Jan Slavíček
Institute of History of the Czech Academy of Sciences
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Hungarian Historical Review Volume 10 Issue 3  (2021):423-443 DOI 10.38145/2021.3.423

“To Maintain the Biological Substance of the Polish Nation”: Reproductive Rights as an Area of Conflict in Poland

Michael Zok
Deutsches Historisches Institut, Warsaw
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Hungarian Historical Review Volume 10 Issue 2  (2021):357-381 DOI 10.38145/2021.2.357

On October 22, 2020, the long-term dispute about reproductive rights in Polish society had a comeback. The Constitutional Tribunal declared the embryo-pathological indication of abortions guaranteed by the law of 1993 to be unconstitutional. The tribunal’s ruling was met with widespread protests, as it effectively forbade almost all reasons for terminations of pregnancies. While members of the Church’s hierarchy and pro-life activists celebrated, politicians began once again to discuss the law, and different suggestions were made (including a draft law similar to laws in effect in other European countries like Germany, and a law which would allow the termination of a pregnancy if the fetus were likely to die, or a law forbidding them in the case that the fetus had been diagnosed as having down’s syndrome). The debates are hardly new to Polish society and history. On the contrary, they date back to the recreation of the Polish state after World War I. This article concentrates on the developments in the Communist People’s Republic that led to the legislation of 1993, which is commonly referred to as a “compromise.” It focuses on the main actors in this dispute and the policymakers and their arguments. It also contextualizes these discursive strategies in a long-term perspective and highlights continuities and ruptures.

Keywords: Catholicism, demography, reproductive rights, Poland

Some Remarks on Actors, Sources, and Figures

In this article, I focus on the last two decades of Communist reign in Poland and the first decade after its downfall as the beginning phase of the country’s transformation from a socialist to a post-socialist society. I have chosen this timeframe because considerable research has already been done on the years immediately after World War II and on the 1950s and 1960s.1 Since this research has tended to concentrate on organizations such as the Polish Family Planning Association2 and the discourses in scientific periodicals3 and advisory literature,4 I focus on other actors and materials. The main agents on which I focus in this study are the institutions of the state bureaucracy, including both ministries and political parties, and Catholic organizations, e.g., the Clubs of Catholic Intelligentsia (Kluby Inteligencji Katolickiej; KIK ). I have also had to reframe my inquiry in response to limitations created by the COVID-19 pandemic, which have made it difficult to access archival materials. Luckily, I was able to collect and analyze some sources from the Archive of Modern Records in Warsaw (Archiwum Akt Nowych; AAN) in periods when the circumstances allowed limited access to its collections containing the sources relevant to the abovementioned organizations and institutions. If one wishes to consider the roles of the actors involved in the discourse on reproductive rights, it would be fruitful to examine the materials of the Polish Medical Association (Polskie Towarzystwo Lekarskie) and the debates on reproductive rights and behavior that were held among physicians. Unfortunately, this is not possible, not only due the pandemic, but also because the materials are stored in the organization’s archive—with the exception of medical journals that were analyzed, for instance, by Agata Ignaciuk.5 Thus, this article concentrates on the (at times public, at times behind-the-scenes) discourse among representatives of the state bureaucracy, political parties, and Catholic organizations.

I should make a second remark concerning the statistical data used in this article. After the liberalization of abortion in April 1956 and the implementation of new liberal instructions in 1959 (which made it possible for a woman to get an abortion on request),6 the state-run hospitals kept records of the procedures that were performed. Opponents of the liberalized law often made references to these records in their public statements, but the figures they cite should be called into question given the striking inconsistencies. They also used other figures of unknown origin. For instance, in 1970, the Catholic NGO Polish Committee on the Defense of Life and the Family (Polski Komitet Obrony Życia i Rodziny, PKOŻiR) estimated the number of “Polish citizens who have not been born because of the existing law” at 800,000 in the time period between 1956 and 1970.7 Also in 1970, the leader of the Polish Episcopate, Primate Stefan Wyszyński, wrote in an aide-memoir addressed to the government of the “dangers to the biological and moral substance of the nation.” Wyszyński claimed that every year one million abortions were carried out in Poland.8 These estimates show how difficult it is to determine with any precision how many abortions were actually performed in Poland. Of course, the accuracy of any given figure may well depend on the person who is citing it and his or her political agenda. A study which draws on the experiences of women by interviewing them may yield some insights on this question.9

Another question comes up concerning the number of abortions performed in Poland. Some historians have argued that the decrease in the number of abortions carried out in state-run hospitals in the 1980s was the consequence of the broad commercialization of abortions.10 In my opinion, this statement is rather problematic for three reasons. First, as mentioned above, the figures cited by opponents of the existing law were often very different and perhaps sometimes exaggerated. Second, the 1980s were a decade of economic and political crisis, leading to the downfall of Communism in Poland. Thus, it would be surprising if, under these dire circumstances, (expensive) private clinics had flourished. It is also impossible to give a definite answer to this question because there are no broad studies on the health and welfare systems in People’s Poland during the 1980s and in the first decade of the so-called Third Republic. And third, some statistics include terminations of pregnancies carried out at private clinics.11 However, it is hard to tell if all abortions in private clinics were reported, or if even there was any obligation to report these procedures.

Therefore, in this article, I use the official numbers as indicators, but I keep in mind that there may have been a high number of abortions performed in private clinics.

 

 

 

 

A Short Overview: Abortions in the First Half of the Twentieth Century in Poland

The recreation of the Polish state after 123 years under Prussian/German, Austrian, and Russian rule made it necessary to reunify political institutions, infrastructure, education, etc. This included the unification of the juridical systems. Regarding the question of the termination of pregnancies, the so-called “Makarewicz codex” from 1932 legalized abortions in extreme cases of danger to the mother’s health or life or if the pregnancy was the result of a crime (rape, incest, or sexual intercourse with minors).12 This legislation was upheld and reestablished (after a short time during World War II, when the German occupiers allowed Polish women to have abortions on request),13 and it remained in force until 1956.14

This changed in 1956 after a public discussion about the necessity of liberalizing women’s access to abortions on request. The main argument for this was the number of illegal abortions performed in back-alley clinics that led to women being injured or dying. An estimated 300,000 of such abortions were performed per year.15 Although met by heavy resistance from the Church and Catholic MPs in the Sejm, who condemned abortions as “murder” and accused supporters of the liberalization of the existing law of being “neo-Malthusians” who sought to pass a “genocidal” law,16 the majority of the Polish parliament voted to change the law in effect and give women easier access to abortion.

Needless to say, this step was criticized by the Church, especially by Primate Stefan Wyszyński, who called the Sejm’s decision a “monstrosity” and declared that it was in contradiction with a woman’s “innate and national mission.”17 In the aftermath, he tried to use his authority as the highest Church dignitary to influence doctors and nurses. Thus, women’s requests were denied, even though they were legal according to the law of 1956.18

The Parliamentary Circle ZNAK (Sign), which was formed after the political liberalization in 1956 and was tightly connected to the KIK, also argued against the new law. At the end of the 1960s, the (all-male) members of ZNAK sent a submission to the Ministry of Health in which they claimed that “a woman’s absolute freedom” would inevitably lead to misuse, and they demanded the introduction of new restrictions.19 Jan Kostrzewski, the Minister of Health at the time, rejected their request. He argued that the law in effect would guarantee “women’s right to self-determination,” and he rejected any restrictions, because “as experience shows, prohibitions and compulsion only lead to illegal procedures and moral as well as biological damage.”20

This is one of the few examples in which there was explicit reference to women’s reproductive rights and a woman’s right to self-determination. The discourse, including the discourse used by the ruling Polish United Workers’ Party (Polska Zjednocznona Partia Robotnicza; PUWP), relied heavily on references to the dangers posed to women’s health and lives.21 Party experts argued that “terminations of pregnancies are not the healthiest method” of limiting the number of children, but they were aware that, because of the prevailing circumstances (i.e., the lack of effective contraceptives due to the Socialist economy of scarcity and the low level of knowledge concerning methods of contraception), abortions were a “necessary evil.” They argued that a ban on abortion would only drive women to seek illegal abortions.22

These examples show the opposing sides in this dispute. In the decade and a half following the Sejm’s decision of 1956, the ruling party defended the law as just and underlined that it was a “necessary evil.” In the 1970s, however, the dynamics of this issue shifted.

Debates on Reproductive Rights in the 1970s: The Perception of “Crises”

The debates dating back to the 1970s saw the rise of different “crises.” Especially in the late years of the decade, “demographic and social disturbances” were addressed, e.g., in the (Catholic) press. Studies by sociologists, e.g., in (new) urban centers, underlined the transformation of the family, which included “decreased size of family, diminished authority of husband/father, increase in extramarital sexual contacts, increased numbers of wage-earning married women, greater personal freedom of family members [etc.].”23 The Church was also alarmed. It saw a “crisis of marriage,” although the numbers of divorces in communist Poland were very low compared to other European or Western countries. In 1960, there were 2.3 divorces per 1,000 marriages. By 1975, this number had risen to 5 per 1,000.24 In fact, the 1970s bore witness in Poland to a rising number of marriages. In the period between 1971 and 1978, 2.85 million couples were married, of whom 85 percent were “young” couples, i.e., both partners were younger than 30 years old.25

The state and party experts on family and demography did not agree with the Church’s interpretation. The Ministry of Justice in particular argued that the new Family and Welfare Code, introduced in 1964, was designed to “ensure the durability of marriage and family.”26 It therefore made it harder for couples who had separated to get a juridically sanctioned divorce. This was especially true if the couple had young children. The Ministry reminded the judges that divorces were “socially undesirable phenomena”27 and should be treated as an ultima ratio to prevent “social pathologies.”28 Thus, the Ministry had a negative stance with regard to divorces which was very similar to (if not as negative as) the Church’s attitude, which considered them a “plague.”29

However, neither the Church’s negative attitude nor the administrative measures stopped the increase of juridically sanctioned divorces in the 1970s.30 In 1979, the courts acknowledged 40,300 demands for abortions. 31 percent of the women requesting a divorce were younger than 30 years old and had at least one child.31

Another threat, according to the Church, was the “disappearance” of the Polish people, because the postwar baby boom had ended, and an average family, especially in urban centers, wanted to have only one or two children.32 Although compared to other European countries, the percentage of the population of Poland that could be considered young was still very high (52 percent was under 30) and the number of young married couples was increasing in the 1970s, the figures regarding childbirth oscillated. In 1970, 546,000 children were born, and this number increased to 582,000 in 1973,33 a higher figure than in 1967, when only 520,400 children were born.34

The Episcopate saw these shifts as a danger to the “biological substance of the nation.” Two aides-memoir, addressed to the government in 1970 and 1977, summed up the Church’s perception of this threat.35 One main reason to which the documents alluded was the liberal law on abortion and working women who could not devote their lives to providing care for their loved ones. The Episcopate also accused the government of willingly limiting the number of children through the means of “anti-natalist” propaganda and “a broad front of contraceptives,”36 although there was a lack of effective contraception in Poland throughout the communist period.37 The Episcopate’s aide-memoir advocated a ban on contraceptives, in particular on the sale of contraceptives to young people.38

As noted above, Primate Wyszyński cited a figure of 1,000,000 abortions per year39 and the allegedly decreasing fertility of Polish women as his main arguments against the existing laws, and he advocated a “proactive demographic [read: pro-natalist] policy.” His contentions are contradicted by the numbers registered by the state-run hospitals: The official numbers of registered abortions dropped from 196,000 in 1962 to 133,000 in 1977.40

But state and party experts also disagreed with the other accusations made by the Church concerning the government and its policies. They argued that, in 1970 and 1977, the Church had offered some dramatically misleading references to the official numbers given by the Main Statistics Office (GUS, Główny Urząd Statystyczny). E.g., Mikołaj Latuch, professor at the Main School of Planning and Statistics (SGPiS, Szkoła Główna Planowania i Stastyki, today the SGH Warsaw School of Economics), was convinced that the aide-memoir had a “propaganda” purpose and was not designed to give scientifically proven answers or interpretations.41 Another expert, Zbigniew Smoliński, who was responsible in the GUS for demographic issues, stated that “the aide-memoir is full of errors with regard to its content” and that, in general, the Episcopate was not able to understand demographic developments or to interpret the numbers correctly. Another expert was convinced that the Church’s aim was to challenge the law on abortion, and that it had made its (selective) arguments in an attempt to discredit the existing legislation, which was “to us a tool of birth regulation, not its cause.”42 Kazimierz Kąkol, the chief of the Office for Confessional Issues (Urząd do spraw Wyznań), who was responsible for maintaining the dialogue and observing the Church’s activities, argued in his statement on the aide-memoir from 1977 that the Episcopate was “doctrinaire” and that it “refuses [to acknowledge] arguments on a rational basis.”43

Furthermore, the state experts stated that the drop in family size, especially in urban centers, was not an effect of the existing laws or the lack of an efficient housing policy. Instead, they argued it was a normal development in industrialized countries. E.g., Kazimierz Romaniuk was convinced that “the 1960s brought Poland back to the [demographic and reproductive] circumstances that are characteristic for all developed countries in Europe,”44 and his colleague Jerzy Piotrowski argued that “a demographic catastrophe has occurred in none of the countries with similar developments.” The latter also contended that “the world’s main problem is rather the excessive growth of the [global] population.” Regarding the aide-memoir, he stated that its authors had chosen the numbers they used in their statement selectively. In particular, the Episcopate’s focus on families with many children was problematic, as Piotrowski explicated, because in his opinion, “having many children was seldom the result of a [willful] decision, [and occurred instead because of] carelessness, alcoholism, inattention to children.”45 He argued that a ban on divorces would not eliminate the problem of couples living separately, and outlawing abortions would lead to illegal procedures. Instead, it was necessary to raise the people’s “culture,” and this could only be achieved through education.46 This was a common argument in defense of the 1956 law.47

Statistics from the 1970s indicated that 45 percent of couples had only one child, and almost 28 percent had two children. Couples without offspring accounted for 18 percent of the total.48 One problem with this statistic is its lack of a subdivision of the numbers according to the ages of the couples and the duration of marriage. As a survey from this period shows, 60 percent of married couples wanted to have two children, which they considered “ideal.” 27 percent wanted to have three children, and only 0.2 percent did not want any children. Unsurprisingly, the number of desired children was closely linked with the educational attainment, especially the woman’s educational level.49 Economic circumstances (particularly housing problems) also played a major role, as did thoughts concerning the ideal way of bringing up children. The government, for its part, advocated the formula “2+3” as the ideal family size.50

But this reasoning convinced neither the Church and its representatives nor Catholic lay organizations like the abovementioned KIK or the Polish Committee for the Defense of Life and Family (PKOŻiR). Although the Committee was a small lay organization, it was closely connected to the Church, and it organized pilgrimages and functioned as a fund-raising group. Its members, mostly men (though there were also some couples), estimated (as mentioned above) that “800,000 Poles” had not been born because of the existing law. The committee argued that the legislation was responsible for the “ill fate of millions of women” who were not able to bear children. Furthermore, its members alleged that there was a connection between the law on abortion and Nazi atrocities during the war.51 The latter became an integral part of the discourse on abortion.

Closely connected to the question of the permissibility of terminating pregnancies on request, infertility was perceived as a threat to the sustainability and growth of the Polish population. The Clubs of the Catholic Intelligentsia estimated that 20 percent of Poland’s young newlywed women were infertile because they had decided to terminate their first pregnancy, although they did not indicate the source or sources on which they based these figures. The Clubs concluded that abortions were the main reason for the “bad quality of children born,”52 and they argued that “with regard to the concern about the quality of the population, the termination of the first pregnancy in particular is extremely harmful, as is commonly known [emphasis mine – M. Z.].”53

The question of infertility was one of the major problems perceived with regard to abortions by the state bureaucracy and the Church, as noted above.54 And it was the core argument for both sides in their support for a ban on abortions in the case of the Church and the liberalization of the law in order to end illegal procedures on the part of the state. Therefore, the Ministry for Health and Welfare had its own numbers, based on its broad network of resident physicians. Although the total number of women who died as a consequence of an abortion was very low (12 cases per year in the 1970s), the alleged effects of the termination of the first pregnancy troubled the Ministry. After the procedure, 2 percent of subsequent pregnancies ended in a preterm delivery and 4 to 8 percent ended in a late delivery. However, the termination of the first pregnancy was estimated to have led to spontaneous abortion of the next pregnancy in 38 percent of the cases. Even if it was not the first pregnancy but rather a later one that was terminated, 30 percent of the next gravidity was concerned. The study came to the unsurprising result that women using contraceptives had less abortions.55

The Clubs accused the government of deliberately trying to destroy the Polish nation by allowing abortions and the use of contraceptives. Functionaries of the state bureaucracy characterized these statements as “absurd” and emphasized the “progressive nature” of the law. Although not denying the negative effects entirely, they highlighted that the number of women assumed to have died in the aftermath of an abortion was very low because the abortions were performed in hygienic surroundings.56

But in the 1970s, concerns about demographic trends began to appear in documents taken from different branches of the party. The Administrative Department of PUWP’s Central Committee, for example, called the abovementioned “dominance of families with only one or two children” “alarming.”57 The figures from this decade showed that while the percentage of children and youth was falling, the number of old people in the “post-productive age” was increasing because of improvements in the healthcare system.58 One document estimated that from 1985 onwards, Polish society would become too old, demographically, to support itself.59 To overcome these problems, voices in the party underlined that it was necessary to restrict abortions to the requirements stated in the law of 1956. This was aimed at private clinics in particular.

During the 7th Party Congress in 1975, party member Barbara Sidorczuk from Kalisz argued that because of women’s double burden (children and work), they decided to have fewer children and at an older age. She referred to the conclusions of demographers who warned that “the decrease in the number of births can become a dangerous trend for the biological future of the nation.” Furthermore, she argued that the decision to have less children “was not taken because of a woman’s genuine convictions” but was influenced by the “problems of fulfilling the many roles” women had.60 Even Edward Gierek, the party leader of PUWP at the time, addressed the demographic problems during a meeting with female representatives in March 1975. The year had been declared an international women’s year by the United Nations Organization; women’s problems regarding in connection with work, children, society, and culture were broadly discussed. During the March meeting, only days before International Women’s Day, Gierek declared that “demographic prognoses indicate that, by the end of the century, the number of Poles should surpass 40 million. To continue the work we have begun, a correct development of the nation and an optimal structure of the population and age are needed. To surpass or even only to reach the figure of 40 million by the end of the century, population growth has to increase. Our state did not always have to introduce an active demographic policy. Today, it has become a necessity.”61 These examples show that, despite their rivalry and ideological differences, Church and party perceived similar threats to the “biological substance of the nation,” especially towards the end of the 1970s.

The Catholic actors in this discourse criticized more than the liberal law on abortion. They also held a grudge against “artificial” contraception, like condoms, IUDs, or the “pill.” Their argument was based on the papal encyclical Humanae Vitae, which banned “artificial” methods of contraception and which had a major impact on Catholic countries.62 Thus, the so-called rhythm method was the only method of contraception that was taught during pre-marriage courses held by the Church and lay persons from KIK. While the courses described the issue in detail using various graphs, for example, concerning the days of a woman’s cycle when she is ovulating, etc.,63 other methods of contraception either were not mentioned or were described as “harmful.” One example is a review by a priest who criticized the proposed outline of such a course to be erroneous, because the part about artificial methods “lacks the basic argumentation against contraceptives[,] that the marital act of connecting and uniting” would suffer.64 Proposed courses and texts by sexologists cooperating with the Clubs were criticized, as one example highlights. The reviewer’s critique focused on the author’s concentration on “artificial” contraception and on the fact that he did not mention “natural” methods. The author’s generally liberal perspective on contraception was perceived as “appropriate for students of medicine,” but not for the courses organized by the Clubs.65 According to one proposal intended for the course instructors which also discussed the structure of the courses, the problem of the termination of pregnancies should be addressed twice: immediately during the first session and during the session about children.66 In the 1980s, the Clubs added that “contraceptives created an anti-natalist attitude among parents,”67 and they advocated “natural methods,” because “they are reliable, cheap, and they do not cause harm.”68

The “Conservative Backlash” in the 1980s and Early 1990s

The 1980s, the last decade of communist rule in Poland and the decade prior to the law of 1993, saw a shift in power. Factors influencing this development included the election of Krakow’s Archbishop Karol Wojtyła as pope John Paul II and the Church’s role first as a sanctuary for dissidents and, later, during the social and economic unrest, as a mediator between the “Party” and “society.” The aforementioned Catholic lay organizations, especially the KIK but also ZNAK as the parliamentary representation of Catholic Social Thought, were very active during this decade. They used their growing influence to challenge the existing law and to submit several draft bills to restrict abortion and, in some cases, even contraception, despite the fact that the number of registered procedures in state-run hospitals had sunk to about 58,000 abortions per year69 and was therefore only a fraction of the figures from the 1960s.

Agata Ignaciuk argues that the decrease in registered abortions in state-run hospitals was accompanied by an increase of procedures in private clinics and that the actual figures concerning the numbers of abortions performed had remained the same or had increased. In one of her articles, she refers to a survey undertaken after 1989 showing that a high percentage of women had an abortion. The 2013 survey indicated that one third of women between 45 and 54 years of age at the time of the study had had an abortion. The percentage for women between 55 and 64 years was even higher (42 percent).70 This is surprising, especially for the 1980s, which was a decade of almost permanent political as well as economic crisis but which interestingly saw growth in the number of private clinics.

The argument provided by Catholic actors was essentially a continuation of the discourse from the 1970s and referred to “biological” reasons. In an aide-memoir from 1987, the Szczecin branch of the KIK repeated the contention that the law in effect endangered the “biological substance of the nation” and its moral foundations. Its wording and content were very similar to the aides-memoir of the Episcopate from the 1970s. The Club’s argumentation also invoked international treaties, such as the United Nations Resolution condemning genocide (1948), and it contended that abortion was a means to conduct such mass atrocities.71 The reference to genocide was commonly used by pro-life-activists in Poland, as noted above. This notion was closely connected, of course, to the experiences of World War II and the Nazi plans to exterminate the Polish elites.

Furthermore, the Szczecin branch argued that it was “a scientific fact that life begins with conception.” Hence, every “artificial termination is a murder with willful intent.”72 In Gdansk, the branch underlined that a law “that enables every person to decide about a human life is injustice,” and it emphasized the personal rights of the fetus, which was seen as an autonomous being independent of its mother. Therefore, the argument went, a pregnant woman should not have any power over the “unborn.”73

These demands were met with resistance from (state-run) women’s organizations. Like other supporters of the status quo, the Women’s League (Liga Kobiet) underlined in its statement dated April 1989 that restrictions on abortion would lead to an increase in illegal termination of pregnancies. It warned of a return to pre-1956 conditions, when the procedures were performed in back-alley clinics instead of “aseptic hospitals.” This return would multiply the dangers to women’s health and lives. As a possible solution, the League underlined the importance of sex education and effective contraception, while at the same time rejecting the Catholic side’s exclusive insistence on “natural methods.” The League’s arguments were based in part on the uncertainties women faced and their “shattered living conditions.”74

However, the modified political system of the late 1980s and early 1990s, which was the result of negotiations between the party and the opposition supported by the Church, experienced a power shift that neither side had foreseen.75 After the partly free elections on June 4, 1989, the reestablished Upper Chamber, the Senate, consisted entirely of members of Solidarity (Solidarność), which had been founded as an independent trade union in 1980 and which was converted, after it had become legal again, into a political actor. In addition to the seats won in Senate, its members also won every free mandate in the Lower Chamber, the Sejm, and they made up 35 percent of the total MPs. The result was a political stalemate which could only be solved by electing Tadeusz Mazowiecki Prime Minister. Mazowiecki was the first non-communist government leader in Poland since World War II, and he was a member of ZNAK and the Warsaw branch of the KIK.

In April 1990, the new Solidarity-dominated Senate was working on a new law on abortion. The draft bill that was discussed in the Upper Chamber, which was based on a paper written by an experts’ commission of the Episcopate76 and anticipated a prohibition on abortions (except in the case of a risk to the life of the mother) and contraceptives (such as the pill and IUDs),77 was very similar in its goals to the demands made in the Church’s aides-memoir in the previous decade.78 A few members of the Senate tried to include “social indications” (which was part of the existing law of 1956) as a reason for a request for an abortion, but they were outvoted.79

The beginning of the transformation was perceived as a period of massive insecurity. This probably influenced the Second National Medical Assembly’s decision to vote for a more conservative codex in December 1991.80 Because of this, the numbers of registered abortions decreased even more, from more than 30,000 in 1991 to 11,640 in 1992.81

Two years after the partly free elections, the first free popular vote took place. It was a victory for the traditionalist “Christian democratic” and “Christian nationalist” parties, which would form a government coalition. The question of abortion was central, despite the social and economic hardships which Polish society experienced in this period.

New and Old Supporters of Liberalization and Restriction

After the first completely free elections in 1991, the first two right-wing governmental coalitions sped up the adoption of a new law on abortion. The parties that were members of these coalitions had been founded during the beginning of the political transformation in 1989 and 1990. Most of them saw themselves as heirs to the legacy of the opposition movement Solidarity, and they described themselves as “Christian democratic.” These parties included, for instance, the Centre Alliance (Porozumienie Centrum; PC), the first party of Jarosław Kaczyński, today’s leader of the governing Law and Justice Party (Prawo i Sprawiedliwość; PiS). Another example is the Christian Democratic Labor Party (Chrześcijańsko-Demokratyczne Stronnictwo Pracy; ChDSP) which considered itself the reincarnation of the Christian democratic party from the interwar years. Others who joined the coalition explicitly called themselves “Christian national,” such as the Christian National Union (Zjednoczenie Chrześcijańsko-Narodowe; ZChN).

The new political system and the first free elections in 1991 did not lead to immediate stabilization. Because of the fragmentation of the votes during the election, the formation of government coalitions was problematic and necessary. Therefore, concessions and compromises had to be made. During Jan Olszewski’s tenure as Prime Minister (December 1991–July 1992), when the idea of a new law on abortion was discussed, the coalition consisted of four parties (the aforementioned PC and ZChN and two even smaller conservative parties representing rural interests). Their number in the governing coalition increased during the tenure in office of Olszewski’s successor as Prime Minister, Hanna Suchocka (July 1992–October 1993). The seven (and for a short time eight82) parties83 had very different ambitions. Unsurprisingly, the governing coalition lasted only 15 months.

The parties had different views on the future course of the so-called Third Republic, and they quarreled over specific political problems, e.g., the political system, the competences of the state president, etc.84 However, the “Christian” parties had a common stance on abortions and wanted to outlaw them,85 while the liberal and centrist parties were split when it came to this question. The emphasis placed on the question of regulating terminations of pregnancies is most obvious in a flyer by ChDSP. Here, the party’s pro-life-attitude and its demand for the “protection of life” has the second highest priority, surpassed only by the sovereignty of the Polish state.86 Also, different actors on the political right constructed themselves as representatives of a nation which “is 95 percent Catholic” and which hence had to be ruled by Catholic morals and defended against “secularization,” “communism,” “liberalism,” and “nihilism.”

