Bernardino Álvarez and the origins of psychiatric care in America – psychiatry in history

Bernardino Álvarez was born in Seville, Spain in 1514. At the age of 20, after receiving military training, he migrated to the New World to serve for the Spanish crown in the Chichimeca conflict located in the region of Zacatecas (North-Central México). Once relieved of his military duties, he encountered trouble with the law as a result of his gambling activity and was imprisoned. Surprisingly, he escaped to Peru where he lived for a number of years and became wealthy.

Upon his return to México-Tenochtitlan, and after finding out about the death of his father, he wrote to his mother inviting her to join him with his siblings in the New World where he was living comfortably. However, his mother replied stating that she was financially stable and she encouraged him to live a pious life. This letter from his mother inspired Bernardino to become a friar and dedicate his life to helping the sick and poor. Having observed how hospitals in the city were crowded and that patients were often discharged before they had recovered, he collected funds for the foundation of a new hospital with larger capacity.

In 1567 the Archbishop of the city, friar Alonso de Montufar, gave Bernardino permission to build the new hospital and designated the location of it next to the Church of San Hipólito, which provided the new facility with its name. Throughout the years Bernardino collected money to expand the hospital. Soon, it welcomed not only the sick and poor but people with intellectual disabilities and severe mental illness (then called ‘innocents’ and ‘mad’). Bernardino thought patients with mental illness could learn virtue from mentally healthy people, thus, he developed the idea of putting patients deprived of reason together with others who exhibited stable mental health. He also emphasised the importance of exercise and diet as a means of recovery in this population. Following the success of the new hospital and the model Bernardino had created for it, he founded a network of similar hospitals in Acapulco, Puebla and Veracruz in México and La Havana in Cuba. All of them were connected.

After Bernardino's death, the Hospital of San Hipólito hired their first physician in 1590, Don José de Cabas. In the modern era, patients with mental illness received medical treatment based on the principles of Hippocratic and Galenic medicine. Thus, good diet, exercise and purging were often prescribed. Friars were also involved in patient care and assisted patients with spiritual care, support and occupational therapy. The hospital tended to patients from all origins and ethnicities, including people with African, Native and Spanish roots. The Hospital of San Hipólito remained active focusing mainly on the treatment of the mentally ill in México over several centuries until the opening of the La Castañeda Mental Asylum in 1910. Today, the original building of San Hipólito is still standing and open to visitors. In accordance with 16th century architectural style, its structure includes a two-floor cloister with a central fountain.

The Hospital of San Hipólito represents an early example of medical care for mentally ill people in the so-called ‘New Continent’. Its approach to the treatment of mental health followed the tradition of other Spanish hospitals for the mentally ill, such as, Valencia (1410), Saragossa (1425), Seville (1436) and Toledo (1480). Before the Enlightenment, a medical approach to mental illness existed in the Hispanic world. San Hipólito's innovative approach to mental illness during this time helps us elucidate the origins of psychiatric care in America.