A page of history

The progress of knowledge about the nature of mental illness and its treatment that has marked the 20th century has not been matched by an equal advance in tolerance and acceptance of the mentally ill by society. Although people with mental illness are no longer universally seen as mad and although it has become accepted that mental illness can and shoud be treated by medical means rather than by a variety of methods of enforcing conformity, most of those who have a mental disorder are stigmatized by their disease.

In the mid 1960's Michel Foucault wrote the History of Madness and postulated that the degree of civilization of a society can be judged by the way in which that society treats its mentally ill members. Nearly a quarter of a century later, the United Nations in their resolution A/46/119 stated that the human rights of people with mental illness must be safeguarded and that the treatment of their illness should be seen as one of their rights.

The progress towards a more humane approach in the field of psychiatry has to be viewed in the light of two major events that affected Europe, and the rest of the world to a lesser extent, in the past decade. The first of these is the downfall of the political systems in Eastern Europe - a series of events that are of particular relevance for psychiatry which has for many years reflected the totalitarian systems of the countries in which it was practiced. Loss of freedom, forced administration of drugs, commitment to mental hospitals for political reasons were telling signs of a system of government that did not tolerate difference and equated dissent and independence of opinion with mental illness. With the disappearance of communist regimes and the discreditation of their ideology and practices also vanished any justification for the subordination of mental-health services to goals of social eugenics and general conformity.

The second set of events affected in particular the countries of the North in which the economic boom dwindled and the current period of feeble growth and uncertainty became the rule of the day. Public health services were among the first to experience the consequence of this change, not least because the economic slowdown coincided with an increasing awareness of demographic changes in the population. Social welfare systems seem to be in danger of falling apart. Mental health care feels these trends more than other medical disciplines for at least two reasons : first because - even in the richest countries - it remains the beggar at the feast ; and second because psychiatry is, even more than other branches of medicine, exposed to the processes of privatization, deregulation and rationalization throught which those concerned with economic matters seek to reduce costs of health care.

The process of change from a State owned mental health care system to industrialized private health care threatens progress towards a humanization of mental health care, because of inequality of opportunity and access to care quality. Faced with the explosive increase of treatment possibilities - some of which are of doubtful value - insurance companies are increasingly reticent to pay. The safety net of psychiatric services maintained by the Government still exists : the lack of attention and the reduction of resources often result in care of poor quality. These trends - though perhaps less visible - also affect countries of the South in which resources are incomparably fewer and psychiatric service seem to be about to lose the ground which they have gained with so much difficulty over the past few decades.

Switzerland and Geneva have always been aware of the humane and social dimensions of mental illness and its consequences in the area of human rights. The origin of this profound interest in the functioning of the mind lies perhaps in the roots of Christianity in Switzerland and in prayer itself - this singular dialogue between mankind and its God. Since Rousseau, literature has shown an interest and even a passion for introspection, the intimate exploration of thought and feeling, a preoccupation with the mystery of how emotion affects all aspects of life, not only art but science too. In the last century, Geneva nurtured an array of eminent psychologists including Piaget and clinicians such as Ajuriaguerra : all of them shared a passion for the individual liberty of all people, including in particular the mentally ill.