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British-born Dr Edward Waldegrave Wardley (MRCSL, 1842) is an unacknowledged pioneer in the history of mental health care in Australia. Between 1857 and 1872, he assisted in the development of a policy of non-restraint across lunatic asylums in New South Wales (NSW). He then went on to extend this approach to the treatment of NSW's criminally insane patients. In addition, he trialled experiments to intellectually engage educated psychiatric patients across the colony. A prolific writer, and sufferer of chronic depression, Dr Wardley serves as a unique example of a nineteenth-century alienist with lived experience of mental illness.

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We address the unconsciously biased perception of psychiatric disorders, highlighting a hierarchical perspective that favours certain diagnoses over others. We aim to uncover reasons for these inequities, emphasising the need for a shift toward pathophysiology-based nomenclature that can promote equal support for each disorder, enhance treatment adherence and encourage open discussions.

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The intriguing story of dhat syndrome is that of medical modernity (psychiatry, clinical sexology) declaring medical premodernity (Ayurvedic concepts of semen loss) as its object. The early history and prehistory of this "culture-bound" diagnosis help understanding it as a dynamic confrontation of local, shifting knowledges. For instance, semen loss anxiety was an established motif both in European early twentieth-century psychoanalysis and again in several Indian psychodynamic texts of the 1960s. Moreover, it became problematically tied to notions of "Indian character". Little realized is that European venereologists were dealing with much comparable clinical presentations since the late eighteenth century, often resolving them in strikingly similar ways. For centuries, European proto-endocrinological ideas tied masculinity to the absorption and recirculation of semen, informing popular conceptions of "semen loss" (spermatorrhea) much comparable to those driven by dhatu physiology, dovetailing in colonial-era medicine. Expressive of growing controversy concerning this physiology after the mid-eighteenth century, a leitmotif of exaggerated fears tied to both "quacks" and proselytizing leading authorities such as Tissot and Lallemand, informed diagnoses of "tabes imaginaria", "spermatophobia", and "imaginary spermatorrhea."

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To address some challenges facing psychiatrists today we discuss issues of happenstance and fulfilment in psychiatric careers through some of the record and reflections of four psychiatrists since the 1950s. We trace the changes in psychiatry attendant to the transition from the welfare to the neoliberal state and=its contemporary postmodern culture. We highlight the crucial importance of political-cultural as well as technological developments in determining psychiatric service management and provision, and clinical practice and career outcomes. In the light of this impact, in a global era that some highly respected authorities consider in apocalyptic terms, we advocate for the incorporation of training in political awareness and activism in the psychiatric curriculum and practice. We suggest that this is necessary for social justice and patient welfare and that it will help safeguard psychiatric professionalism, conscience and self-esteem.

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This paper reflects on a special edition of the journal History of Psychiatry and a related symposium held at Somerville College, Oxford, exploring the innovations in mental healthcare in Oxfordshire led by Dr Bertram Mandelbrote between 1959 and 1988. I draw on clinical culture, biography, mental health policy and my lived experience to understand Mandelbrote's life and work, and his legacy and lessons for contemporary psychiatrists. I explore the ecological niche that Mandelbrote created and conclude with the probable importance of his relationship with Professor Michael Gelder, who led the University of Oxford Department of Psychiatry at the time.

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We report on the play entitled Le Pain quotidien (The daily bread) by Marcel Réja (1873-1957), a French alienist and historian of art in asylums. He also wrote short plays, although he is less well known as a playwright. The plays were printed just in time for the performance, which often took place on the day of the asylum fair. Here, we discuss a one-act play consisting of four scenes in which the actors are his patients.

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Phrenitis is ubiquitous in ancient medicine and philosophy. Galen mentions the disease innumerable times, Patristic authors take it as a favourite allegory of human flaws, and no ancient doctor fails to diagnose it and attempt its cure. Yet the nature of this once famous disease has not been properly understood by scholars. My book provides the first full history of phrenitis. In doing so, it surveys ancient ideas about the interactions between body and soul, both in health and in disease. It also addresses ancient ideas about bodily health, mental soundness and moral 'goodness', and their heritage in contemporary psychiatry, offering a chance to reflect critically on contemporary ideas about what it means to be 'insane'.

