History of Psychiatry: Madness,Science,Culture

'Unitary psychosis' is the collective name for a set of disparate doctrines whose common denominator is the view that there is only one form of psychosis and that its diverse clinical presentations can be explained in terms of endogenous and exogenous factors. This paper examines the history of these doctrines since the eighteenth century in the work of their main sponsors and extricates their conceptual assumptions. It is shown that the nature of the debate between 'unitarians' and those who believed in the existence of separate diseases has changed throughout time, and that to these changes national differences have been important. Earlier discussions made use of conceptual and ontological argument; latter ones of clinical analysis; and the latest debate, that occurred during the 1970s, over-relied on statistical techniques and genetic analysis. The outcome of this long debate remains inconclusive.

Goya remains an enigmatic figure of considerable interest to medical historians. There is limited information about his family background and in 1793 he suffered an illness which has been the subject of much speculation since then. That the illness was a functional psychosis is supported by Goya's depictions of mental hospital scenes and by recent data from the Real y General Hospital in Zaragoza which indicates that there was a strong family history of mental disorder in the family of Goya's mother.

After 1808, to meet public concern, public asylums developed as totally locally financed and controlled non-profit making institutions for both paupers and paying patients, until 1949. Government had no powers except to inspect, and advise on humanity and physical care. The insane continued at home, or went to the workhouse, or private or public asylum. Legally after 1828 every asylum of 100 beds or more had to have a full-time resident apothecary to treat the numerous physical ills in the heterogeneous population. Concerned with diet, hygiene and nursing care, he became administrative head under a ruling committee which controlled all finance, until 1949.