A Premature Obituary Edward C. Spitzka and the American Psychiatry of 1878

On March 4, 1878, at a meeting of the New York Neurological Society, Edward C. Spitzka delivers a blistering attack on psychiatry, basically dismissing all alienists as incompetent and indicating that "the study of insanity should be considered a subdivision of neurology." This address was published in the Journal of Nervous and Mental Disease in 1878 and reproduced in the current issue of the journal. Spitzka asserts that "nothing worthy of notice has proceeded from our insane asylums" and that asylum superintendents may be experts in many things, but they are not experts in the "diagnosis, pathology, and treatment of insanity." To ascertain whether or not Spitzka's characterizations were correct, I examined the medical and psychiatric literature published in English only in 1878. This review indicates that Spitzka was largely wrong. Research was not what it should have been, and the alienists (psychiatrists of that era) knew it. American alienists, however, were otherwise engaged in all manner of deliberations about important issues of the day relevant to the practice of psychiatry. In fact, to an absolutely remarkable degree, the issues of 1878 are the same as those of American psychiatry in the 21st century. That might say much more about psychiatry than Spitzka could ever have known 133 years ago.