As noted above, the centrist and liberal parties were split on this issue. One obvious example was the Democratic Union (Unia Demokratyczna; UD) that was part of the governing coalition in 1992–1993. The party’s women’s circle referred to the resolution of the European Council from 1990 guaranteeing women the right to reproductive self-determination, and it advocated a liberal law. Some of the party’s MPs, for instance Barbara Labuda, represented this position in parliament, for which she was attacked by male party members87 and by delegates from the Christian democratic parties.88 On the political left, the parties opposed a more restrictive law. This included the Social Democracy of the Republic of Poland (SdRP; Socjaldemokracja Rzeczypospolitej Polski), the successor of the Communist PUWP, and the Polish Socialist Party (PPS; Polska Partia Socjalistyczna), a reestablished version of the left-wing party that had been forced into fusion with the Communist Party in 1948.

The PPS was strictly against the new law. In a flyer entitled “Down with police law! We are against the ban on abortion [...],” the party stated that the new law would “interfere with a woman’s right to family planning” and that the conservative-dominated parliament, [its attempt to] try to take control over the private lives of individuals, takes the path of Stalin, Hitler, Ceauşescu, dictators who were against the right to abortions.” The PPS concluded, as the PUWP expert had in earlier decades, that “police and prison will not solve the problem.”89 Although the PPS believed that “abortions are a barbaric act,” it was, in its opinion, wrong “to try to have them eliminated by prohibitions based on parliamentary decisions.” It argued that the numbers of interventions prior to the legalization of abortion in Poland in 1956 (and also in other countries) showed the ineffectiveness of such restrictions. Furthermore, the party feared that in an impoverished society like the Polish one, illegal abortions would become a large-scale phenomenon once again. It favored contraceptives and sex education as the only means to master the situation, and it underlined that a ban on abortion would lead Poland back to the Middle Ages, especially in comparison to the rest of Europe.90

In September 1990, the SdRP criticized the aforementioned Senate draft bill to restrict abortions as an “unrealistic promise that nobody is able to realize.” Furthermore, the party stated that this “fatal draft” would turn women into “aboulic birthing machines,” and it lamented the fact that there was no public discussion on the issue.91 It rejected the penalization of abortions and proposed that (sex) education and contraceptives were the best means to limit the number of interventions. It concluded that “the dramatic decision which a woman [in such a situation] has to take should be based on moral and not juridical categories.”92 The party made the following declaration in its election program: “We believe that women should be in charge of deciding how many children they will bear.”93 Instead of a restrictive law, the SdRP was in favor of a solution similar to the German one: the terminations of pregnancies should be legal in cases of medical and criminological indication and non-punishable on request during the first trimester. Furthermore, a pregnant woman was obligated to have a counseling interview before the procedure. The authors of the SdRP draft bill argued that abortions should be regarded as an exception in extreme cases to the fundamental principle of the protection of human life and not as a contraceptive method, as it allegedly had been used by several women in the communist period.94 As a solution to settle the political dispute, the SdRP favored a referendum.95

The “Compromise” of 1993: Science, Conscience, and Faith

The idea of a national referendum on the legislation on abortion was met with heavy resistance from pro-life-activists and Catholic organizations. Both the Clubs of Catholic Intelligentsia and the Episcopate rejected the idea of any discussion of this issue because, in their assessment, “the protection of life” was not negotiable.96 The Warsaw branch of the KIK denied the request for a referendum because it argued that such a law belonged in the hands of experts and the parliament. It was convinced that it was unwise to entrust such an “emotional question” to the population, because the “easiest way” was often chosen, and this would “open the doors to human feebleness.”97 Therefore, the different views clashed in parliament, especially during the debate prior to the Sejm’s decision on January 7, 1993.

As noted above, pro-life-activists, right-wing politicians, and publicists used (pseudo-) scientific, biological arguments to underline their demands for restrictions in the case of abortion. As the unauthorized stenograph of the Sejm’s 18th session shows, even before the main clash in January, this argumentation was used. ZChN member Jan Łopuszański insisted that the moment of conception as the beginning of human life did not “depend on somebody’s personal beliefs,” but was “a fact.”98 Here, the supporters of a restriction referred to discursive strategies that had been used in Catholic pro-life-discourse before. The KIK in Gdansk stated in its declaration from 1987 that “it is an objective scientific fact that the life of a human being begins with conception” and that “contemporary genetics proves that the zygote is in possession of all the inherited features of a new human individual.”99 Mariusz Grabowski, also from ZChN, used similar arguments based on “biological facts,” as he told the audience during the parliamentary debate in January 1993. Furthermore, he denied that religious motivation was essential for the authors of the new law. Instead, he enthusiastically contended that the new restrictions would protect women, because they would render it difficult to get an abortion.100

Another example of the “biologization” of the debate was the statement made by the chairwoman of the special commission which drafted the new bill. Anna Knysok referred to the abovementioned “facts” concerning the beginning of life, and she criticized the opponents of the new law and maintained that it would not interfere in a woman’s right to self-determination, and she referred to the Universal Declaration of Human Rights.101 She also rejected the demands for a referendum and stated that it was the parliament’s function to decide on issues concerning the common good.102 Opponents of the new law like Danuta Waniek from the Democratic Left Alliance (Sojusz Lewicy Demokratycznej; SLD), to which the post-communist SdRP also belonged, argued that the law would lead to an increasing numbers of illegal abortions and, in the worst cases, to infanticide. She concluded that the law had the potential to “turn a child into an enemy of its own mother.”103

Andrzej Wielowieyski, member of the governing UD party and a long-term member of the Clubs of Catholic Intelligentsia, was against the law in its form at the time because it was not “well-thought-out.” Regarding questions of biopolitics, he is an interesting actor, since he attended meetings at which pre-marital courses were organized by the KIK, and he had served as one of the editors of the Catholic paper Connection (Więź) since the 1960s. During the parliamentary debate in January 1993, he warned that restrictive laws had led to pregnant women taking trips to countries with liberal laws. Furthermore, he was convinced that, if the Parliament were to decide in favor of the law even though surveys indicated that the vast majority of the Polish society was against it, that this could lead to irreversible damage to the young Polish democracy.104 Jacek Kurczewski, a member of the centrist Liberal Democratic Congress (KLD, Kongres Liberalno-Demokratyczny), which was also a governing party at the time, offered a similar argument. In his statement during the debate, he did something very uncommon in this discourse at that time. He separated the medical procedure and the question of its permissibility from the moral considerations. On the one hand, i.e., morally, he declared that abortions were “bad” and that “nobody could doubt that life begins at the moment of the unification of the male and female cell.” However, he favored settling the question of whether or not someone should be penalized for performing an abortion by referendum. 105

But he did not prevail. Instead, the majority of the Sejm voted in favor of the new restrictive law, which was commonly called a “compromise,” because it restricted the availability of abortions but it did not ban them in general. But a closer look at the wording opens up another perspective: officially entitled Law on Family Planning, the Protection of the Fetus, and the Circumstances of the Permissibility of the Termination of Pregnancies, its wording highlights the enforcement of the Catholic pro-life-discourse of earlier decades. The law refers to its subject almost entirely as the “conceived child.” The term “fetus” is only used once in the text (apart from when it occurs in the title), in the passage concerning abortions because of embryo-pathologic reasons. This passage was deemed unconstitutional by the Constitutional Tribunal on October 22, 2020.

Conclusion

The so-called “compromise” of 1993 can be interpreted as a short “truce” in a long-term conflict which can be called (borrowing a metaphor from international relations) a “frozen conflict.”106 This means that the (in this case ideological, moral, and juridical) conflict has not been solved and is smoldering and can therefore flare up at any given moment. That happened after 1993 on several occasions. On the one hand, the first left-wing government attempted to liberalize the law between 1993 and 1997. They did not succeed, because the draft bills were first vetoed by Lech Wałęsa, who was serving as State President at the time, and then ruled unconstitutional by the Constitutional Tribunal.107 On the other hand, right-wing parties and NGOs tried to enforce a complete ban on abortions and the introduction of the obligation to “protect unborn life” into the constitution,108 similarly to the Republic of Ireland, where such a passage was introduced in 1983.109 Until 2020, none of them succeeded in Poland. But the verdict of the Constitutional Tribunal had a major impact and generated a new dynamic which is observable in the current mass protests.

If one looks back at the decision of 1993, two things might be kept in mind. First, it was the unity of the “Christian” parties (despite their quarrels) that led to the introduction of the restrictive law. As I mentioned, the two right-wing governmental coalitions lasted for only 23 months. But they were successful in transforming their (and their allies’) political aims into reality. This is most obvious in the law on the termination of pregnancies and its wording, which resembles the “Catholic” pro-life-discourse more than it does the discourse of a “compromise.” But this includes not only the legislation on abortion, but also the introduction of religious education in schools (via Ministerial decree, without the parliament’s approval) and the signing of a concordat with the Holy See. These were highly controversial steps which indicate that these political struggles go deeper: they can be interpreted as cleavages concerning the essential nature of the Polish state after 1990. In the aftermath of the 1993 decision, the supporters of liberalization (the SLD was the most active) depended on their partners in the governmental coalition. It was therefore difficult to reintroduce a liberal version of the law, especially since, when one such new law was approved by the Sejm, it was vetoed, either by Wałęsa or by the Constitutional Tribunal.

The second intriguing observation is that the discourse, especially in the 1980s and 1990s, was mainly (or better, observably) shaped by (“Christian”) politicians and publicists. Priests also had an influence on the discourse during sermons “in defense of the unborn,” in pastoral letters, or in the interviews they gave. Even in the later years of the Third Republic, the influence of the Church and its representatives had to be taken into considered, e.g., on the eve of Poland’s entry into the European Union.110 The Episcopate looked skeptically at the processes prior to entry and perceived the EU as “godless” and “not compatible” with “Polish Christian values,” especially on the questions of abortion and marriage.111 Therefore, the then left-wing government had to soothe the Church’s mistrust to avoid imperiling Poland’s entry into the EU.112 Since then, the question returns intermittently.

Quo vadis, Polonia? Whither goest thou, Poland? It is difficult to foresee what the next stage in this ongoing, at the moment “unfrozen” conflict will be.

Archival Sources

Archiwum Akt Nowych w Warszawie [Archive of Modern Records in Warsaw] (AAN)

Ogólnopolskie Biuro Komitetu Frontu Jedności Narodowej [All-Polish Bureau of the Committee of the Front of National Unity] (BOK FJN)

Komitet Centralny Polskiej Zjednoczonej Partii Robotniczej [Central Committee of the Polish United Workers’ Party] (KC PZPR)

Centralny Urząd Planowania [Central Planning Office] (CUP)

Porozumienie Centrum [Centre Alliance] (PC)

Chrześcijańsko-Demokratyczne Stronnictwo Pracy [Christian Democratic Labour Party] (ChDSP)

Zjednoczenie Chrześcijańsko-Narodowe [Christian National Union] (ZChN)

Klub Intelligencji Katolickiej [Clubs of Catholic Intelligentsia] (KIK)

Sojusz Lewicy Demokratycznej, Rada Krajowa [Democratic Left Alliance, National Council] (SLD RK)

Unia Demokratyczna [Democratic Union] (UD)

Ministerstwo Zdrowia i Opieki Społecznej [Ministry for Health and Social Warfare] (MZiOS)

Urząd do spraw Wyznań [Office for Confessional Issues] (UdsW)

Polskie Forum Chrześcijańsko-Demokratyczne [Polish Forum of Christian Democracy] (PFChD)

Polska Partia Socjalistyczna [Polish Socialist Party] (PPS)

Socjaldemokracja Rzeczypospolitej Polski [Social Democracy of the Republic of Poland] (SdRP)

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Zok, Michael. “Körperpolitik, (staatstragender) Katholizismus und (De-)Säkularisierung im 20. Jahrhundert. Auseinandersetzungen um Reproduktionsrechte in Irland und Polen.” Body Politics 7, no. 11 (2019): 123–58.

Zok, Michael. “Wider der ‘angeborenen und nationalen Mission der Frau’? Gesellschaftliche Auseinandersetzungen um Abtreibungen in Polen seit der Entstalinisierung.” Zeitschrift für Ostmitteleuropa-Forschung 68, no. 2 (2019): 249–78.

Liberating Pathologization? The Historical Background of the 1961 Decriminalization of Homosexuality in Hungary*

Judit Takács,
Centre for Social Sciences, Hungarian Academy of Sciences Centre of Excellence; KWI Essen
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Tamás P. Tóth
Centre for Social Sciences, Hungarian Academy of Sciences Centre of Excellence; Artist & Researcher in Residence Guiniguada, Canary Islands
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Hungarian Historical Review Volume 10 Issue 2  (2021): 267-300 DOI 10.38145/2021.2.267

Analyzing the principles, considerations, and official explanations underpinning the
(de)criminalization of sexual relations between same-sex partners can highlight that around the mid-twentieth century medicalizing references were used in legal and societal judgments on same-sex intimacy in Hungary (and elsewhere). In this study, we want to illustrate the medicalization process of social issues that otherwise seem difficult to “solve” (i.e., these issues, in this case, were put within a psycho-medical ambit) by focusing on a twentieth-century historical example from Hungary. The background of the decriminalization of consensual sexual acts between adult men in the 1961 Hungarian Penal Code will be explored in detail using previously unknown original archival material from 1958. This article will introduce the changes proposed by the Neurology Committee of the Health Science Council (HSC; Egészségügyi Tudományos Tanács) in 1958 leading to the HSC’s unanimous support for a proposal to decriminalize “unnatural fornication” between consenting adults and to the actual decriminalization of homosexuality (i.e., decriminalization of consensual sexual acts between adult men) in 1961. The empirical foundation of the present study includes archival records from the National Archives of Hungary and other primary sources.

Keywords: homosexuality, (de)criminalization, social history, state-socialism, National Archives, Penal Code, Neurology Committee of the Health Science Council

Introduction

It would be pointless to look for homosexuality anywhere in the criminal codes that were in force in Hungary. This term, which was coined, together with the term “heterosexuality,” by Károly Kertbeny, 1 an Austrian–Hungarian writer and journalist in the late 1860s, does not appear anywhere in these codes. In the second half of the nineteenth century, homosexual practices began to be punishable under the heading of “unnatural fornication” or literally “perversion against nature” (természet elleni fajtalanság) in the chapter on crimes and offences against sexual morality in Article V of the Criminal Code of 1878, the first Hungarian-language criminal code of the Hungarian Kingdom, which was drafted by Károly Csemegi, State Secretary of Justice of the Government of Kálmán Tisza.2 Here paragraphs 241 and 242 drew a distinction between the offences of unnatural fornication committed between men or by a person to an animal on the one hand and the more harshly punished crime of unnatural fornication that involved violence or the threat of violence.3

The most important antecedent to the Csemegi Code of 1878 is the work of Tivadar Pauler, who served as Minister of Justice between 1872 and 1875, on criminal law studies, which was first published in 1864, just a few years before the Austro–Hungarian Compromise of 1867. Here, in paragraphs 396–400, unnatural fornication, i.e., crimen sodomiae or the crime of sodomy, is defined as “sexual intercourse contrary to the natural order,” which should be punished because of its “gross violation of moral sentiment, irrational ignorance of the natural order, demeaning of human dignity, and the withering and harmful effects on one’s intellectual properties and physical health.”4 Pauler’s approach reflects a potential Austrian influence in terms of the offenders’ gender, as according to the Austrian penal code sodomy could be committed not only by men but also by women (the “Tribadie” provision of the Austrian penal code was introduced in 1852 and remained in effect until 1971).5 Pauler distinguished between three main forms of unnatural fornication: it was defined not only as sexual intercourse conducted with an animal or with a same-sex partner but also as a sexual intercourse conducted with a different-sex partner in an unnatural way. At the same time, “serious violations of morality and prudency” within family life were considered only petty offences.6

The Csemegi Code, which remained in effect for more than 80 years, differed in two major points from the legal text proposed by Pauler (1870): its prohibition of unnatural fornication affected neither different-sex partners nor same-sex female partners. However, the precise scope of what exactly constituted unnatural fornication was hard to determine, as was shown in the penal code interpretations by Károly Illés Edvi, a skilled prosecutor who took part in the writing of the Csemegi Code. In his view “in a broad sense it refers to the unnatural satisfaction of any kind of sexual lust,” including “self-contamination and the use of inanimate objects […] these cases, however, have been ignored even by the old legal doctrine and legislation that distinguished three main forms of what could be interpreted as sodomy in a strict sense: sexual intercourse conducted with a) an animal […] b) a person of the same sex […] and c) a person of different sex in an unnatural manner. The case under b) included various unnatural activities that can be conducted among women (lesbian love), too. The present law completely ignores the latter case, which also divided the opinion of the old criminalists, and renders unnatural fornication between different sex partners punishable only as far as it was covered by § 233 [of the Penal Code on sexual assault].”7

Even a quarter of a century later, several points remained contentious regarding the exact scope of unnatural fornication. For example, Pál Angyal, a criminal lawyer who specialized in issues concerning sexual morality and a leading figure of the Hungarian lawyers’ society in the early twentieth century, outlined the desirable changes regarding the future criminal policy in the following way:

de lege feranda [...] 1. onanism should remain unpunished, 2. punishment of fornication between men should be sustained [...] 3. unnatural fornication between women should be criminalized 4. punishment of bestiality should be sustained only because it is morally undesirable to delete an existing ban [...] 5. necrophilia [should be punished] only in the case of causing scandal (possibly under the heading of desecrating a corpse or crime against religion) 6. criminalizing unnatural fornication conducted between different sex persons is unreasonable (except for the cases covered by 233 § of the Criminal Code) because these acts quite often precede or follow normal intercourse […] but fornication conducted by a woman with an adolescent boy should be punished […] 7. seduction to commit homosexual acts or offering these services, however, should be rendered punishable.8

In Angyal’s argument, it is striking to see the double standard applied to non-reproductive sexual practices in terms of the sex of the alleged fornicators: if the acts were conducted by same-sex partners, they were seen as having the potential to cause social harm. At the same time, non-reproductive sexual practices conducted by different-sex partners were depicted as belonging to a broader repertoire of sexual activities or sexual play (such as foreplay), which in the worst case could be interpreted at an interpersonal level as morally wrong. This is why Angyal would have preferred to introduce the criminalization of same-sex “fornication” between women in addition to maintaining the prohibition of same-sex “fornication” between men, while avoiding the criminalization of fornication between different-sex partners.

Criminalization: A Contested Issue

Criminalization of consensual sexual practices between same-sex individuals, especially between adult men, has been a contested issue in Central Europe since at least the second half of the nineteenth century. There had been no discussion of legalization up to this point in time, because for centuries, any queer act transgressing the ostensibly God-given authority of the Church and the monarch had been covered by the broad category of sodomy or unnatural fornication. In the period before the concepts of homosexuality and heterosexuality had been invented, sodomy was understood as an act that could be committed by anyone, regardless of that person’s sex or the sex of the person with whom the act was committed.9

In the 1860s, the German writer and jurist Karl Heinrich Ulrichs argued for decriminalization in a biologically essentializing manner: in his view, urnings, i.e., men who loved men, characterized by a certain degree of femininity of the soul, made up a third sex.10 Thus, according to Ulrichs, adult men in a consensual sexual relationship with each other should not be prosecuted for acting upon their nature-given innate drive. Ulrichs and Kertbeny had known each other since 1864: in that year, Kertbeny’s book on the Austrian American writer Charles Sealsfield was published, in which Ulrichs found “the first mention of my theory in print.” Ulrichs considered Kertbeny one of his first “comrades.”11 They regularly corresponded until 1868, when their disagreement about the practicality of their urning/homosexuality concepts in the argument for decriminalization reached its peak. One of their points of dispute concerned the issue of gender inversion, which Ulrichs presented as an all-encompassing explanation for same-sex desire: in his view, the “truly feminine nature” of urnings would render them biologically more like women than men. In contrast, Kertbeny, while he also observed that homosexual men “like to socialize with women, with whom they behave not as men, but rather as though they were women, loving gossip, domestic work, and concerns, and devoted to each other like sisters,” did not see gender inversion as an essential feature of homosexuality.12

While at first, they both seemed to agree about the necessity of looking for the scientific proof of the inborn nature of homosexuality, Kertbeny later saw this as a useless argument, because of its limited power to persuade legislators. In fact, the first known appearance of the new terms homosexual and heterosexual can be traced to the private letter written by Kertbeny to Ulrichs in 1868, in which Kertbeny put forward a classic liberal argument of non-intervention by the modern state in the intimate lives of its citizens:

To prove innateness [...] is a dangerous double-edged weapon. Let this riddle of nature be very interesting from the anthropological point of view. Legislation is not concerned whether this inclination is innate or not, legislation is only interested in the personal and social dangers associated with it [...] Therefore, we would not win anything by proving innateness beyond a shadow of doubt. Instead, we should convince our opponents—with precisely the same legal notions used by them—that they do not have anything at all to do with this inclination, be it innate or intentional, since the state does not have the right to intervene in anything that occurs between two consenting persons older than fourteen, which does not affect the public sphere, nor the rights of a third party.13

 

In 1869, however, in an anonymously published open letter to the Prussian Minister of Justice, Kertbeny called for the elimination of the Prussian penal code criminalizing same-sex sexual activities by emphasizing that “homosexual impulses are not optional […] but rather congenital,” which “excludes the thought that homosexuals in time, can be made to join the ranks of the majority, which has been born with the stronger drive, normalsexualism.”14 This was the first time that the word homosexual, created from the Greek homo (“same”) and the Latin sexus (“sex”), was publicly used. In this political pamphlet, which was reprinted in 1905 by Magnus Hirschfeld as “one of the best works on the homosexual problem,”15 Kertbeny tried to merge Ulrichs’ innate drive argument with that of privacy:

It is obvious to thinkers educated in anthropology that those who are constrained by such [homosexual] drives either meet with individuals of their own nature, and, therefore, there is absolutely nothing at all to justify objecting to such reciprocal inclinations, because both are lacking normalsexuality by nature, and, therefore, it would be asking too much of them to live their whole life long in absolute chastity, and to submit their existence to a penalty because, through no fault of their own, nature organized them with this very constraint. Or however, such homosexuals turn their inclinations to normalsexuals; and if the modern constitutional state makes a concession to the latter, in principle, in all cases in which no rights of others are injured by it, that they will be allowed to do with their bodies as they please, then it will not be necessary to differentiate between acts, whether the same are natural or would-be unnatural, if they are practiced by the opposite sex or the same sex.16

 

Despite the opposition of Ulrichs, Kertbeny and others, including even the Royal Prussian Scientific Commission for Medical Affairs, in 1871, after the first German unification, the Prussian anti-sodomy statute was introduced as Paragraph 175 into the new German Imperial Criminal Code.17 The introduction of Paragraph 175 facilitated the continuation of criminal prosecution in some parts of Germany, such as Prussia, while it meant the re-criminalization of consensual homosexual acts in other parts of Germany, including Bavaria, Württemberg, Baden, Hanover, and Brunswick.

At the very end of the nineteenth century, decriminalization arguments surfaced in Hungary, too. For instance, in 1894 András Eördögh, a Hungarian lawyer, challenged the article on unnatural fornication by pointing out that it is nonsense to outlaw acts that cannot be prevented and take place mostly in publicly concealed ways, including “the act of consensual sodomy conducted by adults in secrecy that makes the act inherently unpreventable.”18

In the early years of the twentieth century, Hungarian abolitionist lawyers were of the opinion that unnatural fornication should not be rendered punishable by law because it was increasingly seen as a medical rather than legal issue. Instead of legal expert involvement, abolitionists argued for shifting the social responsibility to medical experts, as only physicians would be able (they thought) to distinguish between the symptoms of an inborn mental illness and illicit intemperance. For instance, in 1905, Péter Reich, an abolitionist lawyer, argued for “deleting pederasty from all modern penal codes” on the basis of the “fully elucidated medical notions about pederasty deriving from a degenerate mental disposition” and the recognition that “punishment does not contribute to the improvement of the pederasts’ condition: they cannot resist their inclination no matter how long they would be imprisoned […consequently] deterrence is out of the question.”19 Applying a “cure instead of imprisonment”-framework potentially involved prescribing social isolation that practically meant that the person had to be locked up in specialized medical or mental institutions, an increasingly popular view across Europe (see, for instance, the case of Oscar Wilde).20

It is not difficult to see that abolitionist arguments, common in the medical literature of the period,21 were far from recognizing individual rights and liberties or reflecting the social acceptability of same-sex attraction-based relationships. Rather, their main point was about letting these forms of behavior and relationships, which were typically conducted secretively due to their stigmatization by society, remain concealed so that the chances of social exposure would be minimized, while through criminalization, these cases could easily attract more widespread attention, for instance, by media representations focusing on the “scandalous” details of suspects’ lives. While Hungarian abolitionists did not achieve their goals for more than half a century, some of their arguments resurfaced at the 1958 meeting of the Neurology Committee, which will be discussed later in detail.

 

Changing Decriminalization Landscapes in Twentieth-Century Central and Eastern Europe

To appraise the Hungarian developments in a regional context, we will give a quick overview of the decriminalization landscapes in the former Eastern Bloc countries, where we can see a diversity of approaches to (de)criminalization of same-sex sexual practices. For example, after the reintroduction of a comprehensive anti-homosexuality legislation in 2013, prohibiting the “propaganda of non-traditional sexual relations”22 at the Russian state-level it is perhaps hard to believe that there was a Russian sexual revolution in the early twentieth century.23 The first Soviet-Russian criminal code of 1922 abolished the sodomy laws of tsarist Russia. Indeed, the very first Penal Code proposal of January 1918, only months after the October Revolution, no longer contained the old sodomy legislation, and it set the age of consent for both homosexual and heterosexual acts at 14 years of age.24 The Soviet-Russian sexual revolutionary period and the transitional legalization of same-sex relationships as part of it came to an end with Stalin’s rise to power. The 1934 Soviet Criminal Code recriminalized consensual sexual acts between same-sex adults, and re-decriminalization took place only in 1993. The temporary decriminalization of homosexuality between 1922 and 193325 reflected the rejection of moral standards based on religious belief,26 and the Bolsheviks’ transient position about the criminalization of homosexuality being a bourgeois relic. Stalinism, by contrast, “relied on an intolerant and negative view of sex,” and “for the sake of both the nation and the Communist Party,”27 Stalinism demanded marital and family stability from its citizens. Framing of homosexuality as detrimental to the nation was also a familiar argument used in Nazi Germany about sexual life to serve the goal of preserving the race and the nation, and homosexuality was heavily condemned due to its “asocial” character and its “adverse effects on the German birth rate.”28 We can also observe similarities in the treatment of communists and homosexuals during McCarthyism in the US in the 1950s, comparable with state-socialist considerations of homosexuals being “unreliable elements,” characterized by high levels of “blackmailability”29 and limited (reproductive) contributions to building state-socialism.

