Jonas Feldt, Institute for the History of Medicine and Ethics in Medicine, Charité - Universitätsmedizin Berlin
Anke Desch, Institute for Social and Cultural Anthropology, Freie Universität Berlin
Conference "Feeling DIS/EASE – New Perspectives on Modern History", 29–31 January 2020
The conference "Feeling DIS/EASE – New Perspectives on Modern History" at the Max Planck Institute for Human Development marked the conclusion of the Minverva project "Feeling and Illness - History(s) of a Complex Relationship". The project group, which has been headed by Bettina Hitzer since 2014, dealt with cancer from a medical and emotional-historical perspective as well as with the history of psychosomatics. Hitzer's habilitation "Feeling Cancer - an Emotional History of the 20th Century"  was also developed within the project’s framework.
In addition to taking stock of the past five project years, the aim of the conference was to provide impulses for the history of emotions, medicine and society. As the development of new perspectives, the testing of innovative methods, and the exchange between research projects play an important role to develop synergies, the focus also lay on trans- and interdisciplinary issues.
The first two lecture blocks addressed the sensory perception of sound, touch and smell.
MELISSA VAN DRIE (Copenhagen) spoke about the systematic use of the stethoscope since the early 19th century. Instead of verbal symptom descriptions given by patients, the inside of the body had become the focus of medical diagnostics. Auscultation is a physical technique that enables physicians to distinguish between different acoustic sensory perceptions and to interpret them as healthy or pathological. This technique requires the patient to keep still and silent. The use of the stethoscope thus simultaneously created a new form of closeness and distance between physicians and patients.
JAMES KENNAWAY (London) summarized the intellectual/conceptual history of music, emotions and health since the Age of Enlightenment. Medical knowledge about the body significantly influenced the theorization of music, aesthetics, sensory perception and emotions. Medieval approaches regarded music as an element of greater, cosmic harmony. With the developing medical knowledge of the nervous system in the 17th century, the dominant model was a mechanistic understanding of music as pure nerve stimulation. As a critique of this allegedly “feminine” reception of music, theorists developed the concept of "absolute, masculine" music, in which abstract auditory impressions were transformed by the mind. Medical imaging techniques, in turn, enabled the representation of psychological processes in the brain, but neglected political and cultural contexts. A critical neuroscience must consider historical contexts of the concepts of music, emotions and health.
Musical anthropologist TAMARA TURNER (Berlin) illustrated the cultural and historical constitution of illness drawing on her case study of the _Diwan_ healing ritual in North Africa. In Sufi rituals, physical and mental-emotional suffering is met collectively through body practices. Through the sensory and emotional experience of pain and suffering in dance, song and music, illness is not "cured" but experienced, and worked through in a controlled setting.
MELANIE A. KIECHLE (Blacksburg) described how the institutionalization of public health during 19th century USA argued based on a gendered sensorium. The norm of investigations was the male worker’s health. Cultural and medical notions of male and female sensitivity were reflected, for example, in the devaluation of female testimony in court proceedings to evaluate harmful environmental influences. The new diagnosis of the gender- and class-specific defined disease "neurasthenia" devalued the allegedly increased sensitivity of
women and upper-class men. Similarly, racist notions of Native Americans and African Americans as insensitive to environmental influences excluded the bodies and perceptions of these marginalized groups in early public health.
HOLLY FURNEAUX (Cardiff) spoke about encounters between enemies during the ceasefire in the Crimean War, Peninsular War and World War I. In the British press, the image of the barbaric Russian was contrasted with that of the compassionate English hero. On the battlefield, however, collecting the dead and wounded and providing medical care for enemy soldiers meant a physical-emotional encounter in which the similarity and humanity of the enemy was experienced through conversation, touch, smell and emotion. This contradiction was not only experienced when battle was resumed, but also demanded changes in the legitimization of wars.
