History of Psychiatry: Madness,Science,Culture

In this paper we present some elements of the history of 'scientific' psychiatric hydrotherapy and, moreover, of a particular form of the water purifying ritual - that is, foot washing - among the populations living in Greece and in Orthodox communities in the Balkans. We speculate on the reasons that caused the virtual disappearance of the former, while the latter still flourishes.

The concepts and techniques involved in the origins of psychosurgery during the late nineteenth century are analysed, particularly in the work of Claye Shaw and Gottlieb Burckhardt. It is shown that their views and therapeutic behaviour were guided by scientific, ethical and social warrants not dissimilar from those of today. The debate that followed their work can thus be considered as a trial run to that elicited by the work of Moniz. This paper focuses on the work of Shaw, Cripps, Tuke and Duncan for, until now, it has not featured in any history of psychosurgery. From the point of view of the history of science, their work is important, for it relates to the debate on brain localization, neuronal circuits and the neurobiological representation of mental illness that took place at the dawn of the twentieth century. Nothing is said on the history of psychosurgery subsequent to the work of Moniz.

Archival records of physical restraint usage at the St. Louis Insane Asylum (now the St. Louis State Hospital) were examined from January through June 1885. The demographics of restrained patients were determined from archival admission records. In the 6-month (181-day) sample period, 53 patients accounted for the total of 2,537 incidents of night restraint. Sixty percent of the restrained patients were women and 53% were immigrants. By far most (98.5%) of the incidents of restraint were brought on by violent behaviour (fighting, destroying property, injury to self) while most incidents in modern hospitals result from verbal threats or shouting. When these records were combined with day restraint records from the same 6-month period in 1889, an overall incidence rate of 9.7% per month was estimated. This is similar to rates reported from modern psychiatric hospitals. Possible reasons for the discrepancies and similarities in the types of patients restrained and the activities which brought on restraint in the nineteenth and twentieth centuries are discussed.