If you Google “alienist” now, you’ll be met with at least two pages about TNT’s 2018 show, The Alienist. The Alienist should have been very good— it’s a high-budget period piece based on a novel about solving crimes with psychiatry!!! How do you mess that up?—but, regrettably, it was kind of just okay. Which is a bummer because a.) I always need more TV to watch and b.) I really liked the idea of a show that could tell the masses all about this highly specific chapter of mental health history!
According to M-W, the term “alienist” makes linguistic sense, even if it sounds completely foreign to the modern ear.
“Alienist looks and sounds like it should mean "someone who studies aliens," and in fact alienist and alien are related—both are ultimately derived from the Latin word alius, meaning "other." In the case of alienist, the etymological trail leads from Latin to the French noun aliéniste, which refers to a doctor who treats the mentally ill.”
Most definitions simply state that “alienist” was the old-timey word for “psychiatrist” in the modern era. But that’s not strictly true because, while the job description of the alienist might have been to examine and care for people with mental illness, during the time when alienists were employed, the perception of mental illness was starkly different.
Let’s consider who an alienist might have seen at the turn of the 20th century.
“I am strictly Kraepelinian just now.”
“The Alienist” (both the book and novel) are set in 1896. What else was happening in 1896, you ask? A lot of pretty wild s
tuff! Ford’s first four-wheeled vehicle rolled out into the world, the Supreme Court was on their bullshit with Plessy v. Ferguson, and consummate chatter-box William Jennings Bryant ran for President again. Also, Emil Kraepelin published the fifth (and generally considered to be very important) edition of his book textbook (literally just called A Textbook) and got a whole lotta folks into psychiatry. Or alienism, as it was called.
One of Kraeplin’s biggest additions to the burgeoning field of mental health exploration was the idea that mental illness might be caused by something physical. Which is not at all amazing now, but was at the time. The broader scientific community wasn’t that far off thinking that depression was due to too much bile or that delusions were caused by ghosts or God.
A lot of people really liked Kraepelin’s ideas. In a letter to a colleague, Adolf Meyer described himself as a strict “Kraepelinian.” When he reviewed Kraepelin’s textbook for a journal, he called it a “complete revolution.”
But determining what the physical ailment might have been was no super easy. That same year— 1896—saw the first-ever x-ray on exhibition. The idea of actually looking into someone’s head was pretty fanciful. So instead, alienists were prompted to closely observe both behavior and physical symptoms and connect the dots, so to speak. From a 2010 journal article about his work:
“Clinical observation led [Kraepelin] to the hypothesis that specific combinations of symptoms in relation to the course of psychiatric illnesses allow one to identify a particular mental disorder…He pioneered in the field of psychopharmacological research, which was uncommon in his days. For instance, he combined testing subjects with substances like alcohol, caffeine and chloroform with psychological tests.”
Oh, ok then.
Not everyone was a Kraepelinian; plenty of others both in the field and outside of it were not sold on his theories. Some argued that he often painted with too broad a brush (true; he determined all socialists to be mentally ill without regarding, you know, why someone might have been a socialist in the wake of the Industrial Revolution) while others believed he was too quick to discard non-physical symptoms like “melancholia.”
Still, this idea of observing behavior as a way to diagnose was pretty novel—and highly tempting—to the general public. It was right around this time that everyone, evidently, became a little bit of an alienist and started deducing all on their own.
And here’s the thing: Though a lot of texts define “alienism” as just an outmoded term for “psychiatry,” the truth is that alienists of the late 1800s were really more about investigating, rather than like, curing. From Psychology Today:
“…Eventually the term alienist came to be most closely associated with the forerunners of what we today call forensic psychiatrists such as Dr. Kreizler [of The Alienist]: namely, physicians with specific expertise in criminal psychology who are tasked by the legal system to assess insanity, competency to stand trial, etc. As the field of clinical psychology gradually evolved during that turn-of-the-century period, psychologists specializing in studying and profiling criminal behavior and mentality were also commonly referred to as alienists.”
Alienism, as it was, was more like cognitive science than psychiatry, especially as we think of it. There was very little talking or conversation, for example. Instead, there was an emphasis on observing, watching, and often, judging.
