455579

2013

HPY24210.1177/0957154X12455579History of PsychiatryHashimoto

Article

A ‘German world’ shared among doctors: a history of the relationship between Japanese and German psychiatry before World War II

History of Psychiatry 24(2) 180­–195 © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0957154X12455579 hpy.sagepub.com

Akira Hashimoto

Aichi Prefectural University, Japan

Abstract This article deals with the critical history of German and Japanese psychiatrists who dreamed of a ‘German world’ that would cross borders. It analyses their discourse, not only by looking at their biographical backgrounds, but also by examining them in a wider context linked to German academic predominance and cultural propaganda before World War II. By focusing on Wilhelm Stieda, Wilhelm Weygandt and Kure Shuzo, the article shows that the positive evaluation of Japanese psychiatry by the two Germans encouraged Kure, who was eager to modernize the treatment of and institutions for the mentally ill in Japan. Their statements on Japanese psychiatry reflect their ideological and historical framework, with reference to national/ethnic identity, academic position, and the relationship between Germany and Japan.

Keywords History, Japanese-German relations, nationalism, psychiatry, 20th century

Introduction In 2011 Japan and Germany celebrated 150 years of their official relations.To mark the occasion, Sven (2009) reviewed historical studies of interactions between the two nations. He shows that the history of Japanese-German relations has been favourably depicted from the viewpoint of similarity or approximation in terms of modernization. On the one hand, both Japan and Germany were latecomers in modernizing and forming their respective nation-states; on the other, after the Cold War, Japan and (West) Germany experienced a parallel history in the sense that both were occupied and forced to reform by the Allied Powers, and then both accomplished high-speed economic growth. Since the 1980s the study of Japanese-German relations has become increasingly diversified, encompassing not only the conventional themes of politics and diplomacy but also cultural and technological exchanges and economic relations. As a compilation of earlier studies and for its Corresponding author: Akira Hashimoto, Aichi Prefectural University, 1522-3 Ibaragabasama, Nagakute-shi, Aichi, 480-1198 Japan. Email: [email protected]

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critical and interdisciplinary character, the three-volume work A History of Japanese-German Relations, 1890–1945 (Kudo and Tajima, 2008) was highly valued in academic circles both in Japan and abroad. In addition, these volumes are sceptical of treating this subject merely as a history of friendship between Japan and Germany and a history of learning about the latter by the former; rather, they are interested in the multi-layered relations that describe a history of conflict and opposition. Sven (2009) also points out, however, that the main interests of the volumes are restricted to ‘hard power’, in other words, diplomacy, economics and military affairs. On the contrary, as far as the history of medicine between modern Japan and Germany is concerned, it seems that authors tend to describe it as a simple history of the one-way transfer of knowledge from Germany to Japan and a beautiful narrative of the teacher-pupil relationship, or of the rigorous but sometimes generous German professors and the diligent Japanese students who would later become university professors and academic leaders in Japan (Kraas and Hiki, 1992). But, as stated above, relations between two nations are not simple but are multi-layered processes. Moreover, as recent studies have shown, when we introduce comparative and transnational viewpoints to the modern history of medicine, and to psychiatry in particular (Ernst and Mueller, 2010), we will be able to obtain more critical results for Japanese-German relations. In general the history of psychiatry, whether or not it describes national, international or transnational interests, may be discussed only in the context of medicine or psychology. This article, however, will not deal with a simple history of German influences over Japanese psychiatry, but rather with a critical history of German and Japanese psychiatrists who dreamed of sharing and improving a ‘German world’ across the borders. For this purpose, I will analyse the discourse of psychiatrists, not only by going into their biographical and academic backgrounds, but also by examining them in a wider context deeply linked to the German academic predominance and cultural propaganda from the late nineteenth century to the beginning of the twentieth century.

Japan, Germany and medicine From the mid-nineteenth century to the mid-twentieth century, Germany seems to have been a model for Japan in many respects. The Japanese respected Germany and were eager to learn about its education, science and social system. In particular, the image of modern Japanese medicine and medical doctors was always associated with the German language, German culture and Germany itself. Primarily, this derived from the medical policies of modern Japan. Following the Meiji Restoration in 1868, teachers from German-speaking countries played a crucial role in the process of the modernization or Germanization of medicine in Japan. In 1869 the Igakko (National Medical School) in Tokyo, later to develop into the faculty of medicine at the University of Tokyo in 1877 (the only university in Japan until 1897 when the second one was established in Kyoto), had already decided that German medicine should play a prominent role. This decision seems to have influenced the employment of teachers from German-speaking countries and resulted in the strong position of German medicine in Japan. When the faculty of medicine was founded at the University of Tokyo, most of the subjects were taught by German teachers. But as Japanese graduates went to study in Europe, returned to Japan and became professors, the domination of German teachers in the faculty gradually declined. By the beginning of the 1890s Japanese professors taught almost all subjects. Internist Erwin von Baelz (1849–1913) and surgeon Julius Karl Scriba (1848–1905) were the last two German teachers at the faculty, and they both taught there for over 20 years: the former retired in 1902, the latter in 1901. However, the German influence still remained (Tokyo daigaku igakubu, 1967).

