Selected Aspects of the History of Psychiatric Ideas and Institutions in the Past Two Hundred Years

More than any other medical discipline psychiatry has been and still is influenced by great ideas and social change. In the past 200 years psychiatry has experienced two revolutions of its system of care and an inhumane disaster. The French Revolution brought freedom and the right to treatment to the mentally ill locked away like prisoners in mad houses and insane asylums. As neither the causes of mental illnesses were known nor effective treatments available, the asylums soon resumed their old role as providers of custody and treatments that sometimes resembled torture. As a reaction to this situation German psychiatry bore an idealistic-educational movement, which in Kant's tradition interpreted mental illness as a lost order of mind. Around 1830 C. F. W. Roller developed a theory of isolation, according to which persons suffering from mental illness must be removed from their allegedly pathogenous environment to regain their order of mind in the strictly organized environment of a remote mental hospital. Roller's idealistic model of the isolated mental hospital spread around the world, thus essentially contributing to the isolation of psychiatry and the dreadful conditions that the mentally ill had to endure for almost a century. Evolutionary theory and genetics were followed by an ideological movement of biologism embraced by the leading classes in many countries. Medicine and care for the disabled were seen as counteracting the evolution of the mankind. The enormous increase in admissions to mental hospitals caused by social and demographic changes at the turn of the 20th century and decreasing fertility of the upper classes were misinterpreted as a degeneration of the population. After 1868 these fears led to more and more radical ideologies of eugenics and selective breeding. As a consequence of this movement Hitler in 1939 breached human rights by ordering the killing of the “incurably“ mentally ill. Some 200,000 individuals fell victim to this policy. After World War II psychiatry had to bear the brunt of this disaster. It was not until the reform process was established-in Germany with a delay of about 15 years-that conditions for the mentally ill started to improve. Substantial improvement in the long history of treatment of mental illness did not occur until psychotropic drugs were discovered in the mid 20th century. Developments from the Expert Commission to the present day will be briefly discussed.