Traditional histories of psychiatry, and those which preface the standard medical textbooks on the subject, are good examples of Whiggish historical writing. The dark ages for madness last until the end of the 18th century when Pinel's dramatic removal of the chains of lunatics at BicÍtre, and the establishment of the York Retreat by William Tuke, inaugurate the psychiatric enlightenment. The development of the asylum bears witness to the increasing ability to distinguish between the mad and the poor, idle and criminal classes, and to attempts by various reformers, notably the Tukes and John Conolly, to institute a system of humanitarian care for their patients. After these early steps away from the cruel and barbarous treatment of the mad of the preceding centuries, the medical profession began the process of putting the treatment of the mental illnesses on a more scientific footing. The 19th century saw the identification of a number of organically-based mental diseases, while the early 20th century saw the development of a scientific psychological medicine, informed by the writings of both Meyer and Freud, which could integrate non-organic factors into the aetiological picture of the various conditions. More recently, the development of ECT and the post-war chemotherapy revolution have made possible the management of patients in the community and a partial phasing-out of the now decaying institutions in which they had been housed. While much remains to be done, there can be no doubt that the treatment of the mentally ill has advanced immeasurably since the dark days of the 19th century and before, when the mad were chained, whipped, imprisoned in straw-strewn cells, and exhibited to a curious public for the price of a penny.
LRB 3 April 1986 | PDF Download