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The structure of Germanization can also be applied to psychiatry as a discipline of medicine, and this will be the focus of the rest of this article. Baelz is known to have been one of the first people to teach psychiatry in Japan. He came from Germany to Japan in 1876 and taught internal medicine (including psychiatry). One of his pupils, Sakaki Hajime (1857–97), studied psychiatry from 1882 to 1886 in Berlin at Japanese government expense. After his return to Japan, Sakaki was appointed the first Professor of Psychiatry at the University of Tokyo in 1886 when the department of psychiatry was established in the faculty of medicine. However, Sakaki died young, aged 39. Sakaki’s pupil Kure Shuzo (1865–1932) was then sent to Europe to study psychiatry and neurology at government expense, as a candidate for professor of psychiatry. First, for the study of brain histology Kure visited the laboratory for the central nervous system directed by Heinrich Obersteiner (1847–1922) of the University of Vienna, and a number of Japanese psychiatrists studied here afterwards. Kure then carried out biological-experimental studies in Germany, but in order to develop clinical psychiatry in Japan, it was essential for Kure to learn the theories of Emil Kraepelin (1856–1926) in Heidelberg. Kraepelin, the founder of modern psychiatric nosology, recast the way psychiatrists thought about major diagnoses, elevating such entities as depression and psychosis into diseases (Shorter, 2005). Kraepelin’s classification was based on scientific-objective case observations of symptoms and courses of mental illness. Even today his summary based on countless arduous and careful observations of the mentally ill is referred to as a landmark (Dörner and Plog, 1996). His description of mental illness was sharply opposed to the theory of psychoanalysis of Sigmund Freud (1856–1939), which underlines the psychological mechanism and causes of mental illness. When Kure returned to Japan, became a professor and taught psychiatry based on Kraepelin’s theory at the University of Tokyo, the domination of the Kraepelinian School in Japanese psychiatry was assured. He was called the ‘Begründer’ of psychiatry in Japan (Okada, 2000), and many of his pupils became psychiatry professors at universities and medical schools set up all over Japan following the establishment of the University of Tokyo (Okada, 2002). As a result, by the beginning of the twentieth century the Germanization of psychiatry in medical institutions in Japan was almost complete. Now we turn to the German viewpoint. It may be true that Germany, as a putative centre, had little interest in Japan at the Far Eastern periphery, except for anyone interested in Orientalism, and in fact only a limited number of doctors from German-speaking countries wrote about Japanese medicine or psychiatry. In the late nineteenth century, when the Germanization of medicine had just begun, Japan did not seem to impress visitors. For example, a doctor named Von den Steinen read a paper at the Berliner Gesellschaft für Psychiatrie und Nervenkrankheiten in 1882 on psychiatric institutions he had visited on his 18-month travels around Australia and Asia including Japan, and said that in Japan there was almost nothing interesting in regard to psychiatry (Von den Steinen, 1882). In contrast, Baelz had a great interest in Japan, and while he was teaching psychiatry in Tokyo, he was also a pioneer of anthropological and ethnical studies of the country. The form of madness known in the Japanese vernacular as kitsune tsuki, or fox possession, was diagnosed by Baelz in 1879 as ‘Daemono-Melancholie’ according to the classification of the German psychiatrist Wilhelm Griesinger (1817–68) (Okada, 1983). In the sense described in Edward Said’s Orientalism (1979), Baelz was a genuine Orientalist who was eager to represent Japan in a European manner. In the twentieth century, however, the modernization of medicine in Japan became ‘independent’ of immediate instruction from the Germans (Tokyo daigaku igakubu, 1967). In his diary of April 1900, Baelz expressed his uncomfortable feeling that Japanese colleagues at the university were more and more inclined to ignore his advice, complaining that he had heard nothing about an almost-completed plan for a new hospital built in the grounds of the university. Further, in 1901 at

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a ceremony celebrating the 25th anniversary of his teaching in Tokyo, he made a critical speech on the academic attitude of the Japanese: ‘All the Western countries sent you teachers, who with enthusiasm wanted to introduce this [Western] spirit and dedicate it to the Japanese people. Many times, however, their task was misunderstood. Teachers were treated as the “fruit sellers” of science, whereas they would like to have been and should have been the “gardeners of science”’ (Baelz, 1937).1 The next year Baelz, the last German teacher at the University of Tokyo, returned to Germany. After that, a number of Japanese continued to make their ‘pilgrimage’ to Germany, while only a few German doctors visited Japan, but some of them were crucial for the transnational history of medicine between the two countries. We will first focus on two psychiatrists from German-speaking areas: Wilhelm Stieda (1875–1920) from Riga on the coast of the Baltic Sea, and Wilhelm Weygandt (1870–1939) from Hamburg. Their names and short biographies have been mentioned in some articles on the history of modern psychiatry, but none deals in detail with their interests in Japanese medicine and culture. Their attitude to Japan was clearly different from that of Orientalists such as Baelz in the nineteenth century; they even expressed a feeling of longing for Japanese psychiatry, which had been modelled on German psychiatry. Their feelings might have been partly based on ignorance and misunderstanding, but this article attempts to analyse their discourse from the viewpoint that they wanted to strengthen their academic perspective and nationalistic/ethnic identity by ‘sharing a German world’ with Japanese psychiatrist Kure Shuzo, an academic descendant of German teachers in Japan and of professors of medical institutions in Germany and Austria. The final section of this article will describe Kure in the context of ‘sharing a German world’ with the Germans and his Japanese colleagues and pupils.

