Reflexions on the relationships between history and psychiatry

Abstract

ObjectivesThis article proposes a study on the relationships between history and psychiatry, by examining psychiatry in its history and by analysing the epistemological, clinical and methodological issues involved. MethodThree areas were explored: the relationships between the evolution psychiatric ideas and practices and the historical context from the 19th century to the present; the relationships between the epistemologies of psychiatry and history; and finally, the use of narrative in psychiatric care, particularly in institutional psychiatric care. ResultsThe study of its history shows that psychiatry, unlike other areas of medicine, does not evolve with an increase in knowledge. It accompanies social transformations and the history of ideas and is subjected to its own liberal breakthroughs and authoritarian withdrawals. DiscussionFor the time being, psychiatry has more to gain from a convergence with the social sciences than with medicine or neurobiology. In line with Paul Veyne's epistemology, a number of common points can be identified: causality in psychiatry, as in history, is “retrodictive”. Diagnoses become abstractions, categories, temporary hypotheses that cannot have any claim to be factual values, unlike lesions in medicine. ConclusionsPsychiatry and history are based on the principles of narrative as set out by Paul Ricoeur. Narrative is the common denominator for all types of psychotherapeutic intervention, and it is in particular the basis of institutional psychotherapy. Clinical practice is inseparable from this narrative shared by both patient and carer, bringing with it the pleasure of thought and consolation for loss.