Neither saintly nor psychotic: a narrative systematic review of the evolving Western perception of voice hearing.

We present a social-historical perspective on the evolution of the voice-hearing phenomenon in Western society. Based upon a systematic search from a selection of nine databases, we trace the way hearing voices has been understood throughout the ages. Originally, hearing voices was considered a gifted talent for accessing the divine, but the progressive influence of monotheistic religion gradually condemned the practice to social marginalization. Later, the medical and psychiatric professions of secular society were instrumental in attaching stigma to both voice hearers and the phenomenon itself, thereby reinforcing social exclusion. More recently, the re-integration of voice hearers into the community by health authorities in various countries appears to have provided a new, socially acceptable setting for the phenomenon.

el degeneracionismo al exterminio en la psiquiatría nazi. De Arthur de Gobineau y Benedict Morel a Emil Kraepelin y Ernst Rüdin / From degenerationism to extermination in nazi psychiatry. From Arthur de Gobineau and Benedict Morel to Emil Kraepelin and Ernst Rüdin

Este artículo analiza, a partir el vínculo entre psiquiatría y antropología, cómo se consolidó un discurso organicista capaz de legitimar el exterminio nazi y las políticas eugenésicas en los países democráticos. Partimos del degeneracionismo del siglo XIX y contrastamos la vertiente étnica y racial de Arthur de Gobineau con la vertiente alienista de Benedict Morel, hasta llegar a la síntesis de Cesare Lombroso. Visibilizamos el vínculo que Emil Kraepelin estableció entre la “degeneración” de los individuos y la de las razas, señalando al pueblo judío, como determinante en la consolidación científica de la Rassenhygiene en la que Adolf Hitler fundamentó su Mein Kampf. Destacamos como la justificación para “destruir la vida indigna de ser vivida”, que emergió desde el ensamblaje entre la psiquiatría y la justicia, fue determinante en la transición del III Reich entre la esterilización forzosa y el exterminio. Abordamos el Programa de Eutanasia forzosa a través del importante papel político de Ernst Rüdin, sucesor de Kraepelin y fundador de la psiquiatría genética. Concluimos que el nacionalsocialismo llevó a su máxima expresión la lógica de muerte inscrita en el degeneracionismo. Finalmente, tras una reflexión sobre las reacciones y alternativas de posguerra, destacamos la persistencia contemporánea tanto del determinismo biológico como de la desigualdad legal que marcaron el destino de las primeras víctimas del exterminio nazi.(AU)

This article analyses, from the link between psychiatry and anthropology, how an organicist discourse capable of legitimizing both, nazi extermination and eugenic policies in democratic countries, was consolidated. We depart from 19th century theory of degeneration and contrast the ethnic and racial facet of Arthur de Gobineau with the alienist facet of Benedict Morel, until reaching the synthesis of Cesare Lombroso. We highlight the link that Emil Kraepelin established between the “degeneration” of individuals and that of races, pointing out to the Jews, as determinative in the scientific consolidation of Rassenhygiene in which Adolf Hitler based its Mein Kampf. We stress the justification for “destroying life unworthy of live”, that emerged from the assemblage between psychiatry and justice, as determinant in the Third Reich transition between forced sterilization and extermination. We approach the forced Euthanasia Program through the important political role of Ernst Rüdin, Kraepelin’s successor and founder of genetic psychiatry. We conclude that National Socialism took to its maximum expression the logic of death inscribed in the theory of degeneration. Finally, after a reflection on post-war reactions and alternatives, we highlight the contemporary persistence of both biological determinism and legal inequality that marked the fate of the first victims of nazi extermination.(AU)

Discursos e imágenes sobre la desigualdad. Políticas públicas e institucionalización de la locura en el noroeste argentino (1935-1954) / Discourses and images on inequality. Public policy and institutionalization of madness in the argentinean northwest (1935-1954)

