Evolution of psychiatry: from asylums to mental health institutions

Psychiatry is one of the medical specialties most closely related to social and cultural factors. This means that the values ​​of each era define who breaks the patterns of normality and who does not, who should go to a mental health institution or receive psychiatric treatment, and who should not.

This dynamic is part of what is known as the medicalization process, which consists of converting situations that have been considered normal into pathological conditions and trying to solve them through medicine.

To elucidate how psychiatry evolved in Latin America from the mid-19th century to the mid-20th century and reflect on the relationship between psychiatry and society, Andrés Rios Molina, from the Institute for Historical Research at UNAM, carries out, together with others 13 historians from different Ibero-American countries and the United States, the research project “From madhouses to mental health institutions. Beginnings and development of psychiatry in Latin America ”.

“My colleagues and I incorporate the social and the cultural as central variables to understand the dynamics of psychiatry, because the characteristics of a mental patient, as well as the criteria for understanding it, the diagnoses, the treatments, and even the society, are changing. over time ”, points out Ríos Molina.

From a scientific point of view

Before psychiatry emerged in Europe in the early nineteenth century, from what became known as alienism, with institutions and doctors specialized in the care of the mentally ill, and strategies of what was then called moral treatment, there was no more than “asylums for madmen” and a treatment based on the logic of Christian charity that consisted of keeping them locked up, feeding them, making them pray if they were cared for by members of a religious order … and nothing more.

On this side of the Atlantic, in the capital of New Spain, the so-called “hospitals for the insane” were founded, such as that of San Hipólito, for men, which was located where the church of San Judas Tadeo is today; and the Divino Salvador, for women, on Donceles street, whose building now houses the archives of the Ministry of Health. Both also functioned as mere custodial centers.

Finally, towards the middle of the 19th century, psychiatry arrived in Latin America, where little by little institutions were founded to care for the mentally ill from a scientific perspective.

In the 20s of the 20th century, it was thought that madness could be cured. Thus, techniques such as pyrethotherapy appeared to treat schizophrenia, cerebral syphilis, progressive general paralysis …; and insulin coma therapy to treat schizophrenia as well.

In the 1930s and 1940s, electric shocks predominated in the field of psychiatry. And in the 50s there was a revolution with the appearance of psychotropic drugs.

Formal and polyphonic stories

Ríos Molina and his colleagues want to integrate the formal histories of mental health institutions with diverse histories that he calls polyphonic, formed by the voices not only of psychiatrists but also of patients’ relatives and patients themselves.

“In the archives, we have found letters and documents in which the relatives state the reasons why they have decided to take their patient to an asylum or a mental health institution, it depends on the time of the talk; and, also, letters from patients that bring us closer to the way they faced their illness and their stay in a mental health institution. In short, what interests us is to go from the macro to the micro, to see how psychiatry came to Latin America, took root, and became related to its environment ”, he explains.

As part of this research, the historian has already written a work on the Psychiatric Clinic of Dr. Samuel Ramírez Moreno, who was the father of researcher and university historian Beatriz Ramírez de la Fuente and father-in-law of Dr. Ramón de la Fuente, founder of the National Institute of Psychiatry in 1979.

“Dr. Ramírez Moreno was, from my point of view, the great pioneer of the modernization of psychiatry in Mexico with his private clinic, which he founded in 1931. Unlike public institutions, which provided care especially to people With few resources, this clinic cared for wealthy people seeking shock or electroconvulsive therapy, because at that time it was the only option to solve mental health problems, especially cases of psychosis. ”

Four points

In Ríos Molina’s opinion, to understand the establishment of psychiatry in Mexico, four points must be taken into account. The first is that once French psychiatry was displaced in the 1920s and German psychiatry prevailed, led by Emil Kraepelin, both schizophrenia and manic-depressive psychosis became the focus of this specialty.

“Previously, psychiatrists were dedicated to hysterics, alcoholics, and drug addicts, but with the new paradigm, the identity of their specialty began to be defined. They may not have been able to do anything concrete for the schizophrenics, but they learned to analyze, listen and understand them. ”

The second point is that thanks to the fact that psychiatrists began to be required in the courts to decide whether a defendant had committed a crime in a state of insanity or not (on which it depended whether he was charged or not), many people had the opportunity to learn about mental illness.

“In Latin America, we repeatedly find cases in which society demanded specialized knowledge to resolve legal issues. Thus, the presence of psychiatrists in the legal context gave them a place within society ”, indicates the historian.

The third point is that psychiatric institutions stopped being dark, humid, and dirty spaces, where the mentally ill lived like little animals and were transformed, from a new architectural conception, into modern spaces.

And the fourth point is that, also in the 1920s, the concept of mental hygiene was promoted, on the basis that psychiatrists not only had to cure psychiatric patients but also help the State to take measures to prevent insanity among healthy people.

“In this way, psychiatrists had to work within psychiatric institutions, but also outside them, with vulnerable individuals, such as criminals and children, mainly, so that they did not go crazy in prisons and poor neighborhoods. Likewise, in the context of post-revolutionary Mexican nationalism of the 1920s, they actively participated in shaping the new healthy and productive subject, ”concludes Ríos Molina.

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Collective project: This project brings together renowned historians from Mexico, Uruguay, Colombia, Chile, Argentina, Brazil, Spain, and the United States. Each one analyzes the history of a madhouse, asylum for an insane or psychiatric hospital, with the aim of understanding to what extent the administrative and therapeutic changes reflected much broader transformations in the social and cultural context. Thus, the UNAM seeks to reflect on the processes that made it possible to institutionalize psychiatry in Latin America.

 

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