History of Community Psychiatry

Since antiquity, mental illnesses have proven challenging for individuals suffering with them, for families who wish to support them, and for communities in which they live. Evolution in the development of community services and supports has been predicated on the understanding or interpretation of mental illness, aided by acceptance and innovation, but often anchored in ignorance, stigma, and short-sightedness. Regardless of how one de fi nes community psychiatry (by provider, by setting, by duration of care, by diagnosis, by set of principles, by fi nances/payer of services), multiple facets are important in the evolutions of the fi eld. A historical review of community psychiatry is imperative to comprehending the variables that impact the lives of those touched by mental illness, and may suggest how systems of care should be organized to enhance recovery. As early as the Neolithic era, evidence exists that many attempts were made to treat and cure mental illness. Skeletal remains with large burr holes in their skulls from that era have been speculated to re fl ect interventions in brain disorders (Brothwell 1981 ) . Records from ancient Egypt reported clinical presentations of depression and somatization, with trials of magical spells, applications of body fl uids, use of hallucinogens, and religious retreats to ameliorate these conditions (Nassar 1987 ) . Hindu religious texts denoted interpretations of mental illness as re fl ections of supernatural beings imbued with magical powers, or as a result of the body being out of balance; the religious community responded with application of prayers, herbs, or persuasion (an early attempt at therapy?) (Bhuga 1992 ) . Bodily imbalance was also embraced as an explanation for mental disorders by the ancient Chinese; treatment like herbs and acupuncture sought to bring these back in alignment (Yizhuang 2005 ) . Ancient Jewish cultures viewed mental illness as a re fl ection of a discordant relationship with G-d. Eschewing theories that the etiologies of mental illness were supernatural or divine in nature, Hippocrates recommended close observation, accurately described numerous mental maladies, noted contributory roles of environment, diet, and life style, and suggested treatment be focused on balancing bodily fl uids. Ultimately, Plato embraced the theory that all mental illness was predicated on physical problems, and a Greek physician became the fi rst to suggest humane treatment, including releasing agitated patients from restraints (von Staden 1996 ) . During the Middle Ages, the Quran re fl ected the need to treat those who were mentally challenged with humane protectiveness; some Muslim physicians encouraged the development of trusting counseling relationships and developed patient-centered, supportive asylums from 700 to 200 ad (Million 2004 ) . Unfortunately, such forbearance was not as History of Community Psychiatry