but she also pays attention to locally developed ideas. For instance, she dedicates a subchapter to explaining the theory of Ferenc Schwartzer, the founder of the private asylum mentioned above (116–26).
Reconstructing arguments of the various debates, Lafferton shows how doctors from different backgrounds held very different views. For example, practical-minded psychiatrists working in asylums saw their discipline differently than their colleagues in academia.
Among the ideas mentioned, Lafferton refers to the concept of “degeneration,” which also gained popularity among Hungarian psychiatrists (330–32) and was closely related to eugenic thinking (340–44). In my opinion, however, Lafferton underestimates the influence of eugenics on fin de siècle and early twentieth-century Hungary (363).
A merit of the book is the bigger picture of the societies and inequalities of both post-revolution Hungary of the 1850s and the liberal era following the Austro-Hungarian Compromise of 1867. Of course, uneven access is unsurprising in the case of the Schwartzer Asylum, a private enterprise, which was mostly available for patients from a more affluent background. It is quite fascinating, however, how social stratification shaped the Lipótmező state institution, too, where patients were not only separated by sex or by the severity of their illness but also by their financial status (151).
Given the ethnic and religious diversity of pre-Trianon Hungary, passages discussing their effects on mental health care are particularly interesting. Nationalism comprises another compelling layer. For instance, it is notable how nationalistic arguments were used in advocacy for the creation of the National Asylum, connecting the national goal with civilizational ambition (20–21). As expected, gender discourse also appeared prominently within Hungarian psychiatry.
Chapter 8 is the last substantive chapter that covers the turn of the century years. Its topic deserves a dedicated book due to its intriguing complexity. Psychiatry was already an established speciality, with decades of experience and a settled institutional system. The country had already undergone a dramatic transformation, and new problems had emerged that impacted mental health. Prostitution and syphilis paresis, alcohol abuse, crime, and finally, during World War I, war neurosis or shell shock were all concerns psychiatrists had to deal with both intellectually and in practice.
Emese Lafferton's complex work demonstrates how medical history transcends its disciplinary boundaries: in addition to psychiatry, readers will learn just as much about its historical and social context. Students of medical history may also find the book of value, as the case of Hungary can provide insights that are not found in the discussions of psychiatry in the core Western countries that comprise the majority of the English language literature on the topic.
