An Archive of Adjustments: Reflections of the Remnants of a Discarded Diagnosis

The text is crammed into the center of the card, as if to escape the fraying edges. “Main facts: Patient is a 28-yr-old single male who for the past 2 yrs has shown gradual deterioration in his performance level, with fear at first vague & of an anxiety nature, later projected as audible threats of bodily harm at the hands of his work environment.” In 1930, this troubled man, who we will call David Nolan, was admitted to the Phipps Psychiatric Clinic at Johns

Hopkins Hospital. For years, he had been shifting from job to job, constantly worrying that his “fellow workers were plotting against him.” In the clinic, David's condition remained “essentially unchanged,” as he “clung to the reality of his persecutory ideas,” and insisted that others were “using malign power that interfered with his working efficiency.” Slowly, however, he became more “cooperative” and “active,” and began “restlessly demanding that something be done for him right away so that he could return to his work.” Eventually, David's psychiatrist decided to parole him to his father, so he could be cared for by family as he tended to their farm (Case 8, keysorter card, AMC XV/500659). Although he was discharged shortly thereafter, David's case later became part of a cohort study conducted by two staff members at Phipps: a research assistant named Gladys Terry and a junior psychiatrist named Thomas Rennie. This is why I found his case history, along with dozens of others, on a tattered yellow punch card stowed away in the archive.

Toward the top of David's card is an unfamiliar diagnosis, typed in fading red ink: “Parergastic Reaction.” This obscure illness, I soon learned, was first described in the 1920s by Adolf Meyer, the director of the Phipps Clinic and one of the earliest proponents of dynamic psychiatry in the United States. “We see chaotic and fantastic behavior, strained tension and disorganization of the personality,” he later explained. “The capacity to draw ergasic resources into focus throug