En la presente investigación analizaremos la primera institución psiquiátrica del noroeste argentino, específicamente en la provincia de Tucumán, el Hospital de Alienados (HA), desde el evento que impulsó su creación -la negativa de traslados interprovinciales de pacientes a colonias nacionales en 1935- hasta el retorno a dicha práctica por parte del Estado nacional -en 1954-. Hasta la creación del HA, las posibles respuestas para las personas con problemáticas psiquiátricas eran el traslado a instituciones en otras provincias o el encierro en un asilo de la ciudad y en establecimientos policiales. Ante las graves consecuencias de las últimas alternativas, y la cancelación de los traslados, tuvo que ser el propio Estado provincial el que hiciera frente a la problemática. El HA se constituyó como el primero en Argentina en pertenecer a un Estado provincial y no depender de las arcas nacionales. Este trabajo inaugural en los estudios historiográficos de la región nos permitirá analizar algunos procesos institucionales de las políticas en salud mental a nivel provincial y nacional, las concepciones sobre locura y encierro que se sostenían en aquella época, el flagelo de la pobreza como causa para enloquecer y el efecto de todo lo anterior en la opinión pública.(AU)

In the present investigation we will analyze the first psychiatric institution in northwestern Argentina, specifically in the province of Tucumán, the Hospital de Alienados (HA), from the event that prompted its creation -the refusal of interprovincial transfers of patients to national colonies in 1935- until the return to this practice by the national State -in 1954-Until the creation of the HA, the possible responses for people with psychiatric problems were transfer to institutions in other provinces or confinement in a city asylum and in police establishments. Given the serious consequences of the last alternatives, and the cancellation of the transfers, it had to be the provincial State itself that faced the problem. The HA was established as the first in Argentina to belong to a provincial State and not depend on the national coffers. This inaugural work in the historiographical studies of the region will allow us to analyze some institutional processes of mental health policies at the provincial and national level, the conceptions about madness and confinement that were held at that time, the scourge of poverty as a cause of craziness, and the effect of all of the above on public opinion.(AU)

O nascimento das automutilações como categoria nosográfica / The birth of self-mutilations as a nosographic category

O objetivo do presente artigo é analisar o fenômeno das automutilações, trazendo à luz a complexidade desse campo de estudos e visando apresentar a construção de uma categoria nosográfica para as automutilações. Elas se caracterizam pelo ato de ferir o próprio corpo voluntariamente, sem intenção consciente de morte, e podem se apresentar de diversas formas, configurando diferentes tipos de comportamentos. Partindo das discussões existentes na literatura sobre o fenômeno, inicialmente circunscritas à psiquiatria e, posteriormente apropriadas pela psicanálise, apresentamos um percurso histórico do conceito, contextualizando suas aparições em diferentes cenas e formas psicopatológicas. Buscamos ainda fomentar uma discussão acerca do estatuto do fenômeno automutilatório: trata-se apenas de um sintoma, prevalente em diferentes quadros clínicos, ou estaríamos falando de uma síndrome, entidade clínica diferenciada que afunila e congrega outros comportamentos? Nesse cenário, destacamos o caráter transnosográfico das automutilações, uma vez que o fenômeno perpassa diversos quadros clínicos na forma de sintoma, ao mesmo tempo em que começa a se configurar como uma entidade nosográfica separada de outras doenças.

The aim of this article is to analyze the phenomenon of self-mutilations, to highlight the complexity of this field of study, and to present the construction of a nosographic category for self-mutilation. They are characterized by the act of voluntarily injuring one's own body, without a conscious intention of death, and they can manifest in different ways, configuring different types of behavior. Based on existing discussions in the literature on the phenomenon, initially limited to psychiatry and later appropriated by psychoanalysis, we present a historical trajectory of the concept, contextualizing its appearances in different psychopathological scenes and forms. We also seek to encourage a discussion about the statute of the self-mutilating phenomenon: would it be just a symptom, prevalent in different clinical conditions, or would we be talking about a syndrome, a differentiated clinical entity that narrows down and brings together other behaviors? In this scenario, we highlight the transnosographic character of self-mutilation, since the phenomenon permeates several clinical conditions in the form of symptoms, while at the same time it can be configured as a nosographic entity separate from other diseases.

[History of the development of domestic psychiatry: the period 1940-1980]. / Istoriya razvitiya otechestvennoi psikhiatrii: period 1940­1980 gg.

