Alienist

Alienist (pronounced eyl-yuh-nist or ey-lee-uh-nist)

(1) A medical practitioner specializing in the treatment of mental illness (archaic).

(2) In law, an expert witness who specializes in the legal aspects of mental illness and mental competence (now less common).

1864: From the French aliéniste, from aliéné (insane), the construct being alien(ation) + -ist.  Alien was from the Middle English alien, from the Old French alien & aliene, from the Latin aliēnus (belonging to someone else (the sense of that which was “exotic; foreign” came later), from alienare (deprive of reason, drive mad (literally “to make another's, estrange”)) from alius (other), from the primitive Indo-European hélyos (from which English ultimately gained “else”).  The -ist suffix was from the Middle English -ist & -iste, from the Old French -iste and the Latin -ista, from the Ancient Greek -ιστής (-istḗs), from -ίζω (-ízō) (the -ize & -ise verbal suffix) and -τής (-tḗs) (the agent-noun suffix).  It was added to nouns to denote various senses of association such as (1) a person who studies or practices a particular discipline, (2), one who uses a device of some kind, (3) one who engages in a particular type of activity, (4) one who suffers from a specific condition or syndrome, (5) one who subscribes to a particular theological doctrine or religious denomination, (6) one who has a certain ideology or set of beliefs, (7) one who owns or manages something and (8), a person who holds very particular views (often applied to those thought most offensive).  Alienist is a noun; the noun plural is alienists.

In English, the noun alienist was in 1864 adopted from the French to describe “one who scientifically treats or studies mental illness”.  The French aliéniste was a use of “alienation” in the sense of “insanity, loss of mental faculty”, a development in the use which from the fifteenth century had been used to mean “loss or derangement of mental faculties, insanity”, the notion drawn from the Latin alienare (deprive of reason, drive mad).  The use in English sounds strange to modern ears but was probably an improvement on the earlier “mad doctor” (ie a physician dealing with the mad although doubtless there were a few doctors who were madmen), noted since the early eighteenth century.  Although psychiatry really didn’t come to be accepted as part of mainstream medicine until the late nineteenth century, there had since antiquity been those (not always physicians) in many cultures who specialized in the care of those thought mad although institutionalized professionalism (as opposed to their employment in institutions known often as “lunatic asylums”) waited centuries to be formalized.

The word psychiatry dates from 1808 and was coined by Prussian physician Johann Christian Reil (1759–1813) as the German Psychiatrie (literally “medical treatment of the soul”, the construct being the Ancient Greek psykhē (soul) + -iatry (medical treatment) from the Greek iātrikos (medical) from iāsthai (to heal).  From this evolved the idea of physician specializing in psychiatry being a psychiatrist.  Dr Reil’s word caught on but wasn’t wholly without linguistic competition, psychiater (expert in mental diseases) in the literature since at least 1852.  Although Austrian neurologist Sigmund Freud (1856-1939) seems assumed by some almost to have “invented” psychiatry, his work in the late nineteen century was but one thread in a discipline both well established (if not wholly accepted by the medical establishment) and becoming increasingly used as the first generation of drug treatments became available.  What Freud did however in his systemised method of treatment (psychoanalysis) was define in the popular imagination just what a psychiatrist was.  The profession however had been around for a while and it was in 1841 the Association of Medical Officers of Asylums and Hospitals for the Insane was founded; receiving a royal charter in 1926, it became the Royal College of Psychiatrists.

Patient and alienist: Lindsay Lohan on Sigmund Freud’s couch.

In English, the word alienation had a varied history.  It began in the late fourteenth century in the law of real property (ie real estate) with the sense of “transfer of ownership, action of estranging”, from the Old French alienacion and directly from the Latin alienationem (nominative alienatio) (a transfer, surrender, separation), the noun of action from the past-participle stem of alienare (to make another's, part with; estrange, set at variance), from alienus (of or belonging to another person or place), from alius (another, other, different), from the primitive Indo-European root al- (beyond).  Early in the fifteenth century, the word was borrowed from the notaries and land conveyancers to mean “deprivation of mental faculties, insanity”, this time from a secondary sense of the Latin alienare (deprive of reason, drive mad) and for decades the word seems to appear as frequently in court records as medical journals, decisions on matters of madness very often the province of the magistracy.  A nice blending of the original idea in land ownership with the divorce courts saw “alienation of affection” (falling in love with another) adopted in the US as legal jargon in 1861.  In politics, the theorist most famously associated with alienation was Karl Marx (1818-1883) who in Das Kapital’s (Capital: A Critique of Political Economy (1867-1894) three (very long) volumes explored, inter alia, the idea of the worker being alienated from the fruits of his labor by the employer extracting from the process the surplus value.  That has turned out to be an ongoing process.

In law, although terms like forensic psychiatrist are now preferred, an Alienist was a mental health professional who evaluated individuals in some way involved with a case before a court.  The most publicized of the alienists were those who appeared in notorious criminal trials where typically they were called upon to determine a defendant’s (and less commonly a victim’s or witness’s) state of mind at time of the alleged offense or since and thus their competency to stand trial, be cross-examined or give evidence.  Alienists almost always had a background in psychiatry or psychology and, in recent decades, also specialised training in the techniques of forensic evaluation.  Depending on the jurisdiction, alienists were sometimes asked to comment on recommendations for treatment and offer opinions on issues such as the potential for reform or likelihood of recidivism.

The idea of medical experts offering opinions on mental health matters is now so unexceptional as not usually to attract comment but in the nineteenth century when the first alienists began to be called as expert witnesses, it was novel.  Then, psychology (the clinical study of mental pathologies) was not only embryonic but subject to much criticism by doctors who insisted that diagnosis without empirical evidence was an absurdity and echos of the attitude persist in the views some have of the very existence of conditions such as chronic fatigue syndrome (myalgic encephalomyelitis (ME)).  Then, the mentally ill tended to be confined rather than treated and the psychology of the nineteenth century alienists was very much a laboratory discipline, the clinical or behavioral work today familiar as an orthodoxy mostly still decades away.  Instead, alienists analysed aspects of learning, perception and memory and their craft would now be understood as a kind of study of cognition.  As a profession, the alienists really advanced their discipline in the first three quarters of the twentieth century as understanding improved of the influence of the unconscious mind on individual actions.  Additionally, the consequences of the two world wars provided vast numbers of the mentally damaged to study and in the 1950s and 1960s, it came to be appreciated just how significant could be contextually such as poverty and racism.  All this happened while there were enormous advances in neurology and the physical brain itself came better to be understood, the idea of neuropsychological research coming to be accepted as a valid scientific method to explain the behaviour of individuals.  So much has changed including the nomenclature, the term alienist now rarely used in courts and if asked, most folk would likely assume an alienist is "one who studies aliens".