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In 1762, Louis-Antoine Marquis de Caraccioli (1719-1803), a prolific writer of the eighteenth century, dedicated a book to a psychological theme that medicine has forgotten: 'gaité' in French, which we will translate as 'cheerfulness'. At the beginning of the nineteenth century, this work inspired two doctoral theses in medicine, one defended in Montpellier, the other in Paris. In their texts, Louis Monferran (1785-?) and Vincent Rémi Giganon (1794-1857) explored the therapeutic benefits of the medical prescription of cheerfulness. In addition to lifestyle recommendations, they focused on the psychotropic substances available to them: alcohol, coca, hemp and opiates. In an original and novel way, Giganon introduced and recommended 'le gaz oxydule d'azote inspiré', or inhaled nitrous oxide gas.

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AIMS: The objective of this paper is to explore the evolution of the forms of madness and the model that accounts for it over time. The classical distinction between several categories of mental disorders is contrasted with the idea of unitary psychosis. METHODS: Historical conceptual analysis. The concept of unitary psychosis is explored in its basic features. Its origins in the nineteenth century and developments during the twentieth century are considered. RESULTS: Following the publication of Kraepelin's fundamental handbook, the debate was shaped as pro or against the Kraepelinian dichotomy between dementia praecox and manic-depressive illness. However, the origins of the concept of unitary psychosis as well as some more recent developments are independent from it. CONCLUSIONS: This article argues that, when viewed pragmatically, both positions (the pluralist and the unitary) bring advantages that can be complementary rather than mutually exclusive. The pluralist position allows us to recognize the qualitative differences between phenomena and structures of experience, while the unitary model prevents us from reifying them. This is achieved by paying attention to the diachronic evolution and the pathogenetic dynamics.

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The adult form of attention deficit hyperactivity disorder (ADHD) has increasingly become a focus of adult psychiatry. Despite long-established diagnostic criteria and specific therapeutic approaches for the disorder, the common misconception that ADHD is a "fad" has persisted. Examining the history of psychiatry can make an educational contribution by showing that the adult form of ADHD is a continuously existing illness phenomenon. The present study examines the discussion of sometimes prominent authors about "chronic mania" in German-speaking psychiatry around 1900. The individual concepts were analyzed for their content and compared with each other and with modern diagnostic manuals for adult ADHD. The aim of this work is to question and discuss whether these "chronic-manic concepts" are part of the conceptual history of adult ADHD and whether a gap in the history of this disorder can be filled with their help. It is concluded that in the early twentieth century neurologists reported and discussed about patients who nowadays would almost certainly receive the diagnosis of ADHD. The psychiatrists had difficulty in classifying this disorder into their nosological schemes but their "chronic-manic concepts" show clear parallels to the current diagnostic criteria for adult ADHD and its symptoms.

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We present a social-historical perspective on the evolution of the voice-hearing phenomenon in Western society. Based upon a systematic search from a selection of nine databases, we trace the way hearing voices has been understood throughout the ages. Originally, hearing voices was considered a gifted talent for accessing the divine, but the progressive influence of monotheistic religion gradually condemned the practice to social marginalization. Later, the medical and psychiatric professions of secular society were instrumental in attaching stigma to both voice hearers and the phenomenon itself, thereby reinforcing social exclusion. More recently, the re-integration of voice hearers into the community by health authorities in various countries appears to have provided a new, socially acceptable setting for the phenomenon.

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Many people like to perceive themselves as better than previous generations: more knowledgeable, moral, tolerant and humane. Values associated with these aspects of ourselves may affect how we understand our professional forebears. In the early 20th century, some psychiatrists adopted new biomedical theories, including focal sepsis and eugenics, which resulted in inestimable harm. Detrimental clinical practices arose and were perpetuated in the context of societal values, medical ethics and other forces within and outside the medical profession. Historical understanding of the processes by which these things took place may help inform debate concerning current and future challenges of providing psychiatric care. The methods by which psychiatrists consider their predecessors may also have a bearing on how psychiatrists of the future will perceive us, the psychiatrists of the 2020s.

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Electroencephalogram-based evidence was accepted in a UK law court for the first time in 1939. This paper gives an account of that case, not previously clinically reported, and the individuals involved. Why it was not published in the literature at the time is explored and parallels with more recent technologies are highlighted.

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This brief commentary reflects on navigating two dangers of historical research into psychiatry: hagiographic representations of psychiatrists; and accusations of their self-interest and oppression of vulnerable people.

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This commentary explores issues of professional identity, fairness and discovery in the history of psychiatry in the light of Walter Benjamin's (1892-1940) philosophy of history, especially his concept of Jetztzeit (now-time) and the profession's relationship with the founder and owners of Purdue Pharma LP.