Poland took up a unique position in this regard, since in the period between the 1930s and the 1980s, it had “a more progressive legislation towards homosexuality than some Western Bloc countries.”30 In fact, the Polish Penal Code, based on the French example (i.e., the Napoleonic Penal Code of 1810, based on the French Penal Code of 1791) never forbade sodomy. However, Russian, Prussian and/or Austrian criminal law was applied depending on the particular jurisdiction of the various Polish territories. Today it might sound surprising, but, disregarding the Soviet-Russian criminal code of 1922, the Polish criminal law of 1932 was the first in Europe to decriminalize homosexuality in the twentieth century.31

Romania can also be considered an exceptional case. Here, criminalization of consensual homosexual acts for both men and women was introduced for the first time, coincidentally, just two years after homosexuality was re-criminalized by Stalin in the Soviet Union. The 1936 Romanian Penal Code came into effect during the chaotic years preceding World War II, when the Kingdom of Romania was more aligned with Nazi Germany than Soviet Russia.32 New Romanian legislation entered into force in 1996, criminalizing homosexual acts performed in public places or in a scandalous manner; in addition, the legal regulations opposing “homosexual propaganda” also restricted gay and lesbian people’s freedom of expression and association:33 the infamous “section 200” (i.e., Article 200 of the 1968 Romanian Penal Code, criminalizing public manifestations of homosexuality) was abolished only in 2001.

The notion that homosexuality is a pathological phenomenon and therefore ought not to be punishable by law was essential to the state-socialist governments’ decisions to legalize consensual homosexual sex in Czechoslovakia and Hungary in 1961, but they each relied on different medicalized approaches. Sexology research flourished after the opening of a Czech sexology institute by Josef Hynie in 1921 in Prague, which remained in operation during the state-socialist period. Hynie and his colleagues applied medical rather than criminal approaches to sexual deviations; regarding the sexological treatment of homosexuality, Czech physician Kurt Freund played an especially important role.34 After his failed aversion therapy experiments of the 1950s, Freund came to the conclusion that homosexuality is not “curable” with medication or any other form of therapy, such as electroshocks. He became increasingly convinced that homosexuality ought to be decriminalized, and thus he came to feel that counseling self-acceptance is advisable. Freund admitted that he was not happy about his “therapeutic experiment which, if it has ‘helped’ at all, has helped clients enter into marriages that later became unbearable.”35 Freund took part in organizing a legal-psychiatric seminar, where psychiatrists, sexologists, legal experts, and representatives from the police drafted a consensual proposal about the unnecessity of the prohibition of homosexual acts, which contributed to the renewal of the Czechoslovak Penal Code in 1961.36 The initial draft of the new Czechoslovak Penal Code in March 1961 maintained the general penalization provision for homosexual acts, but its final form criminalized only homosexual acts between adults and minors (youths under eighteen), prostitution, or sexual acts performed under circumstances regarded as a public scandal.37 The law came into effect on January 1, 1962, half a year earlier than the Hungarian provision, and an equal age of consent at the age of 15 was introduced as early as 1990, much sooner than it was in Hungary.

In 1968, Bulgaria and the German Democratic Republic (GDR) decriminalized male same-sex sexual activity on the grounds that homosexuality is a medical matter rather than a police matter.38 However, Bulgaria retained laws against acts that “cause public scandal or entice others to perversity,”39 and Bulgaria set a higher age of consent for homosexual acts than it did for heterosexual sex (18 and 14, respectively), while in the GDR the prohibition of consensual homosexual acts was removed only between adult men, although this prohibition had not been enforced in practice since the end of the 1950s.40

In the same year, Yugoslav legal experts argued against repressive measures for dealing with “deviant sexual behavior of two consenting adults” and defined homosexuality as a “less dangerous social phenomenon” in an official report.41 This led to the first Yugoslav decriminalization wave in the Socialist Republics of Croatia, Slovenia, and Montenegro and in the Socialist Autonomous Province of Vojvodina (in the northern part of Serbia, with a considerable Hungarian ethnic minority) in 1977. In Slovenia and Montenegro, the age of consent remained 14 years of age for all, while in Croatia and Vojvodina the age of consent for homosexual acts was set at 18.42 A second wave of decriminalization took place only after the dissolution of Yugoslavia in the former Yugoslavian republics that had not repealed their relevant laws earlier, starting with Serbia in 1994.

As the Soviet Union maintained criminalization from the 1930s until its collapse in 1990, decriminalization could start only in its successor states, including Ukraine in 1991, Estonia and Latvia in 1992, Lithuania and Russia in 1993, Belarus in 1994; followed by Albania and Moldova in 1995, and Romania in 1996.43

The diversity in the timing and forms of decriminalization (and in some cases, re-criminalization) of homosexual practices challenges interpretations of the region as a homogeneous bloc. Several factors contributed to the heterogeneity we found, including varying cultural, legal, and religious traditions, criminalizing and/or pathologizing approaches, as well as democratic and economic conditions. In the discussion below, we offer a closer look at the specific details of the 1961 decriminalization in Hungary.

Legalizing Same-sex Sexual Acts between Consenting Adults in Hungary

The “decriminalization of homosexuality,” as the legalization of same-sex sexual acts between consenting adults has often been referred to, was not realized in Hungary until Act V of 1961 of the Hungarian Penal Code of the People’s Republic of Hungary came into effect. In the state-socialist criminal code, which entered into force on July 1, 1962, “unnatural fornication” was discussed under Paragraphs 278–279, alongside other crimes against sexual morality. One of the main novelties of this new legislation was what was left out of it: in particular, the “general, i.e., completely unrestricted, penalization of unnatural fornication.”44 With the introduction of this legislation, consensual homosexual activity between adult men ceased to be criminalized in Hungary, as did bestiality. Additionally, the definition of potential perpetrators and victims also changed: gender equality was introduced in the sense that from this point on, both men and women could be prosecuted equally for “unnatural fornication.” According to the official reasoning justifying the bill presented to the Hungarian Parliament on December 15, 1961,

[H]omosexuality is either an inborn sexual perversity rooted in a developmental disorder or an acquired anomaly that develops mainly within neurotic people as a result of some sort of sexual impression during childhood, adolescence, or at a young age. According to medical observations, even in the case of acquired homosexuality or of those who wanted to free themselves (from homosexuality), the soundest therapy could hardly ever lead to the desired result. Homosexuality is a biological phenomenon and can therefore not be handled legally as a crime. Finally, in the course of its legal regulation, the practical point should be considered that criminalization of such behavior would provide a wide scope for blackmail.45

 

The medical(ized) definition of homosexuality that was used as a main reference point in introducing the new legislation offers one indication that, by 1961, the disease models of homosexuality had also reached Hungarian policy-makers. While we cannot be sure exactly how this happened, we can certainly assume that it was the combined effect of several causes, including a wider sense of political relief at the end of the totalitarian Rákosi era (the historical period named after Mátyás Rákosi, the General Secretary of the Hungarian Communist Party between 1948 and 1956), followed by a process of modernization in family policy,46 starting with the liberalization of the previously very strict abortion regulation, and the gradual reinstating of psy-sciences, which had been practically banned during the Rákosi era.47

With the crystallization of psychology and psychiatry as sciences, several disease model variations, some promoting fixed biological determination, others emphasizing the inhibited development or trauma-drivenness of homosexuality, had become increasingly widespread since the late nineteenth and early twentieth century in the Western world,48 and these ideas and models were adopted and adapted by Hungarian psy-scientists too. Medicalization in legal practice may have proven useful because it provided apologetic arguments to protect those found to be involved in illegal (homo)sexual acts from imprisonment. However, the long term effect of applying medicalized and often pathologizing models of homosexuality and other non-reproductive forms of sexuality was that essentialist interpretations of sexuality became so widely palatable and socially acceptable that attempts to get rid of them seem to have been largely unsuccessful, even today.49

The novelties of the Penal Code of 1961 that was in force between July 1962 and June 1979 included setting the age of consent for same-sex sexual relations at 20. The main goal of this clause within Paragraph 279 was to protect the youth aged between 14 (as the age of consent for heterosexual relations) and 20 from “homosexualization” (i.e., becoming homosexual) since, at least according to the legislators’ argument, this is “the age when the sexual drive, due to perverted experiences, can easily be skewed in a distorted direction.”50

Youth protection was one of the main goals of another clause of Paragraph 279 on unnatural fornication committed in a “scandalous manner” (though the definition of what could constitute a “scandal” was rather elusive), for which one could be sentenced to up to three years in prison in cases provoking “disgust, indignation, anger etc. in others.”51 Although the text of the law referred to “others” in the plural, according to the official legal interpretation, a crime had been committed even if the acts were witnessed by only one person who felt disgusted or offended. (This clause could be used as a reference, for instance, by police officers raiding a hotel room where a same-sex couple would have had a tryst in the 1960s.52)

As has already been mentioned, the new Penal Code put gender equality into legal practice in the sense that homosexual acts conducted by women with a partner younger than 20 and/or in a scandalous manner were criminalized too, while homosexual acts between female partners had been beyond the scope of the previous criminal codes. As an additional novelty, all children under the age of 14 could become a victim of sexual assault, not only “decent maidens,”53 while previously the idea of protecting young boys from sexual assault or women perpetrating sexual assault had not even occurred to legislators.

The new Hungarian Penal Code of 1961 introduced many significant changes, among which “decriminalizing homosexuality” is a remarkable one, even though it clearly held same-sex sexual relationships to a different set of standards than heterosexual relationships and provided legal means for the authorities to press charges against people involved in homosexual acts. (For instance, the age of consent for same-sex relationships, irrespective of gender, was set at 20, considerably higher than 14, the age of consent for heterosexual relationships. In 1978, the age of consent for homosexual relationships was reduced to 18, but it was not until 2002 that an equal age of consent was set at 14 for all consensual sexual relations.)54 However, the question of what led to this turn of events in 1961 remains at least partly open.

Psychiatrists in Action

The notion that homosexuality is a pathological phenomenon was essential to the legalization of consensual homosexual sex in Hungary: it was reflected not only in the official reasoning of the bill but also in reports reciting such arguments.55 However, though no mention of the following fact is found in the earlier secondary literature on the subject, the political decision about decriminalization was informed by prominent Hungarian psychiatrists’ expert opinion. Based on previously undocumented archival records found in the National Archives of Hungary, it is clear now that, in 1958, the Neurology Committee of the Health Science Council (HSC; Egészségügyi Tudományos Tanács) provided unanimous support for a proposal to legalize same-sex sexual acts between consenting adults and therefore most probably contributed significantly to the actual decriminalization of consensual sexual acts between adult men, which followed in 1961. It has also become clear that this process was triggered by a single individual’s petition, even though additional details regarding this individual’s original submission, identity, and exact motives remain unknown for the time being.

The Health Science Council began to function in 1951 within the Ministry of Health, which had been established a year earlier.56 Its tasks included “proposing solutions for the management of theoretical and practical medical work [...] preparing resolutions on the application of new medical procedures and new diagnostic approaches,” etc.57 In 2015, in one of the several hundred boxes containing HSC-related material in the National Archives of Hungary, we have found the minutes of a HSC Neurology Committee meeting which took place on March 21, 1958,58 the presentation of Antal Csorba on “Medical and criminal problems of homosexuality,” which was discussed in that meeting,59 and an official report summarizing the expert opinion of the Neurology Committee, written by Zoltán Alföldy, the secretary of HSC, to Comrade Rostás,60 a high commissioner of the Hungarian Socialist Workers’ Party. These documents are significant primary sources. To a certain extent, they reflect social and legal discourses. Thus, by discussing their content, we contribute to an understanding of the arguments, both pro and contra, which shaped the political decision on decriminalization in 1961.

In the HSC meeting of March 21, 1958, which was chaired by Professor Gyula Nyírő, only six psychiatrists took part, including Sándor Fodor, Lilly Hajdu, 61 Pál Juhász and Pál Fodor. Here, we focus on one item of the agenda about the proposal to modify homosexuality-related criminal clauses.62 First, Colonel Antal Csorba, chief neurologist of the Hungarian People’s Army, general secretary of the Hungarian Society of Neurologists and Psychiatrists, and member of the Pavlov Neurology Panel, gave a presentation on the medical and criminal problems related to homosexuality.

The relatively long (seven and half pages) text was thematically divided into eight main sections. These sections included a definition of homosexuality, a brief “literature review” on congenital and acquired homosexuality, prevalence estimates, an overview of modern European criminal practices, a detailed description of abolitionist arguments, a description of arguments for maintaining criminalization, and possible objections to such arguments, followed by the author’s own objections and completed with written proposals for the amendment of the existing law. In general, the proposal seems shaped by the conviction (reflecting and affirming social homophobia) that homosexual acts should be decriminalized not to promote social acceptance, but because the natural aversion deriving from the “healthy heteronormativity” of society is in itself enough punishment for those concerned. Table 1 in the Appendix provides an overview of the pro and contra arguments for (de)criminalization listed in Colonel Csorba’s presentation.

Csorba used a broad definition of homosexuality which included not only actual sexual acts but also the contents of sexual dreams, feelings of fondness, sexual attraction, and love.63 In the presentation, it was pointed out that it is as difficult for a homosexual individual to initiate heterosexual contact as it is for a heterosexual the other way around. It was also stressed that the case histories of homosexual relationships often include severe mood swings, depressive reactions, suicide attempts, and even violent acts. At the same time, Csorba admitted that “prohibition might also play a role in maintaining a constant psychological tension.”64 Csorba distinguished between homosexuality and bisexuality, defining the latter as “two-way sexuality,” when in addition to the main heterosexual interest, occasional homosexual episodes might occur, typically under the influence of alcohol.65

The two-page “literature review” drew attention to the distinctions drawn in textbooks among forms of congenital and acquired homosexuality, as well as bisexuality. In the context of acquired forms of homosexuality, Csorba referred to Freudianism and to Alfred Binet’s and Konrad Lorenz’s approaches, especially in relation to the early stages of instinctual life, when imprinting might play an important role in human sexual development: “it is often the case that memory material reveals the decisive influence of first experiences.”66 Here, Csorba also mentioned the possibility of seduction by adult homosexuals, briefly reporting two unusual examples from his “own material” of a homosexual father who influenced his child’s sexual development. In other cases, he added, it is not about “rough seduction”, but fine involvement and the feeling of sympathy developed in the family (or a familiar) environment that can affect the direction of sexual interest.67 However, he emphasized, new studies seriously challenged the idea of “genetic predetermination,” and he brought up the Turner-syndrome as an example, where “external feminine genitalia are possible with a male chromosome set without the person psychosexually identifying as a man: this person identifies as a woman as she was raised, thus psychosexuality does not seem to be dependent on the sex chromosome” (it is worth noting that this is a complete misunderstanding of what Turner-syndrome, in which a female is partly or completely missing an X chromosome, actually is).68 When highlighting the potential weaknesses regarding the biological-genetic determination of homosexuality, he questioned the validity of Theo Lang’s theory, reviving Richard Goldschmidt’s association of homosexuality with intersexuality,69 by quoting up-to-date medical findings. These findings included an article in The Lancet about the Chromosomal Sex in Transvestites, published by Canadian medical professors in 1954, pointing out that male transvestites have male chromosomes, refuting the contrary “working hypothesis” of Danish professor, Christian Hamburger;70 and another article published by a Swiss psychiatrist and a German geneticist in 1956, challenging the direct link between chromosomal sex and psychosexual development.71 Csorba’s conclusion reflected the conviction that the etiology of homosexuality cannot be reduced to either a congenital or an acquired condition or state: the “innate” form can also result from specific environmental effects, he pointed out at the end, but even in this case, sexual direction would be completed for the most part in early childhood.72

Regarding the prevalence of homosexuality, Csorba indicated that, based on police records, only a small proportion of the true prevalence can be revealed, and it was impossible to gather accurate statistical data because of the socially concealed nature of homosexual relations.73 Yet, in this part he included estimates of Hirschfeld and Kinsey with prevalence figures between 2 percent and 50 percent. Csorba stressed that prevalence data, if it could be collected, would be important for two main reasons. First, “the more common the anomaly, the more desirable it is to withdraw penalization.”74 Second, with the accessibility of reliable statistics, by comparing results from countries where homosexual acts are criminalized and countries where homosexuality is not criminalized, it would be possible to test whether criminalization can be a practical solution at all.

The overview of the modern European criminal practices stressed, as a potential example to be avoided, that “in Hitler’s Germany, [homosexuality] was persecuted with severe penalties but without any particular success.” Regarding the Soviet Union, the text emphatically stated that “the 1927 Soviet Criminal Code did not punish [homosexuality],” while it would have been enough to communicate only the second half of the sentence, where it turns out that, later, homosexuality became a prohibited act punishable “in accordance with subsequent amendments.”75 It was then pointed out that, as in the rest of Europe, in other state-socialist People’s Republics there was no unified position on the criminalization of homosexual acts (here it was erroneously indicated that the Romanian Penal Code of 1948 prohibited homosexual acts only in the case of public scandal and that in Yugoslavia homosexuality has not been criminalized), adding that “the Austrian Criminal Code is the only one that recognizes and at the same time criminalizes female homosexuality.”76

In the next paragraphs, some of the representatives of the abolitionists were introduced, including the German lawyer and self-declared homosexual, Karl Heinrich Ulrichs, who had fought by legal means against the criminalization of homosexuality already in the 1860s, as mentioned earlier. Here, Csorba referred to the fact that, since the era in which Ulrichs had been waging his campaign, countless articles, submissions, and proposals had been prepared by homosexual persons demanding the abolition of criminalization, and he added that “this was a still ongoing process, since one such submission gave the opportunity to compile the present work, too.”77 This sentence clearly indicates that the issue of decriminalization was pushed on the Health Science Council’s agenda by a homosexual individual’s official submission, and since only male homosexuality was criminalized in Hungary, it can be safely assumed that this individual was a man.

It should be noted that the legal overview part did not contain any reference to the 1957 Wolfenden Report, which was compiled by a more diversified committee than the Hungarian one, including officials, churchmen, lawyers, scientists, and psychiatrists, even though its conclusions largely corresponded to the main points presented by Csorba.78 This could be explained by Csorba’s medical background or his focus on other state-socialist countries. It is also possible that Csorba was unaware of the report, which helped to facilitate the decriminalization of homosexuality in the United Kingdom, or he may have been familiar with it but may have decided not to quote it for some reason.

After the remarkable revelation about the Health Science Council’s agenda-setting having been triggered by a homosexual man, Csorba listed the detailed abolitionist arguments, arranged in ten points, followed by the arguments and counterarguments for maintaining criminalization. Table 1 (in the Appendix) gives an overview of these three types of arguments, which are raised in various parts of the text and which we can group according to the thematic categories below.

1. Biological phenomenon and social threat: the prosecution of biological phenomena by law is not logical. However, punishment is necessary to protect the purity of the sex life. At the same time, the purity of society’s sex life will not be damaged if homosexual acts are not penalized. A healthy society with heterosexual preferences has a natural aversion to this disorder. Thus, it is not necessary to have a separate penalty. Homosexuality leads to revulsion and disgust, and it does not tempt imitation, and if homosexual acts are not committed in public, there is no question of any social threat.

2. Lack of objective proof and seduction: the offence cannot be proven objectively. However, it is prohibited because it can corrupt the youth by diverting their sexual development in an abnormal direction. At the same time, in the context of heterosexual relations, protection of the youth is covered by other articles in the criminal law, which can be supplemented with regards to homosexuality.

3. Victimless crime and the protection of family life: an offence which has no victim does not pose any danger either to individual rights or to the interests of society. There is no social harm if the acts are committed by consenting adults and not in public. However, these acts can ruin family life. At the same time, penalization cannot guarantee the protection of family life. “Innate” homosexuals are unable to lead a regular heterosexual family life. Among non-heterosexuals, only bisexuals can perhaps lead regular heterosexual family lives. In this context, penalizing extramarital sexual relations would not be logical, since having an extramarital heterosexual relation is not considered a criminal offence either.

4. Population growth: the defendants do not feel guilty. They see their conduct as natural, and their homosexual acts are only repulsive to heterosexuals. However, these acts inhibit population growth. At the same time, the interest of protecting population growth cannot justify penalization, because in this case contraception should be penalized, too.

5. Doubtful treatment outcomes: punishment has no deterrent effect, nor does it have corrective or educational effects, because it cannot affect a deep-seated biological disorder. On the other hand, it is well known that imprisonment facilitates homosexual inclinations by providing an exclusively same-sex environment for a longer term. However, at least treatment could be provided for the duration of the prison term. At the same time, prisons or prison hospitals are not suitable environments for the treatment of homosexual disorders. Also, this disorder can be treated successfully only rarely (only in the case of bisexual persons who wish to free themselves from homosexual tendencies).

6. Blackmailing: penalization can be the basis of criminal blackmail. However, lack of penalization would not stop blackmailing activities altogether, since public contempt also makes blackmails possible. At the same time, though lack of penalization would not eradicate blackmail completely, it could significantly reduce its probability.

7. Homosexual marriage: the goal of protecting population growth cannot justify penalization, because in this case, contraception should be penalized, too. However, if we acknowledge the legitimacy of homosexuality, homosexual marriage should also be allowed. At the same time, the marriage of homosexual persons as an act attracting public attention and lacking essential instrumental features that constitute the institution of marriage is certainly undesirable (the need for authorizing same-sex marriage does not follow from the lack of penalizing homosexual acts).

8. Relative prevalence and violation of public tastes: the relative prevalence of homosexuality suggests that punishment should be limited. However, public opinion is for penalization. At the same time, the enlightened and educated public does not demand penalization. The situation of homosexuals is quite tragic even without penalization, because even if the law would not penalize this instinctual anomaly, homosexuals would have to continue to hide, because homosexuality would remain a violation of public taste, not to mention the fact that homosexuals are deprived of having offspring, etc.

9. Inconsistency, lack of reliable data, and the negligibility of the risk of “psychological contagion”: it is not consistent that homosexuality only be penalized in cases involving men, while it occurs among women in the same way. However, lack of penalization implies permissiveness that can lead to rampant proliferation. At the same time, the risk of rampant proliferation should be assessed only in a statistically reliable way, but unfortunately, there are no comparable datasets available. In the absence of reliable data, the only thing one can say is that in adulthood, the direction of sexual orientation is permanently fixed, and homosexual impulses would affect the normally oriented not in an attractive but in a repulsive way, thus the risk of psychological contagion seems negligible.

10. Sexual needs: all adult individuals have the right to satisfy their sexual needs, even if the mode of satisfaction is irregular. Thus, homosexuality cannot be rendered a crime given that it does not violate individual or collective interests. However, penalization can limit the frequency of the acts, even if it cannot eradicate the inclination. At the same time, the struggle between the dread of being reported, exposed, and punished and the enhanced instinctual drives almost inevitably leads to the exhaustion of the nervous system and neurosis. Even the fear of punishment cannot restrain the homosexuals’ quest for sexual satisfaction. They feel that the law cannot deprive them of their sexuality. Thus, the notion that punishment would limit the frequency of homosexual acts is highly unconvincing.

Looking through the list of thematic categories emerging from the text, while there were a few references to psycho-medically relevant content, such as the limited risk of “psychological contagion,” doubtful treatment outcomes, and the danger of neurosis, most points were connected to social institutions, concepts, and practices, such as (heterosexual and homosexual) marriage, family, population growth, youth protection, public opinion, avoiding extortion, etc. Additionally, certain legal and methodological problems were also raised by referring to the absence of victims (in the case of victimless crime), lacking consistency regarding the gender of the prosecuted, as well as the lack of objective proof and reliable data concerning the prevalence of homosexuality among the general population. We can also observe that the text was dominated by the arguments concerning decriminalization, which were often rooted in social rather than medical considerations. Consequently, it is not surprising that the proposal concluded that a resolution against criminalization seems “(more) appropriate and fair.”79

At the end of the text, the author presented two proposals regarding how to modify the current text of the law: according to the first option, sexual acts by same-sex partners, whether men or women, should be punishable only if they constitute an assault on or violation of public decency (i.e., if they cause public scandal) or if one of the two participants is younger than 18. According to the second option, zoophilia (or bestiality) should remain punishable, but an equal age of consent of 16 should be introduced for both heterosexual and homosexual relations. Finally, Csorba referred to negative therapeutic experiences and expressed his complete rejection of the potentials of coercive treatment.

Csorba’s submission on March 21, 1958 was followed by a brief discussion during which one committee member suggested that the content which had been presented should be published in the Neurology Review, a Hungarian scientific journal. However, this suggestion was rejected by the chair of the committee: in Professor Nyírő’s view it would not be advisable to give too much publicity to this issue. He and Pál Juhász agreed about the acquired nature of homosexuality (according to the minutes “based on three observed cases of cure, he [Nyírő] does not consider homosexuality either incurable nor innate”80), and thus suggested to increase the age of consent to 20 for “(youth) protection purposes.”81 Lilly Hajdu,82 the only female committee member, disagreed with this proposal, arguing that “setting the protected age limit at 20 years is excessive, especially in the case of women whose sexual maturity is completed by the end of puberty.”83 The discussion ended with the general consensus that the law should be amended according to Colonel Csorba’s first proposal, which set the age of consent for same-sex relations at 20 (six years higher than for heterosexuals). Some of Csorba’s language and arguments did, in fact, reappear in the 1961 Penal Code.

On July 11, 1958, Zoltán Alföldy, the Health Science Council’s secretary, sent only this amendment proposal (together with the list of arguments and counterarguments for decriminalization, shown in columns B and C of Table 1) to Comrade Rostás, who most probably conveyed the neurologists’ expert opinion to the party leadership. The arguments discussed by the HSC Neurology Committee appeared again only in a slightly modified form on December 16, 1961, during the parliamentary discussion of the draft of the new Penal Code, leading to the decriminalization of consensual homosexual acts between adults, implemented on July 1, 1962.

Conclusion

One of the ways of tracing socio-historically changing perceptions of homosexuality is to examine the criminal laws in a country. Since criminal law is supposed to prohibit or constrain the violation of widely accepted codified norms with the support and the power of the state, the criminalization of certain forms of transgressive behavior can indicate the importance attached to certain norms, in our case, to heteronormativity, in a society. Analysis of the principles, considerations, and official explanations underpinning the criminalization of sexual relations between same-gender (male) partners reveals that, around the mid-twentieth century, medicalizing references were used in legal and societal judgments concerning same-sex intimacy in Hungary (and elsewhere).

