[Mental illness without institutions. A field study in the Canton of Fribourg in 1875].

Abstract

In 1875, the government of the Canton of Fribourg decided that a field study should be carried out on the number of mentally ill people in their territory. This happened in view of the construction of a new state mental hospital. With the support of members of the local administration, an experienced psychiatric expert examined 164 mentally ill persons, 147 at home and 17 in general hospitals and homes. In the author's report, the sick person's case history, his present state and proposals for treatment cover on average two pages per patient. Almost all of the mentally ill described in this report can quite easily be classified according to the main categories of modern nosology: there are 69 schizophrenics, 28 cases of affective psychoses, 28 mental retardations, and 39 further mental disorders, most of them identifiable as well. The case histories of the patients, too, correspond with the courses of mental illness as we know them today. There is a very high tendency to develop chronic symptoms. 25 patients lived temporarily or permanently like prisoners, locked in and/or tied up, some of them in repellent conditions. This study disproves the following hypotheses: 1. that the symptoms and the course of psychiatric illnesses have changed significantly since the last century, due to the development in civilisation; 2. that the absence of psychiatric hospitalism and psychiatric labelling prevents the worst and most characteristic kind of schizophrenic and affective disorders and their chronification; 3. that the mentally ill were better cared for in a pre-industrial and agricultural society without psychiatric care such as the community described in the Fribourg report.