The article briefly presents an analysis of the development of domestic psychiatry (with an emphasis on research in the field of psychopathology and nosology) from the post-war period (the Great Patriotic War) to the era of "perestroika". With the founding of the Institute of Psychiatry of the USSR Academy of Medical Sciences under the leadership of V.A. Gilyarovsky, the study of endogenous diseases was based on a multidisciplinary approach, in which the clinical-psychopathological research method was combined with clinical/biological ones. The most important role of the subsequent school of A.V. Snezhnevsky in describing the syndromes and forms of the course of schizophrenia (G.A. Rotshtein, R.A. Nadzharov, A.B. Smulevich, A.K. Anufriev), its age aspects (E.Ya. Sternberg; M.S. Vrono, G.P. Panteleeva, M.Ya. Tsutsulkovskaya; V.M. Bashina) is reflected. The contribution to psychopathology of other leading Russian psychiatrists, who worked mainly in Moscow and Leningrad research institutions of that period, was noted: students of P.B. Gannushkin - O.V. Kerbikov, V.M. Morozov, D.S. Ozeretskovsky, S.G. Zhislin, as well as G.K. Ushakov, A.E. Lichko, M.M. Kabanov, G.V. Morozov, M.V. Korkina, A.A. Portnov, I.N. Pyatnitskaya and others. The priority of A.V. Snezhnevsky and G.K. Avrutsky with colleagues for the introduction of neuroleptics and other new psychotropic drugs in the treatment of mental illnesses is emphasized. The review ends with the activities of M.E. Vartanyan who headed the country's leading scientific institution in the difficult «perestroika¼ era and developed the biological approach to mental illness further with the creation of international research programs.

Mental health services in Norway, 2023.

Norway has, according to the World Health Organization, more psychiatrists engaged in public health services per head of population than any other country, and the proportionate numbers of psychologists and others engaged in mental healthcare are also among the world's highest. Approximately 10% of Norway's gross domestic product is spent on health, expenditure per capita that is the fourth highest internationally. We discuss how this wealth of expertise translates into the delivery of services to the public.

Reshaping the diagnostic borders: Historical analysis of the diagnostic changes following the introduction of the schizophrenia concept.

BACKGROUND: Although the concept of schizophrenia is still widely presented as having replaced that of dementia praecox, studies have shown that the former was broader than the latter, resulting in a more complex diagnostic redistribution. However, this is poorly documented by quantitative approaches. AIMS: We sought to test the hypothesis that the use of the concept of schizophrenia had caused a diagnostic redistribution and to quantify it. METHOD: A retrospective study, based on admission register archives of the Strasbourg University Clinic of Psychiatry was conducted. The frequency of diagnoses given to patients were examined at two key time periods: one before (TP1) and one after (TP2) the introduction of the schizophrenia concept (established between 1926 and 1928). Eight main diagnoses related to schizophrenia were considered. RESULTS: Patients diagnosed with schizophrenia at TP2 mainly received the diagnoses of dementia praecox but also depression, hebephrenia, manic depressive illness, hysteria, paraphrenia, catatonia and mania at TP1. Dementia praecox and hebephrenia were the most relayed by schizophrenia. Bayesian sensitivity analyses confirmed the robustness of our data against distinct scenarios challenging our hypothesis. CONCLUSIONS: Our results confirm the broadening of the concept of schizophrenia compared to that of dementia praecox but also qualify the different concepts supposed to have been impacted. They provide unique quantitative data that define the contours of the diagnostic redistribution thus provoked. They also give relevant input in the current context where the need to rethink the DSM/ICD concept of schizophrenia is still debated.

Pre-pandemic trajectories of depressive symptomatology and their relation to depression during the COVID-19 pandemic: longitudinal study of English older people.

BACKGROUND: Although the COVID-19 pandemic has affected depression, evidence of the role of pre-pandemic history of depression remains limited. AIMS: We investigated how long-term trajectories of depressive symptomatology before the COVID-19 pandemic were related to depression during the pandemic, over and above the latest pre-pandemic depression status. Furthermore, we examined whether those experiencing depression closer to the pandemic were at higher risk during the pandemic. METHOD: Employing data from waves 4-9 of the English Longitudinal Study of Ageing (2008-2009 to 2018-2019), we used group-based trajectory modelling on 3925 English older adults aged 50+ years to identify distinctive trajectories of elevated depressive symptoms (EDS). Fully adjusted logistic models were then used to examine the associations between trajectories and depression during the COVID-19 pandemic (June-July and November-December 2020). RESULTS: We identified four classes of pre-pandemic trajectories of EDS. About 5% were classed as 'enduring EDS', 8% as 'increasing EDS', 10% as 'decreasing EDS' and 77% as 'absence of EDS'. Compared with respondents with absence of EDS, those with EDS history were more likely to have depression during the COVID-19 pandemic, particularly those with enduring or increasing EDS in the previous 10 years. Moreover, the frequency of EDS was more crucial in predicting the risks of depression during the pandemic than the timing of the latest episode. CONCLUSIONS: Trajectories of depressive symptomatology are an important risk factor for older adults' mental health, particularly in the context of crisis. Older people with enduring or increasing EDS should receive particular attention from policy makers when provisioning post-pandemic well-being support.