In the present study, we wanted to offer examples of the medicalization process of social issues that otherwise seem difficult to address (i.e., in this case, these issues were put within a psycho-medical ambit) by focusing on a twentieth-century historical example from Hungary. However, when analyzing the sources, we also identified psycho-medical arguments often interwoven into social arguments. Our investigations revealed that models of homosexuality which pathologized it as a disease and which had been present since at least the end of the nineteenth century exerted an influence on changes to the criminalizing approach to homosexuality in the late 1950s in Hungary. Thus, we can probably state that pathologization brought a certain degree of liberation (at least in a legal sense), while we must also acknowledge that “the 1961 (Hungarian) decriminalization and the 1973 (international) depathologization of homosexuality did not change the pathologizing-normative discursive framework deployed by experts.”84

One of the most well-known critics of the pathologization of homosexuality and, in particular, the role played by psychiatrists in this process was American psychiatrist Thomas Szasz. In his 1961 book The Myth of Mental Illness he touched on ideas which bear affinities with Michel Foucault’s views on how “madness forged a relationship with moral and social guilt.”85 Szasz argued that, by developing and popularizing the concept of mental illness, psychiatrists tried to monopolize functions of moral control over society that had previously been practiced by religious institutions.86 The moral supervision function of psychiatry is especially salient in the ways in which psychiatry contributed to keeping homosexual practices criminalized and pathologized for many decades by providing “scientific” arguments concerning the alleged social harmfulness of homosexuality.87

This approach can be applied only with some limitations to the Hungarian state-socialist context, where both religious institutions and psy-sciences were repressed to a certain degree. However, as was the case in other societies characterized by a strongly antisexual culture, the promotion of compulsive heterosexuality, according to which “natural” sexual practices are somewhat ideal-typically defined as involving genital intercourse and having conception as their main goal, the symbolic significance of homosexual acts could be seen as a real threat88 in state-socialist Hungary.

The main focus of Szasz’s argument was the role played by psychiatrists in the regulation of personal morality in the name of the public good, a central point also raised by the Wolfenden Report (officially the Report of the Departmental Committee on Homosexual Offences and Prostitution, chaired by Sir John Wolfenden), which was originally published in 1957 in the United Kingdom. This was the most comprehensive legal review of homosexuality-related issues in mid-twentieth-century Europe. The report also addressed more general questions, such as the connection between crime and sin and the extent to which criminal law should concern itself with the enforcement of morals. By examining the function of criminal law, the Wolfenden Committee adopted an approach according to which it did not recommend criminalization in regard to matters of personal morality unless they were seen as directly affecting the public good.89

As discussed previously, Colonel Csorba’s submission neglected to reference the Wolfenden Report when giving an overview of the contemporary European legal landscape. In addition to the possible explanations given above, we can add that even if Csorba was aware of the Wolfenden Report, perhaps he chose not to acknowledge its findings due to their somewhat limited relevance and applicability to state-socialist contexts. On the other hand, we can argue that the Hungarian Neurology Committee’s expert opinion contributed to the introduction of legislative change which ceased regulating homosexuality-related personal morality by criminal sanction and limited the scope of legislation to specific issues, including the control of “youth corruption,” with the aim of protecting society from what was perceived by the expert committee and the policymakers as acts and conduct with socially harmful consequences.

In a recent study on sexual criminal law liberalization initiated by the international forensic community after World War II, Wannes Dupont challenged the perception of the 1950s as an “era of homophobia and sexual repression” 90 in Western Europe. Thus, we can see the Hungarian Neurology Committee’s activities and the following legislative change as coinciding with, and at the same time fitting into, a broader trend and an emerging approach to homosexuality characterized by “a fundamental legal distinction between the private realm of consensual sexual discretion and a public sphere of enforced propriety (effectively understood as heteronormative familialism).”91

The Soviet 1950s were also recently reinterpreted by Rustam Alexander, who explored the “bottom-up movement for decriminalization of sodomy among Soviet leading legal experts and their scholarly arguments.”92 By examining archival documents, he noticed that from the late 1950s, several Soviet legal academics kept listing arguments for the abolition of the Soviet anti-sodomy law, but representatives of law-enforcement agencies did not listen to them. This could be explained by the divide between academic and law-enforcement opinions on the criminalization of homosexuality. The main abolitionist arguments included similar ones to those listed in Colonel Csorba’s Hungarian text, such as the “biological” nature of homosexuality and difficulties in controlling it because of its intimate nature. However, in a 1973 Russian manual, there was a new argument introduced about the decriminalization of consensual homosexual acts in other state-socialist countries, including Hungary: “the development of criminal legislation over recent years testifies to the gradual departure from criminalization of consensual sodomy, not only in capitalist countries (England and West Germany), but also in socialist countries (East Germany, Hungary, Czechoslovakia, Bulgaria, Poland).”93 These new findings can raise the possibility of cross-fertilization of legal approaches from different directions within the (not at all homogeneous) group of state-socialist and Western bloc countries, in the realm of supranational organizations, and among these entities as well.

In conclusion, various forms of pathologizing were reflected in the 1958 arguments of the Hungarian Neurology Committee and in the official reasoning of the 1961 bill presented in the Hungarian Parliament. The fact that the issue of (de)criminalization was discussed and decided by a group of psychiatrist experts can in and of itself reveal the functioning of psycho-medicalization. However, this framework provided support for ending the criminalization of consensual sexual acts conducted by adult men. Moreover, the submission, carefully prepared by Antal Csorba, the chief neurologist of the Hungarian People’s Army, was dominated by social rather than medical considerations, and it presented homosexuality as an “anomaly” to which imprisonment was not seen as an effective solution or treatment.

Though we were able to present many pieces of previously unknown information in this study, many questions remain open regarding the timing (i.e., what happened to Colonel Csorba’s submission between 1958 and 1961?), the circumstances, and the causes of the 1961 Hungarian decriminalization of homosexuality. As is often the case with original archive research material, we have found some important pieces of the puzzle, but we are far from seeing the whole picture.

Additionally, we cannot state that, on the basis of our insights, the 1958 opinion of the Neurology Committee or the 1961 Penal Code reform could be interpreted as a sign for the more favorable social treatment of homosexuality than previously. As various forms of media and cultural artifacts and commodities from state-socialism reveal94 and as participants in documentaries report,95 many people who were attracted to members of the same sex continued their mostly closeted life after the 1961 legal reform, and finding partners, for instance, remained difficult for them.

Finally, an unexpected finding of our present study is that the issue of decriminalization may well have been pushed onto the political agenda by a homosexual individual’s official submission, and if this was the case, it can be safely assumed that this individual was a man (since only men were affected by criminalization in Hungary). Unfortunately, assuming there was such an individual, additional details regarding his submission and its path to the Neurology Committee remain unknown for the time being, as no relevant archival data could be found regarding these details. However, on the basis of the documents presented here, the assumption that the decriminalization process of consensual homosexual acts leading to the Penal Code reform in 1961 was triggered by a determined, probably gay, abolitionist’s activities seems well-founded. Assuming this was the case, this can be considered a unique feature of the history of the decriminalization of homosexuality among the state-socialist countries in the 1950s and perhaps even beyond.

Archival Sources

Magyar Nemzeti Levéltár Országos Levéltára [Hungarian National Archives] (MNL OL)

XIX-C-8 ETT. A homoszexualitás néhány orvosi és büntetőjogi problémájáról (Csorba Antal aláírásával) [Medical and criminal problems of homosexuality – signed by Antal Csorba]

XIX-C-8 ETT. Jegyzőkönyv (Nyírő Gyula aláírásával) [Minutes – signed by Gyula Nyírő]

XIX-C-8 ETT. Feljegyzés Rostás elvtársnak (Alföldy Zoltán aláírásával) [Report to Comrade Rostás – signed by Zoltán Alföldy]

Országgyűlési Könyvtár [Library of the Hungarian Parliament]

Országgyűlési irományok [Parliamentary documents] (OGyI)

Az Országgyűlés 1961. december 15-i ülése [Meeting of the Parliament on December 15, 1961] Accessed April 11, 2020. http://library.hungaricana.hu/hu/view/OGYK_KN-1958_01/

Országos Széchényi Könyvtár Kézirattár [Manuscripts Archive of National Széchényi Library]

Kertbeny, Károly. Levéltöredék: Autobiographiai jegyzetek [Letter sketch: Autobiographical notes], 1868.

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Appendix

Table 1. Pros and cons of decriminalizing homosexual acts in Hungary (1958)

A) Abolitionist arguments for decriminalization	B) Arguments to maintain criminalization	C) Arguments against maintenance of criminalization
1. The prosecution of biological phenomena by law is not logical1 […]	BUT punishment is necessary to protect the purity of sex life.2	AT THE SAME TIME the purity of society’s sex life will not be damaged, if [homosexual acts are] not penalized. A healthy society with heterosexual preferences has a natural aversion to this disorder, it does not appear necessary to have a separate penalty. [Homosexuality] leads to revulsion and disgust, and it does not tempt imitation, and if homosexual acts are not committed in public, there is no question of any social threat.3
2. The offence cannot be proven objectively4 […]	BUT it is punishable, because it can corrupt the youth by diverting their sexual development in an abnormal direction.5	AT THE SAME TIME, in the context of heterosexual relations, protection of the youth is covered by other articles of the criminal law, which can be supplemented with regard to homosexuality.6
3. An offence which has no victim does not pose any danger either to individual rights or to the interests of society. There is no social harm if the acts are committed by consenting adults and not in public7 […]	BUT it can ruin family life.8	AT THE SAME TIME, penalization cannot guarantee protection of family life. “Inborn” homosexuals are unable to lead regular heterosexual family life. This [heterosexual family life] can be observed in the cases of bisexuality. In this context, penalizing extramarital sexual relations would not be logical since extramarital heterosexual relations are not considered a criminal offence either.9
4. The defendants do not feel guilty. They see their conduct as natural, and their (homosexual) acts are only repulsive to heterosexuals10 […]	BUT [these acts] inhibit population growth.11	AT THE SAME TIME, the interests of protecting population growth cannot justify penalization, because in this case contraception should be penalized, too.12
5. Punishment has no deterrent effect, nor does it have corrective or educational effects, because it cannot affect a deep-seated biological disorder. On the other hand, it is well known that imprisonment facilitates homosexual inclinations by providing a long-term same-sex environment13 […]	BUT at least treatment could be provided for the duration of the prison term.14	AT THE SAME TIME, prisons or prison hospitals are not suitable environments for the treatment of homosexual disorders. [...] Also, this disorder can be treated successfully only rarely ([only] in the case of bisexual persons who wish to free themselves from homosexual tendencies).15
6. Penalization can be the basis of criminal blackmail16 […]	BUT lack of penalization would not stop blackmailing activities altogether, since public contempt also makes blackmails possible.17	AT THE SAME TIME, though lack of penalization would not eradicate blackmail completely, it could significantly reduce [its probability].18
7. The goal of protecting population growth cannot justify penalization, because in this case, contraception should be penalized, too19 […]	BUT if we acknowledge the legitimacy of homosexuality, homosexual marriage should also be allowed.20	AT THE SAME TIME, the marriage of homosexual persons as an act attracting public attention and lacking essential instrumental features that constitute the institution of marriage is certainly undesirable, [but] the need for authorizing [same-sex marriage] does not follow from the lack of penalizing [homosexual acts].21
8. The relative prevalence of homosexuality suggests that punishment should be limited22 […]	BUT public opinion is for penalization.23	AT THE SAME TIME, the enlightened and educated public does not demand penalization. The situation of homosexuals is quite tragic even without penalization, because even if the law would not penalize this instinctual anomaly, homosexuals would have to continue to hide, because homosexuality would remain a violation of public taste, not to mention the fact that homosexuals are deprived of having offspring, etc.24
9. It is not consistent that homosexuality only be penalized in cases involving men, while it occurs among women in the same way25 […]	BUT lack of penalization implies permissiveness that can lead to rampant proliferation.26	AT THE SAME TIME, the risk of rampant proliferation should be assessed only in a statistically reliable way, but unfortunately, there are no comparable datasets available. In the absence of reliable data, the only thing one can say is that in adulthood, the direction of sexual orientation is permanently fixed, and homosexual impulses would affect the normally oriented not in an attractive but in a repulsive way, thus the risk of psychological infection seems negligible.27
10. All adult individuals have the right to satisfy their sexual needs, and even irregular modes of satisfaction cannot render the act a crime given that it does not violate individual or collective interests28 […]	BUT penalization can limit the frequency of the acts, even if it cannot eradicate the inclination.29	AT THE SAME TIME, the struggle between the dread of being reported, exposed, and punished and the enhanced instinctual drives almost inevitably leads to the exhaustion of the nervous system and neurosis. Even the fear of punishment cannot restrain the homosexuals’ quest for sexual satisfaction: they feel that the law cannot deprive them of their sexuality. Thus, the notion that punishment would limit the frequency of homosexual acts is highly unconvincing.30

 

1 MNL OL, A homoszexualitás néhány orvosi és büntetőjogi problémájáról, 5.

2 Ibid.

3 Ibid. 6.

4 Ibid. 5.

5 Ibid.

6 Ibid. 6.

7 Ibid. 5.

8 Ibid.

9 Ibid. 6.

10 Ibid. 5.

11 Ibid.

12 MNL OL, Feljegyzés Rostás elvtársnak, 2.

13 MNL OL, A homoszexualitás néhány orvosi és büntetőjogi problémájáról, 5.

14 Ibid.

15 Ibid. 6.

16 Ibid. 5.

17 Ibid. 6.

18 Ibid. 7.

19 Ibid. 5.

20 Ibid.

21 Ibid. 6.

22 Ibid. 5.

23 Ibid. 6.

24 Ibid. 7.

25 Ibid. 5.

26 Ibid. 6.

27 Ibid. 7.

28 Ibid. 5.

29 Ibid. 6.

30 Ibid. 7.

Making Sense of Madness: Mental Disorders and the Practices of Case History Writing in the Early Nineteenth Century

Janka Kovács
Eötvös Loránd University
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Hungarian Historical Review Volume 10 Issue 2  (2021): 211-242 DOI 10.38145/2021.2.211

The article focuses on interpretations of madness in early nineteenth-century Hungary medical practice from a comparative perspective. By relying on the methodological approach of the anthropology of writing and the analytical considerations offered by Michel Foucault’s 1973–1974 lectures on Psychiatric Power, the article discusses the formalized and standardized practices of case history writing. It draws on sources from the teaching clinics at the universities of Pest and Edinburgh, as well as the largest mental asylums in the Habsburg Monarchy in Vienna (est. 1784) and Prague (est. 1790), and the ideal type of mental asylums at the turn of the eighteenth and nineteenth centuries, the York Retreat (est. 1796). In doing so, an attempt is made to reconstruct both the physicians’ gaze and (to a certain extent) the patients’ view, and by examining the therapeutical regime of each hospital and its correlations with the institutional background, uncover whether madness was perceived as a pathological somatic or psychological state in the medical practice of these institutions. This is in and of itself a fundamental question if we seek to understand changing attitudes towards the mad and their curability in a period of transition from a “world without psychiatry” to a “world of psychiatry,” when specialized care was still not an option for many, especially in the East Central European region.

Keywords: history of psychiatry, case history, medical gaze, clinical practice, medical writing

On July 20, 1812, Anna Maria Navratil, a 50-year-old female patient afflicted with a serious illness, was taken to the teaching clinic of the Medical Faculty at the University of Pest. Upon admission, she was diagnosed with an enigmatic disease, hysteria, the interpretation of which requires caution.1 She was undernourished and had a weak bodily posture, and she presented the following symptoms: heavy palpitation and pulse, stiffness in the neck, slow metabolism, hard stool, plentiful but watery urine, and globus hystericus, the suffocating feeling of a lump in the throat, typical of hysteric patients. She was also melancholic, sad, and sensitive, and her face mirrored desperation. The woman’s road to recovery (or at least an asymptomatic state) was followed closely by the medical students completing their clinical practice in the wards, as was done in the cases of hundreds of patients treated at the clinic. These day-to-day observations were recorded in case histories, the length and detailedness of which varied according to the personal habits and preferences of each student. The structurally strict and tight narratives consisted of the following standard elements: the day of admission and basic personal data (age, sex, occupation, religion), the anamnesis encompassing the patients’ family history and life events pertaining to illness, the diagnosis and etiology of the disease, the progress of the disease, and the day of death or discharge. In case of discharge, the patient’s current condition was also recorded (perfectus or imperfectus).

Observation as the practice of collecting and interpreting data is age-old. In medicine, however, the epistemic method of writing, the aim of which is the accumulation, recording, and structuring of information, became common only in the sixteenth century, and in medical education it was introduced as a formalized practice as late as the eighteenth century.2 Compulsory case history writing was introduced at the teaching clinic at the University of Pest in 17843 in order to counterbalance the dominance of “bookish knowledge” in dissertation writing, and it remained a prerequisite for a medical degree until the 1840s. Beginning in the 1810s, mentally ill patients, among them hysteric or melancholic individuals, were admitted to the clinic in increasing numbers, and their progress was recorded in the standardized and prescribed observational categories of case histories. This study delves into these materials and by juxtaposing them to case histories written in diverse institutional settings, It also explores patterns and tendencies in the interpretations of “mental” disorders in an era when the early forms of mental normalization were already underway.

In the case of Hungary, the insights offered by the case histories are unique in certain respects. First, there are comparatively few hospital case histories which shed light on the day-to-day experiences of healing. Second, since Hungary had no special institution (either an asylum or a designated hospital ward) to provide at least rudimentary care for the insane until the establishment of the first wards in the Buda hospital of the Brothers of Mercy in the 1830s, the Schwartzer Private Lunatic Asylum (which opened in 1850), or the Lipótmező Royal National Asylum (which opened in 1868), municipal general hospitals, policlinics, and hospitals operated by religious orders (the Brothers of Mercy and the Sisters of Saint Elizabeth) admitted them. Therefore, however sparse the available materials are (and thus the number of mentally ill patients on which some information has survived), the diagnostic and healing practices of the Pest policlinic can be taken as representative for “mental normalization” in Hungary in the period under study.

The primarily somatic approach to mental disorders might also be a direct consequence of the way in which knowledge concerning psychology was disseminated in medical education. From the early 1800s onwards, gradually replacing the dominant approach of Hippocratic and Galenic medicine, more modern theoretical and practical approaches were introduced at the medical faculties at the universities of Vienna, Prague, and Pest. Though individual courses on psychology/psychiatry were not offered until the 1840s, when in Prague and Vienna the first proposals were sent to the Court Commission of Studies (Studienhofkommission) by the primary physicians at the Vienna and Prague asylums, increasing attention was being paid to knowledge concerning psychology. Knowledge of psychology was part of the compulsory training in philosophy (itself a prerequisite of medical education) at the two-year and three-year programs offered by colleges and the philosophy faculties of the universities, either incorporated into courses on logic or taught individually as empirical psychology. Furthermore, from the turn of the eighteenth and nineteenth centuries, basic psychological knowledge was filtered into core medical courses on physiology, pathology, therapy, medical police, and forensic medicine, with the body-soul problem and the problem of mental disorders often being explained from neurological and “social” points of view.4 The latter, gaining ground in the subsequent decades, viewed mental disorders either as diseases of civilization (for example, the consequences of an urban or scholarly lifestyle) and considered the mentally ill in their broader social contexts as individuals to be defended from and also a “danger” to society at large. This, however, as the case histories reveal, rarely surfaced in the context of hospital practice. It remained within the domain of theoretical discourses in textbooks or dissertations.

In attempting to grasp the interpretations of mental disorders recorded in case histories, I focus on the case histories’ layout, seriality, formalized structure, and the cognitive practices written into the narratives and their links with knowledge production and the interpretation of different phenomena in medical practice. The means of interpretation, however, cannot be understood without paying close attention to the correlations between the methodology of writing and the institutional background, which could shed light on whether the “mental” disorders appearing in the case histories under discussion were indeed understood, approached, and handled as mental disorders with a psychological elucidation in mind or whether they were seen and treated as first and foremost somatic diseases disguised as mental maladies. To make sense of the practices at the teaching clinic in Pest, comparative materials, among them the records of hospital administration, statistics, case histories, and patient records will be explored from different types of institutions, ranging from the teaching clinic at the Royal Infirmary of Edinburgh, which operated in a similar configuration as the Pest clinic, to the early asylums of the Habsburg Monarchy in Vienna and Prague and the model of mental asylums in the period, the York Retreat, which was founded in 1796.

In addition to drawing on the methodological approach of the anthropology of (medical) writing, the study’s inquiries are also informed and inspired by Michel Foucault’s lectures on psychiatric power held at the Collège de France between 1973 and 19745 and Roy Porter’s seminal 1985 article advocating the inclusion of a patient’s view in medical history writing,6 which has been introduced and applied in research with more or less success for the past few decades.7 Taking their argumentation as a starting point, I will focus on the following aspects: 1. the ritual of questioning and confession, and the incorporation of the physician’s gaze and the patient’s perspective into the narratives, 2. the importance of pathological anatomy and “family history” in making diagnoses, 3. the applied therapeutical regimes and the length of stays in hospitals, which could be revealing with regards to the preferences of either a psychological or a somatic approach in “mental” normalization.

Managing Mental Disorders: Approaches from Teaching Clinics to Lunatic Asylums

As the layout and structure of the case histories and patient records on the basis of which conclusions can be ventured concerning the physicians’ gaze, the patients’ progress, and the interpretations of diseases depended heavily on the given institutions’ administrative practices, the following section will provide a summary of the most significant institutional tendencies and the nature of the surviving sources.

The richest collection of case histories survives from the teaching clinic at the University of Pest, where the purpose of recording the patients’ cases was twofold. First, case histories were written in partial fulfilment of medical degrees from 1784, following the Viennese example. For his final exam, each student had to summarize the progress of two or three patients chosen from a larger pool with a wide array of diseases.8 The structure of these narratives is in most cases clear and logical, and the main points are well articulated. Second, case history writing was also a compulsory part of clinical practice for fourth-year and fifth-year medical students, as testified by a diverse group of materials on hospital administration (patient records, statistics, case histories, meteorological observations) in Ferenc Bene’s (1775–1858) collection, which was preserved in the Manuscripts Archive of the National Széchényi Library in Budapest.

The teaching clinic was led by Ferenc Bene, chief physician of Pest, dean of the medical faculty (1807–1809) and rector of the University of Pest (1810), and a propagator of smallpox vaccination in Hungary between the 1810s and the middle of the 1840s. In this period, students were required to write case histories on a monthly basis, and these histories were then handed in to him for evaluation (in many cases, the documents were signed by him). In comparison with the exam materials, these narratives are less detailed and less well-structured, but in all cases they mirror the given medical student’s individual style, preparedness, and diligence, and they also show the everyday “raw” experiences involved in working in close proximity to diseases, the students’ progress, and the physicians’ approaches to the students.9 In addition to the longer case histories, on which the second part of this study draws, shorter summaries and reports (synoptica relatio), sometimes reflecting on the same cases as the longer narratives and clinical journals encompassing hospital statistics, were also prepared, in most cases by the assistant physicians at the clinic. Depending on the habits, erudition, and individual preferences of the physicians, the clinical journals had different layouts, and they often varied in the extent to which they went into detail, but their structure remained the same, including statistics (the number of all admitted patients in the previous six months or year, as well as the number of discharged and remaining patients and deaths) and a narrative part summarizing “interesting” or “curious” cases arranged into seven categories.10

As highlighted earlier, the two types of case histories, the practice and exam materials, were similar in their structure but could mirror different everyday experiences of hospital life and the progress of individual cases, as well as the physicians’ individual approaches to health, illness, and therapy. However, both types offer a glimpse into how, sometimes breaking with the “bookish” tradition of medical education, medical students, observing their patients’ progress, documented and at the same time interpreted and approached “madness” and the most frequently described and diagnosed mental maladies in the period and the connections these interpretations had with the content of their curriculum.

From among the case histories written at the teaching clinic at Pest between 1787 and 1847, I have chosen to focus on a narrower period between 1812 and 1828. Prior to 1812, no case histories were written on mental patients, while after 1828 the approach to mental disorders altered in medical education, with changes in both quantitative and qualitative factors, as shown, for example, by the number of admissions, changes in the curriculum, and the thematic spectrum of dissertations. I chose cases for further exploration in which the diagnoses were fully or partially related to mental disorders, mostly the four most common “traveling concepts,”11 hysteria, hypochondria, melancholy, and mania, which were familiar since Antiquity but which have been reimagined and interpreted over the course of the centuries in light of newer theories, such as dualism, mechanical theories, animism, vitalism, and the findings of neurology. As revealed by the Hungarian clinical cases, these maladies were still commonly diagnosed in the early nineteenth century, even though this period saw a slow and gradual transition towards a more nuanced classification of mental disorders (at least in Western Europe and, as we will see in the discussion of diagnostic practices at the Vienna and Prague asylums, to some extent in the East Central European region too) with the work of German physician Johann Christian August Heinroth (1773–1843), the French Philippe Pinel (1745–1826), and his pupil, Jean-Étienne Dominique Esquirol (1772–1840). According to their classifications, some of the categories partly became devoid of their original meaning or were reconsidered and “fell apart.”12

In some of the cases I have selected, mental disorders were concomitant with other diseases and developed in relation to or as a consequence of either neurological (debilitating headaches, epilepsy, St. Vitus’s dance, also known as Sydenham’s chorea) or gastrointestinal diseases. However, the neurological disorders that were not identified as mental maladies and were not accompanied by mental symptoms were not considered. After taking these factors into consideration, I chose 22 longer case histories which include the standard categories of observation (anamnesis, diagnosis, etiology, prognosis, the progress of the disease, therapy).13

As the policlinic of the University of Pest mostly admitted surgical cases, pregnant women, patients with fevers, skin diseases, or inflammations that could make good teaching cases, the low number of mental patients in the statistics, clinical journals, and case histories should not come as a surprise. Furthermore, if we consider the dominance of one particular disease, hysteria (and to a lesser extent its “male counterpart,” hypochondria), the number of mental diseases approached from and diagnosed based on a psychological framework are even fewer in number. As opposed to mania or melancholy, which were primarily diagnosed based on mental and behavioral symptoms, at the time hysteria and hypochondria could easily be interpreted as somatic diseases that could yield physical therapeutics if we consider their symptomatology, even though they were more often than not accompanied by mental symptoms. The dominance of the somatic approach, thus, is pinpointed by the low proportion of mental maladies and high incidence of maladies disguised as such. From among the 22 patients, 18 were diagnosed with hysteria, one with hypochondria, one with erotomania (a disorder characterized by an individual’s delusions of another person being infatuated with them), one with melancholy, and one with delirium tremens.14 Hence, the case histories of the teaching clinic of Pest shed light on interpretations of hysteria and the practice of diagnosing and healing along the lines of somatic medicine, lacking a psychological approach which was, to some extent, already in use in the diagnostic and therapeutic practices in the first asylums of the Habsburg Monarchy or in model institutions, such as the aforementioned York Retreat.