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Este artículo analiza, a partir el vínculo entre psiquiatría y antropología, cómo se consolidó un discurso organicista capaz de legitimar el exterminio nazi y las políticas eugenésicas en los países democráticos. Partimos del degeneracionismo del siglo XIX y contrastamos la vertiente étnica y racial de Arthur de Gobineau con la vertiente alienista de Benedict Morel, hasta llegar a la síntesis de Cesare Lombroso. Visibilizamos el vínculo que Emil Kraepelin estableció entre la “degeneración” de los individuos y la de las razas, señalando al pueblo judío, como determinante en la consolidación científica de la Rassenhygiene en la que Adolf Hitler fundamentó su Mein Kampf. Destacamos como la justificación para “destruir la vida indigna de ser vivida”, que emergió desde el ensamblaje entre la psiquiatría y la justicia, fue determinante en la transición del III Reich entre la esterilización forzosa y el exterminio. Abordamos el Programa de Eutanasia forzosa a través del importante papel político de Ernst Rüdin, sucesor de Kraepelin y fundador de la psiquiatría genética. Concluimos que el nacionalsocialismo llevó a su máxima expresión la lógica de muerte inscrita en el degeneracionismo. Finalmente, tras una reflexión sobre las reacciones y alternativas de posguerra, destacamos la persistencia contemporánea tanto del determinismo biológico como de la desigualdad legal que marcaron el destino de las primeras víctimas del exterminio nazi.(AU)

This article analyses, from the link between psychiatry and anthropology, how an organicist discourse capable of legitimizing both, nazi extermination and eugenic policies in democratic countries, was consolidated. We depart from 19th century theory of degeneration and contrast the ethnic and racial facet of Arthur de Gobineau with the alienist facet of Benedict Morel, until reaching the synthesis of Cesare Lombroso. We highlight the link that Emil Kraepelin established between the “degeneration” of individuals and that of races, pointing out to the Jews, as determinative in the scientific consolidation of Rassenhygiene in which Adolf Hitler based its Mein Kampf. We stress the justification for “destroying life unworthy of live”, that emerged from the assemblage between psychiatry and justice, as determinant in the Third Reich transition between forced sterilization and extermination. We approach the forced Euthanasia Program through the important political role of Ernst Rüdin, Kraepelin’s successor and founder of genetic psychiatry. We conclude that National Socialism took to its maximum expression the logic of death inscribed in the theory of degeneration. Finally, after a reflection on post-war reactions and alternatives, we highlight the contemporary persistence of both biological determinism and legal inequality that marked the fate of the first victims of nazi extermination.(AU)

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En la presente investigación analizaremos la primera institución psiquiátrica del noroeste argentino, específicamente en la provincia de Tucumán, el Hospital de Alienados (HA), desde el evento que impulsó su creación -la negativa de traslados interprovinciales de pacientes a colonias nacionales en 1935- hasta el retorno a dicha práctica por parte del Estado nacional -en 1954-. Hasta la creación del HA, las posibles respuestas para las personas con problemáticas psiquiátricas eran el traslado a instituciones en otras provincias o el encierro en un asilo de la ciudad y en establecimientos policiales. Ante las graves consecuencias de las últimas alternativas, y la cancelación de los traslados, tuvo que ser el propio Estado provincial el que hiciera frente a la problemática. El HA se constituyó como el primero en Argentina en pertenecer a un Estado provincial y no depender de las arcas nacionales. Este trabajo inaugural en los estudios historiográficos de la región nos permitirá analizar algunos procesos institucionales de las políticas en salud mental a nivel provincial y nacional, las concepciones sobre locura y encierro que se sostenían en aquella época, el flagelo de la pobreza como causa para enloquecer y el efecto de todo lo anterior en la opinión pública.(AU)

In the present investigation we will analyze the first psychiatric institution in northwestern Argentina, specifically in the province of Tucumán, the Hospital de Alienados (HA), from the event that prompted its creation -the refusal of interprovincial transfers of patients to national colonies in 1935- until the return to this practice by the national State -in 1954-Until the creation of the HA, the possible responses for people with psychiatric problems were transfer to institutions in other provinces or confinement in a city asylum and in police establishments. Given the serious consequences of the last alternatives, and the cancellation of the transfers, it had to be the provincial State itself that faced the problem. The HA was established as the first in Argentina to belong to a provincial State and not depend on the national coffers. This inaugural work in the historiographical studies of the region will allow us to analyze some institutional processes of mental health policies at the provincial and national level, the conceptions about madness and confinement that were held at that time, the scourge of poverty as a cause of craziness, and the effect of all of the above on public opinion.(AU)