Nesidioblastosis with delayed diagnosis and post-operative complications in a patient with complex psychiatric history.

Nesidioblastosis is a rare condition of organic persistent hyperinsulinaemic hypoglycaemia, with fewer than 100 cases since it was first recorded. However, an increasing prevalence suggests previous underdiagnosis due to poor knowledge and awareness. This case describes the presentation, clinical decision-making and unique challenges in diagnosis and care of a 21-year-old female with nesidioblastosis and extensive psychiatric comorbidities. She was repeatedly misdiagnosed until 2021, despite having presented to emergency departments with hypoglycaemic symptoms for over 7 years. Her symptoms were often misattributed to behaviours secondary to restrictive anorexia nervosa and borderline personality disorder. Even after appropriate diagnosis and management, she suffered a complicated post-operative course. Patients with psychiatric comorbidities are at higher risk of distress, communication difficulties and inadequate social support, all of which could be better managed with increased multidisciplinary collaboration between endocrine, surgery, psychiatry, pain management and social work. This study highlights the importance of well-rounded patient care that addresses all facets of patient health. This approach not only improves quality of care, but also reduces overall readmissions, revisions, morbidity and mortality.

Phenomenology yesterday, today, and tomorrow: a proposed phenomenological response to the double challenges of contemporary recovery-oriented person-centered mental health care.

This paper argues that a dialectical synthesis of phenomenology's traditional twin roles in psychiatry (one science-centered, the other individual-centered) is needed to support the recovery-oriented practice that is at the heart of contemporary person-centered mental health care. The paper is in two main sections. Section I illustrates the different ways in which phenomenology's two roles have played out over three significant periods of the history of phenomenology in 20th century psychiatry: with the introduction of phenomenology in Karl Jaspers' General Psychopathology in 1913; with the development a few years later of structural phenomenological psychopathology; and in the period of post-War humanism. Section II is concerned with the role of phenomenology in contemporary mental health. There has been a turn to phenomenology in the current period, we argue, in response to what amounts to an uncoupling of academic psychiatry from front-line clinical care. Corresponding with the two roles of phenomenology, this uncoupling has both scientific aspects and clinical aspects. The latter, we suggest, is most fully expressed in a new model of "recovery," defined, not by the values of professionals as experts-by-training, but by the values of patients and carers as experts-by-experience, specifically, by what is important to the quality of life of the individual concerned in the situation in question. We illustrate the importance of recovery, so defined, and the challenges raised by it for both the evidence-base and the values-base of clinical decision-making, with brief clinical vignettes. It is to these challenges we argue, that phenomenology through a synthesis of its twin roles is uniquely equipped to respond. Noting, however, the many barriers to such a synthesis, we argue that in the current state of development of the field, it is by way of a dialectical synthesis of phenomenology's roles that we should proceed. From such a dialectic, a genuine synthesis of roles may ultimately emerge. We conclude with a note on the wider significance of these developments, arguing that contrary to 20th century stereotypes, they show psychiatry to be leading the way for healthcare as a whole, in developing the resources for 21st century person-centered clinical care.

History of the administration of psychedelics in France.

This article reviews the historical protocols for the administration of "classic" psychedelics in France, from the 1920s to the 1960s. Taking a chronological approach, it investigates the way mescaline, LSD, and psilocybin were administered, the subjects involved, the route of administration, the dosage, and the epistemological context of the research. From the 1930s, the Sainte-Anne school dominated French experimentation with psychedelics, inserting these studies on "hallucinogens" into a biological conception of therapeutics, where the notion of "shock" dominated. The sessions show particularly anxious experiences, sometimes described as "torture" by the patients who underwent them. With just a few rare cases of recovery reported, these substances were not considered as medicines, but rather as tools for exploration in the context of experimental research; thought of not as psychedelics ("mind manifesters") but as psychodysleptics ("mind disruptors"). While these tools could be useful for the diagnosis of sick patients, French physicians did not manage to demonstrate clear therapeutic benefits in the use of psychedelics, perhaps because of their reluctance, in most cases, to determine an optimum dose, and also very often to appreciate the context of administration and the relationship with the patient. This article allows us to understand the reasons for the therapeutic failures reported by these early French psychedelic researchers, but also to help explain the current reluctance of French health professionals who in the face of the "psychedelic renaissance" remain strongly influenced by the very negative early representations of these substances.

