Mental Health History

Because it is a mission of dedication, nursing has grown alongside religion as an option for service to others. Nowadays, it is not only important to understand health, but also illness, interconnected with the culture, beliefs, and social environment of each individual, with different meanings in different eras. The status of mental illness, replacing the old concept of madness, is recent, given that while in the past the madman was considered possessed, he was also an ignored patient, caught in a tight web of religious and magical meanings. Later, where only supernatural perversions were detected, the possibility of a deterioration of nature arose. In any case, throughout history, there has always been an attempt to decipher the essence of diseases, so “nurses” have always sought, in their observations, to highlight signs, symptoms, and their coherence [1].

Exploratory and descriptive, with reflective analysis following bibliographic research. The search for substantiated information was based on a descriptive approach, focusing on different time periods, their association with existing records on alienation, and how individuals with mental illness were considered and treated. The descriptive research concludes with an invitation to reflect on the evolution of mental health, its trajectory, and the influence of past experiences on the current situation.

Little is known about the care of mentally ill patients among primitive peoples. It is a period in which skeletal remains appear, with skulls that show evidence of trepanation (which allows us to inquire whether it was a way of opening the body for the “exit of spirits”... which allows us to respect that these vestiges were the records of the time...).

Egypt: Writing emerges. It is thought that diseases are caused by spirits that can be expelled with invocations and incantations. The temples represent hospitals; the professionals were the priests. If on the one hand there was the idea that the mentally ill patient was a sinner in the clutches of evil spirits, with care being taken to keep him away, there was also the behavior of exposing him in squares and roads, to signal him...

Greece: initially, the idea of diseases being associated with gods and superstitions was maintained. Later, at the height of Greek culture and with Hippocrates, disease was consolidated as a derangement of the organism, so professionals should strive to observe and describe the symptoms and signs of patients as meticulously as possible… In addition, the first specific care for the mentally ill emerged “…do not disturb the patient during or after a crisis…it is a good sign when sleep puts an end to the delirium…” [2].

Christianity: it is the women of the family who provide assistance to the needy, from a religious perspective of caring with charity “…deformed children, chronically ill people, disabled old people and the insane should be helped in their illness…until death takes them from this world” [2].

Middle Ages: asylums emerged that were not only for the insane, but for a whole range of individuals (the poor, the disabled, the elderly in misery, beggars, libertines, those with venereal diseases, the persistently unemployed). These houses were not intended for health...one was not admitted for treatment...one was admitted because one could no longer or should not be part of society, representing a restricted world, the world of exclusion. Hospitals had beds reserved for the insane (closed beds, a kind of cage to hold furious individuals. Patients with more serious or aggressive mental disorders were flogged, chained, driven out, and subjected to prolonged fasting). These houses revealed a closed system, where forced labor reigned (spinning, weaving, manufacturing objects), with a role of sanction and moral control. With the Crusades aimed at expanding the Christian empire, religious orders such as the Franciscans and the Order of St. Lazarus began to emerge.

Well-organized hospitals, known as hospices, were created to care for the sick with great dedication. The mentally ill, who until then had been mistreated and imprisoned, began to receive greater understanding, and asylums arose to house them. The need to perfect the art of alleviating human suffering and misery was reinforced, as was the idea that meticulous observation and practice were useful for the study of disease.

15^th Century: Following the tradition of charity, the Misericórdias (charitable brotherhoods) emerged. Portugal had many destitute, blind, orphaned, mutilated, and hungry people… consequences of the wars. Under Queen Leonor, the Royal Hospital of All Saints (Praça Figueira) was created, with a wing for consultations and administering medicine, a special award for nobles, a wing for abandoned children, and a specific wing for the mentally ill. In this century, Saint John of God (1495) was born in Montemor-o-Novo, and at the age of 8 he left for Spain. Initially a shepherd, as an adult he decided to dedicate himself to the most destitute. His aspiration, devotion, and fiery speeches were so great that he was considered insane and interned in the mental health section of the Royal Hospital of All Saints in Spain. He experienced the cruelty of the existing methods, which were applied to the “most agitated,” such as being tied up and “whipped until he calmed down.” He decides of his own accord to “become calmer” so that he can put his projects into practice with a hospitable spirit: “dedicating himself to those most in need...he dreams of a clean and airy room...and tries to give each patient the food that is most suitable...as well as the medicines they need.”[2].