Wilhelm Stieda and the Russo-Japanese War Stieda was born to a Baltic-German family in 1875 in St Petersburg. After his gymnasium years in Riga, Stieda studied medicine at the Military Medical Academy in St Petersburg from 1894 to 1899. In 1903 he went to study psychiatry at the University of Heidelberg, where Emil Kraepelin was the Professor of Psychiatry and which was considered to be the centre of psychiatry worldwide. It was natural for Stieda to study in Germany due to his ethnic background. From May 1904 he began to work at Günthershof Asylum (Irren-Heil- und Pflegeanstalt der Kurländischen Ritterschaft Günthershof) in Mitau (now Jelgawa, a suburb of Riga in Latvia), the former capital city of the Duchy of Kurland (Brennsohn, 1929). Since an invasion by the Germans in the twelfth century, Kurland had long been dominated by the Baltic-German ruling class; and although from the end of the eighteenth century Kurland, as a local government, was absorbed into the Russian Empire, the German domination of the land continued (Shima, 2008). The first director of Günthershof Asylum, founded in 1901, was Herman Hildebrand (1871–1928) who was also from a Baltic-German family. He studied from 1889 to 1895 at the University of Dorpat (now Tartu in Estonia). This university, where the language of instruction was German until the end of the nineteenth century, was called the ‘Heidelberg of the North’ and produced many prominent scholars (Shima, 2004). Kraepelin was Professor of Psychiatry at Dorpat from 1886 to 1891, and Hildebrand was an assistant to Kraepelin’s successor, Vladimir Ph. von Tschisch, from 1895 to 1897 (Brennsohn, 1929). When Stieda was appointed to Günthershof Asylum on 1 May 1904, he was the second doctor there. But shortly afterwards Vladimir Bekhterev (1857–1927), his former teacher in St Petersburg, sent Stieda on a mission as a Russian medical officer to investigate and treat war psychosis (Kriegspsychose) on the battlefields of the Russo-Japanese War, which had broken out in February

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1904 (Stieda, 1909a). As in Japan, Russian psychiatry was heavily influenced by the Germanic schools. From before the turn of the century until the Russian Revolution of 1917, most of the top psychiatric practitioners and the teaching establishment in Russia were ethnic Germans. Bekhterev, who was a Russian by origin and the most prominent psychiatrist in modern Russian psychiatry, was educated by German professors (Gabriel, 1986). After studying in 1884–5 in Germany and France, he was appointed Professor of Psychiatry at Kazan University in European Russia and then in 1893 became a professor at the Military Medical Academy in St Petersburg (Fischer, 1932). Russian psychiatry at the time was strongly oriented towards the search for the biological causes and mechanisms of mental diseases, whereas psychology was viewed as a second-rate discipline because it was not based on the physiological operations of the brain. In this context the idea of war psychosis, which emphasized psychological causes or stress on the battlefield, was incompatible with the biological tradition of Russian psychiatry. But in the Russo-Japanese War it seems that, confronted by so many soldiers complaining of psychiatric symptoms, the Russian Army surgeons could not avoid diagnosing and treating about 2000 casualties with psychiatric breakdown that they directly attributed to the stress of battle. Before this war, as with the British in the Boer War and the Americans in the Civil War, soldiers’ behavioural problems were attributed to factors other than the sheer stress of combat, for example, nostalgia, homesickness, nutritional deficiencies or physical diseases. So it is said that the Russo-Japanese War was the first in which soldiers were specifically diagnosed with mental diseases as a consequence of the stress of modern warfare (Gabriel, 1986). Stieda had probably already left Europe via Siberia for the Far East by the end of May 1904. First he worked at a military hospital for the Russian Army in Harbin, Manchuria, which had a psychiatric ward from April to December 1904. Because the number of psychiatric patients increased and the army medical department did not have the surgeons and means to care for them properly, the Red Cross Society established a new 50-bed hospital for mental diseases in Harbin, where Stieda worked from December 1904 when it opened. However, as this psychiatric hospital was small, cases were sent back to Russia as rapidly as possible. The journey to Moscow took a month by train, and transporting patients was very difficult. According to the doctors accompanying them, towards the end of the journey the patients were always irritable, they were less able to adapt to the conditions on the train, and their hallucinations became more acute. At Irkutsk, the city near Lake Baikal in Siberia, all the patients were transferred to new trains for the last stage of the journey to Moscow (Richards, 1910). Stieda (1909a) reported that he was involved in transporting the patients and often brought them from Harbin to Irkutsk. A total of 1347 mentally ill soldiers were admitted to the Red Cross mental hospital in Harbin between December 1904 and its closure in March 1906 (Awtokratow, 1907). Stieda probably came to Japan in January 1906 following the end of the Russo-Japanese War in September 1905. He may have been involved in helping Russian soldiers still in prison camps in Japan to return home. Although he was a medical officer of the former ‘enemy country’, Stieda was welcomed by Japanese psychiatrists. He met Kure Shuzo at the University of Tokyo. It was their first meeting, but they may have already known each other’s names. According to their biographies and the enrolment records of the university,2 both Hermann Hildebrand, Stieda’s boss at the asylum in Mitau, and Kure studied psychiatry around 1899 at Kraepelin’s laboratory in Heidelberg. Kure returned to Japan in 1901, two years before Stieda arrived in Heidelberg but it is very probable that, while at Mitau, Stieda heard about Kure from Hildebrand. As Kure and Stieda had both studied psychiatry in Germany and were influenced by Kraepelinian psychiatry, they must have felt close. It seems that Kure wanted to exchange views with Stieda on war psychosis, for Kure was also involved in diagnosing the mental illnesses of Japanese soldiers who served in the Russo-Japanese War (Rikugun sho, 1913).

