In the course of my wife’s rising career in the administration of a university, I was placed in the position of being the chatty spouse of an increasingly important player in the state politics that is part of a large public university. One of the main venues was the president’s box at football games, to which I jokingly referred privately to my wife as a human dog park with much more interest in the game inside than the one on the field outside. Inevitably, I could not avoid admitting that, yes, I am a psychiatrist. There is a curious paradox in people’s responses to that admission. One common response is, “Oh, we are all a little crazy, aren’t we?” Presumably, this reaction relates to the fact that the anxiety and depression conditions, as I have explained earlier, are directly related to normal, everyday emotions. However, in this comment there is a hint of skepticism that mental illness really exists, a suspicion that patients just want attention and perhaps should be told to suck it up and just live with it like all the rest of us.

Shackled to the wall at Williamsburg

Then there is the opposite reaction: fear. Since I am in regular contact with crazy people, some people will actually flinch as if to protect themselves from my patients’ mysterious contagions or, even more commonly, will assume that I have the power to instantly detect some depravity that lurks inside the recesses of their minds. Very occasionally I have even been moved to reassure these folks not to worry, because “If you were mentally ill, you would be the first one to know it.”

Watching the mentally ill at Bethlem Hospital

If you ever visit Williamsburg, be sure not to miss the “Public Hospital for Persons of Insane and Disordered Minds” to get an idea of what enlightened treatment of the mentally ill in 1793 amounted to. Note carefully the iron rings on the walls of the rooms to which the patients were shackled. The word bedlam was coined by members of 16thcentury London society who would amuse themselves by watching the insane from public balconies in Bethlem Hospital. The stigma of mental illness has many ugly sides and a long history that is very much alive and well today. We psychiatrists proudly carry in our minds a heroic painting of the Frenchman Philippe Pinel, considered the first modern psychiatrist, dramatically ordering chains removed from the insane in a Paris asylum in 1793. For the most part, this history of stigma arises from the fear inspired by schizophrenia, which afflicts one percent of the world’s population across all cultures and environments. 

Phillippe Pinel


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