Among the universities operating a teaching clinic in Europe at turn of the eighteenth and nineteenth centuries,15 the teaching wards at the Royal Infirmary of Edinburgh showed remarkable similarities with the policlinic in Pest. Very much like the reform measures launched by Gerard van Swieten (1700–1772) in the mid-eighteenth century in Vienna, which also had a profound impact on medical education in Hungary, the reform of the Medical Faculty of the University of Edinburgh established in 1726 was also implemented by three pupils of Herman Boerhaave (1668–1738), Alexander Monro primus (1697–1787), John Rutherford (1695–1779), and William Cullen (1710–1790). Following the Leyden model, both in Vienna (and later in Pest) and Edinburgh emphasis was put on bedside teaching and empirical observation, creating the most modern spaces of medical education in Europe.16 By this time, Edinburgh diverged from the English model still followed in Cambridge and Oxford, which relied on an outdated system of theoretical lectures and observation, eliminating clinical teaching almost completely.17 As for the practices of admission, capacity, and patient numbers, there are further similarities between the teaching wards of the Royal Infirmary and the teaching clinic of Pest: in Edinburgh, 20 to 50 patients were admitted on a monthly basis, whereas in Pest the figures were between 20 and 40.18 The clinical case histories written in Edinburgh between the 1790s and the 1810s19 reveal rather similar tendencies to what we have observed in the case of the Pest policlinic. Though medical students in Edinburgh played a somewhat more passive role in the actual treatment of patients, empirical observation, the recording of day-to-day experiences, and the practice of case history writing were at the heart of medical education from the mid-eighteenth century onwards.

The collections of case histories, however, were preserved in a different format: while in the case of Pest, student reports were edited into volumes posteriorly, in Edinburgh, each medical student kept his own books, in which they recorded (or in some cases, copied) their case histories in a different structure from what we have seen in the case of Pest. Though the standard categories of observation also prevail and govern the physicians’ gaze here, medical students in Edinburgh followed different editorial practices. They recorded their daily observations chronologically in the form of diary-like entries in volumes, which allowed them to follow the treatment of different patients simultaneously. Therefore, the case histories follow a rather fragmented structure, with cross-references and indices. This less clear-cut structure, however, allows the researcher to catch a glimpse into the cognitive practices written into the broken narratives. As for the representation of mental disorders in the casebooks, though the Royal Infirmary admitted mental patients in lesser numbers, I have found similar ratios as in the case of Pest. The notebooks of John Abercrombie (1780–1844), who later practiced medicine in Edinburgh, William Pulteney Alison (1790–1859) and Thomas Charles Hope (1766–1844), the two Presidents of the Royal College of Physicians in Edinburgh in the following decades, and David Lithgow (?–?), a practitioner in Dublin, reveal that even though neurological diseases, especially epilepsy, counted as fashionable diagnoses in Edinburgh at the turn of the eighteenth and nineteenth centuries,20 mentally ill patients were either not admitted or were not properly diagnosed in the teaching wards. Altogether, seven patients were admitted with hysteria, two with hypochondria, and one with mania.

As a counterpoint to the policlinics and their primarily somatic approach, the early mental asylums of the Habsburg Monarchy in the late eighteenth century began to use a partially psychological approach in diagnostics and healing by the first decades of the nineteenth century. As we will see, the asylums of the Monarchy occupied a middle ground between the policlinics and model asylums, such as the York Retreat, which played a pioneering role in introducing moral therapy. Furthermore, since the hospital network and the early asylums of the Habsburg Monarchy provided the most important model for the organization of Hungarian hospitals and also the first (private) psychiatric institutions later in the nineteenth century, their practices must be taken into consideration as an immediate context of the trends in Hungary.21 Though it would be ideal to compare the general wards of the Vienna General Hospital (Allgemeines Krankenhaus) to the teaching clinic of Pest, the number of available case histories written by medical students is rather low, and the number of mental patients among them is even lower. Short case histories and the summaries of therapeutic measures in the general hospital were published based on the courses of Anton de Haen (1704–1776) and Maximilian Stoll (1742–1787). These narratives, however, rarely deal with either mental or neurological diseases, and even if they do, the “case histories” often do not follow the standard categories of observation that would enable us to fully grasp the ways in which the maladies were interpreted.22

As for the two most significant mental asylums in the Monarchy, only printed case histories remained, which require a somewhat different approach than the manuscripts from the teaching clinics in Pest and Edinburgh. The first decades of the operation of the first purpose-built asylum on the continent, which was established by Joseph II (1780–1790) as part of the Viennese General Hospital in 1784, and the asylum, the establishment of which was initiated by Joseph II and opened under the reign of Leopold II (1790–1792) in 1790 in Prague, were summarized in two accounts published by Joseph Gottfried von Riedel, the secondary physician of the Prague asylum, in 1830 and by Michael von Viszánik, the Hungarian-born primary physician of the Viennese asylum, in 1845.23 The printed accounts reflecting on the spatial organization, operation, healing activities, and patient statistics of the asylums contain twelve and 13 long case histories each, following the diagnostic categories included in the seventeenth-century, eighteenth-century, and early nineteenth-century nosologies of Thomas Willis (1621–1675), the English physician who played a pioneering role in neurology, François Boissier de Sauvages (1706–1767), the professor of physiology and anatomy at the University of Montpellier, and Johann Christian August Heinroth, the first professor of psychiatry.24 By applying a diverse array of categories and subcategories to describe mental disorders, the narratives of Riedel and Viszánik reveal how early psychiatric diagnostics worked in practice and how the treatments of these ailments were approached. Though Viszánik’s account was published well into the nineteenth century, later than the other materials examined in this study, the structure and logic of his book mirror Riedel’s account, which must have been a source on which he drew. Furthermore, he had been a long-serving physician at the institution by then, with a keen eye to its development from the early years. Also, since the Narrenturm, tcontinental Europe’s first purpose-built psychiatric hospital, found in Vienna, played a central role in the developing network of asylums in the Monarchy and served as a model institution, its diagnostic and therapeutic practice are indicative of the regional approaches to “madness.”

A more specialized approach to mental normalization is revealed by the short case histories included in the patient register of the York Retreat kept from 1796. The Retreat was founded by the Quaker Tuke family, and it remained in their operation in the subsequent decades: the founder, William Tuke (1732–1822), was followed by his son, Henry Tuke (1755–1814), his grandson, Samuel Tuke (1784–1857), and his great-grandsons, James (1819–1822) and Daniel Tuke (1827–1895). According to the somewhat idealized accounts published by Samuel Tuke in 1813 and 1815, the institution and its practices exerted significant influence, and the Retreat served as a model institution for other asylums both in England and on the continent, especially on account of the theory and practices of moral therapy.25 As pinpointed by treatises on medical police and hospital administration, the English model and, especially, the York model had also had an impact in the Habsburg Monarchy.26 The Retreat, which devoted significant attention to religion, philanthropy, a humane approach to mental disorders, the incentive of meaningful occupation, natural environment, and conversations,27 played a vital role in introducing a psychological approach to the treatment of the insane. As for the admission, administration, diagnosing, and recording of the patients’ progress, the York Retreat with its integrated practices serves as a unique example. The rather laconic, usually one-page entries in the casebooks28 of the Retreat briefly summarize the dates of the patients’ admission, readmission, discharge, or death, and also their sex, occupation, the anamnesis, and the progress of their disease. As a sample, I have chosen 100 cases altogether from between 1796 and 1800 and 1815 and 182029 which reveal the almost complete lack of a somatic approach and the dominance of the psychological (moral) approach to diagnostics and therapy.

From Soma to Psyche: Interpreting Mental Disorders

If we seek to identify the differences between the somatic and psychological approaches to the diagnostics and the treatment of “mental” maladies recorded in the case histories, with some modifications, Michel Foucault’s thesis, introduced in his lectures on psychiatric power between 1973 and 1974, could serve as a good point of departure. In his lectures held on January 23, 1974 and January 30, 1974, Foucault called attention to the peculiarities of psychiatric diagnostics which distinguish it from other fields of medicine and medical knowledge in general. He argues that diagnostic practice in psychiatry is only seemingly based on the methodology of differential diagnostics, meaning that a diagnosis is made based on the anamnesis, the observed symptoms, and possible underlying reasons. Foucault argues that, in reality, “medical knowledge in psychiatry functions at the point of the decision between madness and non-madness.”30 Furthermore, he describes psychiatry as a field which does not focus on the body/soma, even though the development of psychiatry was dominated from the beginning by the pursuit of determining the underlying physiological causes of madness (neurological disorders, injuries). But even if psychiatric knowledge is constituted based on the medical observation of signs and symptoms, the question as to whether a patient is mad or not, whether they are simulating their symptoms or not, remain at the core of psychiatric diagnostics. And to determine this, doctors need procedures that could serve as substitutes for the techniques applied in general medicine in order to accept the individual as a patient and for the patient to accept them as doctors.31 This approach, however, disregards the fact that, from the 1820s to the 1860s, especially in the first decades, the very period Foucault discusses, we can only talk about “psychiatric power” and the success of such techniques if the people who were diagnosed with mental disorders were in fact admitted to institutions specializing in psychiatric problems, where madness was evaluated, described, and treated as, first and foremost, a psychological (mental, behavioral) problem. But what about those institutions where “mental” disorders were diagnosed without the intentions and especially the means of psychiatric normalization? How did general physicians approach the problem in the first half of the nineteenth century?

As mentally ill patients with different diagnoses, especially but not exclusively in the East Central European region, were more often than not taken into the care of policlinics, general hospitals, poor houses, and other non-specialized institutions, in short, outside the world of psychiatry, the problem of psychiatric diagnostics and the treatment of patients in need of specialized treatment brings up a set of issues and has further implications for (proto)psychiatric care and institutionalization in the region. To underpin this argument, I have chosen to focus on several factors (the naming of the disease, as well as its description and progress, the anamnesis, including the body of the “suffering family,” the point of view of the narratives, and the length of stays in hospitals) that help us determine whether the diagnostic and therapeutic practice of the different institutions pertained to a somatic and/or a psychological approach to mental disorders.

From among the five institutions examined in this study, it is, not surprisingly, the practice of the York Retreat that conformed more or less to the requirements described by Foucault, as far as one can tell on the basis of Samuel Tuke’s idealistic accounts and the casebooks. In almost all cases, the entries in the casebooks serving both as patient registers and clinical journals with short synoptic case histories contained a diagnosis. These diagnoses,32 instead of using common nosological categories and, if viewed from the Foucauldian perspective, somewhat “artificial” medical terminology, reveal a decision concerning whether the patient in question was mad or not. The patients received their diagnostic labels based on their temperament or behavioral and mental symptoms, such as derangement, deranged; insane, insanity; of the melancholiac kind; melancholic derangement, or mental anxiety.

The practice of the physicians in the early asylums of the Habsburg Monarchy, however, following the nosologies of Willis, Sauvages, and Heinroth, suggest that they relied more closely on differential diagnostics and less on the decision as to whether a given patient was mad or not. This observation on my part might of course be distorted, as both Riedel and Viszánik included model cases in their accounts, including accurate indications of which physicians’ nosologies they were following. The everyday, raw experiences of diagnostic practice are thus lost here. Among the case histories, they labelled patients with (by early nineteenth-century standards) modern categories, such as melancholic monomania (monomania melancholica) and more common and older categories, such as puerperal mania (mania puerperalis), acute mania (mania acuta), pure or simple melancholy (reine Melancholia, melancholia simplex), or mania (reine Tollheit, mania simplex).33 In case of the policlinics, where somatic medicine prevailed, almost all patients were diagnosed either with hysteria, hypochondria, or, in a few cases, delirium tremens (confusion or mania caused by the withdrawal of alcohol). The leading diagnosis, hysteria, an elusive disease which could have significant mental symptoms and was classified as a neurological or mental disorder, could also be interpreted, as underlined by the case histories, as a somatic disease with typical symptoms, such as clavus and globus hystericus, gastrointestinal, and menstrual problems.

Foucault’s other suggestion about the pre-history of patients and its correlations with diagnostic practice, however, could be relevant here with some modifications. According to Foucault, the decision between madness and non-madness (or, depending on the context and situation, the method of making differential diagnoses) required the technique of questioning or the search for signs in one’s family history to identify the moments when madness surfaced in some way or another. This, though rather fragmentarily, surfaces in the case histories, though probably requiring a slightly different interpretation than the original Foucauldian take on the problem.

Closely related to the above point, Foucault also suggests that questioning served as a substitute for the methodology of pathological anatomy in making a differential diagnosis. When it came to mental disorders, as the tools offered by pathological anatomy were not sufficient to decide between madness and non-madness, family history gained a special significance. Constituting the body of the “suffering family” by extending the scale of examination beyond the individual, a physician could discover signs and connections suggesting one’s predisposition to madness.34 Interrogating patients about their family history has been a common method in general medicine for centuries. In psychiatric diagnostics, however, as Foucault argues, it is of vital significance for the right choice between madness and non-madness. As suggested earlier, however, Foucault ignores the frequent use of labels in the 1820s and 1830s (and in Hungary, even later35), such as melancholy, mania, hypochondria, or hysteria, or simply madness, outside of specialized institutions. Even though questioning and the family history were fundamental parts of the case histories, connections between madness, the suffering family, and the patients’ status at the time are rarely revealed.36

At the university clinic of Pest, the medical history of the mentally ill patients’ parents was recorded in 17 cases.37 If we consider those patients only, whose diagnosis was, as revealed by the narratives, based on behavioral and mental symptoms, very laconic references are made to the early signs of madness described by Foucault. Sigismundus Fekete, a 26-year-old patient who suffered from erotomania, a peculiar delusional disorder, was admitted to the clinic on July 19, 1826. Johannes Slavik, a 23-year-old melancholic patient, was admitted two years later, on November 27, 1828. According to his case history, Sigismundus Fekete had healthy parents, and the only health-related event in his anamnesis was that he had received the smallpox vaccine as a child.38 Johannes Slavik, however, had a more detailed family history and anamnesis: according to the records, his father died of tuberculosis (phthisis), and ten years prior to his hospitalization he had already had a melancholic episode, and his current episode had begun ten days earlier.39 Here, the signs to which Foucault referred are clearly identifiable both in terms of the distant past and recent events. The hereditary nature of the disease surfaces in only one anamnesis: the mother of Anna Nagy, a 25-year-old hysteric patient, also suffered from hysteria (“ex mater hysterica”), however, as hysteria was approached as a primarily somatic disease in these case histories, the phenomenon described by Foucault applies to this case with restrictions.

References to the patients’ mental state in other significant, standard sections of the case histories, such as their health status upon admission (status praesens) and the progress of the disease (decursus morbi), are also relatively scarce. In early nineteenth-century medicine, which did not have modern diagnostic measures and tools, the patients’ own reflections on their conditions and symptoms were vital for making the correct diagnosis. In cases of mental disorders, getting to know the inner world of patients is all the more important, as the observable (behavioral) phenomena are insufficient to give a reliable account of their condition, its seriousness, and its curability. At this point, the patients’ or their relatives’ perspective40 often filtered into the narratives. In the case histories of the teaching clinics of Pest and Edinburgh, the patients’ complaints are often recorded in the third-person singular (accusat, complains). And even though these utterances are filtered and mediated by the physicians’ perspective and are organized into coherent narratives by them, in these instances, however rare they may be, the physician’s gaze orienting the narration and the “lived” experience of patients are juxtaposed.

In most cases, the physicians’ perspective prevails. When the hysteric or hypochondriac patients’ mental symptoms are reflected on briefly, we have characterizations like “choleric, nervous and anxious behavior and proneness to sadness” in the case of Elizabeth Szabó,41 who was admitted to the clinic on January 30, 1815, or “sadness with misanthropy” in the case of Ferenc Schober,42 admitted on December 19, 1823.43 Sometimes, however, the patients’ complaints are clearly discernible from the narratives, and though they mostly give accounts of their physical pain, they sometimes reflect on their mental state, such as Elizabeth Enzmann, a 40-year-old patient, who was admitted to the teaching clinic of Pest on November 25, 1817 with severe emesis and hysteria. Enzmann complained of anxiety (“accusat anxietates”) to the medical student examining her. As for the teaching wards of the Edinburgh Royal Infirmary, the patients complained of a wide array of symptoms, from toothaches to globus hystericus. However, their inner lives, feelings, and mental pain either remained concealed from their doctors or the doctors did not consider them important enough to record in the case histories. Whichever the case, this clearly indicates the absence of a psychological approach, and even though there are counterexamples to this tendency, by and large, the same conclusions hold for the teaching clinic of Pest.

The case histories recorded in the asylums, also in the third-person singular, allowed slightly more space for the patients’ own perspectives. In the casebooks of the York Retreat, in the synoptic summaries of the patients’ condition, complaints were rarely included, and even if they were, the entries mostly gave accounts of physical pain. Michael Viszánik and Josef Gottfried von Riedel, however, often devoted more space to the patients’ experiences of (mental) pain and recovery. These tendencies are most discernible from the anamneses and the progress sections. The anamneses not only detail the health-related events of the patients’ lives from childhood to adulthood but also reflect on the sociocultural settings from which they came. Their path to the asylums, organized into a narrative by the physicians, reveal much about the conditions, family background, and chances of (re)integration into society. Some of the experiences point towards the accidental nature of madness and its underlying reasons, such as changes in one’s personal environment. This is well illustrated by the case of an unnamed female patient admitted to the Prague asylum on January 28, 1828. Her melancholic sadness, boredom, and suicidal tendencies were induced by her husband’s alcoholism, even though she had led a happy, cheerful life before.44 On the other hand, through these narratives, we can catch a glimpse into how a patient’s attitude and mental condition changed over the course of treatment and how they gradually opened up to their caretakers. A female patient admitted to the Prague asylum in December 1829 with pure madness (reiner Wahnsinn, ecstasis simplex), completely unaware of her condition, responded well to the treatment, and on the seventh day of her stay, she shared the unknown details of her path to the asylum and began to accept her condition.45 And even if she is not heard, the narrative, the case history’s progress and therapy sessions illustrate that moral therapy and one of its most important components, conversation with patients, was known and practiced in the Prague asylum, in a setting still dominated mostly by somatic medicine.

Observation and therapy at the policlinics of Pest and Edinburgh were often influenced by the bookish knowledge which the students were expected to acquire during their theoretical courses, neither of which were specialized in the practical approaches to empirical psychology or psychiatry.46 Though mental symptoms, along with lifestyle and sociocultural dimensions, were part of the textbook definition of hysteria, in the clinical setting, these aspects were seemingly negligible and were not considered fundamental for identifying and diagnosing a certain disease. In case of both Pest and Edinburgh, there seem to have been two dominant sets of symptoms. One of these clusters included gastrointestinal symptoms, excessive stool and urine, pains, and severe cramps. Though it is not mentioned explicitly in any of the sources, this was probably understood in the context of the theory of vapors, which (it was thought), by rising from the stomach and bowels, were responsible for disturbing the mental faculties.

On the other hand, case histories point to the unyielding persistence of the gynecological interpretation of hysteria, with regular references to the disturbances of the menstrual cycle. From among the 18 hysteric patients in Pest, the date of the first period is recorded (between 11 and 17 years of age), and the changes or disorders of the cycle (excessive bleeding or the lack of periods for longer of shorter intervals) were directly linked to the appearance of hysteria and its progress. Other textbook symptoms included lockjaw or trismus, globus and clavus hystericus, and the so-called hysteric fits, the nature of which are rarely reflected on in the case histories, even though they were rather common. In Edinburgh, almost all case histories contained some reference to them.47

Therapeutic measures matched the dominant symptoms of the disease at the policlinics. As the therapy sessions in the case histories testify, the theoretical basis of healing was based on the Hippocratic and Galenic system of medicine, still dominant in the early nineteenth century, aiming to restore the balance of the four humors with bloodletting, clysters, and emetics (wild senna, ipecacuanha, asafetida). These measures were complemented with herbal remedies (valerian, chamomile, lemongrass, opium, or henbane) and chemically distilled oils (peppermint, cinnamon, and wild orange) serving as sedatives, which became widely popular in the eighteenth century with the spread of the neurological approach.

As for therapeutics, the early asylums of the Habsburg Monarchy were transitional between two poles on our scale, the two policlinics and the York Retreat, where references to the practice of moral therapy surface not only in Samuel Tuke’s accounts, but also in the case histories.48 In Viszánik’s and Riedel’s case histories, the more traditional, somatic approach is complemented by some components of moral therapy, typically those that were feasible in an urban setting. In the two asylums, in addition to the abovementioned therapeutics, cold baths were also in use as an early form of hydrotherapy.49 Since one of the cornerstones of moral therapy, the assignment of activities to the patients in a natural setting and useful occupation in, for example, gardens, was not necessarily possible in Prague or Vienna, the two physicians, especially Riedel, paid attention to conversations with patients and to the task of making the environment more bearable by, for example, furnishing and equipping the wards in a “friendlier” manner.50

As a final aspect, it is worth looking at the lengths of stays in hospitals. By the turn of the eighteenth and nineteenth centuries, most physicians realized that mental disorders could be rather persistent, and since healing (if possible) or at least subduing symptoms in general took much longer than the treatment of other (somatic) ailments, patients usually needed longer periods of hospitalization. The length of stay (LOS) is thus a good indicator of both the approaches to mental normalization and the possibilities hospitals had in offering treatments for patients inflicted with mental disorders. From the perspective of this last consideration, the average length of hospitalization underpins the tendencies observed in the respective sections of case histories, such as the anamnesis (illness-related events in one’s family or personal history), diagnosis (especially the naming of the disease), or the progress and therapy sections including the applied curatives and other measures (conversation, change in environment, etc.).

The teaching clinics of Pest and Edinburgh were on the low end of the scale: in the case of Pest, the length of hospitalization can be calculated in 19 of the 22 cases, with the average length of stay (ALOS) being 47 days (approximately 1.5 months). The shortest period of hospitalization was five days (Rosalia Hany, diagnosed with hysteria51), while it was the melancholic Johannes Slavik52 who spent the longest time in the clinic, 228 days altogether. This, at the same time, reflects on the differences between the interpretations of hysteria (primarily a somatic disease and curable as such) and melancholy (primarily a mental disorder, identifiable on the basis of mental and behavioral symptoms). Similar tendencies prevailed in Edinburgh, with the average length of stay being even lower (23 days). The shortest stay was the hysteric Elisabeth Erskine’s53 (six days), whereas the maniac John Williamson54 stayed for 50 days in the teaching ward of the Royal Infirmary.

As for the two asylums considered “transitional” institutions, the ALOS differed significantly: in Vienna it was only 62 days (ca. 2 months) and in Prague it was twice this, 134 days (ca. 4.5 months). The highest ALOS was, as expected, in the York Retreat. However, it must be noted that the dates in the casebooks are rather unreliable due to the frequent readmissions and follow-up care provided for the patients (when it was possible, the superintendents of the asylum paid attention to their patients even after they were discharged). It is therefore in most cases impossible to work with exact numbers, and that is why I have chosen to rely only on 42 cases in which the dates of admission and discharge were given precisely (a further twelve cases ended with death, among them one suicide). Basing my calculations on the selected cases from between 1796–1800 and 1815–1820, the ALOS was 632 days (ca. 21 months), with the lowest stay being 34 days and the highest being 2,790 days (ca. 93 months).

 

Table 1.

Lengths of stay and average lengths of stay in the hospitals

Institution	Shortest LOS	Longest LOS	ALOS
University clinic of Pest	5	228	47
University clinic of Edinburgh	6	50	23
Vienna asylum	12	180	62
Prague asylum	15	273	134
York Retreat	34	2790	632

 

If we consider the length of stay a good indicator of the seriousness of a disease and the efficacy of mental normalization, these numbers clearly show that, from among the institutions under discussion, it was indeed the model asylum that could fulfil its function of conducting therapy, the two asylums of the Habsburg Monarchy integrated the newest approaches and older methods (purging, bloodletting etc.), while the two policlinics only took on the responsibility of subduing (somatic) symptoms and offering a temporary asylum for those showing the symptoms of disorders classified as “mental.” As for the teaching clinic of Pest in the focus of my inquiry, both the methods of identification and therapy indicate that the medical students who were completing their practical semesters and who did not take practical courses on psychiatry could only rely on knowledge they gathered from the rather scattered material in diverse courses (introductory courses on empirical psychology focusing on the basic outlines of the cognitive faculties, physiology, pathology, therapeutics, medical police, and forensic medicine). Thus, even though psychological knowledge gradually filtered into the curricula and textbooks of the Medical Faculty of the University of Pest, in the absence of a specialized institution, a psychological approach would have been impossible to implement in practice, and this necessitated the fundamentally somatic approach to the treatment of patients labeled as mentally ill (or diagnosed with maladies disguised as such). However, it must also be underlined that the period between the end of the eighteenth century and the 1830s marks a turning point in the history of psychiatry in Hungary, and even if we can only talk about a belated introduction of the psychological approach in medical practice, the mere fact that patients with these conditions were even accepted into the policlinic after the 1810s was a great step towards reconsidering the attitudes towards their treatment, which was addressed in both theoretical approaches and practice more intensely after the 1830s.

Archival Sources

Archiv der Universität Wien (UAW)

Sonstige Archive, Josephsakademie (k. k. medizinisch-chirurgische Militärakademie) und Garnisonsspital, Wissenschaftliche Elaborate, Krankengeschichten.

Borthwick Institute for Archives, University of York

York Retreat, Casebooks, 1–3.

RET 6/5/1/1/A (Volume 1, 1796–1828)

RET 6/5/1/1/B (Volume 2, 1803–1820)

RET 6/5/1/2 (Volume, 1828–1838)

Budapest Főváros Levéltára [Budapest City Archives] (BFL)

1103.a. St. John’s General Hospital, General Administration, vols. 4–15. Patient Records (1857–1873).

Országos Széchényi Könyvtár Kézirattár [Manuscripts Archive of National Széchényi Library] (OSZK Kt.)

Quart. Lat. 2165. Historia morborum, in clinico medico... Scientiarum Universitatis ab anno scholastico 1815/1816. usque ad annum 1838/1839. tractatorum, descriptae per candidatos medicinae, Pestini.

Quart. Lat. 2166. Relationes de aegris in instituto chirurgico-practico... Universitatis Scientiarum... tractatis Pestini ab anno scholastico 1816/1817. usque ad annum 1840/1841. descriptae per assistentes ac auditores.

Quart. Lat. 2168. Conspectus synopticus in clinico medico practico Regiae Scientiarum Universitatis Hungaricae ab anno 1814. usque ad annum 1824. pertractatorum, per assistentes et auditores conscriptus, Pestini.

