Introduction

In 1918 Emil Kraepelin wrote: (D

A hundred years ago, they were practically no alienists. The care of the mental patients was nearly everywhere in the hands of head supervisors, attendants and administrators of the houses for the mentally ill and the role of the physicians was limited to the treatment of the physical illnesses of the patients.

He pointed out that, in the first decades of the nineteenth century, many of the books dealing with psychiatric themes were still written by medical doctors, such as Reil (who coined the word psychiatry), who had few contacts with mental patients or even by philosophers and theologians, and that only in the great scientific centres had specialists appeared 'who had decided to spend their life in the study and treatment of mental diseases'.

The history of psychiatry as a medical specialty has to be distinguished from the history of psychiatric medical knowledge which began in ancient Greece with the birth of medicine as a science. For more than 2000 years some physicians observed and treated mental illnesses, institutions were created in which the 'lunatics' and the 'insane' were received. But, as rightly pointed out by Kraepelin, the truth is that psychiatry was not really a medical specialty. One can argue about the precise date of the appearance of psychiatry as a specific field of medicine and of the psychiatrist as a specialist devoting his professional competence exclusively to the care of the mentally ill. Denis Leigh recognizes that 'some degree of specialization occurred [in England] among respectable physicians' in the middle of the eighteenth century when the monopoly of Bethlem was broken and new 'lunatic hospitals', such as St Luke's were opened.(2) On the other hand, the American historian Jan Goldstein stresses that in France the language, as an exact reflection of the underlying reality, began to use expressions such as homme special to describe a physician specializing in a branch of medicine such as psychiatry only around 1830.(3)

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