The history of mental illness
The first documents attesting symptoms related to psychiatric pathology date back to ancient Egypt. The ancient Egyptians believed that the seat of symptoms, which we now call psychiatric, was the heart and made no distinction between organic and mental illness.
The history of medicine as an independent discipline with respect to philosophy and religion begins with the Greeks who started the process of freeing the interpretation of the symptoms of mental illness from superstition and mystical-religious causality. In ancient Greece popular opinion believed that mental pathology was the result of the influence of evil and persecutory deities such as Mania or Lyssa, Dionysus, Hecate or the Furies. The cycle of Homeric poems frequently refers to the madness of the protagonists. The passions of the Homeric heroes, including madness, however, seem induced from the outside and have the character of transience. Achille’s anger and Agamemnon’s offense are the fruit of Ate (in Greek Ατη, ruin, deception, foolishness), goddess of deception who walks on the heads of mortals, leading them into error.
Madness is also a recurring element in classical tragedy. We remember the bloodthirsty folly of the Bacchantes, the folly of Oreste, that of Ajax. Plato in the Phaedrus describes four types of madness:
- Prophetic madness: Characteristic of the visionaries and connected to the prophetic divination. One example is the trance of the Pythia of the oracle of Apollo in Delphi.
- Telestical madness: O ritual, it was the madness of the Dionysian rites, characterized by a liberating purpose and induced by music, songs and orgiastic dances.
- Poetic madness: Due to the possession of the Muses, it granted poetic inspiration.
- Erotic madness: Linked to love and eros.
Hippocrates introduced the innovative concept that mental pathology, as well as physical pathology, depended on circumstances relating to the individual and not to divine influence. In the treatise On Sacred Disease Hippocrates deals with folly in the description of epilepsy, called “the sacred disease” and considered until then the result of divine possession. In the treatise the symptoms of the disease are minutely enumerated but above all this pathology offers the cue to the author for taking a stand towards the traditional conceptions on mental illness. Hippocrates says: «This is the way things are about the so-called sacred disease. It does not seem to me that it is more divine or more sacred than other diseases, but like other diseases it has a natural cause and derives from it.
In the first century AD, in Rome, Celsus dealt with madness in his work De re medica. Celsus takes up the concepts of Hippocrates’ mental illness, specifying the use of some terms: “insanity” to indicate mania and fury, “frenzy” which was always accompanied by fever, “delirium” which could be cheerful or sad, partial or general. Celso also studied the use of therapeutic tools for mental pathology such as music, reading, dialogue.
Seneca considers madness the effect of those who are prey to uncontrollable passions. In the Letters to Lucilio he says: «… no enemy has brought as much offense to men as their passions. This unbridled and mad thirst for pleasure would be unforgivable if the culprits themselves did not suffer the consequences of their actions. And rightly their unrestrainedness torments them: in fact, any passion that goes beyond the limits established by nature becomes fatally boundless and uncontrollable. Moderate man finds his limit in nature, while the empty fantasies that arise from passions are boundless. “
Another important element in the history of mental illness, in Roman times, were the legal aspects related to it. Consistent with the great Roman legal tradition, in fact, the presence of a mental disorder at the time of the commission of a crime was considered a mitigating factor, however the judgment on sanity was entrusted to the judges and not to doctors.
During the Middle Ages there was a return to a vision of mental illness as the fruit of the influence of magic and supernatural powers. Mentally ill patients were often considered possessed or under the control of the devil and as such not subject to medical treatment but the intervention of magicians, priests or inquisitors. The term “madness” was born in the Middle Ages as an onomatopoeic voice indicating emptiness or bellows. The madman is often represented with an open mouth holding a rolling pin (the madman’s stick). In feudal courts it has the role of jester, has the task of entertaining and is not subject to prohibitions.
Significant progress was made in the Arab East in the organization of mental health care with the creation of specific wards for these patients in Baghdad hospitals. Similar structures arose subsequently also in Europe in Paris, Montpellier, Zurich.
Another typical phenomenon of the Middle Ages are the so-called “psychic epidemics” that affected large sections of the population, such as flagellants, tarantati, or real states of possession of entire groups in convents. Of particular interest are the outbreaks of shingles (name with which the infection with herpes zoster was also indicated), actually due to intoxication by ergot or Claviceps purpurea a fungus capable of parasitizing grasses including rye with which the bread was prepared. Ergot intoxication was capable of leading to hallucinations that led those affected to relate the disease to imaginary demonic or supernatural forces, as the cause was not known. The disease was contracted in northern European countries, where contaminated rye was used to make bread. The sick, going on pilgrimage to the sanctuaries dedicated to Sant’Antonio, moved southwards, changing their diet and eating wheat bread, alleviating or eliminating the symptoms of intoxication. However, this effect was attributed to the miraculous work of Saint Anthony.
