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Logo of medhistThe Wellcome Trust Centre of the History of Medicine (UCL)Medical History
 
Med Hist. 2010 July; 54(3): 427–428.
PMCID: PMC2889482

Book Reviews

Obsession: a history
Reviewed by Rhodri Hayward

Lennard J Davis.
Obsession: a history,  Chicago and London,  University of Chicago Press,  2008, pp.  290, £14.50, $27.50 (hardback  978-0-226-13782-7). 

Lennard Davis advances two inter-related arguments in this thoughtful history of obsessive disorder. First, he argues that the obsessive-compulsive disorders have achieved a central place in the modern imagination: as the driven behaviour of its sufferers embodies the focused activity celebrated in modern capitalism. Second, and I think less convincingly, he claims that the scientific enterprise can itself be seen as a new particular form of obsessive activity that emerged in the nineteenth century.

Davis’s first claim is difficult to resist. The language of obsession is deployed widely and loosely in contemporary society. Advertisements for perfumes or trousers feature writhing androgynous clones breathlessly whispering about the extent of their obsessions. Our everyday enthusiasms for, say, biscuits or Kate Winslet are now inflated in ordinary speech and media representations through the language of psychopathology. Modern novels, such as Ian McEwan’s Enduring love and tabloid stories like those surrounding the death of Jill Dando, exploit the erotic associations of criminal stalking. And indeed these illicit infatuations provide a benchmark for our own romances with anything less than obsessive involvement somehow demonstrating the banality of the relationship. At the same time, the reported incidence of diagnosed cases of obsessive-compulsive disorder (OCD) appears to be on the rise. Since the 1970s, it has moved from being one of the rarest mental disorders to one of the most common, afflicting almost 4 per cent of population.

How do we account for the epidemiological and cultural ascent of OCD? Davis is a leading proponent of the new “biocultures” programme, a methodological approach that has sought to overcome the theoretical failings associated with the medical humanities, and he develops an analysis that works to integrate insights from both social contructionism and biomedical investigation. For many historians, this approach may seem all too familiar: it provides a nuanced model that draws in equal parts upon the constructivist philosophies of Ian Hacking and the biologically driven narratives associated with René Dubos and Alfred Crosby. Davis describes the changing cultural, social and economic ecology of the illness, arguing that the presentation of this pathological behaviour cannot be disentangled from its broader context. He locates the emergence of OCD in the new diagnosis of “partial insanity” that appeared at the end of the eighteenth century. The notion of partial insanity, as developed by J C Prichard and Philippe Pinel, insisted that the sufferer maintained a certain level of insight into their condition. It was a form of mental alienation in which the patient became a helpless witness to their thoughts and actions. The new concept was framed through legal debates over personal responsibility and drew upon the imagery of faculty psychology to describe the internal contest and conflict that rent the personality.

Davis provides impressive readings of William Godwin’s Caleb Williams (1794) and Thomas Love Peacock’s Nightmare Abbey (1818) to illustrate the emergence of this new alienated sensibility, but curiously ignores James Hogg’s Private memoirs and confessions of a justified sinner (1824) with its combination of partial delusion and obsessive persecution. This minor oversight forms part of a more substantial omission; that of the religious context of the developing category of OCD. Although Davis acknowledges the theological origins of the conceptual vocabulary and the linguistic roots of the word “obsession” in a spiritualized version of siege warfare, he uses the 1736 Witchcraft Act as kind of cordon sanitaire, arguing that the disappearance of demonological discourse creates the secular space for the new mental philosophy. However, the disruptive agency granted to obsessing ideas in nineteenth-century medico-psychological writings was predicated upon the older ideas of demonic enchantment and at the same time theological explanations of devilish obsessions began to be framed through new practices such as mesmerism and hypnotism.

One way of looking at the progress of obsession is to see it as a process in which different aspects of our identity—our ideas, our flesh or our unconscious—are imagined as having agency: an agency that can conflict with our own personal socially acceptable goals. Davis provides an enlightening and fairly breakneck tour through these various versions of obsession. Occasionally he seems to strike a false note. His assertion that psychoanalysis originates in the investigation of obsession (rather than hysteria as claimed in more conventional accounts) is unconvincing and the idea that Freud’s career was bookended by discussions of obsession ignores the large literature on psychoanalysis and anthropology that he produced after Inhibitions, symptoms and anxiety in 1926. This fairly monomaniacal interpretation of Freud contrasts unhappily with the following chapter on ‘Obsessive sex and love’. Whilst sexological ideas are central to the contemporary understanding of obsession, Davis’s discussion drifts onto the familiar territory of sexual continence and excess whilst ignoring the literature on erotic fixation. It would have been useful to have had some discussion here of the distinction between erotomania and erotolepsy and the pathologization of infatuation in conditions such as de Clérambault’s syndrome. This chapter, which repeats material from the introduction, forms the most distracted section of Davis’s work.

The unevenness of the treatment in these middle chapters does help to bring home Davis’s central contention that judgements over obsessive-compulsion are purely conventional. It also opens up the author’s second argument regarding the obsessive nature of scientific and academic work. Although it may at first appear simply as a provocation, Davis’s illustration of the obsessive and repetitive nature of scientific methodology in his engaging case studies of Freud and Galton demonstrates the uneasy status of OCD as it is celebrated and pathologized in different contexts. It also highlights the most interesting aspect of Davis’s findings: the dependence of the illness upon the wider material environment. As he notes throughout this work, the ritualism and regularity that characterizes obsessive-compulsive behaviour is dependent upon a whole series of concrete innovations from modern home plumbing to the rise of personal time-keeping. Although Davis does not press home this aspect of his investigation, his attention to the cultural and material ecology of mental illnesses demonstrates the value of the biocultural approach to the history of psychiatry.


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