The keynote by JOANNA BOURKE (London) discussed the methods used by those treating alleged victims of sexual violence, who often show shame as a central reaction. According to Bourke, medical actors play an important role in understanding, interpreting and classifying, but also in framing sexual assaults. Sensory perceptions of the treating persons, such as the olfactory perception of the presumed victim’s breath, were given a special importance during the examination. This led to renewed shame on the part of the victims during these investigations. Reasons for this were, among others, the role of the examiners, who sometimes found themselves exposed to accusations of sexual assault. In addition, there was the partial lack of perception of the presumed victims as patients and the disgust of the treating persons. One consequence was the paradox of the victims’ instead of the perpetrators’ shame. The silence about the problem of sexual violence implied the notion that victims were different from “normal” people. This could be counteracted by a more open approach to the issue of shame. Bourke's research concentrated on the USA and Great Britain since the late 19th century, focusing on the development of forensic techniques and technologies relevant to forensic medicine.
The session Narrating Knowledge and Therapy dealt with the issues of narrating and documenting disease and knowledge.
VOLKER HESS (Berlin) analyzed the representative formation of diseases through medical-administrative documentation. He described the transformation from indisposition (_aegritudo_) to illness (_nosos_) and the process of de-individualization in the documentation of illness between 1730 and 1930. The documentation processes are closely intertwined with social and societal contexts. Furthermore, the type of disease documentation contributes to the formation and understanding of the disease.
MARIETTA MEIER (Zurich) examined to which extent authors of medical records and documentation practices influence the acquisition of knowledge. Meier presented a psychiatric case study from 1953, in which the author attempts to write from an objective observer's perspective despite his active participation in the experiment. The deliberate exclusion of emotions in the documentation could be understood as a narrative practice of the actors.
In the session Narrating Disease, examination of different approaches such as self-image or Big Data in illness narratives was brought into focus.
FRANZISKA GYGAX (Basel) described the close connection between illness and emotion in auto-narrative descriptions of illness. The texts document disruptions in everyday life as a result of serious illnesses; some authors also use them to record mental and physiological changes, for others the texts had a therapeutic effect. Of high relevance here is the examination of the writers' own narratives and the specificity of the language they chose. The narrative search brings forth a new language in which the expression of emotion plays a central role. Non-linear and incoherent narratives were an alternative narrative strategy.
KIRSTEN OSTHERR (Houston) spoke about changes in narratives of health and illness through digitalization and Big Data. Digital health promised a sterile environment in which humanity would take on a higher status through more empathy. An interpretative framework is needed to analyze digital content, including social networks, as the platforms prescribe the ways users express themselves. This requires access to collected data for academic purposes as well as increased interdisciplinary cooperation with data science projects, in which data sets can also be critically analyzed by reverse engineering.
The session Hybridization dealt with emotions in medical case studies, in which the boundaries between categories of life and bodies become blurred.
MAGALY TORNAY (Bern) presented her meta-analysis of dream interpretations of Swiss nurses. In the 1960s, the psychiatrist Roland Kuhn obliged his employees to take part in a psychoanalytical dream analysis in order to improve their work performance. He classified their behavior, which was caused by bad working conditions (e.g. lack of personnel), as depressive. This resulted in a hybrid setting in which work, emotions, gender roles and clinical hierarchies in the everyday life of nurses clashed and their roles as workers, patients and private individuals merged. The compulsion to keep dream diaries and discuss them with the doctor was experienced by the nurses as a humiliation and usually led to break-off or dismissal. Not dreaming or remembering could be interpreted as resistance against pathologizing one's own behavior.
IRMELA MAREI KRÜGER-FÜRHOFF (Berlin) analyzed narratives of Parkinson's patients who have experienced an alienation of their own bodies through the disease and a brain pacemaker prosthesis. In autobiographies and comics, the affected persons used linguistic and visual metaphors of their bodies as machines and of maintaining a balance through the prosthesis and the possibility of temporarily switching it off to describe their physical-emotional experiences. The brain pacemaker creates an "artificial naturalness" and relational autonomy, in which the "off phase" is experienced and used as a fragile moment of freedom from the disease and technology. The practice of writing and drawing and the resulting narratives are not only conditioned by the disease, but also by genre expectations and the socio-cultural background of the authors.
