- 1 First treatments for the mentally ill
- 2 From seclusion to release
- 3 Phillipe Pinel and mental illness
- 4 The emergence of Psychiatry
- 5 The “Tower of the Fools”
- 6 First reforms in the treatment of mental health
First treatments for the mentally ill
In 1656, by means of a Royal Decree, they were created in France the “General Hospitals”. Unlike what his name indicates, it was not medical establishments, but administrative structures with semi-legal status that granted him legal autonomy outside the ordinary courts to decide the detention of persons considered antisocial. Article XII established that they had power of authority, detention, administration, police, jurisdiction, correction and punishment. As a result of this, hundreds of people with mental suffering were kidnapped by the police by order of the directors of the General Hospitals and detained without prior trial. In this sense they were in worse conditions than the prisoners, since they had no right to defense and a sentence was not necessary for them to be locked up. A few years after the enactment of this decree there were already 6000 people locked up, 1% of the total population of France.
Until the end of the Renaissance the "madman" was not deprived of rights, although this did not prevent the abuse they could suffer. They were considered peaceful, isolated from the cultural world and wandering the city. From the seventeenth and eighteenth centuries they became considered furious, manic, violent or suicidal. After the French decree of 1656, similar laws were passed throughout Europe that combined confinement with the deprivation of their rights (Galende, 2008).
In London, the Bethlem Royal Hospital, known as “the Asylum of Bedlam”, began offering shows in the 18th century where for a penny (or free the first Tuesday of each month) you could witness the brutal methods that were applied to people with mental suffering who were hospitalized. The spectators could take sticks to hit the inmates and were often given alcohol to see the effects they produced. In 1814 he came to have 96 thousand visits, becoming the biggest show in the city (Sanz, 2012).
In 1789, within the framework of the French Revolution and before the Declaration of the Rights of Man and of the Citizen, a group of officials alerted on the situation of confinement of thousands of people who had left the newly deposed Monarchy and advised the seclusion only to the "manifestly crazy" That same year the Legislative Assembly, through its Begging Committee, appointed a commission to visit the confinement establishments.
From seclusion to liberation
In 1790 the Assembly approved a Decree that ordered the release within six weeks of all persons held in castles, houses of religion, houses of force or prisons by order of the old regime, unless they were legally convicted of major crimes or because of insanity. The same decree established later than in the next three months “insane” people had to be transferred to hospitals.
Although it is often said that during the Revolution there was the "liberation of the crazy", as we see here, what was really about was the creation of a new legal and legal system to deal with madness. They tend to accept that it was the revolutionary doctor and politician Phillipe Pinel (1745-1826) who initiated a social policy for the treatment of mental health. However, it was not Pinel but a police chief and a judge who visited the asylums to see how the assembly decree was to be applied. The police opposed these freedoms, and in 1791 a new law held families responsible for the damages that the released individuals could cause and gave power to the municipalities and the Police for their social control (Galende, 2008).
On August 25, 1793 Pinel was appointed Director of Bicêtre, a combination of jail and asylum for aliens. On December 4, 1794 he was appointed Professor of Internal Medicine and in 1795 administrator of the Salpetriere, former arsenal of the Imperial Army converted into a Homeless Hospital and - since 1660 - destined as Alien's Asylum (Vigliola, 2004). During his performance in both institutions Pinel released only 49 people whose behavior was considered acceptable or whose alienation or criminality was simply doubtful.
Phillipe Pinel and mental illness
In its Medical-Philosophical Treaty of Mental Alienation (1801), Pinel considered that there was a single mental illness - Alienation - that presented four morbid entities: mania, melancholy, dementia and idiotism. He held three possible causes of Mental Alienation:
- Physics: directly cerebral or sympathetic;
- Heritage, to which he attributed a prominent place; Y
- Morales: unbridled passions and excesses of all kinds.
Since the latter was the main one, he proposed a “moral treatment”Consisting of institutionalization of the patient to move him away from the behaviors that led to alienation, and subject it to a severe and paternalistic discipline by the professional. For this, the doctor must be a person of moral and ethical qualities that could generate the adequate confidence of a good Doctor-Patient relationship (Bercherie, 1985).
However, the psychiatrist and psychoanalyst Emiliano Galende (2008) argues that Pinel should be included as one of the reformers of his time, since he rejected the use of chains and immersion in water that was performed in some nursing homes, treatment of which he said what was it "a delirium of doctors, worse than the disease" However, he was not optimistic about the final destiny of the inmates he considered incurable. He was, on the other hand, in favor of the patients considered "cured" being hired in nursing homes as mucamos or nurses, in an attempt to keep them inside the institution.
For the historian Umberto Galimberti (2013), Pinel "freed" the madmen from the prisons based on the principle that the madman cannot be equated with the offender. This creates the myth that psychiatry is a science of human liberation, when in fact the madman freed from prison was immediately held in the Asylum. From there begins his ordeal within a "Total Institution", to use the expression of Goffman (2006) that refers to those places destined to the repression of subjectivity. In this sense it can be considered as the “asylum seeker”.