Armchair Alienism
And now, dear reader, I will leave you with several examples of how, though alienism and psychology aren’t really the same thing at all, nothing really every changes all that much.
The term “alienist” fell out of fashion in the early 20th century, though the word does make appearances well into the 1920s and 1930s. Specifically, alienists were getting brought into courtrooms to testify on all sides of various cases.
For example, here’s another New York Times article, this time citing the importance of an alienist’s work in the famous Leopold and Loeb trial. Here’s the headline:
ALIENIST DECLARES LEOPOLD AND LOEB ARE DEVOID OF SOUL; Quotes One as Saying He Could Think of Killing Just Like Choosing Pie.
Leopold, along with his friend, Richard Albert Loeb, were two wealthy college kids who were arrested for kidnapping and murdering a 14-year-old. In their trial, alienist William White testified for the defense and used his title as an alienist to state that the “boys” were too crazy to be responsible. He admitted that Leopold had “a host of anti-social tendencies,” but cautioned that “he was the host of an infantile make-up which was a long way from the possibility of functioning harmoniously with his developed intelligence.”
Having a plethora of alienists take the stand both for and against Richard Loeb and Nathan Leopold seems to reflect the shifts in views of psychiatry and alienism—specifically, highlighting psychological factors and observable traits that would likely have never entered a courtroom prior. Maybe it helped? They weren’t put to death (though they did get life in prison). Either way, the alienists of this trial walked so the Nancy Graces of the world could run.
One last example of alienism at its finest.
In September of 1896, the opinion of an anonymous, self-declared alienist was published in the New York Times. His conclusion? That William Jennings Bryan—who, again, was running for President at the time— was of a “mind not entirely sound.”
The unknown author describes Bryan as “unhinged,” having “male hysteria,” and being “cranky and unmanageable." He characterizes Bryan’s years of campaigning as a symptom of some greater issue, stating that “a certain class of lunatics use nearly all their mental activities in this occupation, to the endless annoyance of their friends, relatives and physicians.”
As is often the case, concerns for Bryan’s “mental wellness” seemed to mostly be rooted in personal issues, rather than those which might be observed by an alienist:
When egotism becomes abnormal, the individual practically suffers from a delusion, and his state is known as that of “meglomania.” The presence of expansive and grandiose ideas in men of genius, or in men who have done something that has proved their power is natural enough. But here is a man with neither experience in statesmanship nor training in finance, nor success in his profession, who is spluttering mediocrities over forty-five States, and thinks that he is winning them to him and gaining for his country financial salvation. And this belief is growing in him, though to every impartial observer his cause is becoming steadily weaker.
Which does make me wonder: Was this just a personal acquaintance of Bryan’s who was sick of his constant speeches? Maybe an old classmate who didn’t like him back in school? Was he even an alienist at all? Who decided who was an alienist, anyway?
Here’s the kicker on the letter:
Mr. Bryan, in my opinion, is developing into what Italian alienists call a political mattoid, or what German writers would call paranoia reformatoria. In a recent treatise on the subject, (Entarlung und Genie, p. 203,) I find this striking paragraph: “In the histories of mattoids, we find that a strong characteristics the tendency to assume a kind of apostleship, united with an unshakable belief in their declarations and services rendered. And this belief in times of political agitation often leads the mattoid into prominent political roles. He often possesses certain tricks of thought and expression which men of sense and honesty will not or cannot use, but which can quickly with the masses.”
Surely this applies will to the support of my diagnosis. The political mattoid is an average man with a talent, or pseudo talent, that he cannot use wisely or sanely. His judgement is false, his actions foolish, egotistic, and extravagant. What is more serious, if given a chance, he surely ends in some disaster or folly from the dominance of his grandiose idea, or, perhaps, from some real insane or delirious act.
It does not much matter about names, however. The evidence that Mr. Bryan is developing into a political mattoid, or a paranoiac reformer, or a cranky and unmanageable politician, is, I believe, strongly manifest, and is worth the serious attention of the American people.
Incredible. And also, a great example of alienism at its finest—it was a kind of rugged psychoanalysis based mostly on gut feelings, personal experience and worldview, and the occasion awareness of unusual symptoms.