In the sessions Constructing Objects and Spaces the role of materiality and space in the sensory and emotional experience of illness was discussed.
MONIKA ANKELE (Hamburg) used the establishment of bed treatment in psychiatry around 1900 to illuminate the co-constitution of materiality, practices and sensory perception. She argued that the bed had become a co-actor of therapy, subjectifying patients by making them an object of constant observation. The reduction of external stimuli and movements led to an increased awareness of one's own illness, but also of the other patients. Although self-reflection and rest were supposed to initiate healing, the bed treatment caused a feeling of powerlessness in patients. Due to limited possibilities for action, they interacted primarily visually with their environment. The sickbed thus structured not only the room, but also the patients' perception and interaction possibilities.
BRENDA LYNN EDGAR (Geneva) analyzed the use of nature images to promote healing in health care institutions in the 20th century. Idyllic images of nature were attributed a health-promoting effect in various disciplines. This view was based on assumptions from evolutionary psychology about the effect of "paradisiacal" nature, which were substantiated by the concept of _biophilia_ in the 1980s. These assumptions are closely linked to emotional norms that are conveyed in medical theory, literature, architecture and art, but also through bodily practices. Images of nature in healing institutions are products of capitalist societies that are supposed to evoke positive emotions based on cultural constructions and metaphors. The immersive effect of the representation of intact nature could be understood as a reflection of the healing sought.
ANNMARIE ADAMS (Montreal) illustrated the use of architecture and design for self-presentation and control of affective perception by using the example of the _Montreal Neurological Institute and Hospital_ entrance hall. The neurosurgeon Wilder Penfield sought to achieve absolute control over the perception of the space by visitors to the hospital through his design of the hall. The central element of the church-like hall is a statue, to which Penfield had an intense emotional connection. Brains and nerve cords are found on drawings and are imitated by ceiling design and furniture. They convey the impression of being inside a brain. The room reflects the intended emotional reactions of the visitors and Penfield himself.
JENNIFER LYNN THOMAS (Champaign) analyzed the design of 19th century psychiatric clinics in the USA. Nature was said to have a restorative effect on the health of patients. Physical activity was also considered beneficial for recovery. Horticulture, leisure activities in nature and a wide, rural view were therefore central elements of design and everyday life in psychiatric clinics. At the same time, the architecture was hierarchical and segregated, conveying medical and institutional authority. The mental health of the patients was to benefit by the closeness to nature and a clear social and medical structure.
The session Predicting and Securing addressed questions about the influence of emotion in prevention programs after 1945.
ALEXA GEISTHÖVEL (Berlin) and MARCEL STRENG (Düsseldorf) worked on the subject of psychotherapeutic treatment of criminals in the 1960s and 70s. The focus of examination was the West German forensic psychiatrist Wilfried Rasch, who was entrusted with designing model facilities in North Rhine-Westphalia. These were intended to teach offenders to find a "healthy" way of accessing and dealing with their feelings.
ANJA LAUKÖTTER (Strasbourg) analyzed television programs intended to sensitize audiences to health risks and possibilities of prevention and early detection. In these programs, diseases were presented through a mixture of fictional and non-fictional elements in a way to create an emotional reaction with the viewer. Emotions were consciously utilized to convey information. However, they were not used if the emotionalization was in danger of being overused. This established a paternalistic approach that could be described as "fear of too much fear".
ANNA C. ZIELINSKA (Nancy) discussed an Israeli genetic screening program that tests couples for common and serious hereditary diseases in advance to having children. One aim of the program is to identify founder mutations and to prevent genetic diseases in future generations by choosing a genetically suitable partner. The program pursues a preventive approach and is constantly being expanded to include new diseases. This creates greater pressure to have children, as the conceived children are more likely to be genetically healthy. This program is to be seen as a consequence of neo-liberal tendencies in Israel.