The emergence of Psychiatry
Another French physician, Antonio Atanasio Royer-Collard (1768-1825) imitated Pinel in the Maison Nationale de Charenton, of which he became Chief Physician in 1805. In 1816 Royer-Collard was appointed Professor of Legal Medicine in Paris-sy in 1821 he was the first holder of the Chair of Mental Medicine (Bercherie, 1985).
Jean Ettiene Esquirol (1772-1840), a disciple of Pinel and his successor in the administration of Salpetriere since 1820, is considered the creator of Psychiatry as branch of medicine specializing in mental disorders. Esquirol's proposals revolved around compulsive confinement, legislation to transfer to the doctor the legal power and legitimation in medicine of a branch specialized in mental alienation (that's why it was also called Alienist Medicine).
On June 30, 1838, the "Alien Law" or "Esquirol Law" was approved in France, which proposed the creation of Asylums for Alienados or Asylum - specialized in dealing with "manic fury" -, established the conditions of admission and guarantees concerning individual freedoms, it suspended the citizens' rights of the alienated, organized the protection of their assets, and gave the psychiatrist the power of a doctor, judge and police to dispose of people. He considered the "alienated" as "dangerously ill for himself and for others" that he should be admitted with and without his consent. In the fifteen years after the approval of the law, 50 asylum centers had already been created throughout the country - which were under the authority of the Ministry and the Police Prefecture - and hundreds of others in the rest of Europe (Galende, 2008) .
The "Tower of the Fools"
In Vienna a Narrenturum or “Torre de los Locos”, which had five floors and 140 cells, which came to accommodate 250 people which were monitored by a pan-optical mechanism. A report of 1843 denounced the state of dirtiness of the place, the lack of lighting, and the conditions of inmates who were tied with chains on arms, legs and neck, poorly fed (sometimes to the force) and whose attention was realized by a hollow protected by a solid iron fence.
In America, asylum centers were also created following this model. One was opened in Brazil in 1852 and another in the Dominican Republic in 1879.
Inhuman treatments for the mentally ill
Psychiatry was debated between "organicists" and "psychics", but the former dominated the madhouses and university chairs. These considered that the mental illnesses were due to a diseased brain, for which neither the patient, his family or society were responsible, and the doctor's power over the patient was legitimized. Following this logic, treatments were applied throughout the nineteenth century that included corporal punishment using whips or birch rods, immobilization using straitjackets -invented in 1790-, straitchairs -created in Philadelphia-, beds where they were tied for days with a hole for bowel movements or the swivel chair -created by Erasmus Darwin- in which many died, “disgust” treatments by using purgative and vomiting, cold water baths that used to include immobilizing bathtubs that prevented patient mobility and water jets in the head, administration of mercury, use of leeches and ants, scalp cuts, and electric shocks. Those who died with these brutal treatments were often noted as "escaped" or "cured."
First reforms in the treatment of mental health
The therapies used by the disciples of Pinel went against the principles sustained by the French Revolution. However, as Foucault points out (cited by Stolkiner and Solitario, 2007) this represented the birth of the political and modern states. In a city designed for the free wandering of citizens in public spaces, and in a society where subjects governed by reason were supposed to make the necessary choices to position themselves freely and individually, it was necessary to define a material and symbolic space for host the "madness" and protect those who could not exercise their freedom by being "alienated."
These ideas were in line with the birth of industrial capitalism that needs to "get out of circulation" those people unable to produce profits for the bourgeoisie. Only in the second half of the twentieth century reforms would be carried out in the area of Mental Health aimed at defend the human rights of people with mental suffering.
This article is a fragment of the book: Brief History of Persons with Disabilities: from oppression to the struggle for their rights, Mauritius, Spanish Academic Editions, OmniScriptum, 2018.
- BercheriePaul (1985) The basics of the clinic, Manantial Publishing.
- Galende, Emiliano; (2008) “Brief History of Disciplinary Cruelty”, in: Galende, Emiliano and KrautAlfredo; Mental Suffering, Buenos Aires, Editorial Place.
- GalimbertiUmberto; (2013) The myths of our time, Madrid, Debate.
- Goffman, Evering; (2006) Stigma: deteriorated identity, Buenos Aires, Amorrortu. g
- Stolkiner, Alice and Lonely, Romina; (2007) "Primary health care and mental health: the articulation between two utopias", in: Maceira, Daniel (comp.); Primary Health Care: articulation between two utopias, Buenos Aires, Paidos.
- Vigliolia, Pablo; (2004) "History of Pinel and the liberation of the insane", in: Therapeutic Dermatological Update, No. 25:56 (at atdermae.com).
- Depression test
- Goldberg depression test
- Self-knowledge test
- how do others see you?
- Sensitivity test (PAS)
- Character test