modern era of mental healthcare.
Each generation and society builds upon the inherited knowledge of the past, even when they are not consciously aware of the fact.
Occasionally the progression falters, as it did during the Middle Ages when the vast scholarship of the Graeco-Roman period was for centuries barely kept alive by the diligence of monastic orders in the West and by Eastern scholars. Fortunately, Graeco-Roman discoveries in science and medicine, literature and the arts were recovered during the Renaissance and society has since made immense advances in these areas. Mental health nurses are very aware that research into the history of psychiatry is a source of wisdom that contextualises and adds depth to mental health nursing practice (Leishman 2005; Warelow & Edward 2007). An opportunity to reflect upon the historical precedents for prevailing mental disorders, and the ways in which they have been diagnosed and treated in the past, can enhance the ways in which contemporary clinicians view their practice.
Mental disorder cannot be discovered by archaeology or by any means other than written sources, and sometimes the terminology cannot be translated exactly. It is inevitable that in the millennia covered briefly in this chapter, attitudes towards mental disorder and the mentally ill, and even mental disorders themselves, will have changed over time. As with our own society and culture, attitudes towards mental disorder probably would have differed within any society or culture at a given time. Both ancient and modern ideas about mental disorder and ‘madness’ are contextual and shifting. Sometimes the ancient world seems familiar to ours, but there are moments when we realise how different a world we inhabit now; we can learn from both the differences and the similarities. The history of a discipline or profession provides a common ground from which to evaluate clinical experience. We can learn from the mistakes of the past but we can also take pride in our predecessors’ achievements.
medical education abandons its emphasis on the teaching of history, Latin and Greek. Sigmund Freud and his colleagues received a sound classical education, which included the study of Latin and Greek, legend and mythology (Richards 1991). Just as the Greek language determined the nomenclature of most body parts and diseases, it also influenced the naming of early psychoanalytic phenomena such as mania and melancholia, neurosis and psychosis, the ego and the id and the Oedipal and Electra complexes.
Stoic philosophy held that everything is perpetually in the process of changing and that people should strive to make their thinking as clear and accurate as possible. The early practitioners of cognitive behavioural therapy (CBT) recognised a kinship with Stoic philosophy and its premise that thoughts, feelings, behaviour, biology and the environment are interrelated (Blackburn &
Davidson 1990). The 2nd century AD Roman emperor Marcus Aurelius (121−180 AD) was a Stoic, and he noted in his Meditations countless thoughts that seem to illustrate CBT principles, for example:
We shrink from change, yet is there anything that can come into being without it? Could you have a hot bath unless the firewood underwent some change? Could you be nourished if the food
suffered no change? Do you not see then that change in yourself is of the same order, and no less necessary to nature? (Meditations 7:18)
Perhaps it is the need to believe that modern medical science holds the key to a better world that leads some writers to minimise the achievements of the past, or to ignore them completely.
However, in some cases medicine, culture and society have not improved dramatically. Scull (2015) says that although we like to console ourselves with visions of progress, people with a mental illness still die around 25 years earlier than the rest of the population, and that their mortality rate has actually accelerated in recent decades. Sometimes the past can hold valuable lessons and precedents that have been lost and that, when rediscovered, can assist us to achieve a better outcome for ourselves as healthcare practitioners and for our clients. A surprising amount survives:
Suer (1995) says that French psychiatry is directly based on ancient
medicine, and traces the survival in modern psychiatric care of ancient medical terminology, psychiatric terms (e.g. mania and melancholia), theories of aetiology (airs, climates and humours) and personality types.
Nursing is a genuinely ancient career but other professions use and even invent historical precedents to assist in the glorification of their own profession. For example, psychiatry as a profession has only slowly developed in the course of the past 160 years since the American Psychiatric Association (APA) was commenced in 1844 with 13 members. Yet the influential medical historian and psychoanalyst Bennett Simon boasts that what makes the medical model ‘unique’ is the unbroken line that joins ancient and modern practitioners (Simon 1978).
Alexander and Selesnick, in their classic and much-reprinted psychiatry text, maintain that psychiatrists and psychiatry are the culmination of an intellectual and professional evolution that began with witch doctors and philosophers and claim that: ‘the precursor of the psychiatrist was any man who tended another in pain. The story of psychiatry thus begins with the story of the first professional healer’ (Alexander & Selesnick 1966, p. 3). It is clear that the possession of a lengthy historical pedigree is considered an advantage for a profession.
Some nurses try to demonstrate that their profession has existed since ancient times. For example, Doona (1992) claims as ‘nurses’
three women from the ancient literature—Euryclea, Cilissa and Medea’s nurse—but none of these characters can be said to be
‘nurses’ as we understand the term today. All three are aged women who had in their youth ‘nursed’ or suckled children. They would not have cared for ill or wounded patients as would their modern ‘nursing’ counterparts. In the present climate, which emphasises tertiary education, research and professionalisation in nursing, if nurses were to investigate and to own their own true history they could lay claim to a very distinguished lineage. Nurses do not need to invent or inflate the historical achievements of their ancient colleagues.
Burnard (2007) laments the exclusive emphasis on recent research in nursing education today and recommends that more historical research be performed by nursing scholars: Holme (2015) has
similar concerns that poor understanding of nursing’s history undermines both nursing education and policy decision making.
Nursing scholarship in fact prides itself on being present-centred in the belief that this is the same as being innovative and progressive.
But Burnard (2007) claims that in the ‘clamour to cite only the latest papers … students are often citing older ideas without appreciating their genesis. Thus well-known scholars’ work is often attributed, inaccurately, to more recent workers in the field’ (p. 665). If we never use older works, how do we know if what we are reading is innovative or derived from some earlier, original thinker’s work?
Mental health nurses are not well served by existing mental health nursing texts if they seek to find out more about the history of mental healthcare or mental disorders. The social context in which Western nursing takes place today has altered enormously.
Today’s professional nursing, undertaken outside the home in institutions removed from the family, is an exception in the historical sense compared with the millennia during which nursing was undertaken by the family and their peripheral members, neighbours, slaves and servants, or later by religious orders.
Having a mental disorder in past times was not necessarily an impediment to leading a productive and consequential life. Ancient societies did not acknowledge many of the manifold mental disorders that are assiduously identified and isolated in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (APA 2013) today, and in many ways they were more compassionate and tolerant than many societies today. It seems that the aim of modern medical or psychiatric writers in propagating exaggeratedly negative notions about the past is to emphasise the belief that things have changed for the better—a belief that might be meaningful to the health profession, but does no justice to the past.