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Kure and other psychiatrists arranged for Stieda to inspect some psychiatric institutions in Tokyo and Kyoto. After his return to Mitau in March 1906, Stieda published an account in a German medical journal with favourable comments on Japanese psychiatry. For example, he was impressed by the atmosphere in an asylum in Kyoto, saying that, ‘The major impression I had from the asylum was the silence and cleanliness’, and by the outpatient care in Iwakura Village near Kyoto, where many mental patients stayed in small, Japanese-style inns in a free, relaxed atmosphere (Stieda, 1906a). The fact that he called Iwakura ‘a Japanese Gheel’ encouraged the nationalistic ideas of Japanese psychiatrists who were trying to catch up with European standards; Gheel, a small village in a suburb of Antwerp in Belgium, was known for its foster family care of mental patients which at the time was highly valued by psychiatrists worldwide (Hashimoto, 2010). But Stieda was convinced that there was much more still to do in Japanese psychiatry: ‘The higher the form of culture that life in Japan can achieve, the more the care for the mentally ill will improve.’ He claimed that, as a modern state, modern treatment in asylums must be developed instead of religious and traditional care, which he thought still remained in Japan. On the other hand, in the last part of his article Stieda (1906a) concluded that the task of doctors was to develop care for the mentally ill suited to local conditions and the national character (Volkscharakter) of Japan. He appreciated that Kure was not only an asylum reformer using the European model but that he also recognized the value of Japanese tradition. In contrast, his attitude to Russia and the Russians, the rulers of Kurland (and the Baltic countries), was very critical. Incidentally, Schaikewicz (1906), the former director of the Military Hospital in Moscow, asserted in his article on mental illness in the Russian Army during the RussoJapanese War that psychiatric diseases peculiar to military service should be separated from wellknown clinical syndromes. According to his observation, although the clinical picture was very similar to that of the first stage of melancholy, dementia praecox (schizophrenia) or catatonia, it should be diagnosed rather as ‘Amentia depressivo-stuporosa,’ for which military service is the undeniable aetiological factor (Schaikewicz, 1906). Stieda, however, had a different opinion and in two articles he clearly opposed Schaikewicz. He wrote: I think that it [Amentia depressivo-stuporosa] can be sorted into already-known syndromes, above all into that of dementia praecox and partly into that of manic-depressive insanity. […] In general the psychiatrists on the battlefield expected to find a unique war psychosis. Even the director of a Russian public asylum, a well-known psychiatrist in Russia, moved to the battlefield for that […]. But from none of my colleagues there did I hear about genuine war psychosis as a special form of psychosis. (Stieda, 1906b)

Further, Stieda argued that only in Moscow, far away from the battlefield in the Far East, did military psychiatrists believe they had seen special forms of mental illness, which were supposed to have been found only among soldiers and to be caused by various mental influences during military service; however, the psychiatrists had started with entirely the wrong premises, as amateurs in the field of mental illness might (Stieda, 1909a). On the one hand, it could be said that Stieda, as a follower of the Kraepelinian School,3 opposed a psychological notion of war psychosis from a biological viewpoint. Stieda’s academic position is clear when we read his criticism of psychoanalyst Sigmund Freud – who in a sense was an antagonist of Kraepelin – that clinical science should not be led by artificially constructed possibilities but rather by reality (Stieda, 1909a). On the other hand, inspired by his Baltic-German identity, Stieda may have had an antipathy to the domination of the Russian Empire and psychiatrists in Moscow as symbols of Russia.

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Stieda, after returning to the asylum in Mitau in 1906, worked there until 1909, then moved to Riga where he worked as a private practitioner and a hospital doctor. In 1914–18 he was again called to military service. In 1918 he came back to Riga, but in 1920 he died of typhus at the age of 45 (Brennsohn, 1929). The details of his activities after 1909 are unknown.

Wilhelm Weygandt and Kulturpropaganda The second German with a strong influence on early Japanese psychiatry was Wilhelm Weygandt, born in 1870 in Wiesbaden. He first read German studies (Germanistik), philosophy and theology in Strasbourg and Leipzig, and then began to study medicine in 1892 at the University of Leipzig. After he obtained his PhD under the experimental psychologist Wilhelm Wundt (1832–1920) in 1893, he continued to study medicine in Freiburg, Berlin and Heidelberg and obtained his MD from the University of Würzburg. In 1897–9 Weygandt worked as an assistant in Kraepelin’s laboratory in Heidelberg (Kreuter, 1996). During this period Kure, who was also studying under Kraepelin, met Weygandt (Okada, 1982). In 1908 Weygandt was appointed the director of Friedrichsberg Asylum (Staatskrankenanstalt Friedrichsberg) in Hamburg, and in 1919 he became Professor of Psychiatry at the University of Hamburg, which had just been established (Kreuter, 1996), so he held these two posts concurrently. Weygandt was an ardent conservative nationalist and liberal thinker, who later felt a deep sympathy with the Nazis. His nationalistic identity was especially evident during World War I. He emphasized the supposed highly intellectual and moral quality of the German nation, and characterized the peoples of the Romance languages (Latin Europe) as physically and mentally immature and the British as egoistic and unscrupulous (Weber-Jasper, 1996). His German identity was, however, completely deflated by the German defeat in World War I. He then tried to overcome his pessimism about German culture by thinking of the parallels between the care of mental patients and the level of culture. The notion of parallelism was probably an analogy that originated from ‘das Prinzip des psychophysischen Parallelismus’ asserted by his teacher Wundt in Leipzig, which premised that any psychic process should correspond to a physical one. Weygandt argued: Just as the use of soap has been referred to as a barometer for the state of a culture, we can also say that welfare for the helpless, especially the mentally defective, is such an index. […] and where specially developed care for mental patients exists, the whole culture can also be considered to be highly developed. (Weygandt, 1931a) While the care of mental patients in France, which improved in the middle of the nineteenth century, is at the moment poor, Germany made great progress in this field prior to the [First World] War. (Weygandt, 1933)

In his articles Weygandt often referred to the word Kultur and compound words such as Kulturentwicklung, Kulturland, Kulturniveau. This was not peculiar to him, but a phenomenon of the time, also seen in the writings of his contemporaries. It seems that Weygandt’s ideas and behaviour were influenced and encouraged by Deutsche Kulturpropaganda after the second decade of the twentieth century (Bresler, 1937). From the mid-nineteenth century to the mid-twentieth century, in the process of the formation of their state and nation, the Germans regarded the concept of culture as the highest value of humanity. This ideological concept emphasized the identity of individuals and groups, and the differences in national character, through which various academic disciplines – for example anthropology, cultural history and cultural sociology – were produced and

