Diagnosing the "master mechanism of the universe" in interwar and war-era America

Drawing on personal testimonials and questions addressed to psychiatric hospital officials, this article explores how patients and their loved ones engaged with the idea of diagnosis in interwar and war-era America. I argue that diagnosis had synergies with intellectual sensibilities of American modernity, among them an enthusiasm for science and newness, a modernist sense of time that could be both forward- and backward-looking, and a knowable, interpreted self. While self-understanding and the creation of life narratives were more often considered the bailiwick of psychoanalysis in this period, understanding subjectivity and self-interpretation were not solely expressed in its conceptual vocabulary. Patient and family dialogs with diagnosis and psychiatric authorities allow for an illumination of the interaction between domestic intuitions, common sense, and folk wisdom, on the one hand, and institutional taxonomy, categorization, and scientific terminology on the other, or more broadly, between dispositions that are ostensibly antimodern and more modern ideas. I suggest that the protean and wide-ranging intellectual origins of the discipline of psychiatry, along with the inherent ambiguity of psychiatric diagnosis during the early 20th century, allowed patients to participate in their own medicalization in the most capacious way possible: by combining biology with diagnostic narrative capacities, as well as broader perceptions of morality and character. In the concluding reflection, I speculate about why it is that late 20th-century American critics and activists have tended to view diagnosis and medicalization as coercive and threatening, in contrast to earlier 20th-century patients and their intimate observers.