HSTCMP 410 A Medicine History Society Medicalization May

HSTCMP 410 A: Medicine, History, & Society Medicalization May 11, 2016 Laura Harkewicz, Ph. D. 1

Agenda Discussion of influenza film (small & large group) --- Collect essay Recap Brief history psychiatry Medicalization Vitamins Hospitalization of childbirth Gender & marriage Medicalization today 2

Sigmund Freud & Psychoanalysis Studied with Charcot Between 1890 s & WWI, Sigmund Freud stressed diagnosis and therapy through clinical observation & theorizing Mind governed by the unconscious Because of link to Charcot, psychoanalysis has never been able to fully escape the charge that success is a product of suggestion, not a true cure (1856 – 1939) 3

Sigmund Freud & Psychoanalysis Studied with Charcot Between 1890 s & WWI, Sigmund Freud stressed diagnosis and therapy through clinical observation & theorizing Mind governed by the unconscious Because of link to Charcot, psychoanalysis has never been able to fully escape the charge that success is a product of suggestion, not a true cure (1856 – 1939) 4

Freud & shell shock “Conversion” – the puzzling leap from the mental to the physical Soldiers often displayed physical symptoms such as paralysis, muscular contracture, and loss of sight, hearing, or speech with no apparent physical basis. Freud’s theories of neuroses explained these as “conversion hysteria” – symbolic representations of suppressed memories and unconscious conflicts 5

The public & psychotherapy 1919, The Saturday Review - Freud’s books now “discussed over the soup with the latest play or novel” 1950 s – all kinds of “complexes” and neuroses including: Juvenile delinquency, housewife blues, family conflicts, alcoholism, adjustment problems, & generational conflicts Popular films like Rebel Without a Cause featured images of “crazy, mixed-up kids” Leading to the “psychiatrization of everything. ” 6

From psychiatrization to medicalization 7

“Medicalization”: The extension of medical practice & ideology to ever-widening areas of life & the transformation of human conditions into treatable disorders Reflection of mechanistic ideas – now not just body, but all aspects of life as something that may be described via chemical, physical processes (e. g. scientifically/medically) 8

Three sections to today’s lecture: 1) Vitamins & medicalization of food 2) Transformation of hospital & hospitalization of childbirth 3) Chemistry of hormones & medicalization of sex and marriage 9

1) Vitamins & the medicalization of food Dutch troops in Indonesia - beri Sinhalese for “I can’t. ” Characterized by fatigue, musclewasting, nerve damage, constipation, and cardio-vascular complications. Institutional contexts of disease 10

The Beriberi Bacillus Germ theory dominant Possible relationship to poor diet ignored Believed infectious People who contracted it were isolated Sanitary measures seemed to help But beri returned 11

Uncertainties remained Microbe? Toxin? Failed to satisfy Koch’s postulates: Microbe must be present in all cases of the disease and absent from healthy subjects Microbe must be able to be isolated and cultured Microbe must be able to infect healthy animals New microbe must be same as original 12

Christiaan Eijkman (1858 – 1930) Dutch physician and professor of physiology Disciple of Koch Director of lab in Batavia (Jakarta) Indonesia Used chickens to try and isolate bacillus 13

The chickens and rice observation Fed white rice – chickens suffer from beri Given the brown rice they recovered An experiment followed (see right) 14

The experiment continues In 1895, Eijkman decided to test his theory on people Chose prisoners Found prisoners who were fed white (polished) rice were more likely to get beri than those fed unpolished (brown) rice. 15

Frederick Gowland Hopkins (1861 – 1947) English biochemist Foods contained trace substances essential for health In 1912, fed rats various diets “Astonishingly small amounts” essential for sustenance “Accessory food factors” 16

Kazimierz (Casimir) Funk (1884 – 1967) Polish-born biochemist Worked on isolating the substance in brown rice that appeared to prevent beri Succeeded in 1912 17

Vitamins Because the substance contained an amine – a compound derivable from ammonia – he named it a “Vitamine” – a vital amine Designation Vitamin A, B, C, etc. roughly corresponds to the order in which these substances were identified 18

Vitamins and more vitamins Vitamin A was later found to be two substances – the second christened Vitamin D Vitamin B was similarly split into various different chemicals Turns out beri is caused by Vitamin B 1 (thiamine) deficiency In 1929, Hopkins and Eijkman won the Nobel Prize for Physiology and Medicine for their discovery of vitamins 19