The year 1550 is marked by the death of St. John of God in Granada on March 8th, after a life dedicated to the sick and mentally ill. In 1606, the Order of St. John of God was formed, which advocated the separation of the sick according to their illnesses into separate compartments, where the mentally ill were treated with gentle and caring manners. Due to visible results, this Order was invited to reorganize military and naval hospitals. Later, in 1741, the book “Religious Postilla and Art of Nursing” was written by Father Santiago of the Order of St. John of God, where one can read “The classrooms where you will study will be the wards, where the books are the sick...”[3]. The concept of Postilla derives from the French Apostille, meaning annotation, and being a set of handwritten explanations about the performance of nursing at the time, one can speak of nursing records... Emphasis is placed on respect for the dignity of individuals in all dimensions of their personality, with the same concern for helping them.

18^th century: large asylums proliferate. While in the Middle Ages and with religious orders there was some understanding towards the mentally ill, this century saw a regression in treatment. The situation of internment was imposed on the mentally ill, the patient being removed from their family and deprived of liberty. The reformers in 1789 sought to replace internment by returning the mentally ill to their families and freedom, but doubts about their dangerousness persisted and the need to contain them resurfaced. The psychiatrist Pinel stands out, reinforcing the idea that the mentally ill should receive treatment and compassion in appropriate establishments, and that those less agitated should not be incarcerated. Asylums gave rise to other institutions, this time exclusively for the mentally ill; however, the treatment methods remained similar. The idea arose of creating a kind of family for these patients, where they felt comfortable, but where moral control remained the same. Punishments, threats, food abuse, and humiliations were used as means to instill guilt in the patient for less-than-correct behaviors. There are records of ice baths, applied if the patient committed a transgression or experienced a delusion, forcing them to deny what they had revealed; there are records of a rotating machine where the patient was placed, spinning them until they fainted (the goal was to restore their reasoning to its natural circuits) ...

19^th century: records concerning the living conditions of mentally ill patients in large hospitals, such as São José in Lisbon and Santo António in Porto, reveal a lack of hygiene, and the absence of light, furniture, and ventilation in the rooms. The Rilhafoles Hospital received people by order of the authorities and in the name of decency, order, and public safety, since the mentally ill had not yet acquired the status of patients. Florence Nightingale implemented reforms at various levels, most notably emphasizing the importance of record-keeping and documentation.

In no sphere of human action has the inhumanity of men towards man been more evident in the past than in the treatment of madness [4]. The history of mental health thus leads us to reflect on the possibility that knowledge may have been linked to forms of cruelty. If this historical journey highlights a change in the ways of viewing, explaining and treating mental illness, according to the era and the social, cultural and scientific context, psychic understanding implies, on the part of the Mental Health Nurse, an attitude of predisposition, attention and discernment regarding the individual’s reactions as they are experienced by him, and interconnected with culture, beliefs and environments. In this way, this reflection has shared the paths taken by a vast number of “nurses” who, over several centuries, developed a set of activities with the mentally ill. The needs identified in this area and the inherent lack of literature provide an incentive for further research, since seeking the past with different meanings in different eras is a path that must be taken to analyze the present and envision the future.

1. Foulcaut M (2008) Mental illness and Texto & Grafia Editions Ltd, Portugal.
2. Nogueira M (1990) History of Porto Salesian Editions, Portugal.
3. Sant-Iago D (2005) Religious postilla and the art of nursing: Furnished with erudite concepts from various literate, moral, and scribal authors. Lisbon Alcalá Portuguese, Portugal.
4. Walker K (1958) History of Lisbon National Advertising Company, Portugal.