Clinical Diagnosis of Mental Disorders

For centuries the "treatment" of mentally disturbed individuals was quite simple. They were accused of collusion with evil spirits, hunted, and persecuted. The last "witch" was killed as late as 1782 in Switzerland. Mentally disturbed people did not fare much better even when the witchhunting days were gone. John Christian Reil gave the following description of mental pa­ tients at the crossroads of the fifteenth and sixteenth centuries: We incarcerate these miserable creatures as if they were criminals in abandoned jails, near to the lairs of owls in barren canyons beyond the city gates, or in damp dungeons of prisons, where never a pitying look of a humanitarian penetrates; and we let them, in chains, rot in their own excrement. Their fetters have eaten off the flesh of their bones, and their emaciated pale faces look expectantly toward the graves which will end their misery and cover up our shamefulness. (1803) The great reforms introduced by Philippe Pinel at Bicetre in 1793 augured the beginning of a new approach. Pinel ascribed the "sick role," and called for compas­ sion and help. One does not need to know much about those he wants to hurt, but one must know a lot in order to help. Pinel's reform was followed by a rapid develop­ ment in research of causes, symptoms, and remedies of mental disorders. There are two main prerequisites for planning a treatment strategy.