In the concluding discussion, chaired by Bettina Hitzer and Rob Boddice, the trans- and interdisciplinary breadth of the selected lectures and the adoption of a double perspective on emotions (of those treating and those being treated) were emphasized as the central strengths of the conference. The contributions showed that physical and social control often occurred through the pathologization of emotions along the categories of gender, race and class, and that power structures had a direct impact on forms of (de-)emotionalization. The limited documentation of emotions in historical sources was highlighted as a methodological challenge. Due to the objectivity often aimed at in medical and natural sciences and to the "unspeakability" of emotions, the latter are often not explicitly documented.The contributions were able to highlight the complexity and depth of the topics, the condensation of which will remain a challenge for the history of emotions in the future. However, they impressively demonstrated the promising combination of emotion-historical approaches with other methodological perspectives. The conference papers will presumably be published in 2021.
Welcome and Introduction
Bettina Hitzer (Max Planck Institute for Human Development, Berlin)
Melissa van Drie (University of Copenhagen): Medical Listening and Its Stages: Of Stethoscopes, Sensory Practice and Sonic Affect
Tamara Turner (Max Planck Institute for Human Development, Berlin): Moving Feelings: Vibrating Dis-ease through Interoceptive Bodily Practices with Music
James Kennaway (University of Roehampten, London): Musical Emotions, Health and Disease since the Enlightenment
Commentary: Daniel Morat (Freie Universität Berlin)
Joanna Bourke (Birkbeck, University of London): Forensic Sense: Sexual Violence, Medical Professionals, and the Senses
Sensing: Touch and Smell
Melanie A. Kiechle (Virginia Tech): Domestic Environs and the ‘Weaker’ Sex: How the Gendered Sensorium Shaped Nineteenth-Century Public Health
Holly Furneaux (Cardiff University): Treating the Enemy
Commentary: Rob Boddice (University of Tampere)
Narrating Knowledge and Therapy
Volker Hess (Charité Universitätsmedizin Berlin): Writing Disease and Medical Recording, 1730–1930
Marietta Meier (University of Zurich): Third Person: Narrating Dis/ease and Knowledge in Medical Texts
Commentary: Kerstin Maria Pahl (Max Planck Institute for Human Development, Berlin)
Franziska Gygax (University of Basel): Feeling (and Falling) Ill: Finding a Language of Illness
Kirsten Ostherr (Rice University): Digital Therapeutics, Virtual Health, and Robot Pathographies
Commentary: Elizabeth J. Donaldson (New York Institute of Technology)
Irmela Marei Krüger-Fürhoff (Freie Universität Berlin): Balancing Neuroprosthetic Regulation and Individual Agency: Written and Drawn Experiences of Living with Parkinson’s Disease and Deep Brain Stimulation
Magaly Tornay (University of Bern): Dreaming Nurses: A Situated History of Psychoanalysis
Commentary: Sybilla Nikolow (Bielefeld University)
Monika Ankele (University Medical Center Hamburg-Eppendorf): Constructing Objects, Transforming Practices: The Sickbed in Psychiatry
Brenda Lynn Edgar (University of Geneva): Projecting Paradise? Some Questions for the History of Emotions on the Therapeutic Use of Images of Nature, 1930’s–Present
Commentary: Jeanne Kisacky (New York)
Annmarie Adams (McGill University, Montreal): Inside Penfield: Emotions, Neurology and Hospital Architecture
Jennifer Lynn Thomas (University of Illinois at Urbana-Champaign): Landscape as Treatment: Contextualizing the Insane Asylum Movement in the United States
Commentary: Benno Gammerl (Goldsmiths, University of London)
Predicting and Securing
Alexa Geisthövel (Charité Universitätsmedizin Berlin) / Marcel Streng (University of Düsseldorf): ‘Inner Security’: Psychological Diagnosis and