The history of psychiatry goes back about two thousand years. However, the last 150 years have seen the most developments in psychiatry as we know it today. In the past, the emphasis was on the medical side of psychiatry. In the years after the war, the medical aspect became less important. In recent years, more and more people have been looking at it from a medical point of view. Thus, developments within psychiatry continue to swing back and forth.

• Antiquity
• The Middle Ages
• Rationalism
• Situation until 1950
• Situation after 1950
• Antipsychiatry and dehospitalization
• Current situation

Antiquity

As long as man has existed, he has attempted to gain insight into his own being and the functioning of body, mind, the interaction between them and the diseases that can arise. The Greeks spoke of the presence of internal forces or the will of the gods when someone was mentally ill. Hippocrates (460-375 BC) made the connection between physical and mental functioning. This led to the realization that mental illness was a disease of the brain. More scientific explanations were sought and the magical explanations were no longer sufficient. At that time, there was a great search for physical causes for psychiatric problems. This is called biological psychiatry.

The Middle Ages

In the Middle Ages, care for the mentally ill came down to the family and close relatives. During this time, more and more attempts were made to offer them treatment. There were no medicines at that time, so herbs, prayers and exorcisms were used. Exorcism includes witch burnings, in which anyone suspected of witchcraft was burned at the stake. Many mentally ill people were victims of this. The treatment of physical complaints was not much different. When family care did not help, the mentally ill were often given up. These people often ended up on the street and started to lead a wandering life and neglect themselves. The current psychiatric syndromes correspond to the descriptions of the syndromes from the Middle Ages. There was an increasing need for shelter options for the wandering mentally ill. The first institutions emerged at the beginning of the 15th century. The first asylum in the Netherlands was founded in 1425. These homes became a kind of prison for all people who wanted to be removed from society. These people were in the institutions without any therapeutic purpose or prospect. The criminals who also ended up in these institutions were used as cheap labor. However, they eventually suffered from their mentally ill fellow residents. Madhouses were then created to house the mentally ill.

Rationalism

Around 1800 the time of rationalism began, with greater insight into the diseases and the belief that the diseases could be treated and perhaps even cured. The Parisian physician Phillipe Pinel (1745-1826) wrote the first manual on psychiatry. Ways were sought to nurse in a humane manner, without the use of coercive measures. In the mid-nineteenth century it became clear that psychiatric patients benefited from having structure in their day and from being guided in this. The first law on the insane was introduced in 1841. This law made it easier to admit the insane. And in addition, the law offered resources and rules to improve the legal position of nurses. Despite the improved insights, people still did not know what to do with the mentally ill. On the one hand they wanted to get people back into society, on the other hand they placed new buildings on the edge of the city to accommodate the mentally ill. The composition of the institutions was also still very mixed, with, in addition to the mentally ill, also addicts, dementia and antisocial people. The scientific boom during the time of rationalism (invention of X-rays, developments in chemistry, etc.) brought with it more knowledge of psychiatry and influenced the approach within psychiatry. This is how psychiatry became a profession in itself. The German physician Emil Kraepelin (1856-1926) played an important role in psychiatry because of his theory of pathology. The French neurologist Jean Charcot (1825-1893) became famous towards the end of the nineteenth century. He conducted experiments on patients using hypnosis. One of the people who attended his lectures was the Viennese neurologist and psychiatrist, Sigmund Freud (1856-1939). There is more information about Freud later in this report. In any case, it is certain that Freud’s teachings and theories have had an unprecedented influence on all of social life, and in particular on psychiatry.

Situation until 1950

By this time there were the independent psychotherapists and the asylum psychiatrists. Everyone had their own method. During this period, many female nurses were hired within the institutions, to give the institutions a more open and friendly appearance. Occupational therapy emerged. The insight came that it is important to be busy and have a daytime activity. People were therefore put to work as much as possible, adapted to their capabilities, so that it could have a therapeutic effect. The resources for treatment were still limited. To maintain peace in a department, heavy sedatives and opiates were used, to which people quickly became insensitive and became addicted.

Situation after 1950

The 1950s saw the advent of medicine, which revolutionized psychiatry. There was no more unrest in departments, there was much less compulsory nursing and social contacts were established. The medications used were effective, but often had unpleasant side effects, which made people prefer not to take medications, especially if their complaints decreased. Depot preparations were introduced, in which an injection was given at intervals of a few weeks or a month, which was slowly absorbed into the body. This allowed people to live more independently and were no longer tied to taking their medications every day. As more and more disciplines emerged that dealt with the daily lives of psychiatric patients, a resistance arose against medical power. They were against all interference and wondered whether all this was really necessary. This resistance movement is known as antipsychiatry.

Antipsychiatry and dehospitalization

The advent of new medicine in the 1950s led to the belief that psychiatric patients could be cured of their illnesses, and that institutions could eventually be closed. However, this turned out not to be the case, as few chronic conditions could be cured. Without medication, the complaints returned, and these medications also had side effects. The anti-psychiatry that emerged was convinced that psychiatric complaints were not so much an illness, but an expression of problems within society. An urge arose to break away from authority and lead a life of one’s own. This led to the creation of communes and increased drug use. This idea was followed within psychiatry and the distance between patients (from then on called clients) and practitioners was reduced to radiate less authority. There was no longer treatment, but guidance. The hierarchy disappeared and the psychiatrist was no longer at the head of the table, but ended up in the team of various disciplines. Dehospitalization emerged from this period, in which people with a chronic illness were released from institutions as much as possible. The emphasis was on this, and no longer on the treatment itself. Focus was placed on the daytime activities of patients and investments were made in social services. However, this resulted in people falling between two stools, not being treated appropriately and therefore becoming homeless. This belief was then retracted.

Current situation

It has been shown throughout history that psychiatry follows the views of society. An attempt is always made to find a balance between the independence of a psychiatric patient and the professional patronization and interference that comes with this. A major development is the creation of the DSM-IV. This is a manual that is used worldwide and offers a clear language for diagnosis. This has made psychiatry much more precise. Psychiatry continues to develop in this way based on society.