Institutional Psychiatry

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Institutional psychiatry describes the traditional, conventional and medical- historical development of psychiatry in socially more or less separated institutions e.g. B. along the lines of the York Retreat . In Germany, these institutions, which had mostly been founded since the beginning of the 19th century, were run as large state hospitals with a representative architectural style and were considered to be so-called sanatoriums and nursing homes. This already expresses their dual character, which includes a division into acute and chronic cases. Mainly due to the mostly rapidly growing number of chronic cases, these institutions developed into large hospitals with up to 3,000 beds . The term institutional psychiatry goes back to Karl Jaspers (1883–1969), who coined it as a contrast to the term used for university psychiatry .

Institutional and University Psychiatry

Karl Jaspers saw it as a feature of institutional psychiatry that psychiatrists “led a lonely life with their patients far from traffic”, which was characterized by a certain “sometimes sentimental humanity”, but also by a certain robustness in dealing with problems , as well as a certain "pastoral dignity". They also had a certain level of general education, but without any real depth. The personal closeness to the patient was in contrast to the attitude of those psychiatrists who, from around the second third of the 19th century, made up the character of university psychiatry. They no longer shared “life with their patients from morning to night”; contact with the patient became “more heartless, petty, impersonal, uneducated”. The work got lost in "endless details, measurements, counts, findings". However, Jaspers also emphasizes the advantages of university psychiatry. How the relationship between institutional and university psychiatry will develop in the future cannot be said.

Chronically mentally ill

In the past, the chronically mentally ill were often considered incurable, today they are often classified as care cases . Nevertheless, until around 1980 the workforce in psychiatric hospitals (institutional psychiatrics) consisted mostly of such patients. With the change to the hospital character of the former institutions for the mentally ill as patients now in acute need of treatment, it is related that a change had to take place for these hospitals. The demand to reduce the number of beds to a maximum of 500–600 was raised. With this, however, the psychiatry inquiry also made demands on the university psychiatry , which refers to its special tasks, but until then had not participated in the sectorized standard care of patients (according to geographically determined care areas or sectors).

Uwe Henrik Peters describes the problem of the chronically mentally ill as follows: "In contrast to university psychiatry, there are practical problems (in institutional psychiatry) in the treatment of the chronically ill, the elderly, institutional organization and social reintegration."

History of Psychiatry

The general journal for psychiatry (Berlin) should be mentioned as the organ of institutional psychiatry between 1830 and 1860 . It was founded by Heinrich Damerow together with Carl Friedrich Flemming and Christian Friedrich Wilhelm Roller in 1844. - The foundation of the “ Archive for Psychiatry and Nervous Diseases ” in 1867 by Wilhelm Griesinger together with Ludwig Meyer can be seen as the beginning of university psychiatry and the associated scientific research . Ackerknecht described this development as the “victory of the mechanism”. Thanks to Griesinger, psychiatry was "turned on its head". This quote from Karl Marx is intended to express that Griesinger utilized the results of romantic medicine just like Karl Marx those of Hegel's philosophy , but weighted them differently. The field of psychiatry was only represented comprehensively by institutional psychiatrists until around 1890 - for example by the Illenau School by Richard von Krafft-Ebing or by Heinrich Schüle . From then on, university professors in psychiatric science were leaders. However, the return of social psychiatry may also be seen as the end of classical German psychiatry and reminds us of the beginnings of institutional psychiatry in the 19th century .

literature

Individual evidence

  1. ^ A b Dörner, Klaus : Citizens and Irre . On the social history and sociology of science in psychiatry. (1969) Fischer Taschenbuch, Bücher des Wissens, Frankfurt / M 1975, ISBN 3-436-02101-6 ; (a) Re. “Architectural style”: page 304; (b) Re. "Foundation of the archive": page 316
  2. ↑ a b Eikelmann, Bernd : Basic social psychiatric knowledge . Enke, Stuttgart 1997, ISBN 3-432-27801-2 ; (a) Re. “Dual character of sanatoriums and nursing homes”, page 23; (b) Re. “Definition of terms in social psychiatry”, page 3
  3. ^ A b Dörner, Klaus and Ursula Plog: To err is human or textbook of psychiatry / psychotherapy. Psychiatrie-Verlag Rehburg-Loccum 7 1983, ISBN 3-88414-001-9 ; (a) to district “large hospital”: page 419; (b) Re. “Reducing the number of beds and consequent restructuring of care practice” on page 419
  4. ↑ a b c Ackerknecht, Erwin H .: Brief history of psychiatry . Enke, Stuttgart 3 1985, ISBN 3-432-80043-6 ; (a) Re. “Origin of the designation”: page 62, footnote 5; (b) Re. “Victory of the Mechanism”: page 62; (c) Re. “Materialistic and psychologistic interpretation of psychiatry”: page 70 ff.
  5. ↑ a b c Jaspers, Karl : Allgemeine Psychopathologie . Springer, Berlin 9 1973, ISBN 3-540-03340-8 , Appendix § 4 Historical on psychopathology as a science. - Institutional and university psychiatry. Page 705 f.
  6. ↑ Peters, Uwe Henrik : Lexicon of Psychiatry, Psychotherapy, Medical Psychology . Urban & Fischer, Munich 6 2007; ISBN 978-3-437-15061-6 ; Lexicon-Stw. "Institutional Psychiatry": page 40 (online)
  7. ^ Franz Kohl: Heinrich Schüle (1840-1916) - psychiatric researcher, textbook author and pioneer of institutional psychiatry in Baden. In: Gerhardt Nissen , Frank Badura (ed.): Series of publications of the German Society for the History of Neurology. Volume 7, Würzburg 2001, pp. 103-114.
  8. ↑ Schüle, Heinrich : Clinical Psychiatry . Special pathology and therapy of mental illnesses. Vogel, Leipzig 3 1886