Quart. Lat. 2169. Synopsis observationum practicarum circa aegros in instituto medico-practico Regiae Scientiarum Universitatis Hungaricae, sub auspiciis domini professoris Joannem Pozsonyi assistentes. Pestini, 1818–1821.

Quart. Lat. 2172. Brevis eorum expositio, quae et quomodo in clinico medico Regiae Scientiarum Universitatis Hungaricae manu ducente... professore Francisco Bene acta sunt... Descripta per Josephum Krieger (1818).

Royal College of Physicians of Edinburgh Archives (RCPE)

DEP/ABJ/1–2: Men’s Cases (1800–1801)

DEP/1/1/5–9: Women’s Cases (1801)

DEP/AWP/2/1–6: Cases taken from the Clinical Journals of the Royal Infirmary of Edinburgh (1809–1811)

DEP/AWP/2/7–8: Clinical case notes (1811)

DEP/HOT/1: Clinical Casebook (1796–1797)

DEP/LID/1: Clinical Case notes (1812)

Semmelweis Egyetem Levéltára [Semmelweis University Archives] (SEL)

1/g, Annual Reports of the Clinics of the Medical Faculty, 1825–1835, Boxes 1–3.

50/a, Historiae Morborum

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Appendix

Table 2.

Cases of the York Retreat

Name	Age	Diagnosis
Margaret Holt	65	–
Rachel Raw	49	–
John Ellis	26	maniacal
Sarah Merill	50	insanity
Anne Noble	25	insanity
Joseph Reynolds	26	epileptic (falsely diagnosed as a lunatic at first)
Mary Evens	26	melancholic insane
Mary Pyle	50	insane
John Bower	45	disorder is of the melancholy kind
Mary Bayes	58	religious insanity
Elizabeth Thompson	56	insanity of the melancholy kind
John Waltonford	30	–
Thomas Ellein	39	religious melancholy
Sarah Delves	55	insanity, lowness of spirits
James Hashold	32	derangement
William Carcott	45	derangement
John Richardson	74	insanity
Mary Atkinson	54	deranged
Susanna Reynolds	72	–
Hannah Dumbleton	n. a.	incurable
John Fawcett	45
John Gundrey	24	derangement
Hannah Ponsonby	56	derangement
Abigail Sheppard	20	–
Mary Prideaux	45	derangement
Katharine Patchett	45	–
Joshua North	n. a.	violent derangement
James Blouse	24	disorder of the melancholy cast
Hannah Forster	24	–
Solomon Chapman	50	a mixture of melancholy and mania alternating
Sarah Wood	64	derangement
Samuel Clemesha	60	derangement
Ann Wallis	22	dementia
John Baker	43	derangement
John Young	46	derangement
Nathaniel Samms	54	derangement
Ann Gibbins	38	derangement
Judith Robert	30	insanity due to epileptic fits
Charles Spencer	50	his disorder is of the melancholic kind
Thomas Wellington	48	hypochondriacal melancholy
Richard Gunn	60	deranged
Mehitabel Moore	24	derangement
Elizabeth Flint	20	of the melancholic kind
Elizabeth Frith	40	melancholy
Hannah Woodewille	19	–
Susannah Winter	n.a.	epileptic fits, mental derangement
Hannah Bradshaw	c. 30	incurable
Mary Dearman	27	melancholic Insanity
Hannah Young	22	hysteria
Joseph Lupton	60	of the melancholy kind
Abigail Smith	36	in a state of insanity
John Fawcett	64	insanity
John Akins	51	melancholy
George Simpson	23	religious enthusiasm
John Lees	25	weak capacity, insanity
Sarah Cork	44	melancholy
Lydia Brown	29	insane
Elizabeth Bagg	41	melancholy derangement
Mr [?] Simmson	?	great confusion of ideas
Samuel Merill	22	–
Mary Mantle	57	many nervous affections
Charles Lloyd	42	insanity
John Smith	20	–
John Littlewood	38	melancholy kind
John Curtis Bentley	20	insanity of the melancholy kind
Rachel Evans	24	derangement
Chris Choat	57	palsy fit
Elizabeth Hamburg	42	–
John Coleby	78	melancholy
Henry Perkins	30	melancholy derangement
Sybela Mallinson	57	insane, melancholia
Elizabeth Lancaster	?	imbecile state of mind
Jane Heslop	62	disordered imagination, insanity
Thomas Broadbent Bland	44	nervous & hypochondriacal symptoms
Mary Simms	44	drinking
Henry Bearle	23	furious mania
John Hall	69	mania
Martha Broadhead	17	insanity
George Tichell	29	mental derangement
Mary Fletcher	?	mental derangement
Ann Anderson	24	–
Elizabeth Jardine	38	low melancholy state
Susan Woodwille	35	deranged
Owen Weston	24	deranged
Ann Groves	22	–
Joseph Ruston	47	insanity melancholy
Joseph Russel Warwick	74	religious melancholy
John Payne	48	maniacal symptoms
Sarah Midwinter	31	–
Elizabeth Dickinson	71	–
Jane King	57	–
Edward Night	16	deranged
George Arger	74	–
Aaron Richardson	43	insanity
Jane Biggs	35	aberration of mind
Hannah Laycock	21	deranged
Mary Oddie	28	weak intellect
Edwin Swan Rickman	30	insane
Sarah Field	48	insane
John Kingston	28	imbecility of mind
Rebecca Bland	39	mental anxiety

 

 

Table 3.

Cases of the Prague Asylum

Name	Age	Diagnosis
N. N.	24	reiner Wahnsinn (ecstasis simplex)
N. N.	–	Wahnsinn mit Tollheit (ecstasis maniaca)
S. W.	41	Wahnsinn mit Wahnwitz (ecstasis paranoia)
J. F.	44	Wahnwitz (ecnoia)
P. J.	46	Verrücktheit mit Tollheit (ecnoia maniaca)
B. M.	40	reine Tollheit (mania simplex)
R. R.	40	religiöse Melancholie (melancholia religiosa, melancholia supersitiosa)
W. B.	44	reine Melancholie (melancholia simplex)
H. D.	27	Blödsinn mit Krämpfen (anoia simplex)
F. R.	28	reine Willenlosigkeit (abulia simplex)
F. S.	25	melancholia metamorphosis, melancholia zoantropica
A. U.	37	daemonomania
R. A.	23	reine Scheue (panphobia)

 

Table 4.

Cases of the Vienna Asylum

Name	Age	Diagnosis
A. Fr.	30	mania
W. J.	39	delirium tremens potatorum
B. G.	31	mania
W. Al.	26	mania acuta
M. Th.	32	melancholia cum convulsionibus
K. Al.	20	mania
V. Const.	16	mania ex onania
F. Fr.	24	mania
H. M.	27	mania acuta
P. T.	36	monomania melancholica
G. J.	30	mania puerperalis
S. J.	30	monomania anglica

 

 

Table 5.

Cases of the Edinburgh Royal Infirmary

Name	Age	Diagnosis
Elizabeth Erskine	28	hysteria
Betty McKay	53	hysteria (incurable)
Jane Murray	14	hysteria
Pringle Young	53	hypochondria
Jane Mitchell	23	hysteria
Margaret Christie	25	cephalagia from hysteria
Daniel Hill	65	hypochondria
John Williamson	35	mania
Christiane Scroggie	11	hysteria
Barbara Johnstone	20	hysteria

 

Table 6.

Cases of the teaching clinic of the University of Pest

Name	Age	Diagnosis
Elisabetha Szabó	17	epilepsiae cum hysterismo
Anna Obst	37	hysterismo cum infarctibus abdominalibus
Klara Werl	22	hysteria
Cunigunda Gramlin	23	hysteria
Julia Tergoth	18	hysteria cum methrorragia
Elisabeth Enzman	40	vomitus chronicum cum Hysteriasi
Barbara Roletsky	20	Hysteria cum Epilepsia
Rosalia Hany	18	Hysteria
Maximilianus Hirschl	31	Delirium Tremens
Anna Skarlein	21	Hyperkinesia Hysterica
Maria Havrekerin	26	Hyperkinesia hysterica
Susanna Schedner	27	Gastralgia cum Hyperkinesia Hysterica
Catharina Koháné	50	Hyperkinesia hysterica
Maria Steiner	24	Hyperkinesia hysterica
Franciscus Schober	33	Hyperkinesia hypochondriaca
Anna Streditzin	36	Hyperkinesia hysterica
Fekete Sigismundus	26	Erotomania
Juliana Koszonits	26	Rheumatismus cum hyperkinesia hysterica
Anna Beck	16	Hysteria spasmorum hystericorum
Johannes Slavik	23	Melancholia
Anna Nagy	25	Paralysis rheumatica extermitatum superiorum et hysterismus
Anna Maria Navratill	50	Hysteria

 

Hypochondria as a Poetic Disease: Medicine and Ethics in the Case of an Early Nineteenth-Century Hungarian Poet

Gábor Vaderna
Eötvös Loránd University / Research Centre for the Humanities
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Hungarian Historical Review Volume 10 Issue 2  (2021): 189-210 DOI 10.38145/2021.2.189

Medical knowledge reached a wider range of social strata in the eighteenth and early nineteenth centuries. Popular medical books described diseases and how to cure them, and the press regularly addressed the topic of having a healthy body. Meanwhile, representations of the perfect body became an increasingly important problem for neoclassical art. This case study investigates how Dániel Berzsenyi (1776–1836), one of the important Hungarian poets of the early nineteenth century, thought about the human body. For him, the representation of the body was, on the one hand, an artistic problem which raised questions concerning manners of imitation and, on the other hand, an artistic problem which was associated with the display of human virtues and thus with ethical discourse. Berzsenyi gave an account of his illnesses, which can be traced back to hypochondria, in a private letter. His self-analysis has three layers. First, his private letter could be read as part of a sensible epistolary novel. I argue that Berzsenyi introduced himself as a sensible hero, who was ill because of his own uncontrollable emotions. Second, hypochondria has a medical context. Considering the continued influence, in Berzsenyi’s time, of the ancient doctrine of bodily fluids, I demonstrate that this disease may have become a mental illness associated with poets. The reason for this is that the emotions entertained by the sensible man led to the emergence of physical symptoms which were associated with the hardly definable concept of hypochondria. Third, one’s relationship to one’s body could be a moral issue. Berzsenyi attempted to assert his own moral superiority by describing his own illness. Thus, his letter also fit into a moral context of the contemporary theoretical debates in which he was involved. My paper shows how aesthetics, ethics, and medicine were interconnected and how different forms of knowledge circulated between the forums of the arts and other social forums.

Keywords: hypochondria, sensibility, poetry, medicine

Morieris, non quia aegrotas, sed quia vivis
Seneca (Ep. 78,6)

Self-Fashioning and Psychology

“What a task it is to build a bridge between contemporary psychology and the perception of the historical world!” Wilhelm Dilthey wrote enthusiastically in 1894, though he then cautioned that this goal could only be reached step by step. We can capture the individual together with history by looking for the inner meaning that connects them.1 This approach has had a significant influence on modern literary history and theory and also on the ways in which we converse about literature in everyday life. History determines the subject, while the subject’s intellectual achievement influences history. However, what is the relationship between the historical subject’s psyche and the psyche of the person who is now thinking about him? I. A. Richards gave his Cambridge students poems to analyze without telling them anything about the origins or authors of the text. In his 1929 Practical Criticism, he claimed that thanks to the persistent work of his students who first encountered serious difficulties in text comprehension, he became able to conduct a close analysis of the poems. Richards thus distanced himself from the abuse of psychology, and he proposed that the literary text should only influence the reader’s psyche, and we should ignore the psychology of historical subjects.2 Still, can we exclude all factors that lie outside the literary text so easily? Although twentieth-century literary theory, which primarily focused on the linguistic achievements of literary works, tried to relegate the psychological contexts to the background (or at least to tame psychology), talk of history meant that elements of psychology were sneaked back into the discussion, nonetheless.

The problem thus has a dual nature. On the one hand, historical agents thought something about themselves, and they also expressed their opinions about their own essence. This is the problem of self-fashioning, research on which was initiated by New Historicism.3 According to New Historicism, historical subjects construct their identities within the constraints of their opportunities, and they fashion the social image through which others perceive them. On the other hand, pre-modern subjects are very difficult to interpret without considering modern psychological constructs. When historical agents write about themselves, it can easily tempt us to force familiar psychological clichés onto our “victims.”4

In the following, I will present a case that can be understood through the concept of modernity, but which precedes Freudian psychology and its institutionalization.

It is the year 1820, and we will peek into the private correspondence between two Central European poets. One of them was sick, and he was attempting to decipher his illness. We will see how medicine, aesthetics, and ethics were intertwined in his writings.

Sensible Self

In the discussion which follows, I introduce several nineteenth-century Hungarian poets. Hungarian literary history at the beginning of the twentieth century (Geistesgeschichte in particular) paid considerable attention to our protagonist, Dániel Berzsenyi (1776–1836), who researched the relationship between psychology and history. Berzsenyi was an ideal candidate to make this connection. We know very little about his life, and what he claimed about himself is occasionally based on verifiably false facts. He came out of nowhere, no one knew who he was or where he came from, and no one knew how or from whom he had learned to write poems. The best-known poet of the era and the other character in our story, Ferenc Kazinczy (1759–1831), published Berzsenyi’s poems, though they never met in person. Berzsenyi’s volume of poetry was published in 1813, followed by the expanded version in 1816. The poems instantly became an important part of Hungarian poetry (and continue to be so to this day). But no sooner had Berzsenyi arrived on the literary scene in Hungary than he suddenly disappeared from the prying eyes of the public. In 1817, Berzsenyi received a negative review from a young man named Ferenc Kölcsey (1790–1838) which upset him, and so he barely spoke to anyone afterwards. Kölcsey was also a poet (he later wrote the poem that became the current national anthem of Hungary). When Berzsenyi died in 1836, Kölcsey apologized to him in his eulogy.

The lack of sources concerning the details of Berzsenyi’s life became the point of departure for psychological explanations of his poetry. At the beginning of the twentieth century, Dániel Berzsenyi was popular as an author among the supporters of a thriving Geistesgeschichte (as well as among those who, although they distinguished themselves from the adherents of Geistesgeschichte, were still engaged in something very similar). I will mention only a few examples. Gábor Halász attributed the breakdown to the clash between the poet’s true nature and his principles,5 while Ferenc Fejtő attributed it to the lack of self-confidence.6 László Németh analyzed the connections between brilliance and an allegedly melancholic character.7 Mária Rónay, in her article A rejtélyes Berzsenyi Dániel – a pszichopatológia tükrében (The mysterious Dániel Berzsenyi – In the light of psychopathology), described his poetic career as the work of a man who was a sickly father who suffered from anxiety and was also stingy and, in his advanced age, anti-Semitic.8 Henriette Szirmay-Pulszky, in her monograph entitled Genie und Irsinn im Ungarischen Geistleben, classified Berzsenyi as schizoid, and concluded, on the basis of his alleged physical and spiritual characteristics, that he was a psychopath prone to melancholy and was deeply depressed.9 The list goes on and on. One almost gets the impression that Berzsenyi was looking for trouble, as if, even if unwittingly, his life goal had been to gnaw at his own soul and provide work for psychoanalysts, as if the physician and historian Sándor Puder’s following statement made in 1933 were true: “Real literature is analytical, and it was already so at the time when psychoanalysis was nowhere to be found. Even as early as at that time, [Berzsenyi] unconsciously used the method of psychoanalysis in his analytical, psychologizing literature.”10

I disagree with this. If we stick to Dilthey’s original idea, i.e., if we seek not only to define, build out of fragments, or develop the inner ingredients of subjects from an inner meaning (psychology) but also to define the comprehensive framework and meaning (Geistesgeschichte) into which the individuality fits, it does not suffice to provide a psychological portrayal of Berzsenyi. And, although the inner psychological meaning of a personality cannot be uncovered in enough depth in my opinion, no matter how hesitant we are to take the slippery route of psychologization, I will attempt to reconstruct Berzsenyi’s disease, or more specifically, one of his mental illnesses.

Berzsenyi ceased all communication with Ferenc Kazinczy in 1817, following Ferenc Kölcsey’s critical review. He simply did not write to him anymore. Kölcsey was Kazinczy’s student, and when Berzsenyi asked about him, Kazinczy defended him. Thus, the issue at hand was one of human relationships, as is documented in the correspondence until the friends stopped communicating with each other. Three years later, in the winter of 1820, an old friend of theirs notified Kazinczy that Berzsenyi was in Sopron: “We only rarely see each other. He, as he says, became sick two years ago and was mistreated; the consequence of which became one of the greatest building blocks of his hypochondria, which not even the Buda spa could improve, but only the Füred one, or rather, sour water. Now, he says he is in passable condition, but he dare not read: he spends his time in the theater and the café, and we also visit each other sometimes.”11 Possibly after having communicated with this common friend, Berzsenyi grabbed his pen and wrote one of the letters which is cited the most often in the secondary literature on Berzsenyi.

Overall, we do not know much about what Berzsenyi was doing in Sopron. We also do not know too many details about his illnesses beyond what he (and their common friend) claims, namely that he was plagued by hypochondria and that he visited the baths in Buda and Balatonfüred. The contents of the letter are startling and unexpected, and it also rhetorically expresses the state he said he was in. The letter reads as follows:

Dear Sir,

You did not visit your dying friend; and behold, his shadow shall come upon you. His shadow, I say, because the soul you once bothered with so much is no more. Yes, Dear Sir, even though I am beginning to live again, my soul has long since died, and it has been replaced by a new unknown soul, dark and cold as night, and still as the grave. The horrific disturbance that has turned my whole nature upside down could have had no other result than this half-death. And since this half-death can easily become complete, and since my headache still often tolls the bell of death in my ears, I did not want to die as your imagined enemy but wanted to let you know that whatever crime I committed against you, I did it amidst the deepest hypochondria. For the same reason, pity me or laugh at me as you please, but do not hate me, rather attribute everything to my cruel illness, which has often made me half-crazy and half-mad. The causes of my illness were a quinine-treated inflammation of my gallbladder and a dangerous fall in which my shoulder was dislocated, and my shoulder blade was fractured, and my head also suffered a large bruise, all of which caused me to be confined to bed for six months. The rude criticism [by Kölcsey] perhaps also belongs here, which provoked me into thinking in a state when I was most incapable of doing so. You can imagine what a tremendous job it was for me to aestheticize with a confused head, an angry heart, and without any books, even though I have never read aesthetics or poetry other than Rájnis’s Kalauz (Guide to poetry). Now I’m reading and smilingly reviewing my feeble attempts of the time. You should smile at this, too! This is how I have always been: I did not think I needed to study, and therefore I did not study.12

A friend of yours from Pest once told me that you would not even be capable of writing a scholarly work like Kölcsey’s critique. Now I think you could not write such a rude one. But whether you wrote it or not, it does not matter to me now. You could have had dark hours like I have, and you were free to treat me like all my friends throughout my life; you did nothing new to me. This is how I now feel about Kölcsey, whose abuse I would tolerate just as much as I have tolerated that of Mondolat, had I not written that hypochondriac countercriticism;13 but since I did write it, I must also write another, for it would be quite a ridiculous conclusion to my literary life. This is also how I feel about Thaisz, Szemere, and Vitkovics, who mocked me to my face in my miserable state,14 and who found it appropriate to trample on my ashes even in the Tudományos Gyűjtemény (Scientific collection); this is how I feel, I say, because I know very well that those who torture the pitiful with such insults will be helped by neither rhubarb, nor the sour water of Füred, nor my text.

And so, Dear Sir, I live and write again, and behold my very first letter is Yours. Accept my cold hand once again with the calm soul with which I offer it to you. I am well aware that there could be no reason, no desire, for you to fraternize with a deteriorated hypochondriac; but it is not friendship I am coming for, since, believe me, my resignation is also complete both towards you and towards the whole world, and my heart desires, knows no good but the serenity of this resignation; I just wanted to let you know that my state has improved so that you think better of me and do not consider me your enemy, and do not hate me. Be fortunate, be happier than I am, and do not experience the misery I have endured.15

 

We are between life and death, in a paradoxical half-death: still in this world but already beyond the death of the soul. This is a surprising transmutatio: the immortal soul is already dead, but the mortal body is still alive. And the dead soul is replaced by another, possibly death itself, with its metaphors crowding around it: shadow, darkness, cold, night, the grave, the cold hand. Very much like the protagonists of sensible epistolary novels, Berzsenyi eliminates the difference between life and death, between body and soul. On the one hand, life has become just as problematic as death through his illness; on the other, by this era, the physical and spiritual symptoms of an illness appeared as each other’s complements. It is no coincidence that the poet first lists his physical symptoms and returns to his spiritual problems in the following sentence. Much as the body does not exist without the soul, health does not exist without illness. István Mátyus, the author of a popular medical handbook of the era, a six-volume edition on dietetics, writes “people in perfect health are quite rare in this world, and if someone does manage to step up to this state for an hour or two, he cannot stay there for long, due to the miraculous structure of nature. Instead, good health starts to deteriorate, so that we have to extend health to certain limits.” From the eighteenth century on, the natural state was not the healthy one, i.e., health was not a clearly defined, enclosed whole, “there are smaller and larger illnesses, but there is also lesser and greater health.”16

Part-whole relations also disrupt narration, and metonymic story-building is disrupted in the letter, with metaphorical relations foregrounded instead. This is again a popular method of the epistolary novels of the era: frustrated and fragmented narration. The metaphorical construction of the text (text built on some image and the associations surrounding it) is also present here (through the metaphors of death); however, the train of thought is not coherent, and consecutive paragraphs are only loosely connected to each other (although there is no switch between the topics). The frequency of salutation and the deixes pointing to the addressee are of course not surprising at all, sensibility also viewed openly owning up to one’s feelings and displaying uncontrolled virtuous impulses coming from deep down as an anthropological feature, which also meant the fragmentation of the text.

At times we almost reach incomprehensibility. For example, in the break in thought between the second and third paragraphs: while in the first he dismisses his friendship with Kazinczy, among others, he begins the second by addressing Kazinczy as a friend. Immediately after the impossibility of recovery, only signaling the break in his thought by a line break, he writes about his resurrection: the notion of death alternates with the possibility of a fresh start throughout the letter. Complete death does not take place because it would also mean the end of the self-narrative, and the writer and narrator (uniquely, these two are one and the same here) do not wish that. He does not wish for his story to end with a sick hypochondriac text in front of the public, and so he first needs to write the missing ending to the novel of his life. The act of writing is thus only an excuse for self-fashioning; in other words, a kind of fictitious, imaginary life and a lived life, assumed to be real, are all mixed up here. Evoking the other also directs attention to the self in the letter. Friendship becomes the territory of absence, and the letter may make up not only for the lack of personal encounters but also for the avoidance thereof. Namely, imitating an in-person meeting quickly turns into an analysis of resignation. Resignation thus deletes notions of friendship and animosity and enters the same intermediate borderland located between body and soul, life, and death.

So far, I have listed the characteristics of the Berzsenyi letter that connect it to the popular epistolary novels of the era in terms of narrative technique. However, at the beginning of the paper, I set out to talk about Berzsenyi’s disease and mental illness, so let us thus leave the territory of aesthetics and enter dietetics.

Hypochondria

The second half of the eighteenth century was the heyday of medical anthropology, and around this time, philosophical anthropologies were also written by physicians for physicians in large quantities, thus man becomes a patient in a representative manner through anthropological nosologies and the birth of clinics. This is best illustrated by the large number of medical handbooks written for laymen in the second half of the eighteenth century, including in Hungarian.17

If we ask what hypochondria could have meant, at least roughly, in the first decades of the nineteenth century, we will not receive a clear answer. Burgeoning medicine offers so many different solutions; it describes the different symptoms in great detail (often through interesting stories), processes so many different medical ideas and provides so many seemingly sure-fire formulas that we can easily encounter problems upon evaluating a disease.

István Benedek, in his short essay on Berzsenyi’s melancholy, wrote about the difficulties of interpreting hypochondria in 1982. “Just as it will not be easy to orient oneself in the substance and interpretations of today’s schizophrenia in the next century, erstwhile hypochondria is also a large umbrella. It is related to what today lies behind psychopathy, neurasthenia, psychasthenia, neurosis, and many other, less popular expressions, it is related to apathy, melancholy, amentia, and the expression ‘dementia’, used in French-speaking areas. Instead of the many foreign expressions, it is easier to approach it through a simple-minded definition: a melancholic affliction that sinks you into inertia. It is not insanity, not a reaction to external circumstances, but an enigmatic constitutional characteristic, God’s curse.”18 Although these various types of madness may not be as blurred in early modern times as Benedek claims,19 hypochondria is quite a “large umbrella,” and accordingly, a popular topic of contemporary medical literature. A German historian of medicine, for example, counted that in the Jena Journal der praktischen Arzneykunde und Wundarzneykunst edited by Christoph Wilhelm Hufeland, one of the best-known medical professors of the time, ten percent of the literature on nosology is on hypochondria.20 This is a high ratio, and although it is equally interesting, and I do not have precise data on the Hungarian material, the four Latin-language dissertations published in Hungary that discuss hypochondria exclusively, and the chapters of the popular medical handbooks that discuss hypochondria show that the Hungarian medical-anthropological discourse was also keenly interested in the issue.

In the case of hypochondria, even the classification of the disease in terms of nosology is difficult to determine. This is because we cannot disregard the fact that initially, based on the typological classification of ancient humoral pathology, melancholy, which had enjoyed a long career in the history of European medicine and culture, also included hypochondria. Namely, Galen sees the origins of melancholy as lying in a disorder of the hypochondrium, the upper part of the abdomen, and this connection seemed logical until the beginning of the eighteenth century.21 For example, Ferenc Pápai Páriz still wrote about “Hypochondriaca Melancholia” in his popular medical handbook Pax Corporis in 1690.22 Since “in the age of Reason,” a shift of emphasis within the concept of hypochondria can be detected, i.e. “a dynamics of the corporeal space gives way to a moral theory of sensitivity,”23 we can observe how hypochondria and its related feminine disease, hysteria, replaced the pair of melancholy and mania, and how these structures operated and divided in parallel with each other. However, according to Michel Foucault, “physicians of the classical period did try to discover the qualities peculiar to hysteria and hypochondria, but they never reached the point of perceiving the particular coherence, that qualitative cohesion which gave mania and melancholy their unique identity.”24 Hypochondria cannot be defined or located, and it is difficult to specify. For example, in Immanuel Kant’s 1764 treatise Versuch über die Krankheiten des Kopfes we find the following: “The hypochondriac has a disease which, in whatever place it is chiefly located, is nevertheless likely to wander intermittently through the nervous system to all parts of the body.”25 Its seat cannot be located, and it is in constant motion and, thus, difficult to catch.

