The roots and Seeds of Humanistic Psychiatry

In the 18th and 19th century, the Western World went through dramatic changes in the understanding of mental health and in provision of services. William Tuke (1732 - 1822) in the UK and Philippe Pinel (1745 - 1826) in France were in the forefront of a humanizing movement known as “moral treatment”. This humanization of services lost ground through the 19th and 20th centuries, giving rise to the maintenance and spreading of large mental health institutions where people suffering mental distress were severely separated/segregated from external reality and not given the rights of “normal” (adapted) people. A positive idea of asylum (with certain downsides – see below under “Critical Movements as base for a Humanistic Psychiatry”) was replaced with segregation. During the Second World War, a number of British doctors started the Therapeutic Community movement in the UK, in many ways returning to the ideas of Tuke and Pinel. They observed that transforming the environment of the “mentally ill” would also dramatically change their condition. A number of similar movements spread through Europe and the US giving rise to a new understanding of mental illness, sometimes even contesting the term illness itself, and often attempting treatment without medication. Alongside the growing therapeutic community movement and the humanization of services another dominant trend was rising: the “technologization” and commodification of interventions based on value-free science. Whilst not the aim of that trend, it often dehumanized relationships. There is an implicit tension between “being-with” (humanistic values) and “doing-to” (technical expertise). A “doing-to” stance has often been rooted in psychiatric manuals like DSM (Diagnostic and Statistical Manual of Mental Disorders) or ICD (International Statistical Classification of Diseases and Related Health Problems) which suggest the existence of objective states which are value-free and where concepts such as “autistic” or “schizophrenic” entered daily discourse and gained legitimacy. Increasingly we find ourselves in a “quick fix” culture dominated by a technical-rationality model of science, a change nicely termed by some authors as the “McDonaldization of Society” (Ritzer, 1993). How can Being and Doing coexist in the service of patients and families? The relational paradigm and the scientific postmodern era arose at the same time that positivism and empiricism are growing. There are disparate movements of integration and sectarianism; important differences between affective and cognitive neuroscience; large gaps between theory and practice; contradictory evidence for and against “broken-brain” models. Is it possible for science to go back to “the ordinary” and start being human again, acknowledging the impossibility of separating figure from ground? Neurobiology can be significantly modified through medication and psychotherapy, but also through play and occupational therapy, and by diet and lifestyle. The right weighting of the components of mental health, and the right measures of it, can only be known through secure and trustworthy therapeutic relationships, helping to give meaning to interventions. The establishment of epistemic trust within psychologically enabling relationships is perhaps the only non-controversial ingredient of change, as research and practice consistently confirm (Pereira and Debbané, 2018; Norcross, 2002). With this volume, we propose to open the debate between three main themes: psychotherapy (including psychological and philosophical influences), neurobiology (including cognitive and affective neuroscience) and psychopharmacology. The three main themes are clinically applied in what we call the “Intervention Triangle”. The book is first focused on epistemologically distinct frameworks and gradually attempts to consider the integration of these three fundamental vertices of practice. The volume will be particularly relevant to practitioners working towards integrative frameworks. Although unidisciplinary integration has been a theme in several research and theoretical publications, this book offers an interdisciplinary, comprehensive and reflexive view of mental health problems and approaches, avoiding developing into mere eclecticism. Following a number of congresses, international meetings and the publication of Schizophrenia and Common Sense (Hipólito, Gonçalves and Pereira, eds. 2018) the first editor has decided to put together a second volume, grounded on the discussions undertaken during the Second International Mental Health Congress of Romão de Sousa Foundation. Several authors from this congress, and several others with an interest on the subject of integration and common sense mental health, agreed to publish and contribute towards the humanization and democratization of mental health services. This volume results from the honest effort of all the authors, editors, reviewers and assistants. We hope it can contribute towards common sense in 21st century mental health.