Psychiatry

Whenever chance brings me together with someone and he learns the specialty to which I have devoted myself, he smiles a singular smile — half bashfulness and half strangeness — and says:
— So you doctor the mad?
And I say in answer to his question:
— No, my dear fellow; I doctor the sick.
Signs of astonishment mount his face, and he looks as though he had not grasped what I mean, or understood what I am driving at; and so I go on speaking, explaining to him the truth of my specialty and its nature.
I tell him how people, ever since they appeared on the face of the earth, have concerned themselves with themselves and taken note of the abnormality that comes over them and over their behavior. There is no doubt that the first of the human race realized from the very beginning that some people are stricken by something strange and obscure, which alters their conduct, twists their thoughts, and works upon their deeds and their behavior; and they noticed at the same time that these stricken persons for the most part complain of no evident ailment, no visible bodily defect. And so the truth of the matter was hidden from them, and they went searching for various interpretations and explanations of those strange phenomena; and these inquiries of theirs were far removed from matter and what arises from it, inclined, naturally enough, toward spiritual and metaphysical concerns. People in that epoch of human evolution believed that the world is full of spirits, and that these spirits are of two kinds: a kind that is all goodness and benefit, and a kind that is all evil and harm. They believed, too, that both kinds are able to work upon man — upon his mind and upon his body alike — and therefore they held that if there appeared in one of them an unpraiseworthy conduct, contrary to custom and usage and opposed to the prevailing religious, social, and political beliefs, they concluded that the person was under the sway of one of the spirits of evil. And they called these spirits devils and demons, or jinn.
But if there appeared in someone a praiseworthy conduct, conforming to the custom and usage then prevailing, and agreeing in particular with the religious, social, and political teachings, then the spirit ruling over him in that case, as they believed, was a spirit of goodness and blessing. And to these spirits they gave the name of angels.
And who among us does not know all this?... But what concerns us in this account is that these views were, and still are, spread far and wide among the common run of people; and in the past they were the first foundations upon which the men of religion — and some physicians as well — built their teachings concerning those stricken with mental illnesses. These strange beliefs had a far-reaching effect upon the course of psychiatry and its evolution.
If we turn to the other branches of medicine, we notice that they were, on the whole, earlier than psychiatry in evolution and progress. This goes back, in truth, to the fact that the psyche, the mind, and opinions did not submit to detached study with the ease with which the body and matter submitted. Moreover, the psyche was from the beginning a special preserve of the priests, who monopolized it and refused to give it up; they exploited it and forbade all others to occupy themselves with it; they preserved its primitiveness and the old reactionary

theories that had treated of its affairs, and they beat back every attempt made by the liberated among physicians, philosophers, and scholars to make clear its features and to light up its dark regions.

And since the prevailing faith held that the causes of mental illnesses are metaphysical, religious, spiritual, their treatment remained within the compass of superstition and metaphysics. Many believed that the sole means of curing the sick man lay in driving those accursed spirits out of his body. So they tried — and still try — to drive them out in various ways. Some shackle the patient and wind his legs about with ropes and chains down to the foot, then rain blows with sticks upon the soles of his feet, believing that if the spirit feels pain from this beating, it will go out of the sick man in flight... Some cauterize the patient on his head, supposing that the heat of the cautery is enough to expel those spirits... Some would bore a hole in the skull, that the spirit might escape through the hole... Some bind the patient with fetters and shackles and tie him fast to a wall or to a huge stone, firm-set and immovable, believing that the evil spirit cannot endure confinement or captivity, and will soon gather itself up and desert its victim, never to return... And the patient would be thrown into a dark, filthy corner and given the worst of foods, and salt water, and dry black bread, so that when the spirit dwelling in him could no longer bear this ill treatment, it would leave him and go far away... People went to such lengths in inventing methods and devising means that some of them went so far as to burn the patient whole, to drive that unclean spirit out of his inward parts; and they looked upon the death of the patient as a secondary incident beside the great benefit he gained.

