2010, Number 6
Salud Mental 2010; 33 (6)
La contribución de La Castañeda a la profesionalización de la psiquiatría mexicana, 1910-1968
Sacristán C
Full text
Language: Spanish
References: 40
Page: 473-480
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ABSTRACT
On September 1, 1910, more than two thousand people celebrated the one hundredth anniversary of Mexico’s Proclamation of Independence with the inauguration of a psychiatric hospital. According to the event’s official chronicler, the 25 buildings constructed by order of president Porfirio Díaz on the site of the former Castañeda Hacienda would place Mexico among the leading countries in the world in treating mental health pathologies. But, what had been Mexico’s development in this field during the XIX century? Could we consider La Castañeda «the birthplace of public psychiatry» in Mexico?This work analyzes La Castañeda’s contribution to the professionalization of psychiatry in Mexico, not only by looking at the place that research and teaching traditionally had in hospitals, but also by looking at other mechanisms that help to form a discipline, such as the capacity to bring light to scientific societies and to bring credibility to a new medical field such as psychiatry, so much in need of therapeutic successes in those years.
In the XIX century around 400 articles, theses and books by Mexican, Hispanic and foreign authors were published that dealt with topics associated with psychiatry. The old hospitals of the colonial system such as San Hipólito and La Canoa established a form of treatment called «moral treatment», precursor to psychiatry, and were directed by a doctor substituting a director-administrator. Between 1865-1910, five projects for a modern mental hospital were made, one of which saw fruition in the form of La Castañeda. In 1887 the first course dealing with mental illness was taught and in 1906 the first specialization in psychiatry was brought about. Nonetheless, this movement was cut short by the Revolution of 1910 which assailed the country for almost a decade and provoked that La Castañeda be left without state support.
The professionalization of Mexican psychiatry can be divided in three stages: 1910-1925, a period marked by the decomposition brought on by the war; 1925-1945, characterized by the major medical and administrative reform of the hospital, and 1945-1968, a stage which included the slow dismantling of La Castañeda. In the first stage, La Castañeda saw a certain level of deterioration in its assistance practices, as 25% of patients who entered between 1914-1916 were not diagnosed, and 45% of patients of those entering between 1917- 1920 were not diagnosed either. This fact is explained by the institution’s instability in those years. Between 1910-1923, La Castañeda had twelve directors. Academic courses in mental illness continued to be offered and a medical society was formed, but with few results.
In 1925 Public Welfare asked doctor Enrique Aragón to inspect the Asylum and present a detailed report of any reforms needed. The three most serious problems he discovered were: the deficient way in which doctors handled patient’s clinical records, shortages and poor training of personnel and the fact that there was almost no research being done.
From 1925-1945, La Castañeda experienced great reforms thanks to three doctors who wanted to professionalize psychiatry in Mexico and place it at a competitive level with hospitals around the world, which they had seen in visits to Europe and the U.S. These doctors were Samuel Ramírez Moreno, Alfonso Millán Maldonado and Manuel Guevara Oropeza, who received support from the federal government. In 1929 a system of occupational therapy was established as a means of rehabilitation, and outpatient services were offered to those not needing hospitalization. In 1932 a Children’s Ward was inaugurated and the following year the School for Abnormal Children, both directed by Mathilde Rodríguez Cabo, the first woman psychiatrist in Mexico. Alongside Ramírez Moreno, she began a project offering courses in psychiatric nursing and caregiving. In 1935 the Drug Addicts Unit was inaugurated, and in the years following shock therapies were introduced. A laboratory was established to perform traditional clinical analyses, as well as bacteriological and pathological analyses, and microphotography, both to improve diagnoses and to move research forward. All was influenced to a great extent by Spanish neurobiology which came about after the Spanish Civil War, when exiles such as Dionisio Nieto were received in Mexico.
In order to strengthen the guild, at this stage there were important initiatives. In 1934, the Revista Mexicana de Psiquiatría, Neurología y Medicina Legal, the first journal in its field in Mexico, was published. In 1937 the Sociedad Mexicana de Neurología y Psiquiatría was founded, as well as its official organ, Archivos de Neurología y Psiquiatría de México.
Around 1943, a project which would become Mexico’s policy of mental health for the years 1945-1968 began to be conceived. This policy would lead to the demolition of La Castañeda, and replace it with farms or field homes for the mentally ill. This therapeutic model, with chronic patients in mind, was based on recreational and occupational therapies, and its intention was to place patients in contact with nature, under a regimen of liberty and dedicated to productive and dignified activities. Yet these farms were located far from urban centers, isolating patients even further from family. In fact, psychiatry itself was also isolated from the rest of the medical world.
La Castañeda closed on June 29, 1968, and with it more than 68 000 lives, could they talk today, might well tell this story differently.
REFERENCES
Tropé H. Poder real, locura y sociedad: la concepción de los locos en los privilegios fundacionales otorgados al Hospital de Inocentes de Valencia por los monarcas aragoneses (1409-1427). En: XV Congreso de Historia de la Corona de Aragón. Actas Tomo I. El poder real en la Corona de Aragón (siglos XIV-XVI). Zaragoza: Diputación General de Aragón; 1996; pp.307-318.
Sacristán C. Para integrar a la nación. Terapéutica deportiva y artística en el manicomio de La Castañeda en un momento de reconstrucción nacional, 1920-1940. En: Agostoni C (ed.). Curar, sanar y educar. Enfermedad y sociedad en México, siglos XIX y XX. México: Benemérita Universidad Autónoma de Puebla, Universidad Nacional Autónoma de México, 2008; pp.99-123.