Looking Back at Psychiatry in General Practice

Extract

As students at the Durham medical school in Newcastle during the early thirties, we were taught that illness could be due to certain factors and these were listed. The malady could be caused by infection, acute or chronic, trauma, neoplasia. … there were many possibilities but at the very end was a sort of garbage bin for all the diseases which did not fit neatly into the organic syndromes; these were called hysteria or psychoneurosis. These functional cases were diagnosed in a purely negative way, by a process of exclusion. No attempt was made to explain possible reasons for these troubles and there were no suggestions as to how to treat them. We were led to believe that such people were no more than time-wasters, suffering from unworthy maladies. If neurosis in all its forms gave rise to disdain, psychosis produced overt panic, as exemplified in the following case history. A young woman of 20 was admitted to a medical ward in the late stages of pregnancy because she was suffering from severe Sydenham's chorea. She was so bad, she was constantly in danger of falling out of bed and she was quite unable to speak coherently. It must have been because of this she was deemed mad, and a respectable medical ward was certainly no place for a lunatic. Fear in both the medical and nursing staff had completely obliterated all feelings of compassion. She was certified and transferred to the asylum where she died the next day. It was well known that chorea gravis carried with it a bad prognosis and, after all, there were side wards. The poor lass should have been allowed to die in dignity in one of them.