Heredity of Schizophrenia in India: A 1928 debate.

Shaw, a British psychiatrist working in India, observed that the incidence of Schizophrenia was higher among a community of Parsis as compared to other ethnic groups. He published his findings in two British journals. The paper drew responses from two other psychiatrists. The debate is examined in colonial context during which occurred and some implications for contemporary research.

"On Suggestion" by John Bostock, 1923: A comparison with twenty-first century understandings of the placebo effect.

OBJECTIVES: This paper describes Australian psychiatrist John Bostock's 1923 concept of suggestion and compares it to our understandings, in 2023, of the placebo effect. CONCLUSIONS: Bostock's 1923 article on "suggestion" gives us a glimpse of the history of Australian psychiatry. It also stimulates thought about the current understandings of the placebo effect. Now, as then, placebo effects can play a critical role in patient outcomes. However, careful consideration is required to ensure contemporary ethical standards are met and harm is not done.

Happy Birthday "One Flew Over the Cuckoo's Nest": A Momentous Tale in the Quest for an Effective and Ethical Approach to Psychosurgery.

The anniversary of the publication of 'One Flew Over the Cuckoo's Nest' by Ken Kesey offers an opportunity for reflection on the use of neurosurgery in psychiatry. We used a narrative, historical and dialectical method to deliver an account of the controversial subject. A balanced representation of the negative and positive aspects, acknowledging some of the questionable ethical practices while describing well-reasoned applications is provided. It includes neurosurgeons, psychiatrists who have embraced these procedures with unwarranted enthusiasm and those who have opposed. Neurosurgical techniques for the treatment of severe mental disorders have evolved from rudimentary procedures which were used to 'correct' unwanted behaviours associated with a wide range of severe mental disorders to more refined and selective approaches used as a last resort to treat specific mental health conditions. In the absence of specific aetiological models to guide ablative surgical targets, non-ablative, stimulatory techniques have more recently been developed to allow reversibility when surgical treatment fails to obtain a sizeable improvement in quality of life. The subject is concretely illustrated by two eloquent clinical images: one on a series of brain computed tomography scans carried out on a Canadian population of subjects, who underwent leukotomy decades ago, and the other more contemporary on an implantation surgery to epidural stimulation. Alongside technical advances in psychosurgery, a regulatory framework has gradually developed to ensure vigilance in the appropriateness of patients' selection. Nevertheless, harmonisation of protocols around the world is necessary to ensure consistency in obtaining and maintaining the highest possible ethical standards for the benefit of patients. If the neurosciences promise today, in their new, better framed, and reversible applications, to provide answers to unmet therapeutic needs, we still must remain attentive to drifts linked the introduction of intrusive technologies for purposes of domination or behaviour modification that would impede our individual freedom.

Telepsychiatry: what clinicians need to know about digital mental healthcare.

The COVID-19 pandemic has rapidly accelerated the use of online and remote mental healthcare provision. The immediate need to transform services has not allowed for thorough examination of the literature supporting remote delivery of psychiatric care. In this article we review the history of telepsychiatry, the rationale for continuing to offer services remotely and the limitations of psychiatry without in-person care. Focusing on randomised controlled trials we find that evidence for the efficacy of remotely delivered psychiatric care compared with in-person treatment is of low quality and limited scope but does not demonstrate clear superiority of one care delivery method over the other.

Sailing between Scylla and Charybdis: invited response to 'Blame or discovery?'

This brief commentary reflects on navigating two dangers of historical research into psychiatry: hagiographic representations of psychiatrists; and accusations of their self-interest and oppression of vulnerable people.

Blame or discovery? Walter Benjamin's Jetztzeit, Purdue Pharma LP and 'our values and our historical understanding of psychiatrists'.

This commentary explores issues of professional identity, fairness and discovery in the history of psychiatry in the light of Walter Benjamin's (1892-1940) philosophy of history, especially his concept of Jetztzeit (now-time) and the profession's relationship with the founder and owners of Purdue Pharma LP.