Let us instead allow Foucault to classify and meticulously analyze “figures of hypochondria”26 and examine the function this disease plays in the patient’s life. Through his disease, the hypochondriac enters the territory between body and soul, life and death, a place that cannot be detected. First, this disease makes life similar to death, which is no surprise after having read Berzsenyi’s letter. This problem is so central that the Hungarian István Mátyus, for example, illustrates the difficulties of defining life with the frequent phenomenon that happens to hypochondriac men and the hysterical women related to them: “What life is, is not as easy to determine as it seems at first glance. Namely, many died a long time ago who were thought to be alive by society; at the same time, many lived who were thought to be dead for sure. Examples of these are the many hysterical women and hypochondriac men who, having fainted […], hardly seemed to be alive, what is more, oftentimes seemingly having died completely, they were placed under the dissecting knife or in the coffin; but after some time, they came back to life on their own or with the help of some external tool, much to everyone’s surprise.”27 The comatose and the hypochondriac are closely related to each other. On the other hand, the close connection between the body and soul also surfaces in hypochondria, and in this period, probably no disease of the mind existed that would be independent of particular physical processes. The hypochondrion (in Latin: hypochondrium), as mentioned above, is the upper part of the abdomen, the right and left part of the abdominal cavity enclosed by the arches of the diaphragm. This was the part of the body where diseases of the mind had been located since Galen. It is still a widespread view in popular medicine to this day that different gastric problems, primarily stomach ulcers or irritable bowel syndrome, are consequences at least in part of an overwrought, stressful life. In his popular handbooks on dietetics, Mátyus looks for the causes of various diseases in the incorrect flow of different humors. Yet, if hypochondria is a disease that also affects spiritual life, the humors also reach the mind; in other words, the direct causes of the illness are the “frequent strong spasms in everyone’s weakened internal parts, driven by the thickened, rancid humors that have collected and settled in them, which wander around the whole body and cause a sudden multitude of changes both in the body and the mind. Its more distant causes, on the other hand, are all that weaken the stomach, thicken and sour the blood, and do not allow it to flow freely inside the internal parts.”28 The internal space of the body is freely permeable, obstacles and obstructions are created at different points, different humors slow down and decrease the speed of life functions and disturb the quality of life,29 for the sensible person pax corporis is already an unattainable ideal. Christoph Wilhelm Hufeland recounts one of the teachings of Dutch professor Herman Boerhaave from Leiden, who lived approximately one hundred years before him and remained a dominant figure in European medicine in the eighteenth century: “Boerhaave says that the blood that flows onto the brain makes people see bloody ghosts and rainbows.”30 This means that physical and mental illnesses are closely related, and we cannot separate medicine from psychology. As Christian Friedrich Richter put it very eloquently at the beginning of the eighteenth century, “The matter or the body is attracted by the soul through the union to such an extent, mixes with it so much, so to speak, as if the soul became material-like or corporeal, and as if the body became spiritual.”31

Material and spiritual things, these two good friends, alternated between tightening and loosening their friendship, and they also drifted apart from each other after a while. This is how hypochondria slowly turned from an illness of sensibility into an illness of the imagination. This change can also be detected in Hungarian popular medicine. For example, in Sámuel Köteles’s Philosophiai anthropologia (Philosophical anthropology), published posthumously in 1839 (and written some time during the 1820s), these two diseases still appear after each other, but they are already separate diseases. As he writes about hypochondria, “This disease is a fear, restlessness, and despondency resulting from some impending indeterminate harm. The hypochondriac indeed experiences some illnesses which originate from the irregularity of bodily functions, especially in the bowels. These illnesses are not such that some serious illness or even death would result from them, but the lively imagination of the hypochondriac nurtures them. Thus, hypochondria becomes the source of many diseases.32 This is how an imaginary invalid becomes a hypochondriac (Molière’s Argan is not yet a hypochondriac but merely a malade imaginaire), and by the second half of the nineteenth century, imaginary illness also became an illness of its own. The expansion of nosological literature first resulted in the appreciation of hypochondria, while soon afterwards, being unable to earn its own place within the framework of this system, it was devalued into a meta-disorder. This place for hypochondria was created by the overgrowth of the system to which it owed its existence. It is no coincidence that hypochondria, i.e., the disease that was looking for its place in the human body, appeared as some kind of civilizational, particularly urban disease.33 While Hufeland could still make fun of one of Boerhaave’s students without mentioning hypochondria, because he literally loved the Dutch professor’s teachings and was thus “an animated lesson,”34 the Viennese physician, Baron Ernst Feuchtersleben already calls hypochondriacs “the volunteers of medicine,” “who have dug themselves into the entire pathology, who write themselves prescriptions from books.”35 It was somewhere around this time when the context of Dániel Berzsenyi’s illness, to be interpreted in the discourse of sensibility, became blurred, and this is where the psychological descriptions of modernity floundered.

Constipation

Or maybe that context did not disappear completely. A common characteristic of disease and related mental illnesses, which continued for a long time, is that mental instability (the illness of the head or the heart, depending on the person) and abdominal (constipation-related) illnesses are linked. In 1830, József Horvát, a doctor of medicine and arts, translated Franz Richter’s book into Hungarian and rewrote the parts on hemorrhoids and related illnesses, including hypochondria. He discusses the abdominal consequences of madness in the chapter Az aranyérnek gerjesztő vagy távolabb okairól (On the inflicting or other causes of hemorrhoids). He thinks it is obvious that no explanations are needed: “Everyone knows the influences mental illnesses have on health in general and on the functioning of the organs of the lower body in particular so well that we should not say anything it.” According to Horvát-Richter, “people prone to anger and irritation already suffer from illnesses of the lower body anyway, or at least they are on the verge of thereof, and so they are also more or less likely to have hemorrhoids,” while the more hidden mental illnesses, the so-called “discouraging affections,” such as worry, sadness, fear, listlessness, timidity (all of these are characteristic of hypochondria), also influence processes in the lower body, even if more slowly. However, these do not cause any serious physical problems, only digestive disorders and “obstructions”: “These, weakening the circulation of blood, are particularly harmful to digestion, and they cause obstructions especially in the abdomen.”36

The obstructions disrupt the entire body. For example, in Berzsenyi’s letter to Kazinczy, he also mentions his headache: “my headache still often tolls the bell of death in my ears.” Franz Schedel (a Hungarian literary historian known as Ferenc Toldy), in his lecture notes on dietetics prepared for his medical students, still links headaches to gastrointestinal disorders in 1839: “Constipation causes wind and cramps, and if it lasts, it obstructs the unimpeded circulation of blood in the lower body and causes it to amass in some parts and causes aches, more specifically, obstructions towards the head: headaches.”37 In Sámuel Rácz’s 1776 Orvosi oktatás (Medical training), it is sadness that is linked to these physical processes, again without mentioning hypochondria: “Those who often suffer from stomach cramps are glum, sad, withdraw from merry amusements, become weak, are happy to sit, become pale and have difficulty breathing whenever they have to move: the stomach is often obstructed; the digested matter is formed into pellets.”38 A little headache, some sadness, constipation and blockages (obstructions), and occasionally unexpected wind are all not so fatal here anymore, and although nosology has changed here and there, the interfaces and contacts within the system have remained the same.

In my opinion, by emphasizing hypochondria, Berzsenyi provides Kazinczy with a key to reading his letter. He offered it not, or not only, as some weak explanation as to why he committed his crime (that he had written his Countercriticism), rather than offering a way to read his sensible epistolary novel, in which he is also a character. In illness, the border between life and death dissolves, while in the illness of hypochondria, it is the border between physical and mental illness that dissolves. It is no coincidence that Berzsenyi’s (the narrator’s, the hero’s) physical injuries (overturned car, broken bones) and mental injuries (confused head, angry heart, and ignorance) appear next to each other, even if it is somewhat unexpected. The energy of the opposites straining on each other (I live and die, write, and do not write, selfless friendship and no friendship, scholarship and amateurism, etc.) can be channeled into hypochondria. Analyzing Johann Ulrich Bilguer’s 1767 essay entitled Nachrichten an das Publikum in Absicht der Hypochondrei, László F. Földényi concludes that existence thickens around hypochondriacs, but just like in the case of all vortices, everything turns into nothing beyond a certain point.39 If Berzsenyi is heading towards something in his letter, it is the serenity of resignation. The complete dissolution and elimination of opposites.

Ethics

Berzsenyi’s letter is an unfriendly letter to an old friend: the salutation is formal (“Dear Sir”), Berzsenyi floats the idea that it was in fact Kazinczy who wrote (or at least suggested) Kölcsey’s criticism, etc. In the second paragraph, friendship is presented as a possible opposite to hypochondria. In social life, problems are dissolved, while loneliness creates a sense of absence, and in loneliness, the balance of the body and soul is disturbed. However, a disloyal friend punishes not only us but themselves as well. According to Berzsenyi, “those who torture the pitiful with such insults will be helped by neither rhubarb nor the sour water of Füred, nor my text,” i.e., the disease will catch up with them too. Namely, discarding one of the main spiritual virtues, i.e., friendship, is one of the main symptoms of hypochondria (as this is what the next paragraph is about, i.e., how he replaced Kazinczy’s friendship with resignation). And it is also probably no coincidence that he recommends the water of Füred and rhubarb to András Thaisz, Pál Szemere, and Mihály Vitkovics. Kölcsey agrees that this is no coincidence. He was familiar with the text of the letter, and this is where he sensed the biggest insult: “That he [Berzsenyi] believed that he did not have to study, that he is already studying and he wants to replace his hypochondriac Countercriticism with a better one, that he considers Thaisz, Vitkovics, and Szemere as people who mocked him to his face and who trampled on his ashes, and when talking about them, he keeps mentioning rhubarb and Füred water: these, my dear friend, are the words of deepest hypochondria. But this hypochondria comes not only from the quinine-treated inflammation of the gallbladder, or from tipping over, it is feared that its biggest lair is in the mistaken idea of the pretended invincibility of genius.”40 But why exactly are these the deepest words of hypochondria?

Rhubarb is an old medicine, and in Házi orvos szótárotska (A small dictionary of home medicine), a compilation of sixteenth-century herbaria written by the infamous Hungarian charlatan of the time, Mihály Nedliczi Váli, it is primarily recommended as a remedy for stomachache; what is more, boiled in the juice of Hungarian aszú grapes, it not only eases the dryness of the throat, but it can also be used to treat dysentery, bloating, stomachache, hiccupping, and of course, melancholy.41 And mentioning the Füred water which was considered to be a medical miracle cure in the era in question, may also be of significance.42 The different sour waters and baths often served as treatments for various illnesses of obstruction, such as constipation and the hemorrhoids related to it, as well as melancholy and hypochondria.43 The best-known of these is probably the Füred water, which Hungarian physician János La Langue’s book on waters recommends for curing the most diverse illnesses of constipation, including hypochondria: “this water has strengthening, releasing, and digestive powers, so it helps the weakness of the stomach and the abdomen, third and fourth-day chills, blockages of the liver, spleen, kidney and uterus, and hypochondria.”44

Does Kazinczy understand the language of hypochondria? In a letter written seven years later, he enthuses to an aristocrat friend of his: “Your letter would horrify me with the news that your soul has been plagued by hypochondria. But you lament about it in such a beautifully written letter that if hypochondria was capable of making one write in such a way, I would ask the Gods to release it on me as well; not even the healthiest soul can write such a letter.”45 Hypochondria is thus characterized as a condition which brings up something that had been closed off below, much as the language of Foucault’s déraison, or pain, creates an independent discourse in the era of sensibility.46 In his response to Berzsenyi dated 18 January 1821, Kazinczy rejoices over his fortunate recovery from the illness and the restoration of the balance of his mind: “Truth and time finally lift the fog, and what is clear is known as clear.”47 This is the paradox of hypochondria: the more we want to help the patient, the deeper we push them. Everything can be reversed. We may even behave ethically towards our patient in the long run; at the same time, this cannot be the method to treat the symptoms that are currently perceived.

The end of their friendship is the beginning of the disease. In Berzsenyi’s 1820 letter, we can first read how true friends (Kazinczy and his followers in Pest) betrayed Berzsenyi and pushed him into illness, and then how now there is no point in making friends with him: what is more, it is impossible to make friends with him anymore. The disloyal friends may suffer all that the one they betrayed had to suffer. Kazinczy’s response letter wants to resolve this tension, and as a good friend, he consoles him, since patients always need hope:48 “You call your state a half-death. Your letter exposes this claim as untrue, because you did not write more enthusiastic ones in your healthy days either, life and strength sparkle within. I would be inconsolable if this hope did not revive you. Nec dis amicum est, nec mihi te prius obire, my dear friend.”49 The Latin quote comes from the first strophe of Horace’s ode written to the sick Maecenas (Carm. 2,17), which has been considered the ode of intimate friendship for centuries, and in the next strophe of which Horace attributes half of his soul to his friend. In other words, Maecenas–Berzsenyi’s “half-death” would also bring death to Horatius–Kazinczy: “ibimus, ibimus, / utcumque praecedes, supremum / carpere iter comites parati.” Their friendship, their shared astrological sign (“utrumque nostrum incredibili modo / consentit astrum”) imposes responsibility on both friends, if one of them is sick, their illness is also shared (as the parallel stories of the last three strophes of the Horace ode suggest), and a shared sacrifice is necessary: “Reddere victimas / aedumque votivam memento: / nos humilem feriemus agnam.”

The end of their friendship is the beginning of the disease. The flip side of this may also be true: friendship is a balm for illness. It is literally medicine. Sir Francis Bacon writes this on friendship: “We know diseases of stoppings, and suffocations, are the most dangerous in the body; and it is not much otherwise in the mind; you may take sarza to open the liver, steel to open the spleen, flowers of sulfur for the lungs, castoreum for the brain; but no receipt openeth the heart, but a true friend; to whom you may impart griefs, joys, fears, hopes, suspicions, counsels, and whatsoever lieth upon the heart to oppress it, in a kind of civil shrift or confession.”50 The constipations and stoppages of the body orifices and the constriction of the soul happen parallel with each other, and a good friend can resolve our problems. However, the hypochondriac does not have friends. Kazinczy also knows what can be read in a popular medical book, that “sad, listless persons need to be cheered up, and we should try to take them to merry companies,” but also that “such patients […] are broody, fearful, skittish, mistrustful, and they often become quite dejected if someone contradicts their foolish opinions or does not believe them.”51 Kazinczy wishes to relieve Berzsenyi by listening to him, but an obstruction that he cannot unplug stands in his way.

 

***

 

When Berzsenyi chooses a literary form for his letter (the sensible epistolary novel), he consciously enters a medical discussion in which aesthetics and morality are interconnected. In this essay, I attempted to describe the narrator’s illness with the help of the contemporary practice of medicine and anthropology, and I eventually located its place in a moral-ethical discourse. I concluded that these three seemingly different areas are linked very closely, and those who only reconstruct Berzsenyi’s psyche can only enrich the psychological literature of their own horizon, while they will necessarily draw the wrong conclusions, since Dániel Berzsenyi himself cannot lie on the psychoanalyst’s couch. I tend to believe the cautionary note of the abovementioned Christian Friedrich Richter, who warned that those who “wish to place the body only in the jurisdiction of medicine and the soul in that of the humanities and place intellectual life in the theological faculty are wrong.”52

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Doctors into Agents: The Technologies of Medical Knowledge and Social Control in State Socialist Hungary*

Viola Lászlófi
Eötvös Loránd University / École des Hautes Études en Sciences Sociales
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Hungarian Historical Review Volume 10 Issue 2  (2021): 328-356 DOI 10.38145/2021.2.328

In this paper, I analyze different situations in which the doctor-patient relationship, the knowledge/information produced within this framework, and the practices of medical questioning came to the fore in the work of the state security services, one of the typical institutions of social observation and surveillance of the Hungarian socialist state. I examine work and recruitment dossiers opened from 1956 to the 1980s which document either physicians’ uses in state security observation of information which they gained about their patients during their professional (medical) activities in or in which the physician-patient relationship appears as a context of the physician’s recruitment. I discuss how physicians constructed the patient when the gaze of the state security forces was also arguably part of their medical gaze. I contend that medical knowledge and, more generally, information revealed in the professional (medical) context and used in the framework of network surveillance, taken out of their strict medical context, constituted a gray zone of power. On the one hand, this information was a useful tool with which the regime could exert some measure of effective social and political control beyond the borders of healthcare, while on the other hand, it could help physicians develop a certain degree of social resistance.

Keywords: state socialism, history of medicine, state security, doctor–patient relationship, gray zone of power

From end of the 1940s, the developing state socialist system aimed to modernize several facets of social and political life in Hungary. Building on the social and ideological objectives of the new system and conforming to international tendencies, the state engaged in a comprehensive pursuit of modernization which encompassed the provision of welfare benefits, such as universal healthcare, the development, extension and structural reorganization of which began in the early years of the state socialist regime.1 As early as the 1940s, the directive of providing more citizens with health insurance and creating a state-funded universal basic healthcare system yielded the restructuring of healthcare in many countries. This process intensified significantly after World War II.2 By 1961, with the extension of universal health insurance, almost all citizens were eligible for healthcare in Hungary, and after 1975, it became accessible essentially for free to the whole population.3

The de-privatization of the existing healthcare institutions and the establishment of new hospitals, the extension of the network of general practitioners, and the development of outpatient care enabled access to healthcare for both urban and rural populations. Healthcare providers, who previously operated private medical practices, were now employed by the state.4 By introducing these measures, the reigning party’s aims were to advance the medicalization of society and to create an institutional framework which would symbolize the provision of a high level of public care for the workers, the group favored by the state socialist system but marginalized by previous regimes.5 Consequently, medical knowledge and the doctor–patient relationship as a form of social interaction came to play a decisive role in molding socialist welfare. This process and its implications have been addressed in sociological inquiries, but historians have not yet given them adequate study or interpretation.6 However, the cases have not been examined in which doctors, who by then had come to fulfil a fundamental role in welfare provision and thus had a higher number of social contacts than they earlier had had, became the agents of state power not only on account of their medical knowledge but also as the employees of the state security forces, which was one of the key institutions of political repression, responsible for monitoring and controlling individuals in society. In this study, I focus on these rare but all the more significant instances when the state security’s gaze exerted an influence on (and arguably was part of) the medical gaze. The cases under study constitute only a small proportion of the state security files reflecting on the performance of physicians, which means that the position physicians enjoyed in society (as figures in whom trust and confidence was placed), which was clearly considered beneficial for the intelligence network, was little exploited.

As a well-definable group of people possessing specialized knowledge and the related power, physicians have already been discussed in Michel Foucault’s works. Foucault perceived power as a set of techniques, maneuvers, and functions which are distributed based on the strategical positions occupied by individuals or groups within a society. Power, furthermore, is operational, and it thus applies in social contexts and systems of relations in which both bottom-up and top-down processes are observable, and both the dominant and the dominated groups participate in developing power relationships.7 In a medical context, this power could find expression in various phenomena, from medical consultation to health education, and due to the constant presence and operation of power, individuals learn and practice required behaviors, and these processes and rituals of adaptation play a fundamental role in maintaining social order. In short, people become medicalized.8 There are, however, two aspects which weaken the force of this argument in the context of socialist Hungary. Foucault’s observations apply primarily to a capitalist context. Furthermore, he presumes that, although medical and state power are closely related, they cannot be reduced each to each other. The relationship between them should be the subject of further analyses in different social and political contexts.

Taking these arguments as my point of departure, in this study I seek to outline the different aspects and functions of medical activity (institutional, social, responsibility for the production of knowledge) which made doctors and their knowledge of interest outside of healthcare contexts or, the other way round, which impeded the use of this knowledge in new contexts. I also seek to address how the methods used primarily in medical contexts by healthcare experts were used and interpreted during their work within the network of the state security forces. Based on the available evidence, I argue that the methods and practices of the production of knowledge used during medical fieldwork within an institutional context (the development of trust in the doctor–patient relationship, the making of diagnoses) and the social control obtained through such practices produced a certain gray zone of power9 when they were adopted in the framework of state security observation. On the one hand, doctors, due to their social-institutional power, could exert significant social control, but on the other hand, this very power could enable them to put up a certain amount of resistance.

In examining this phenomenon, I explore recruitment and work dossiers, altogether 10, which center on information obtained in a medical context by doctors who had already worked as agents or who were only being pursued by state security.10 All of them were written after the 1956 Revolution in the Kádár era, but their distribution within this period varies between diverse dates. The exact dates are always indicated in the footnotes. As for the content of the dossiers, however, there are no significant differences. Through the lens of the dossiers, we catch a glimpse into a rather heterogenous medical practice, as the doctors in question had a diverse array of expertise (psychiatry, neurology, family medicine, inner medicine), came from a geographically heterogeneous background, and worked in different institutional settings (hospital, local practice, psychiatric institution). Due to the lack of documentation, in several cases it is not known why or how they were recruited by the secret police. The recruited physicians were classified into several categories, such as agents, informants, and secret emissaries.11 As these nuances of classification are unimportant in interpreting the information the doctors obtained and thus in answering my research questions, for the sake of simplicity, I refer to them as informants and/or agents. Their exact functions are summarized in Table 1 (see below).

Social Control and the Production of Knowledge

To be able to grasp how the doctors’ opportunities to become useful informants, their work for the secret police, and the usefulness of their reports were evaluated and how this related to the distinguishing characteristics of their profession, in short, whether a gray zone was indeed supervened, first, it is worth giving a brief summary of earlier research on the “success” of state security observation and the agents whose role was indispensable to this success.

As has been pointed out by a number of studies focusing on the practices of the production and interpretation of state security reports, which are fundamental to any understanding of how the system itself worked, an analysis or discussion of the observational techniques used by the secret police forces, such as the Romanian Securitate, the East German Stasi, or the Hungarian State Protection Authority, may do little to further our knowledge of the actual social realities of the time.12 Secret polices forces were created to strengthen socialist systems and to prevent disruption within society. Thus, one of the tasks entrusted to these police forces was the creation in their reports of a discourse which buttressed both the terminology and the reasoning of the state ideology. The creation of this discourse allowed the regimes to label allegedly disruptive events using terms that reinforced the state narrative (for instance, espionage or sabotage) and to identify perpetrators as culprits from this narrative (for instance, the saboteur, the bourgeois, and the kulak). In course of time, the state security forces were given new missions, and their protective functions, which purportedly were intended to advance the building of socialism through the pursuit of complete control over society and the protection of the social order, were replaced with an all-encompassing ubiquity and the wish to know and monitor every minor secret of each and every citizen.13 According to János Rainer M., in the Hungarian case, this change had been implemented by the 1960s.14 This alteration of functions, however, left the linguistic construction of reports untouched: reports still had to be written in a language interpretable (and acceptable) to both the state security force and the party.

The informants’ ability to fulfil their mission (to observe and to meet the expectations placed on them with regards to their reports) was strongly influenced by their relationships with case officers. Katherine Verdery drew on the analogies between the system of state security and educational institutions, and Sándor Horváth has compared the connection between informants and their case officers to the teacher–pupil relationship.15 Horváth argues that the individuals’ first reports within the state security system and the case officers’ criticism of their form and content could be perceived as part of a process of socialization and learning during which the informants appropriated the fundamental methods of their new “work,” such as the logic and formal requirements of report writing, as well as the perception of their own social environment based on either opposition to or conformity with the system.16 This knowledge, at the same time, could prove flexible, and it could be used by the informants to pursue their own personal goals through the secret police. Moreover, the teacher-pupil concept reflects the (limited) flexibility of this relationship. The success of gathering information and the efficiency of the relationship were determined not only by the officer’s intentions to educate and socialize the informant/pupil, but also by how successfully the two actors asserted their own will in their collaboration.

The teacher–pupil relationship as a metaphor, however, is not only relevant from the perspective of learning and socialization. It is also a great signifier of another, psychologically more sensitive interpretive process, a core element of the paternalistic, almost controlling relationship between informants and their case officers. The primary focus of this is not the report written by the informant, but his behavior, personal dilemmas, and social status. As the textbooks on operative psychology (written particularly for case officers) reveal,17 the individual’s personality and his eligibility to work within the network of state security were considered as early as recruitment plans were written, and recruits were continuously assessed from the perspective of their psychology during their operation within the network, for example, in instances when the sincerity of their reports was evaluated.18 Qualities such as intelligence, good memory, learning ability, politeness, and attentiveness were highly desired, but it was also considered valuable if the individual was ideologically trustworthy and had a wide social network on which he could rely during his work within the network.19 Though timidity or nervousness, which were seen as weaknesses since they might lead to the unmasking of secret activities, were not considered so dire as to disqualify a potential recruit, case officers were trained thoroughly to be able to motivate their informants (who had different personal values and came from diverse social backgrounds) to work efficiently. Since the informants had no insights into the operation and aims of the state security forces beyond the immediate world of their specific tasks, the case officers, taking on the role of “psychologists” and “sociologists,” had to use different tactics to secure the success of the operation. They were responsible for noticing and addressing the mental problems that could arise from stressful situations, and they had to have an extensive knowledge of the informant’s social network and its usability. This knowledge was essential if the case officers were going to give their informants.

Doctor–Patient Relationship as the Situation of Observation

The value of informants in the eyes of the state security forces thus depended not only on the content and form of their reports, but also on their psychological characteristics and social embeddedness as the preconditions of a systematic acquisition of information. Following this line of thought, first I examine the aspects of medical practice that made doctors desirable as informants in the eyes of the state security forces.

The case of “Tarkői”20 sheds light on why and how medical activity could be either the reason, the aim, or the circumstance of recruitment. In October 1957, when the 32-year-old “Tarkői” was approached by the agents of the secret police, he was working as a general practitioner in Miskolc, though he had originally been trained as surgeon.21 He was recruited because of his participation as a physician in the 1956 Revolution: he organized first aid stations in the “counterrevolutionary centers” of Miskolc.22 It was not uncommon for agents of the state security forces to approach someone because of his or her participation in the events of the revolution. In many cases, a person who had participated in the revolution would be under pressure to cooperate with the authorities simply out of fear of the potential consequences of refusal were he or she to refuse. The state security forces, furthermore, were also motivated to approach such individuals in the hopes of uncovering other “counterrevolutionaries.” The case of “Tarkői,” however, is different. The professional and political norms in this case are in stark opposition: as far as the medical explanation goes, as “Tarkői” had taken the Hippocratic Oath, he was ethically obliged to provide each sick or injured person proper medical care during the revolution.23 Thus, he was only fulfilling his professional duty. In the eyes of the state security forces, however, his medical-professional activity was understood as advancing the success of the “counterrevolution.”

