EDITORIAL
Retrieving the history of psychiatry
Flávio Shansis
Editor, Rev Psiquiatr RS
Recently, in 2007, Goodwin & Jamison launched the second edition of their book Manic-depressive illness.1 Since its first edition, this publication has been a landmark for all psychiatrists and especially for those who dedicate to what is today considered bipolar disorders (BD). More than presenting updated information about this theme, it has drawn attention, since its first edition, to the authors' focus on historical retrieval. In this case, on historical retrieval of the concept of manic-depressive illness. Goodwin & Jamison resume the Kraepelian concept already in the title of their work, by making it clear that manic-depressive illness comprehends not only what we today understand as BD, but also recurrent depressions. According to current classification systems, they are part of the so-called unipolar disorders.
What could be just a conceptual discussion, in our understanding, is much more than that. Those American authors retrieve a past of tradition in European psychiatry and, by doing so, question the classification manuals currently in use. Indirectly, they accuse contemporary psychiatry of forgetting its past by "slicing" diagnoses instead of inserting them into a psychopathological coherence (which has caused an increased and questionable frequency of the so-called "comorbidities"). This is, therefore, the great merit of these authors by emphasizing the need of always seeking in history itself answers for current dilemmas. Situations in which "the wheel had already been invented" are not rare. In times of fast food, the information society forgot that the world did not start when man reached the moon. Current psychiatry, which is strongly influenced by American psychiatry, insists on believing that there was no "intelligent life" before the so-called DSM (Diagnostic and Statistical Manuals of Mental Disorders).
In 1899, Emil Kraepelin,2 in the introduction of his classical textbook, already made an essential remark for those who intended to dedicate their lives to the mentally ill. He said: "Those who treat and study mental diseases should first, based on bedside observation, outline the clinical forms of the disease; they should define and predict its course, determine its causes and discover the best treatment and then, finally, prevent insanity." We know that alienists, when having a close contact with their patients, could observe and describe the evolution of many psychiatric disorders. One the one hand, they lacked therapeutic resources at that time, but on the other they had clinical accuracy and intellectual brilliance.
Hippocratic writings, such as Nature of Man (400 b.C.), already showed a humoral nature of mood variations, such as black and yellow bile. Aristotelian thinking valued the heart more than the brain as the dysfunctional organ in melancholy. Arateus of Cappadocia (second century A.D.) made brilliant descriptions of manic conditions, which were elaborated and compiled by Galen of Pergamum (131-201 A.D.). Until the Middle Ages, the classical Greek-Roman concept that physical and mental afflictions should be under medical care was maintained. It was when the medieval "Age of Darkness" attributed the domain of diseases to the Catholic church. Fortunately, many essential documents were not burned thanks to the brave work by physicians such as Avicenna (around 1000 A.D.). In the 19th century, and before that, French (Pinel, Esquirol, Falret, Baillarger) and German (Kraepelin, Griesinger) schools undoubtedly contributed to the development of psychiatry. And it is in this historical context that Brazilian psychiatry arises: as young as our country. History tries to help us understand our imperfections. Looking at our past as a nation and at the past of our specialty can help us better tolerate our limitations. However, it can also enable us to remake previous paths often chosen in a disputable manner. It has been evident that psychiatry needs to rethink itself. It has been equally evident that Brazilian psychiatry also needs it. In the past issue of our journal, we focused on the future, as an attempt to predict what lies ahead of us in our specialty. In the current issue, we turn our eyes to the past, try to understand current good and bad outcomes of Brazilian psychiatry in search for answers since its origins. Revista de Psiquiatria do Rio Grande do Sul once again reaffirms that the history of psychiatry plays a major role in its editorial line. Now is the moment to retrieve even more the history of Brazilian psychiatry. May it help us search for solutions for a public health system that has caused so much suffering to those with mental diseases.
References
1. Goodwin FK, Jamison KR. Manic-depressive illness: bipolar disorders and recurrent depression. 2nd ed. New York: Oxford University; 2007.
2. Kraepelin E. Manic depressive insanity and paranoia. Edinburgh: Livinsgtone; 1921.
Publication Dates
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Publication in this collection
13 Dec 2007 -
Date of issue
Aug 2007
