Extending the Boundaries of Psychiatry: The Professional Strategies of Richard von Krafft Ebing

Although revisionist historians of psychiatry have pictured nineteenth-century psychiatrists as powerful agents of social control, in fact their position within medicine, as well as in society at large, was precarious. During the first half of the nineteenth century doctors had won dominion over the most serious and dangerous forms of mental dysfunction, but their authority was basically confined to the walls of the lunatic asylum, which housed especially the chronically insane of the pauper classes. Moreover, even in the second half of the century, alienists, as they were often called at that time, had difficulties in convincing other scholars and the public that as physicians, they had an exclusive and scientific insight in the nature of insanity. For psychiatry to be accepted as a distinct branch of modern medical science, it was necessary to prove that mental disorders were organic diseases of the brain and the nervous system and that they could be cured. There was, however, hardly any anatomical or physiological evidence of the somatic basis of mental illness and as a therapeutic institution the asylum did not come up to expectations. Throughout the nineteenth century, psychiatry's scientific program remained inadequate and its intellectual and professional weaknesses made it vulnerable. Psychiatrists operated in the margins of medicine as well as of society.
Here I will deal with the career of the German-Austrian psychiatrist Richard von Krafft-Ebing (1840-1902) as an example to show in which ways late nineteenth-century psychiatrists tried to solve these professional difficulties and to promote the scientific as well as the social status of their specialty. To clarify Krafft-Ebing's professional strategies, I will focus on the close connections between the divergent cognitive contents of his work, the changing institutional setting of his psychiatric practice, and the shift in the social background of his patients.