On Promoting Mental Health

Up until about fifty years ago psychiatrists were convinced that mental health or mental illness depended exclusively either on physical health or on constitutional characteristics transmitted by heredity. The principle that mental illness was solely brain illness was accepted as an axiom. Consequently, the efforts of all psychiatric investigators were, for many years, limited to research in laboratories in an attempt to discover in the anatomy, physiology or bio-chemistry of the body, and particularly of the brain, the causes responsible for the diseases of the mind. The great impulse that psychology received from Wund's revolutionary approach, and the establishment of the first laboratories for experimental psychology, greatly influenced psychiatric research, and it was Kraepelin, one of his disciples, and the venerated master of classic clinical psychiatry, who was the first to apply, and with excellent results indeed, the methods and techniques of experimental psychology to clinical psychiatry. It was Kraepelin, also, who strongly influenced by the theories of Virchow, gave great and fruitful impulse to the research on histopathology and particularly brain pathology in mental diseases. His three pupils, Nissl, Alzheimer and Spielmeyer were the first to investigate the microscopic alterations of the cerebral-cortex in the different mental diseases. The results were excellent and, thanks to their work, we have learned a lot about the anatomical substratum of certain psychoses, the so-called organic psychoses. The anatomical pathologic method, however, failed to show any pathologic substratum, not only in the neuroses but also in the two great groups of psychoses, which then, as to-day, made up more than half of the population of mental hospitals, i.e., the manic-depressive psychosis, and the psychosis at that time called dementia praecox. Kraepelin, the indefatigable defender of the theory of the organic origin of all mental disorders, clearly saw the limitations of this anatomic method. It was then that he turned his research, in his Institute in Munich, toward neuro-physiology, neuro-chemistry and genetics. Greatly encouraged by the re-discovery of the work of Mendel (for so many years forgotten), he strongly encouraged research on heredity in mental illness under the specialized direction of another of his pupils, Rudin. But the many years of painstaking research carried out by Rudin and his collaborators and followers also failed to reveal the answer so anxiously hoped for. Though hereditary factors could not be by any means discarded, results showed that it was not possible to give any adequate answer to the relatives of psychotic patients, who, influenced by the emphasis put on heredity, asked the psychiatrist about the destiny of their children or themselves. It was found that it was not possible even to establish what was called the hereditary prognosis of mental diseases. About this time, however, Bleuler, though also brought up in the classic Kraepelinian school of thought, saw the possibility of bringing Freud's ideas into the field of the major psychoses. It was he who first introduced the psycho-dynamic factor in psychiatry, and he was the first who tried to "understand" even if he could not "explain" the meaning of the symptoms and the behaviour of the dementia praecox patient. This way of approaching the