The first encounter between the case officer and “Tarkői” occurred in a medical context, when the officer visited him as a patient suffering from a contagious disease. The goal of his visit was to get to know the doctor and to assess his eligibility. The case officer’s two-page report portrays a professionally competent physician with a wide social network, or in other words, a suitable candidate for the role of informant. As the officer reports, “Tarkői” “received him with great politeness,” examined him thoroughly, wrote a prescription, and engaged in pleasant conversation about the local problems of healthcare and his own life and past. The “well-trained” doctor “had a good memory and good conversational skills.” He was not “verbose, but rather direct and friendly.”24 “Tarkői” was thus the ideal type of a socialist physician, and he met all the requirements that a medical professional had to meet to serve both individual patients and society properly. In the medicalization of society, the individual doctor–patient relationships were given great significance, and one of the most important components of these relationships was personal sympathy.25 Furthermore, as pinpointed by studies in the period, this confidential relationship had a substantial impact on the recovery of patients, so “Tarkői’s” behavior would have been a perfect foundation for an ideal doctor–patient relationship if he was visited by a real patient.26

This confidential conversation on “Tarkői’s” professional qualities also offered a good opportunity to evaluate his potential as a good informant: his caring and attentive nature and his proneness to “flattery” made him a trustworthy and ideal candidate in the eyes of agents of the secret police.27 Furthermore, “Tarkői’s” future case officer got a clearer idea of his social network. He concluded that “[‘Tarkői’] knows people from different [social] backgrounds well. Some of his patients have functions either in the party or the state bureaucracy.” Though the officer wished to point out “Tarkői’s” wide clientage and the value of his work for the community, the underlying logic shows the categorization of individuals according to their relationships with the state socialist system. This prefigures the potential aspects of observation.28 Consequently, the case officer’s report shows “Tarkői” as an ideal candidate due to his wide social network and trustworthy nature. His professional qualities could also easily be translated into the new context.

Confidence in the case of an ophthalmologist from Kalocsa in Southern Hungary, who worked under the code name “Siva,” and his case officer was built on an appealing doctor–patient relationship and an underlying existential vulnerability. “Siva” started working for the network in 1953, and by 1962, when his assignment was changed, he was already an experienced informant. From 1962 onwards, he was ordered to observe and report on the activities of W., one of his close acquaintances, who also happened to be his patient. The dossier reveals that W. turned to “Siva” for advice on numerous occasions and even recounted some aspects of his clerical activity that could have been seen by the authorities as seditious.29 This confidentiality in itself could have been exploited by the secret police, but the doctor–patient relationship, which was formed after they had already grown close owing to their common interest in music, added another layer to it. This new aspect made their relationship, which had been casual, in certain respects hierarchical and formal.30 The case officer, realizing this change in power relations, decided that from then on, observation should occur in a new, medical context: “The pretext of the invitation should be a follow-up examination after a previous illness. […] As his doctor, he should reassure him [W.] about his condition. He should point out that with occasional check-ups, he would recover completely. He should offer his services, help, and complete confidentiality. Thereafter, he could get to the point [investigating potential seditious activities].”31 Regular meetings necessitated by the condition of W.—[meetings] that allegedly served [W.’s] interests—secured the opportunity for further inquiries and for maintaining a confidential relationship. W. was thus observed in a delicate situation, in which the patient is both vulnerable and is expected to confide in his caretaker.32 Though vulnerability is not mentioned explicitly in the above passage, by instructing the informant to calm the patient, the case officer implicitly suggests that he expects the patient to be anxious in a situation in which the doctor’s diagnosis clearly would have consequences for his perception of his physical and mental wellbeing, short-term and long-term. And even though questioning about potential seditious activities followed the physical examination, the situation itself and the conscious reflection on the potential feelings it could induce all suggest that the doctor–patient relationship was viewed as more valuable from the point of view of observation than other, even closer relationships (close acquaintance, friendship), as it was founded on (physical) vulnerability.

“Siva’s” case officer considered the doctor–patient relationship useful because of its official, hierarchical nature and its confidentiality, which made it a rich source of information. The information obtained concerning the patients’ activities and social relations during examination and treatment, however, did not necessarily have to be used by the agents of the secret police: the protection of privacy and the prohibition of the use of information outside of the administrative context of healthcare were regulated, and under state socialism, all patients had the right to medical privacy.33 This regulation, which simultaneously served the doctors’ professional autonomy and the protection of patients, even if the extent of medical privacy was not generally agreed upon, encompassed all information (regardless of its nature) that came to light in medical contexts.34 Divergence from the principle of medical privacy because of loyalty to the system or fear of the state security forces will be discussed later. The question of whether the case officers reflected on the norm of medical privacy and its impact on the work of the secret police should be addressed here.

This phenomenon is discussed only once, in the case of a doctor who used the code name “Szentedrei,” though whatever qualms he may have had about protecting patient privacy, they do not seem to have hindered his activities as an agent. “Szentendrei” was a psychiatrist, and at the time in question, he worked as a primary physician at the Institute for Work Therapy in Pomáz. He had a rather wide social network. One of his close acquaintances was a man named György Krassó,35 who was a significant member of the opposition in the Kádár era. At Krassó’s request and with the case officer’s approval, “Szentendrei” examined Krassó’s French female friend. The woman “subjected herself to an almost one-and-a-half-hour medical examination,” the results of which were to be delivered to the French woman’s Hungarian friend, but “keeping medical privacy in mind.”36 In this case, medical privacy not only did not hinder the work of the secret police, but appears to have confirmed “Szentendrei’s” trustworthiness. “Szentendrei’s” willingness to ignore the patient’s right to privacy casts light on his work not only as a doctor, but also as an agent. He shared information with the state security forces that he did not necessarily share with someone who was close to the patient (Krassó).

In conclusion, medical activity and the doctors’ position within this context were associated in the eyes of the secret police’s agents with both social confidence and reliability, as well as exploitable vulnerability. Moreover, physicians, who conformed to the norms of modern medical practice had character traits that were perceived as desirable in their new “work environment” within the network of state security.

The Perception of Medical Knowledge within the Network

Medical diagnosis, social prognosis

So far, we have seen that doctors were considered ideal informants, but we have not touched on how the actual methods they used to diagnose and cure their patients were understood in this new context. How did the medical gaze construct its patient when the state security’s gaze was absorbed into it?37

An agent who worked under the code name “László Kaposvári” was a 45-year-old hospital physician in Sopron. In 1975, he shared the story of a young female neurology patient with his case officer. The composition of the report suggests formal and logical deliberateness. In the first part, relying on the information shared by the patient’s father, “Kaposvári” recounts the underlying reasons for hospitalization and the circumstances of the onset of her daughter’s illness: “According to the father, his daughter was hospitalized because she was recruited by two agents of the state security in Sopron. […] They even gave her money so that she could cover her expenses when she meets suspicious persons [who wish to flee the county].”38 The report then reflects on the need for hospitalization because of an “occupational disease.” Though the following sections of the anamnesis were mostly anonymized, the available details suggest that the condition of the patient was analyzed further.

If we interpret the report with the state security’s gaze in mind, the story of a de-conspired informant unfolds. However, if we consider that “Kaposvári” also used the specific methodology of medical knowledge production to construct the narrative, another possible interpretation is implied. Reliance on the father’s account could imply that the report was constructed similarly to a heteroanamnesis.39 In this, the patient’s condition is clearly interpreted as an “occupational disease.” This explanation is then mirrored in the doctor’s diagnosis. Therefore, the report highlighted the risks of the agents’ work to the individual’s health, even though the original aim of the report was to indicate possible threats to the state socialist system, for example, seditious behavior.40 This also meant that “Kaposvári” not only ignored the prescribed standards of report writing but also favored the individual’s interests as opposed to the society’s (or the regime’s). Bearing this in mind, it is rather striking that the case officer accepted his report without criticizing its form and content.

“Kaposvári” was not the only person who applied the same methodology used in medical diagnostics to interpret information reported to the secret police. A man who went by the name “Hegyi” also used this method on some occasions between the 1960s and 1970s. “Hegyi” was the primary physician41 of the Intapuszta Institute of Work Therapy, located close to the Austrian border. Owing to his position and wide social network,42 he was considered a potentially “useful” informant, and his recruitment was of great importance to the state security forces. His dossier contains two reports, the subjects of which had valuable relationships with people abroad. He characterized them as follows:

In my estimation, the onset of his lunacy was around ’54 or ’55, with the appearance of paranoid delusions. […] From a psychiatric point of view, his current condition could be evaluated as follows: he is in a balanced state, which means neither recovery nor health. Any unexpected event or trauma, in fact, any curious occurrence could induce remission. […] I do not think he could give any valuable information, as he has been hospitalized for approximately 15–16 years.43

 

He recounted that at work he had many conflicts because of his drinking, sometimes he showed up to work drunk. […] As we say, he suffers from chronic alcoholism. […] I would say that because of his obscure relations, he could be useful […] though not for obtaining information, rather for some other assignments, as he is an existentially unstable, unreliable person.44

 

The reports from which these rather expressive passages are quoted can be divided into three lengthy sections. In the first part, “Hegyi” discusses the individual’s past and his or her preceding medical conditions in detail. The wording and underlying logic of these narratives evoke the structure and content of anamneses: they detail the evolution of symptoms and the changes in the individuals’ behavior in a chronological order. The anamnesis in these cases, however, not only functions as a standard medical method of questioning, but is also fundamental to the “social prognosis” presented to the case officer. “Hegyi,” though he does not want to follow the logic of the state security forces in “reconstructing” his patients based what he was told, provides a thorough explanation for his medical observations in order to ensure that his case officer understands it properly. On the other hand, he characterizes the patients, who were potentially interesting for the secret police, in a narrative framework which was, owing to his professional, medical expertise, more “comfortable” for him than for the non-expert case officer. And although unusually an informant’s work was evaluated by his or her case officer, in these particular cases, no evaluations were made, which might suggest that this recurring method was accepted by “Hegyi’s” case officer.

It is rather difficult to determine, however, whether what these methods were part of a general tendency or were simply individual approaches to the composition of these specific narratives. Could medical knowledge play a part in procuring a more advantageous position in a situation when an informant was both an observer and someone under observation? Or did physicians who were also serving as informants simply use the routinized techniques of producing medical knowledge in another context? The doctors, logically, do not reflect on their choices of register in their reports, so a deeper analysis of the problem would require situations in which a possible change or break is detectable which then leads to the conscious use of medical knowledge tailored to new circumstances. I have only found one such case, that of “Orvos.”45

“Orvos” was a radiologist in Budapest and also an emblematic figure of the neo-avantgarde underground musical scene of the capital from the end of the 1950s. In 1960, he wrote a report on the potential spying activities of a clerical figure and employee of Orion, which was a state-owned company manufacturing telecommunications equipment. “Orvos” and the worker were introduced to each other by a friend on account of their common interest in speakers. In his report, “Orvos” described the worker as a well-prepared person in telecommunication. Born in Transylvania, he had a widespread network of friends and acquaintances abroad, and he traveled frequently to repair and sell radios. And even though his activities were suspicious in and of themselves, “Orvos” also added that his new acquaintance had several names, and his ID, which contained false information, was not valid. This report had significant relevance for the authorities, but the structure of the report was so chaotic that “Orvos,” though he had already been working as an agent for nine years, was asked to revise it. Thereafter, “Orvos” made some changes to the report and amended it with a medical evaluation missing from the previous version: “Medical opinion. […] I consider unverifiable and exclude personality change due to trauma or family and genetic inheritance. Though his interests are not monomaniac, his judgements are partly compulsive. Based on this, I consider his stories credible and true.”46 This addition suggests that after his earlier unsuccessful attempt, “Orvos” intended to use his medical knowledge to underline his opinion, assuming that medical knowledge is a socially accepted area of expertise of which he was in possession. His report suggests that the observed spy was, in fact, of sound mind and that his activities could indeed undermine the system. In this light, the value of “Orvos’s” activity as an informant was significantly more valuable. The report was eventually accepted by the case officer and assessed as operationally valuable. Although “Orvos” was a radiologist and his medical description was based on psychiatric knowledge, his report could be considered acceptable and interpretable for two main reasons. First, as I mentioned at the beginning of my article, reflecting on mental problems and the nonconformist behavior of the target person or the informant was one of the recommended methods during state security observation. Second, the information given by “Orvos” may have been acceptable to the officer because, despite the officer’s operational training, the officer presumably saw “Orvos” as having a more profound knowledge of psychology than he, the case officer, had.

Until now, I have focused on procedures and methods which are not strongly linked to the different fields of medicine but are generally true for physicians who work in an institutional context. The last three examples, however, show the significance of psychiatric and neurological expertise, since psychiatric and neurological expertise serve as the technology with which the patients are “reconstructed” in this new narrative context, outside of the medical field. This might be linked to the development of psychiatry as a discipline. Though psychiatry, especially with the broadening of neurological knowledge, was given a strongly biomedical character in the period, diagnosing “madness” required different “tests” that were meant to determine the normalcy or abnormality of the individual’s behavior from the perspective of society at large. The social character of these tests does not mean, however, that they were not medically verifiable methods. They were created precisely to attest to the medical validity of the different technologies of mental normalization.47 From among the three doctors, only “Hegyi” had a confirmed background as a psychiatrist. Still, one does not necessarily have to be a specialist in psychiatry to give an account of the social and political implications of a patients’ psychological functions, as physicians had all been required to appropriate the basics of psychiatry and neurology during their studies. Psychiatric knowledge, however, was one of the rare forms of medical expertise which was seen as enabling a physician to interpret patients’ attitudes towards the norms of socialist society. This knowledge also made these reports valuable for the authorities, but at the same time, it did not expose the patients or the doctors to the discursive and hierarchic logic characteristic of the state security.

 

Differences in knowledge, social prestige, and hierarchy

As we have seen, the doctors examined so far did not use the expected discursive and logical patterns, but rather recreated the techniques of medical knowledge production in a new context. This seems to have been an accepted, even recurring method, as in most cases, the doctors were not ordered to revise and resubmit their reports, and sometimes the information obtained this way had considerable operational value. But what could explain the approval of these methods? It seems plausible that regardless of the applied discursive techniques, the reports were comprehensible for the case officers. In case of “Hegyi” and “Kaposvári,” this interpretation could suffice. However, “Orvos’s” case does not seem to fit into this logic: he first provided the information, which had considerable operational value, and then he amended his report with a medical explanation, and this explanation led to the acceptance of his report. Furthermore, the content-centric explanation is weakened if we consider that expecting the informants to conform to the discursive logic prescribed by the state security also had a disciplinary aspect: the practice of ordering the informants to revise their reports was important in sustaining a hierarchical relationship. If the relationship between the case officer and the informant is understood more flexibly, taking other factors, for example, social prestige into consideration, we can find further explanations as to why medical knowledge was accepted by the officers as a methodology with which to interpret operationally valuable information.

One possible explanation is the high social prestige of doctors and medical knowledge. Doctors in state socialist societies, owing to their expertise in maintaining and restoring the health of workers, who were seen as the pillars of society, were of fundamental importance, and their positions were linked in both medical and sociological discourses to considerable social prestige.48 The first prestige analyses were carried out, however, only in the 1980s, in 1983 and 1988. The analyses underpinned the high social prestige of doctors: from among the 156 occupations under study, hospital physicians were ranked first and general practitioners fourth.49 As for the amount of expertise required to hold a certain position, hospital physicians were ranked first and general practitioners second, above all other occupations. Therefore, based on a representative sample, medical knowledge was considered the most valuable knowledge.50

A second explanation is grounded on the quality and unapproachability of medical knowledge. Due to the gradual professionalization and specialization of the different fields of medicine and the proliferation of technologies, the production of medical knowledge became more specific and impenetrable for non-experts.51 Thus, the agent-doctors based their work within the network of state security on a form of knowledge and its methods of evaluation that were largely incomprehensible for outsiders. And even though public health policy strove to incorporate some elements of the “socialist self-consciousness” into the discourse and urged the members of society (the patients) to turn to medical ethics committees,52 the task and prerogative of evaluating the complaints and possibly issuing sanctions were still in the hands of medical experts, not laymen. If we accept this explanation, it is likely that even the possibility of criticizing medical knowledge was dismissed by laymen, who, in this case, were the officers of the state security forces.

Opposition in the Wards

The adaptability of medical knowledge and the doctors’ positions, which rested on the solid foundation of the social value of their knowledge, presented something of a conundrum from the perspective of the state security forces. While their position in society was advantageous, as they could operate easily as observers in a wide social network, their expert knowledge made them unreliable, as they could manipulate the obtained information and mask potential seditious activities effortlessly. Consequently, the specific features of diagnostic and therapeutic practice and their social perceptions could enable doctors to elude the interpretive (and at the same time, disciplinary) methods dictated by the logic of the state security forces. What complicates this scheme is that applying the techniques of medical knowledge production in this new context implied the violation of professional norms and disregard for medical privacy. These explanations, however, are still insufficient to give a reassuring answer to my original research questions, because the above conclusions focus exclusively on the possibilities of obtaining information in a medical context. So far, I have not explored the phenomena strongly linked to medical activities that made the presence of doctors as the agents of state security services indispensable. Or to medicalize my inquiry: where did the blind spot of the secret police lie, a blind spot to which only doctors had access?

The secret police, as one of the fundamental networks of surveillance in the Kádár era, strove to uncover the secrets of individuals or certain groups and their attitudes towards social norms and to interpret the implications of their potentially threatening activities. Consequently, the secret police tried to infiltrate alternative spaces in society, for example, meetings among people belonging to intellectual circles or private art events that were for some reason hidden from the public eye.53 As for hospitals, the secret police was supposed to have easy access to any information, considering the public funding and extensive administrative practices of these institutions. Yet this was not always the case. Fortunately, some of the dossiers reveal exactly how permeable the walls of hospitals were and who had access to information produced within these spaces.

“Viola” worked as a physician at the First Department of Neurology of the hospital on Róbert Károly Boulevard. She was recruited because, in the hospital and especially at the neurology clinic, more people who had actively participated in the events of the 1956 Revolution were hidden. By the time “Viola” was recruited, the agents of the state security forces, who played a leading role in identifying and tracking “counterrevolutionaries” until 1963 (when a general amnesty was proclaimed), had already identified three such individuals. This could be seen as a success. However, by this time, already more than a year had passed since the revolution. Also, this particular institution played a particularly prominent role in serving the medical needs of the state socialist elite, especially the Hungarian army and the Soviet troops stationed in the country. These two facts may have cast a shadow on the efficiency of the agents’ work in identifying the potential enemies of the system. Therefore, a doctor was needed to provide an inner perspective and assist the police forces in their efforts to detect those hiding from retribution. That their reasoning in the assignment plan was sound was proven by “Viola” during their first meeting: she immediately named an individual who had successfully eluded the gaze of state security. The further analysis of the assignment plan also reveals that hospitals could serve as “asylums” for those who wanted to escape retribution.54 And as this example testifies, they sometimes hid in plain sight, but owing to the (partial) impermeability of the hospital’s walls, doctors were indispensable in assisting the agents of the state security in exposing potential enemies.

The recruitment of “Viola” in 1958 could be explained either as a consequence of the relative closeness of the revolution in time or the efforts of the authorities to expose the enemies of the system. However, even when these circumstances did not hold, hospitals remained places of interest for the agents of the secret police, as the cases of “Kaposvári” and “Marossi Pál,” a physician at the Second Department of Internal Medicine of the Medical University of Pécs, show.

“Marossi” was first asked to report on a patient in 1960. The patient, K. L., who had been at the clinic for months, was a religious person and had numerous visitors. Though “he was not visited by the priests of the Church of the Order of Mercy, he often called priests for fellow patients and strove to persuade others to follow his example. The directors of the clinic, however, prohibited him from continuing with such activities.”55 K. L.’s religiosity is emphasized throughout the report, and this explains why he was under surveillance. However, “Marossi” tried to divert the attention of the case officer from K. L.’s religiosity by making it seem as if it remained merely a private matter and did not influence the other patients.

Like “Marossi,” “Kaposvári” also gave an account of his patients’ behavior in the wards. He reported that “Mrs. H. A., a teacher from Sopron, listens to Radio Free Europe daily, though she does not share what she has heard with the others.” Upon evaluation, “Kaposvári” added the following: “Mrs. H. A. listens to Radio Free Europe again. However, her roommate is hard of hearing, and thus she does not know which frequency her roommate listens to.”56 According to a 1953 court decision, listening to RFE was not prohibited as long as it was not done in public. “Kaposvári,” who presumably was familiar with the court decision, by referring to the hearing loss of Mrs. H. A.’s roommate, tailored his report to the norms and expectations of socialism, and he used a medical explanation to minimize the possibility of any drastic measures being taken by the police. Although the informants never knew what the State Security Service would do with the information obtained through them and or what consequences their contributions to the system would have for the individuals “denounced,” according to the report issued by “Kaposvári,” the patient had not violated any rules, so the report qualified as operationally valuable, and the agents of the state security remained alert.

The cases of “Kaposvári” and “Marossi” reveal that the individuals under surveillance were already known by the secret police, and their stay in the hospital was seen as a period that could be instrumental in uncovering their potential seditious activities. It was therefore particularly important, from the perspective of the authorities, to keep them under observation on account of their potentially threatening activities and the ideological influence they could exert on other patients. As both cases illustrate, the social space of hospitals was seen as a milieu in which listening to the RFE or engaging in religious activities that were tolerated if done in private could become subversive because of the impact they could have on other individuals. This is something that authorities could not turn a blind eye to. Furthermore, reports on the visitors who came to see these patients could shed light on the patients’ social networks, which in turn could assist the authorities in tracking other potentially dangerous individuals.

Observing the behavior of patients was only one possible reason for the active presence of the secret police in medical institutions. As the cases of “Lénárd Pál” and “Angyalföldi” illustrate, other, more complex problems of socialist healthcare could come to the surface, which, in addition, could shed light on the common violation of norms by either doctors or their patients.57 While “Angyalföldi” reported on the practice of prioritizing Yugoslavian patients, who paid in foreign currency for medical services, to the detriment of insured Hungarian patients, “Lénárd Pál,” a neurologist at the Székesfehérvár hospital, wanted to declare a patient who had already suffered of ill health an invalid. However, in doing so, encouraged by his case officer, “Lénárd” did not follow the usual, official route, but rather bribed other physicians, a seemingly common method for declaring healthy individuals invalids. Though the two situations differ, the aim in both cases was to uncover activities that had already been known broadly, but the authorities were in need of more information (names, venues, dates) to move forward. These were significant details that non-medical personae would not have been able to unearth. The above situations also demonstrate that hospitals, even though they were intended, in principle, to serve the wellbeing of society, could function as institutions in which the evasion of norms was rather frequent.

The last five cases prove that hospitals and wards enabled subversion and could serve as hiding places for enemies of the state and at the same time could effectively conceal these activities. The impermeability of the hospital’s walls is due to its function as a total institution. As Erving Goffman points out, hospitals and similar institutions, such as prisons, monasteries, and schools, have a special, socializing function either to habituate individuals to follow norms or to correct their behavior. If these institutions are going to perform this function successfully, any passage between the inner world of the institutions and the “real” world outside must be severely restricted. The physical and mental separation of the two spaces could mean reformulating the rules and norms of the outside world, all the while creating a new order within the walls of the institutions.58 The agent-doctors, therefore, could offer a glimpse into a segment of social space that would have been impenetrable without their cooperation. At the same time, this impermeability meant that they had some autonomy in selecting the information to be shared or concealed.59

Conclusion

In this study, I have offered several concrete cases illustrating ways in which doctors maneuvered within the network of the state security forces, one of the most significant institutions of state socialist societies responsible for the surveillance and control of individuals. A physician’s adherence to professional norms, expertise, and institutional position made him or her a potentially valuable asset in the eyes of the authorities. It was not as simple to exploit this potential, however, as it may have seemed initially. Though on many occasions, the doctors’ performance as agents was assessed positively by their case officers, the doctors often failed to follow the prescribed norms of construing the enemy. The gray zone between the standard practices of the state security forces and medical activities denotes social spaces which the authorities would have been unable to permeate without the assistance of medical practitioners. At the same time, this points at a specific quality of medical knowledge that made these spaces inaccessible for outsiders, thus facilitating social resistance, at least to some extent.

I have also attempted to underline that, following Foucault’s argument, the affiliation between doctors and their case officers exerted an influence through relationships and institutions. In the framework of the strongly hierarchical operations of the state security forces, the social position of physicians also came into prominence, and in this context, this social position gave physicians a certain amount of autonomy. In the future, this aspect should be explored in further detail, using a wider array of sources which could shed light on the extent to which the publicly funded healthcare system and its publicly financed employees could realize their autonomy from the state in other respects, such as medical education and primary care.

 

Appendix

Table 1.

Name	Specialty	Place of operation	Year of birth	Role in the network
“Viola”	Psychiatrist	Budapest	1925	Agent
“Tarkői”	GP/surgeon	Eger	1925	Informant
“Marossi Pál”	Internist	Pécs	1921	Agent
Orvos”	Radiologist	Budapest	1931	Agent
“Siva”	GP/ophthalmologist	Kalocsa	1924	Agent (until 1958) Thereafter: informant
“Szentendrei”	Psychiatrist	Pomáz	1931	Informant
“Hegyi”	Psychiatrist	Intapuszta	1922	Informant
“Kaposvári László”	Pulmonologist	Sopron	1930	Secret emissary
“Angyalföldi”	Internist	Békéscsaba	1950	Secret emissary
“Lénárd Pál”	Neurologist	Székesfehérvár	1945	Secret emissary

 

Archival Sources

Állambiztonsági Szolgálatok Történeti Levéltára [Historical Archives of the Hungarian State Security] (ÁBTL)

2.8.1. BM Vas Megyei RFK személyi gyűjtők [Ministry of the Interior, Vas County Police Headquarters, Personal dossiers]

3.1.1. B-84186 “Viola”

3.1.1. B-92993 “Tarkői”

3.1.2 M-17361 “Marossi Pál”

3.1.2. M-17764/1 “Orvos”

3.1.2. M-18864/1 “Siva”

3.1.2. M-31222 “Szentendrei”

3.1.2. M-33556 “Hegyi”

3.1.2. M-37256 “Kaposvári László”

3.1.2. M-39489 “Angyalföldi”

3.1.2. M-39640 “Lénárd Pál”

4.1 A-3120. Ivanin, G. I. Az operatív pszichológia néhány kérdése [Some questions of operative psychology]. Moscow, 1973.

4.1. A-3121. Láng György. Operatív pszichológia III. A hírszerzés hálózata vezetésének és nevelésének szociálpszichológiai kérdései [Operative psychology III. Some questions of social psychology on leading and training the members of intelligence services].

4.1 A-4510. Horváth István. A pszichológia és szociálpszichológia felhasználása hálózati munkában [Using psychology and social psychology in the work of intelligence services]. Thesis.

Decree No. 8. Medical Regulation, 1959.

11/1972. (30. VI.), Regulation of medical workers, issued by the Ministry of Health.

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