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O objetivo do presente artigo é analisar o fenômeno das automutilações, trazendo à luz a complexidade desse campo de estudos e visando apresentar a construção de uma categoria nosográfica para as automutilações. Elas se caracterizam pelo ato de ferir o próprio corpo voluntariamente, sem intenção consciente de morte, e podem se apresentar de diversas formas, configurando diferentes tipos de comportamentos. Partindo das discussões existentes na literatura sobre o fenômeno, inicialmente circunscritas à psiquiatria e, posteriormente apropriadas pela psicanálise, apresentamos um percurso histórico do conceito, contextualizando suas aparições em diferentes cenas e formas psicopatológicas. Buscamos ainda fomentar uma discussão acerca do estatuto do fenômeno automutilatório: trata-se apenas de um sintoma, prevalente em diferentes quadros clínicos, ou estaríamos falando de uma síndrome, entidade clínica diferenciada que afunila e congrega outros comportamentos? Nesse cenário, destacamos o caráter transnosográfico das automutilações, uma vez que o fenômeno perpassa diversos quadros clínicos na forma de sintoma, ao mesmo tempo em que começa a se configurar como uma entidade nosográfica separada de outras doenças.

The aim of this article is to analyze the phenomenon of self-mutilations, to highlight the complexity of this field of study, and to present the construction of a nosographic category for self-mutilation. They are characterized by the act of voluntarily injuring one's own body, without a conscious intention of death, and they can manifest in different ways, configuring different types of behavior. Based on existing discussions in the literature on the phenomenon, initially limited to psychiatry and later appropriated by psychoanalysis, we present a historical trajectory of the concept, contextualizing its appearances in different psychopathological scenes and forms. We also seek to encourage a discussion about the statute of the self-mutilating phenomenon: would it be just a symptom, prevalent in different clinical conditions, or would we be talking about a syndrome, a differentiated clinical entity that narrows down and brings together other behaviors? In this scenario, we highlight the transnosographic character of self-mutilation, since the phenomenon permeates several clinical conditions in the form of symptoms, while at the same time it can be configured as a nosographic entity separate from other diseases.

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The article briefly presents an analysis of the development of domestic psychiatry (with an emphasis on research in the field of psychopathology and nosology) from the post-war period (the Great Patriotic War) to the era of "perestroika". With the founding of the Institute of Psychiatry of the USSR Academy of Medical Sciences under the leadership of V.A. Gilyarovsky, the study of endogenous diseases was based on a multidisciplinary approach, in which the clinical-psychopathological research method was combined with clinical/biological ones. The most important role of the subsequent school of A.V. Snezhnevsky in describing the syndromes and forms of the course of schizophrenia (G.A. Rotshtein, R.A. Nadzharov, A.B. Smulevich, A.K. Anufriev), its age aspects (E.Ya. Sternberg; M.S. Vrono, G.P. Panteleeva, M.Ya. Tsutsulkovskaya; V.M. Bashina) is reflected. The contribution to psychopathology of other leading Russian psychiatrists, who worked mainly in Moscow and Leningrad research institutions of that period, was noted: students of P.B. Gannushkin - O.V. Kerbikov, V.M. Morozov, D.S. Ozeretskovsky, S.G. Zhislin, as well as G.K. Ushakov, A.E. Lichko, M.M. Kabanov, G.V. Morozov, M.V. Korkina, A.A. Portnov, I.N. Pyatnitskaya and others. The priority of A.V. Snezhnevsky and G.K. Avrutsky with colleagues for the introduction of neuroleptics and other new psychotropic drugs in the treatment of mental illnesses is emphasized. The review ends with the activities of M.E. Vartanyan who headed the country's leading scientific institution in the difficult «perestroika¼ era and developed the biological approach to mental illness further with the creation of international research programs.

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Norway has, according to the World Health Organization, more psychiatrists engaged in public health services per head of population than any other country, and the proportionate numbers of psychologists and others engaged in mental healthcare are also among the world's highest. Approximately 10% of Norway's gross domestic product is spent on health, expenditure per capita that is the fourth highest internationally. We discuss how this wealth of expertise translates into the delivery of services to the public.