Consumer marketing AMA opposition 1941 – FDR summoned National Nutrition Conference for Defense By 1943, enrichment of foods like flour, bread, and milk are mandated by War Food Administration Good nutrition imperative to national defense 20

Science of Nutrition 1920 s - “science of nutrition” one way women entered medical research “Domestic science” turned the kitchen into a laboratory All of life became a biochemical process The science of nutrition made the idea of a perfect modern citizen possible Health could be designed through nutrition 21

The Recommended Daily Allowance (RDA) When they got sick, just enough was added to make them “well” This is considered the Minimum Daily Requirement (MDR) A little bit more was added for “safety” – this is the RDA Good nutrition = model citizen = necessary for national defense 22

2) The hospitalization of childbirth 23

The transformation of the hospital From the 1880 s, hospitals included wellequipped and sterile operating theatres Alongside free beds for the poor, private rooms were built for paying patients 24

20 th c. - modern hospital =total institution with own labs & ambulance services Paying patients Patient chart 25

Childbirth in the hospital before early 20 th c. By the end of the 18 th c, maternity hospitals for unmarried girls Most married & wealthy women delivered at home 1870’s antiseptic procedures introduced in hospital obstetrics Now safer to give birth in hospital 26

Hospitalization of childbirth Before 1900 Impact of germ theory & antiseptic procedures Affects ideology of childbirth 27

Ideology of hospital birth In U. S. - midwives banned Hospital delivery only Birth as pathological process Injections Anesthesia Episiotomy Forceps Maternal mortality rates in U. S. hospitals stayed high 28

Reforms to hospital structure and practice Separate obstetric wards Penicillin Better training of gynecologists Statistics for hospital births improve In 1970’s, backlash against hospital childbirth began 29

3) Hormone research and the medicalization of sex Hormones - chemicals released by one organ & transported to other parts of the body to affect their functioning Questions about the regulation of sex characteristics 30

Endocrinology’s beginnings 1889 – distinguished French physiologist, Charles Édouard Brown -Séquard He treated himself with the juice from crushed guinea pig and dog testicles Boasted that he had renewed clarity and vitality Charles Édouard Brown-Séquard (1817 – 94) 31

Organotherapy became wildly popular Clinics opened worldwide Endocrinology was born 32

Hormones & sexual difference 1905 - “Hormone” from the Greek for “set in motion” Techniques were castration and transplantation Ovaries & testes removed from animals, cut into fragments, & reimplanted in different locations in the body Raw materials 33

Binary framing of sex hormones Males had male sex hormones and females had female ones 1920 s - discovery of male sex hormones in women and vice versa Break in the dualistic notions of gender Modern androgyny can be traced back to this period 34

Research into female sex hormones In 1923, zoologist Edgar Allen (1892 – 1943) Two Berlin gynecologists used this idea to determine how to diagnose pregnancy Collection of urine of pregnant women Crystals of estrogen were isolated in 1929 35

Research into male sex hormones 1931 a German isolates androsterone Amsterdam team - “testosterone” 1940 s - found that an extract from a wild yam growing in Mexico could be transformed in the laboratory into progesterone, cortisone, and testosterone 36

The Pill Norethindrone – inhibits ovulation Margaret Sanger (1879 – 1967) grant for research into effective hormonal birth control 1955 - clinical trial conducted among the poor in Puerto Rico 1957, the US FDA approved norethynodrel as a “menstrual regulator” Two years later is was approved as an oral contraceptive 37

Marriage Manuals New genre appearing in the 1920 s Used the writings of sexologists and endocrinologists to argue for the rationalization of marriage Marriage was failing 38

Theodoor Van de Velde (1873 – 1937) Ideal Marriage first published in German and Dutch in 1926 Van de Velde was a Dutch physician and gynecologist He is credited with showing – in 1905 – that women ovulate once per menstrual cycle This concept contributed to calendar-based methods of birth control 39

Van de Velde’s text Best seller Suppressed by Hitler in 1933 Book was grounded in Van de Velde’s own experience of one unhappy and one happy marriage. Book combines laboratory science with sex advice Included moral exhortations about monogamy 40