Do I exaggerate if I say that most of the patients we see and examine have tried amulets, written charms, and talismans, and have visited the priest or the sheikh before finding their way to us — the one read over them and the other blessed them, and neither did the one profit them nor the other avail them?... Nor is that all: if we review the vocabulary we use in our everyday talk, we find that we still use the very same words the ancients used. We say today of the old abandoned house, for example, that it is inhabited — meaning that jinn and spirits dwell in it. And we speak of the man stricken with mental ailments in a similar fashion: we say that so-and-so is inhabited, or rather possessed, or touched, or brushed; and what we mean by this is that one of the evil spirits has clothed itself in him, or touched him, or brushed against him... And when they write charms for him, or trace lines for him, or read over him, or take him on visits to the monasteries and the saints, they do so on the strength of an old maxim, namely that "when the angels come, the devils depart" — a belief that has become one of the famous proverbs...

And perhaps we may observe that the greatest trace of the old views in the present time is that we still describe those stricken with strange mental symptoms, those who walk the paths of abnormal behavior, by saying that they are "majnun" — mad; and the madman is not a sick person, but a person whom the jinn have clothed themselves in and mastered... This is an important and grave matter, for our view of those stricken with mental illnesses in these days is not the offspring of the knowledge we have attained, nor does it spring from our grasp of the truth of these illnesses, or from any feeling of ours that those stricken with them are still of mankind, that they feel and sense and think like other human beings. It is a view differing utterly from our view of any other sick person, and that because we did not believe, before, that they were among the sick; rather we counted them among those of evil souls and abominable morals and weak, wavering faith — for how else could the evil spirits have been able to enter into them and work upon them and make of them a brute instrument of their passions and their ends?...

For this reason those stricken with mental illnesses became hated; people fear them and take pains in torturing them and punishing them for what their souls have committed; their families disown them, and friends and relations keep far from them... And so the illness — an illness and nothing more — became a shameful disgrace, a stain that nothing could wipe away but burning or death or retribution... or the other methods of expiation.

It is only fair that I point out here that this ill treatment was a feature of social life in Europe more than in any other spot on earth — to a degree that leads us to believe that in certain epochs it was peculiar to Europe alone.

That is the reason psychiatry lagged so far behind in its evolution. But the scholars and the physicians were able to

master public opinion and gather the reins of these matters into their own hands, defying thereby all the social authorities — religious and political alike — for the sake of the rise of a new science, firm of pillars and fixed of foundations, submitting entirely to scientific methods and their laws and to rigorous ways of research. And for this they paid everything dear and precious, and paid it lavishly... They suffered persecution, and torture, and homelessness and exile, and poverty, and privation... And that for one reason only: they wanted to replace those false, fanciful views with realistic, scientific views, and they believed that "mental illnesses have no connection whatever with evil spirits or with devils"; and instead of studying how to expel these alleged spirits, they devoted themselves to the study of the effective means of treating those illnesses and curing them.

Psychiatry — which studies and treats all the abnormal states that afflict man's psyche and his mind and his individual and social conduct — is one of the modern branches of medicine. And we do not overstep the truth if we say that in its present form and in its current scientific state it is a very recent branch indeed, which saw the greatest and boldest strides of its evolution in this century — nay, in the years that followed the First World War. It is today one of the branches of knowledge that have done away, to a far-reaching degree, with superstitions and reckless fanciful notions, not in medicine alone, but in many other fields besides: in sociology, in psychology, in history and philosophy and elsewhere. And we do not exaggerate if we say that psychiatry — and the sciences of the psyche in general — is among the cultural weapons we employ in every field of life, be it political or social or industrial or educational... For it concerns itself with man insofar as he is a living human being: it studies people's thoughts and decides between the reasonable among them and the unreasonable; it analyzes their emotions and feelings, to decide between the abnormal among them and the normal; and it devotes the greater part of its activity to the study of their conduct and behavior, separating the acceptable therein from the unacceptable...

The task of psychiatry is man's well-being in all its aspects, and his liberation from the bonds of superstition, of partiality, and of intellectual and doctrinal despotism. And a task carrying such a mission is a grave task, no doubt of that; and full readiness to undertake it is among the necessities that demand special study, wide general reading, and a comprehensive, steady effort... The aim behind all this is that we make of the individual whose mental and emotional rights have been lost among illusions and superstitions a human being free of psychological bonds, of their fears and their tyranny... regardless of whether he is mad, as they say, or not mad, sick or not sick... For, after all, these are all human beings...