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developed, but which at the same time might lead to racism and racial discrimination. The concept of culture in Germany is clear when it is compared with the concept of civilization in France, which underlines universality and humanitarianism but possibly also provided an excuse for colonialism (Nishikawa, 2001). Weygandt presented his ideas of the superiority of Germany in his publications. Between 1897 and 1935 he also gave about 90 lectures on German psychiatry in more than 20 countries in Europe, North and South America, Asia and Africa. He lectured in German in countries such as Russia, Japan and Bulgaria, but otherwise in English, French, Italian, Spanish and Portuguese, for he was also a good linguist. The Germans had been convinced that in terms of foreign cultural policy Germany lagged far behind other nations such as France and Britain. In 1913 Theobald von Bethmann Hollweg (1856–1921), Chancellor of the Reich, stated that, as the Germans were a young nation and underestimated its resources, they did not know what they were capable of winning by force, and what they could never obtain if they only used force. Further, describing cultural propaganda as ‘the imperialism of ideas’, Hollweg asserted that Germany should use this as a basis for its foreign policy, although he thought that the Germans were not mature enough for this (Engel, 2003). After World War I the problem of German cultural propaganda remained controversial. Carl Heinrich Becker, German scholar on Islam and Prussian Minister of Culture, stated in 1919 that it was known that other nations such as the Americans, the British and the Spanish had been successful with their cultural policies in foreign countries, but, on the contrary, Germany had achieved nothing in this field. Between 1919 and 1929 the notion of cultural propaganda was discussed more and more, and it was clearly referred to as a part of Germany’s foreign cultural policies (Engel, 2003). Documents in the Staatsarchiv Hamburg suggest that Weygandt also welcomed the German cultural propaganda policies of the 1920s, as he often applied to the University of Hamburg for a grant for his foreign travels. For example, in a letter to the university administration (27 June 1923), he asked for his travel expenses to Argentina; as well as giving the itinerary of his trip, he emphasized that his lecture planned for Buenos Aires would be expressed in terms of German cultural propaganda (but unfortunately he seems to have received no funds).4 In another letter to the university administration (1 Mar. 1926), he asked for his travel expenses to Lisbon in Portugal, where he had been invited to give a lecture. He pointed out that for six years he had enthusiastically and successfully spread German scientific knowledge among foreign scholars by giving lectures in North America, Argentina, Italy, Portugal and Poland, though until then he had had no funds except for his own money.5 German cultural propaganda also had a direct influence on the administration of Friedrichsberg Asylum, where Weygandt was the Director. A letter from the health administration of Hamburg to the asylum (19 Apr. 1929) said that medical and academic staff of the asylum who were to give scientific lectures abroad should inform the health administration of the lecture in advance; the health administration, together with the foreign ministry, would then check whether the planned lectures would conflict with certain political ideas or be suitable for the audience. The same letter also states: ‘The German diplomatic mission points out that otherwise German cultural propaganda will be easily damaged rather than be useful.’6 Weygandt’s lectures in foreign countries were thus critically evaluated. Johannes Bresler (1866–1942), a psychiatrist and the founder of the medical journal Psychiatrisch-Neurologische Wochenschrift which had a wide circulation among German-speaking doctors, said: ‘In a series of his lectures Weygandt often fought against the opposition raised by audiences and critics, as in Paris he presented the German Act for Hereditary Health as a model. […] Weygandt’s lectures to foreign doctors and scholars contributed to letting them understand today’s Germany’ (Bresler, 1937). While Weygandt was convinced of the superiority of German psychiatry and German culture over those of other nations, the hegemony of psychiatry in the twentieth century was gradually

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moving from the European continent to the New World. The First International Congress on Mental Hygiene was held 5–10 May 1930 in Washington, DC, under the initiative of the former mental patient and the founder of the mental hygiene movement Clifford W. Beers (1876–1943); perhaps by this time, the decline of Germany and the rise of the USA, at least in terms of care of the mentally ill, seem to have made a strong impression. About 3600 psychiatrists and experts on mental health from 53 countries came to the congress, and Weygandt attended as a delegate of the German government. It seems, however, that he was not very impressed with the widespread mental hygiene movement started by Beers in America. In his report of the congress, Weygandt (1930a) wrote: ‘If, in Germany, the idea [of mental hygiene] does not awake the same interest as in other countries where they try to improve mental hygiene, it is no surprise. Above all, in terms of the care of mental patients in hospitals, it has already been a part of German life for a long time.’ In other words, he argued that the US idea of mental hygiene was not new and had already been realized in Germany. At the annual meeting of the American Psychiatric Association, which was held at the same time in the same city, Weygandt was very proud to lecture on the modern treatment of mental illness in German hospitals, showing a film on medical treatment and occupational and recreational therapy at Friedrichsberg Asylum. When he showed the same film at the University of Chicago, a colleague there who was going to take Weygandt to a nearby asylum said, ‘our asylum visit no longer has any purpose, because the asylum cannot provide anything like that shown in the movie’. Weygandt (1930a) referred to this episode as evidence that his presentation impressed the audience. On his way home from the USA to Germany via the Pacific Ocean and Siberia, he went to Japan in June 1930. Kure Shuzo had announced Weygandt’s visit in a Japanese medical journal, saying it would be the first time that such a leading authority in German psychiatry had visited Japan (Kure, 1929/30a). During his two-week stay, Weygandt gave lectures at universities and medical colleges in Tokyo, Kyoto, Osaka and Okayama, and went sightseeing to Nikko, Mt Fuji, Kyoto and so on, guided by Japanese colleagues (Kure, 1929/30b). Weygandt felt a special affinity with Japan. As he noted, ‘It is an honour for our [German] science that so many experts from Japan have carried out their academic development in Germany and Austria’ (Weygandt, 1933). Moreover, Kraepelinian clinical psychiatry and experimental psychological and anatomical research were dominant in Japan, while psychoanalysis was taught only at the University of Tohoku in Sendai, under Professor of Psychiatry Marui Kiyoyasu (1886–1953) who had learned psychiatry from Adolf Meyer (1866–1950) at Johns Hopkins University in the USA (Yamamura, 1984). Like Stieda, Weygandt also took a sceptical view of Freud and his theory of psychoanalysis (Weygandt, 1930b). To his delight, all young doctors had to master the German language, and many of the publications on psychiatry in Japan were written in German. So he argued that people in Germany should be more helpful to the keen visitors from the Far East (Weygandt, 1933). Regarding his travels to non-Western countries, Weygandt described his impressions of psychiatry. For example, Turkey was making an effort to introduce modern institutions to replace the extraordinarily out-of-date asylum care for the mentally ill from the era of the sultans, but some of the older, small asylums reflected the underdeveloped level of civilization. On the other hand, he had nothing to report on the care of the mentally ill in China, as he said that real care did not exist there. Its humble beginnings reminded him of the early Middle Ages in Europe. In contrast, in Japan Weygandt was very intrigued by the care for the mentally ill, which was based on the ‘old culture’ nation (Kulturland); he said that this was because Japan developed from a closed feudal state into a totally modern nation in less than two generations by taking progressive factors from the West (Weygandt, 1931a). As for Japanese psychiatry, he again emphasized the parallels between the care