In the Renaissance we witness the birth of a new vision of the mentally ill. In Elogio della Follia Erasmo da Rotterdam describes the madman as the bearer of a different vision of existence and as such worthy of being respected. This line of thought will travel through history, leading to the phenomenology of Husserl and Jaspers in the twentieth century. During the sixteenth century Paracelsus dedicated to psychiatry the treatise of diseases that rob us of the reason in which it first restored their initial natural basis to mental illnesses, then proposed a main distinction of these pathologies in five different types, namely: epilepsy, mania, ” true madness ”, San Vito dance and suffucatio intellectus. The real madness is divided into 5 other categories, that is: lunatic, insane, Vesani,
In the seventeenth century there was a further secularization of mental illness, however, in this period the slow but progressive shift of the mentally ill person into an antisocial subject began and therefore forced to total physical isolation. The absolutist regimes favored internment campaigns of the poor and social deviants in special structures such as the Salpêtriere in Paris.
During the eighteenth century, important progress was made in the psychiatric field in the renewed cultural climate of the Enlightenment. The conceptions that saw psychiatric malt as a demon to be redeemed with flames definitively fell, and the foundations were laid for an innovative nosography of psychiatric disorders as well as an improvement in their assistance. In this sense, the Florentine Vincenzo Chiarugi was an essential figure who made a fundamental contribution to the psychiatry of the time. He returned the madman, in scientific and cultural terms, to the identity and dignity of a patient, that is, a person in need of care and hospital asylum.
Daughter of the Enlightenment and the French Revolution, psychiatry, at its beginnings, presents itself as a medical and at the same time humanitarian discipline, aimed at separating the mentally ill from the so-called deviants – vagabonds, prostitutes, delinquents, alcoholics and so on – with which until then they had been confused, in order to ensure their care and assistance from the State. Before 1838, in fact, psychiatric patients hospitalized for acute care at general hospitals, if considered incurable, were sent to a special section together with dangerous or marginalized individuals. It was in 1838 that the law on assistance to the alienated – future model of all European legislation on the matter – was promulgated in France, with which an institutional reality was sanctioned which, by virtue of its own logic,
Since the beginning of the nineteenth century, passion and irrationality, put aside by the Enlightenment, become the object of real cult and in the medical field the idea of the centrality of passions in the etiology of mental illness is making headway. Man is no longer rationality alone.
Esquirol, a French psychiatrist, formulates a theory according to which the madman can be cured precisely because his ailments are due to an “excess” of passion, to an uncontrolled passion.
Starting from this assumption, patient care cannot be limited to a series of imposed reasonings and treatments but depends on the direction of the “passions”.
The most severe treatments therefore do not represent the therapeutic basis but a tool to be used only in extreme circumstances.
In the second half of the 1800s the reductionist principle was affirmed according to which mental illnesses have organic and non-affective causes. The treatment of mental suffering passes through the study of brain anatomy and pathology in order to isolate the causes of each individual disease and define specific therapies.
Emil Kraepelin, a German psychiatrist, overcoming this approach through a more complex approach to psychiatry, combines brain anatomy and neurology with experimental psychology and the investigation of the patient’s history and produces the first important classification according to which serious mental illnesses occur they divide into dementia preacox and manic-depressive psychosis.
From the beginning of the twentieth century, based on the organic concept of mental illness, new treatments were introduced such as frontal lobotomy and electroshock.
Freud’s theory, according to which the difference between normality and madness lies more in the intensity and in the symptomatic quantity than in the quality, paved the way for a progressive departure of psychiatry from the purely organicistic sciences.
Important changes in the way we relate to mental illness were possible thanks to the introduction of psychotropic drugs, antidepressants, benzodiazepines and neuroleptics in the mid-1950s, and allowed to start treating patients suffering from serious psychotic disorders even outside the mental hospital context.
Between the 1960s and 1970s, the idea was affirmed that mental illness could be linked to social factors, a position supported by social psychiatry and by antipsychiatry, according to which society labels those who try to oppose themselves as mentally ill to the oppression and conformity of the system.
Any transgression of the social norm, even original and creative, is labeled as madness.
Finally, in the 1970s there was a sharp criticism of mental institutions, accused of punishing, through electroshock and constricting measures, people previously punished by family and society because they were not in compliance with the rules. These concepts and events led to our conception of mental illness today.