Politicization of psychiatry and the improvement of ethical standards in the 1970s.

Background: The Code of Ethics for Psychiatry adopted by the World Psychiatric Association in 1977, also known as the Declaration of Hawaii, was a milestone in the development of ethical standards in psychiatry. The impetus for the development of the code came primarily from the politicization of psychiatry, first discovered in the USSR, and later in other countries of the socialist camp, such as Romania, Yugoslavia, and the People's Republic of China. The purpose of this article is to trace reasons for the lack of consolidation among Western psychiatrists against the politicization of psychiatry and their efforts to improve the ethical standards in this medical field. Methods: We analyzed unpublished documents from the Archive of the German Association for Psychiatry, Psychotherapy and Psychosomatics, the private archives of the West German psychiatrists Gerd Huber and Walter von Baeyer as well as research works. To examine these sources, we implemented the historical-critical method. Results: The World Psychiatric Association made efforts to collect, analyze and discuss materials concerning psychiatric ethics in order to create the Code of Ethics for Psychiatry and establish an Ethical Committee. In general, the reaction of Western psychiatrists to the information about the internment of dissidents in psychiatric hospitals was restrained and focused on attempts to solve the issue together with the Soviet colleagues. Conclusion: The international policy of détente of the time as well as collisions between different medical concepts and ethical dimensions did not allow Western psychiatrists to condemn cases of politicization of psychiatry without proir clarification of the situation. The efforts of the World Psychiatric Association in the ethical field improved the ethical standards for psychiatry.

Entre mujeres-locas y hombres-psiquiatras: asimetrías emocionales en la sala 20 del Manicomio Provincial de Málaga (1909-1950) / Between female psychiatric patients and male psychiatrists: emotional asymmetries in room 20 of the provincial institute of malaga (1909-1950)

El tipo de relación que se desarrollaba entre un psiquiatra (hombre) y una paciente (mujer) durante la primera mitad del siglo XX, en un psiquiátrico de la periferia como el Manicomio Provincial de Málaga, estuvo marcado por el proceso legitimador de la especialidad, los esfuerzos por encontrar datos positivos en la medicina mental, así como elementos relacionados con la construcción generizada de la locura. Tras la Guerra Civil, veremos el desarrollo de los actos diagnósticos y la aplicación de las terapias de choque en la institución, y como se fue haciendo aún más profunda la brecha relacional entre psiquiatras y “locas”. El objetivo de este trabajo es abordar qué elementos estuvieron presentes en la construcción de las subjetividades de las mujeres-locas de la sala 20, qué regímenes emocionales influyeron en estas relaciones y mostrar, por último, cómo la tecnificación de la terapéutica durante los años 40 dio lugar a la perpetuación y amplificación de una asimetría emocional entre psiquiatras y “mujeres-locas” de la sala 20, circunstancia en la que las mujeres mostraron también sus estrategias de resistencia.(AU)

The type of relationship that was developed between a psychiatrist (male) and a patient (female) during the first half of the 20th century in a psychiatric hospital on the outskirts such as the Provincial Asylum of Malaga, sustained many peculiarities related to the legitimizing process of the specialty, the efforts to find positive data in mental medicine, as well as elements related to the gendered construction of madness. After the Civil War, National Catholicism permeated the diagnostic acts and the application of shock therapies in the institution, deepening the gap between psychiatrists and mad women. The objective of this work is to highlight what elements were present in the construction of the subjectivities of the mad women in room 20, what emotional regimes influenced these relationships and to show, finally, how the technification of therapeutics during the 40s gave rise to the perpetuation and amplification of an emotional asymmetry between psychiatrists and mad women in room 20, a circumstance in which the women also developed their strategies of resistance.(AU)

Our values and our historical understanding of psychiatrists.

Many people like to perceive themselves as better than previous generations: more knowledgeable, moral, tolerant and humane. Values associated with these aspects of ourselves may affect how we understand our professional forebears. In the early 20th century, some psychiatrists adopted new biomedical theories, including focal sepsis and eugenics, which resulted in inestimable harm. Detrimental clinical practices arose and were perpetuated in the context of societal values, medical ethics and other forces within and outside the medical profession. Historical understanding of the processes by which these things took place may help inform debate concerning current and future challenges of providing psychiatric care. The methods by which psychiatrists consider their predecessors may also have a bearing on how psychiatrists of the future will perceive us, the psychiatrists of the 2020s.