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of mental patients and the level of culture. In a report on his visit to Japan, Weygandt (1933) admired the special type of care for mental patients that had developed in this ‘old culture’ nation. By birth the Japanese have an intense social feeling (Sozialempfinden) and a deep sense of family (Familiensinn). Besides, their way of life is simple and modest; the houses are extremely simple, with little furniture, but very clean and stylish; in the same way the care is nothing less than luxuriant and hygienic. As a result, they feel, first of all, inclined to take care of their mentally-ill family members in their own houses.

But the care of mental patients at home had long been controversial within Japanese policy for psychiatry, because it revealed a backwardness in terms of modern hospitalization and often led to miserable situations such as patients kept in small cages at home among poor families. It is not certain how Weygandt was informed of the reality of such patients, but it seems that, by being faithful to his own theory of parallelism, he set a high value on the relationship between the care of mental patients and the role of families in Japan, which he called Kulturland (Weygandt, 1933). Weygandt was fascinated by Japanese culture. When he visited Tokyo in 1930, his Japanese colleagues gave him a present of a precious collection of woodprints and watercolour paintings from the feudal Edo period, which dealt with Japanese insanity. In a German medical journal, Weygandt (1934) discussed the Japanese representation of insanity by including some pictures from the collection. From his descriptions, we realize that he wanted to gain a deep understanding of the history of Japanese art. Further, in 1931 Weygandt published his collection of poems, ‘Auf Bergen und Meeren’, which was based on his travels in Japan; these included poems on ‘Kamakura’, ‘The Falls of Kegon’, ‘Nikko’, ‘Mt. Fuji’ and ‘Silk Raising’. However, even in his literary works we can detect his ‘culture-oriented’ principle, as in this extract from ‘Silk Raising’: ‘Volcanic ground promises only poor fruits/ nevertheless a diligent people know how to do so/ They make an effort to raise silk worms/ through high culture they overcome any difficulty’(Weygandt, 1931b). Weygandt’s last years are said to have been difficult. In 1934 he retired early from the University of Hamburg for ideological reasons. In addition, his desire to be a member of the Nazi organization (NSDAP) was rejected because of his former career and his lack of anti-Semitism. In 1937 he returned to his home town of Wiesbaden with his wife, who died later the same year. Weygandt was also unwell, having suffered from chronic asthma for years. He died in 1939 when the illness got worse (Weber-Jasper, 1996).

Kure Shuzo as a supporter of German and Japanese psychiatry Kure Shuzo was born to a family of scholars in 1865 in Tokyo (then called Edo). His family had produced many university professors who were actively involved in the modernization of Japan. Kure was certainly a friend of German culture and science, as Weygandt (1932) described in his obituary in a German medical journal. Kure contributed much to the spread of modern German psychiatry in Japan: as already mentioned, many of his pupils went to study in German or Austrian academic institutions, where he himself had studied and his colleagues taught psychiatry. When they came back to Japan, most of them became psychiatry professors at universities or medical schools, or found promising positions as medical officers in central or local government or as practitioners in modern hospitals. In this way, Kure’s German academic network was formed all over the country. On the other hand, Kure strongly criticized the situation in Japanese psychiatry. After returning from study in Europe between 1897 and 1901, he consistently asserted that home custody of the mentally ill – a symbol of the backwardness of Japanese psychiatry – should be abolished (Seishin

