Brief history of psychiatry in Uruguay

Abstract

In Uruguay, during the colonial period which lasted until the early 19th century, people suffering from mental illness in Uruguay were treated the same as the world over: they wandered the streets, begging for alms, and were sent to prison if they committed antisocial acts. Among the first patients in the Charity Hospital founded in Montevideo in 1788 was a person suffering from mental illness, but it was not until 1817 that separate facilities were made available for the mentally ill, cared for as a result of the humanitarian ethic associated with the Spanish religious tradition. After independence from Spain and Portugal, achieved between 1813 and 1825, the newborn nation was riven by civil war in 1843 (Guerra Grande or Great War). Although medical care became progressively more organized during this period, conditions were unfavourable for the care of the mentally ill, and technical knowledge in psychiatry did not develop until the conflict had ended, when there was a flood of physicians reaching the R io de la Plata on ships of the French and English fleets. As in most countries, the practice of psychiatry was initially linked to the analysis of medico-legal cases (Casarotti, 2007, p.2). To provide psychiatric care for the country’s quarter of a million people, the first ‘insane asylum’ was created in 1860, followed in 1880, after the population had doubled, by the inauguration of the National Mental Hospital, renamed the Vilardeb o Hospital in 1910. In both, medical care was initially provided by medical practitioners and homeopaths, and was progressively taken over by specialists in the study of mental alienation, influenced by the French school of medical thought, which dominated the entire field of medicine. The Mental Hospital was built during the 1875–1886 military dictatorship that followed the decline of the previous predominantly rural, tradebased Uruguay, heavily dependent on the leadership of chiefs. The building was developed as part of the country’s first modernization project. At that point in Uruguay’s history the state governing systems were organized, agriculture and livestock farming was restructured, and transportation was improved, enabling the integration of inland Uruguay with the port city of Montevideo. Safe conditions were established, production was modernized, and in particular reform was carried out of primary education (1875) and of the university, the Universidad Mayor (1885), aimed at a more utilitarian education. In 1876 the School of Medicine (Facultad de Medicina) was created. Uruguay’s modernization process was completed over the final decade of the 19th century and the first 30 years of the 20th, with social, economic and political reforms that transformed it into a balanced, confident, optimistic and progressive society, known as ‘the Switzerland of South America.’ The university’s Chair of Psychiatry was created in 1908 and the Psychiatry Society in 1923. They were both composed of small groups of specialists carrying out teaching and research at the Vilardeb o Hospital, and they were the crucial factor in the development of psychiatry in Uruguay. Over this period, the professors appointed to the Chair of Psychiatry were trained in full or in part at major European clinics and shared the French vitalist approach to psychiatric thinking. The activities of the Psychiatry Society were recorded in its journal, published continuously since 1929 and included works by foreign as well as national researchers. To meet mental pathology treatment needs, psychiatric assistance was initially focused on the hospitalization of acutely affected patients and progressively addressed the prevalence of chronic pathology. Treatment institutions in the form of ‘agricultural colonies’ were created in 1912 as an initial approach to therapeutic communities, along with sheltered homes