The Evolution of Psychiatry across Europe
Based on current United Nations (UN) estimates, Europe has a population of over 740 million people with mental illnesses accounting for nearly 20% of all diseases in Europe, affecting 1 in every 4 people (WHO).
Unlike third world countries, General Practitioners (GP’s) in 95% of European countries refer people with mental health problems, 86% diagnose mental health problems and an equal amount regularly treat people with common mental disorders (WHO).
This wasn’t always the case, Europe has a checkered past when it comes to the issue of mental illness. Let’s take a journey through European mental health history from the classical Greek society to present.
Classical Antiquity Era (776 BC – 300 AD)
During the classical era, the belief in Greek society was that psychotic behaviour could be attributed to magical and paranormal entities. They interpreted this behaviour as a form of punishment for wrongs committed against the gods.
Though this was the norm, there were a few individuals who believed it to be an illness rather than the possession of a demonic entity.
Philosopher’s Hippocrates (460-370 B.C.) and Plato (428 – 328 BC) contributed to the early description of mental illness believing it to be a health issue as opposed to a spiritual or religious matter.
Despite limited knowledge on the anatomy of the brain, Hippocrates described the brain as the interpreter of consciousness and the body’s most important organ.
He described depression, epilepsy, psychosis and hysteria, concluding that they were the consequence of a diseased brain and recommended treatment such as rest, bathing and dieting.
In fact, the Hippocratic School of Medicine approached the study of medicine in a holistic way where social, spiritual, physical and psychological factors were held responsible for the cause of mental disorders.
Plato on the other hand described the concepts of health, as harmony between body and mind and disharmony between the two was the cause of mental disorders. He believed that disturbed behaviour grew out of conflicts between emotion and reason.
Middle Ages and Renaissance Era (300 AD -1600 AD)
Transitioning into the middle ages, the Roman Empire rose to conquer much of Europe effectively ending ancient Greek culture ushering in a new era led by the Roman Christian church.
As the church’s influence increased, so did it’s role in governance, and it was religious creed not civil law that became the supreme voice of authority.
The church came to control the practice of medicine, defining it’s goals and prescribing treatments for various conditions. Thus ending the legacy of rationale inherited from the Greek philosophers.
Demonology and superstition gained renewed importance in the explanation of abnormal behaviour. Many people strongly believed in casting out of evil spirits from the body of an afflicted person.
Despite these beliefs, enlightened governments like England made serious efforts to care for mentally ill people as the Crown had the right and duty to protect them.
Thus, the English government sought to treat each patient as per their condition by dividing them into two categories, natural fools and persons non compos mentis.
A natural fool was a mentally retarded person whose intellectual capabilities had never progressed beyond those of a child, what we today call childhood developmental disorders.
Persons non compos mentis (Latin for “not sound of mind”) were persons who did not show mental disability at birth. Their deviant behaviour was not continuous, and they might show long periods of recovery.
English physician John Weyer (1515 – 1576), emphasized psychological conflict and disturbed interpersonal relationships as causes of mental disorders. He was resolute in the belief that witches were mentally ill, rather than agents of Satan.
He argued that clinical treatment must be geared towards meeting the needs of the patients rather than simply following religious rules. He spent a lot of time observing his patients, concluding that inner experience and disturbed relationships with others were significant causes of mental illness.
The Age of Reason and Enlightenment (1600 AD & 1700AD)
During the 17th and 18th centuries, known as the Age of Reason and Enlightenment respectively, reason and the scientific method came to replace faith and dogma as ways of understanding the natural world.
In England the movement toward humane treatment gained impetus as a result of the psychotic breakdown suffered by King George III in 1765.
This event precipitated a constitutional crisis and made many people aware that even prominent individuals were not immune to mental illness.
Madhouses had existed in England for many years, but only in 1774 did Britain pass its first parliamentary act licensing such institutions and regulating the admission of patients to them.
French physician Dr. Philipe Pinel worked at the Bicetre Hospital, Paris which accommodated about 200 male patients. In 1794, instead of blows and chains, he introduced light and fresh air, cleanliness, workshops and promenades but above all kindness and understanding.
During the 17th and 18th centuries, both groups – those who analyzed subjective experience and those who sought to identify physical defects – finally rejected the idea that demons and supernatural forces were the causes of deviant behaviour.
As a consequence, by the end of the 18th century, superstition had been almost totally replaced by a commitment to rationality, scientific observation, and humane treatment of the mentally ill.
The Reform Movement (1800 AD – present)
The growth of a scientific attitude toward mental disorders in the 18th century contributed to an increase in compassion for people who suffered from them becoming the basis for the reform movement of the 19th century.
Thomas Laycock, a professor of Medicine at Edinburgh University published a book entitled, “Mind and Brain” in 1860. In the book, he stressed that ‘…a practical knowledge of mental science is essential to parents, jurists and legislators, governors of jails, schoolmasters, and teachers, ministers of the gospel, naval and military officers and employers of labour.’
In his view, psychiatry was not a narrow specialty but a discipline for general application in studying the conduct of man.
An important step towards humane treatment of the mentally ill occurred on May 25, 1815 when the British House of Commons ordered a ‘parliamentary inquiry into the Madhouses of England.’
At the time treatment was brutal. Patients were whipped, beaten, and chained in addition to the bleeding and vomiting treatments then generally common in medical practice.
One such madhouse was the Hospital of St. Mary of Bethlehem in London, had become known for the noise and chaos prevailing within it.
Their activities were of such great interest to the public that visitors often came to observe the antics of the patients. Tickets were even sold to this popular tourist attraction.
Many changes have occurred since then for Europe to be ranked as having some of the best mental health practices in the world.