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iryoshi kenkyukai, 1974). This custom in modern Japan may be unique in the history of psychiatry, in the sense that it was not a relic of the pre-institutionalization phase but was a reality which was authorized by the government in the modern period: on 1 July 1900 the Japanese government enacted the first law for mental patients, the Mental Patients’ Custody Act (1900). Its main purpose was to give public control of mental patients through custody. This depended greatly on the patriarchal family system in Japan, and to make responsibility for custody clear, one person, usually a family member, was assigned to take care of the patient.7 The family member had to file an application with the government office to put the patient in an institution.8 At the time, however, the number of mental hospitals was so restricted that the law allowed the confinement of patients at home under the control of the police.9 Before that time, and going back to the feudal Edo period (1603– 1868), home custody as a form of confinement of the mentally ill had most likely occurred thoughout the country (Hiruta, 1985), but after the enactment of the Mental Patients’ Custody Act, these patients had to be firmly controlled by the central and local governments. Regardless of the desire of leading psychiatrists, the hospitalization of the mentally ill was not successfully achieved. As a result, many of the mentally ill stayed at home without medical control and, if they were thought to be dangerous, they were confined there. Under Kure’s guidance, his 12 assistants at the University of Tokyo inspected a total of 364 custody rooms in 15 prefectures all over Japan between 1910 and 1916. Each assistant took charge of one or two prefectures and visited them, mostly in the summer holidays. In 1918 their final report was published in a medical journal, in which 105 cases of home custody were described with a number of photographs and illustrations. The cases were divided into four classes, according to the structure of the custody room and the patients’ treatment by their families: ‘good’, ‘average’, ‘bad’ and ‘very bad’. Of these 105 cases, 70 per cent were classified as ‘bad’ and ‘very bad’ (Kure and Kashida, 1918). Based on the many descriptions of cases and statistical observations, Kure and Kashida (1918) concluded in the report: ‘we have come to know that the state of home custody in Japan is extremely miserable and that control by governmental offices is imperfect’. Although it was natural for them to criticize home custody and the Mental Patients’ Custody Act, they recognized that the central issue was really the shortage of psychiatric institutions: We have an almost complete lack of national and public (prefectural) mental hospitals. The capacity of private mental hospitals is also very low. Of the estimated 140,000 to 150,000 mental patients in Japan, some 135,000 to 145,000 do not receive any benefits from medicine. Our nation and society abandon them and think of them like worn-out shoes. When we compare the public system and the institutions for mental patients in civilized Western countries with those in Japan, the former and the latter are as different as light and darkness. Over 100,000 patients in Japan are unfortunate, not only because they became ill, but also because they were born in this country. (Kure and Kashida, 1918)

Their desire for improvement was partly realized in the law for building public (prefectural) mental hospitals: the Mental Hospital Act of 1919. The above report by Kure and Kashida is said to have played an effective role in the establishment of this law (Okada, 1964). The construction of public mental hospitals, however, was slow. Kure’s interest in psychiatric institutions was linked to the modernization of his own hospital after the German model. He was deeply involved in the planning of Matsuzawa Mental Hospital, where he was the Director. This prefectural asylum was the oldest public mental hospital in Japan, established in 1919 in the suburbs of Tokyo; at the time, the Professor of Psychiatry at the University of Tokyo was also the director of this Tokyo prefectural asylum. Alt-Scherbitz Asylum (Heil-und Pflegeanstalt Alt-Scherbitz) near Leipzig was ever present in his mind as a model for psychiatric

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institutions. Around 1900, while studying in Europe, Kure had visited Alt-Scherbitz and met Albrecht Paetz (1851–1922), who directed the asylum for 42 years until his death (Kure, 1902a). This German asylum was established in 1876 and was thought by experts to be an ideal modern institution built on the new-style ‘pavilion system’, characterized by many small wards (pavilions) spread over extensive grounds. In contrast, the earlier asylums were a complex of huge closed buildings connected to each other by corridors and therefore known as the ‘corridor system’ (Paetz, 1893). After Kure came back to Japan, he immediately reported to Japanese doctors on the asylums in Europe, including Alt-Scherbitz (Kure, 1902b), and started to reform the treatment and care of patients in Sugamo Mental Hospital, located in the centre of Tokyo and the predecessor of Matsuzawa Mental Hospital. (This asylum, established in 1886, had been built following the corridor system, which by then was already thought to be old-fashioned in Germany; Faulstich, 1993.) Kure abolished the use of shackles for the patients and introduced new treatments from Germany such as occupational therapy and Dauerbad (duration bathing). Between 1903 and 1909, a total of four wards constructed from bricks in a Western style were finished at Sugamo Mental Hospital (Okada, 1981). The design of these new buildings had been planned by Kure’s predecessor, and according to Kure (1916) they were modelled on the wards of Alt-Scherbitz; when they were completed the pavilion system was partly realized at the asylum. When Stieda visited Japan in 1906, he came to Sugamo and saw the new brick wards, commenting that, ‘In spite of the difficulties a few new brick pavilions have already been completed with high-ceilinged, bright, and ventilated sickrooms. For the moment some experiments will be conducted in terms of the mixing-up of Japanese and European styles’ (Stieda, 1906). But Kure was not satisfied with the reform there: the asylum was located on such small grounds that it seemed to him to be impossible to make it an ideal hospital like Alt-Scherbitz. The moving of the asylum from Sugamo to the suburbs of Tokyo was a good chance for Kure to put his ideas into practice. In selecting the site of the new asylum, he was very faithful to the German literature, and he referred to the book by Paetz (1893), the director of Alt-Scherbitz. As desirable conditions for building a modern asylum, Paetz listed convenient access by rail and road, water supply and sewerage, a scenic spot, huge grounds, and so on. Accordingly, Kure and his colleagues chose Matsuzawa Village as the best site among 13 candidates (Sugamo Byoin, 1917). Although the new Matsuzawa Mental Hospital left many tasks to be done later, the hospital was completed in 1919 following the pavilion system of Alt-Scherbitz. Weygandt, who visited Matsuzawa in 1930 (Fig.1) praised it: ‘Kure enthusiastically tried to modernize the asylum and introduce the achievements of the care for the mentally ill in the West, especially in Germany. So he gave preference to the pavilion system and also operated the open wards based on that concept’ (Weygandt, 1932). However, it could not be said that Kure was an uncompromising Eurocentrist and Germanophile. He was more sympathetic to the history and culture of psychiatry of his motherland, unless they were incompatible with the direction of modernization. In a 1903 article published in Vienna in German, Kure dealt with Japanese psychiatry, which he described from a long-term historical view from ancient times to the nineteenth century and the end of the feudal Edo period. Here he took a neutral attitude towards traditional remedies, some of which, as he stated, were still used (Kure, 1903). In his other articles, however, he highly valued some traditional practices, trying to give them a new interpretation in the terminology of modern Western medicine. For example, a kind of incantation called shuho was practised at the temples of the Nichiren sect in Chiba Prefecture and was described as religious psychotherapy; bathing in the hot spring at Jogi Onsen in Miyagi Prefecture was like Dauerbad (duration bathing), which was used in Europe as physical therapy for mental patients at the beginning of the twentieth century (Kure and Kashida, 1918). Kure (1912)

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Figure1. Wilhelm Weygandt (front row, centre) and Kure Shuzo (second from right) at Matsuzawa Mental Hospital, 1930 (Source: Kure Shuzo sensei seitan hyakunen kinen kaishi, Tokyo, 1965: 79).

also wrote about Awai Jinja Shrine at Naruto in Tokushima Prefecture, a Shinto shrine known for its long tradition of bathing at the seaside (suigyo). In 1927 Awaijima Mental Hospital was established beside this shrine by the villagers and the Shinto priest who, in planning the hospital, had visited some modern institutions in Tokyo and Kyoto. After the hospital opened, the bathing of the patients continued as part of their daily treatment until 1948. Kure evaluated the combination of modern Western hospitalization with Japanese tradition (Awaijima Hoyoin, 1978). On the whole, he was a typical modern and ‘enlightened’ psychiatrist who studied in Europe, but on the other hand he was an ethnically-oriented scholar who supported Japanese history, culture and science by referring to the European context.

Conclusion Both Stieda and Weygandt were impressed by Japanese psychiatry. In terms of care for the mentally ill they both praised the good combination of Japanese tradition and Western modernity. However, Stieda visited Japan in 1906 and Weygandt in 1930, so they saw different degrees of modernization of psychiatry. When Stieda came, the number of psychiatric beds, which Japanese psychiatrists took as an indicator of modernization, was very limited all over the country. Unpleasant effects caused by religious and traditional remedies might have been evident, as Stieda (1906) suggested in his article on Japanese psychiatry. In contrast, when Weygandt visited Japan, there were already many psychiatric beds in private hospitals mainly located in city areas, and more and more new treatments from Europe were practised in modern hospitals. So Weygandt’s evaluation of Japanese modern psychiatry seems to be more positive than Stieda’s. Weygandt (1931a) pointed

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out: ‘While also in Japan the care for the mentally ill still has a patriarchal trait according to its traditional way of life, the [university] clinics are making the effort to undertake Western-style scientific research and to provide totally modern Western facilities’. However, both visitors had some similar interests in Japanese psychiatry. First, they felt close to German-oriented psychiatry there, for their academic backgrounds in German biological psychiatry modelled after Kraepelin were the same as those of Japanese psychiatrists. Nevertheless, we cannot forget the role of Kure, who was a good translator of language and culture; as he had a similar academic background and values as the two Germans, he was able to represent Japanese psychiatry in line with the German context and this clearly led to their favourable understanding of Japanese psychiatry. In other words, Stieda, Weygandt and Kure shared a ‘German world’ in which they could think, speak and write in German. Second, both Stieda and Weygandt tried to overcome their ‘depressed’ and ‘injured’ German nationalistic/ethnic identity and pride in international relationships within Europe by idealizing the supposed success of the modernization of Japanese psychiatry under the strong influence of German psychiatry. As a Baltic-German, Stieda identified himself with German ethnicity. While he worked on the battlefield of the Russo-Japanese War as an army surgeon of the Russian Empire, he had negative feelings not only towards Russia as the ruler of the Baltic countries, but also towards Russian psychiatrists who were attempting to discover the effects of war psychosis in opposition to the theories of German psychiatry. So it would be natural if Stieda were to sympathize with Japan, the enemy of Russia, and with Japanese psychiatry as a strong supporter of German psychiatry. In contrast, Weygandt’s hostile feelings to France, England and other European countries and his sympathy with Japan seem to be clearer and more explicit. He tried to confirm the superiority of both the German and Japanese nations by referring to the parallelism between the care of mental patients and the level of culture. Needless to say, however, German psychiatry was completely destroyed by the Nazis, with whom he felt a deep sympathy. Notes 1.  All translations are by the present author. 2. Erlaubnisscheine für Personen reiferen Alters vom Wint. Sem. 1883/4 – Som. Sem. 1902: Universitätsarchiv Heidelberg. 3.  Stieda (1909b) calls himself a ‘Kraepelinianer’. 4. Staatsarchiv Hamburg, 361-6V Hochschulwesen – Dozenten – und Personalakten I411 Band1 (Personalakte Prof. Dr. Weygandt). 5. Staatsarchiv Hamburg, 361-6 Hochschulwesen – Dozenten – und Personalakten I411 Band2 (Personalakte Prof. Dr. Weygandt). 6. Staatsarchiv Hamburg, 361-6V Hochschulwesen – Dozenten – und Personalakten I411 Band1 (Personalakte Prof. Dr. Weygandt). 7.  The Mental Patients’ Custody Act, Article 1. 8.  Ibid., Article 3 (and its enforcement regulation, Article 3). 9.  Ibid., Article 9.

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A 'German world' shared among doctors: a history of the relationship between Japanese and German psychiatry before World War II.

This article deals with the critical history of German and Japanese psychiatrists who dreamed of a 'German world' that would cross borders. It analyse...
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