The Historical Development of Psychiatry in South Africa since 1652

Article excerpt

The Dutch East India Company perforce had to make the first efforts to deal with mental illness among early settlers and passing soldiers and sailors at the Cape. Accommodation for the behaviourally disturbed was in a primitive structure adjacent to the first Van Riebeeck fort; this was enlarged in 1674 but proved inadequate, and when a new hospital was built in 1699 adjacent to the Company Gardens, mentally ill patients were moved 'into a small enclosed apartment for locking up the mad! It is interesting to note that this pattern (hospital facilities for the mentally ill becoming inadequate for growing needs) has endured to this day in many of our modern psychiatric hospitals. A third hospital was built in 1772 near the Company Gardens, again with some space for mental patients, and again this became overcrowded and patients were transferred to the nearby Slave Lodge. The opening of Somerset Hospital in 1818 under the British colonial government was a new hope. Some beds were set aside for 'lunatics' who were cared for among the physically ill. This was the only such facility in the Cape Colony at the time, so patients were admitted from as far away as the Eastern Cape. (1)

Psychiatric diagnosis as we know it did not exist, and the mentally ill, lacking an obvious physical cause, were simply called 'insane', 'mad' or 'lunatic', the latter because of the supposed effects of the moon. They were largely thought to be possessed by demons--which could be dispersed by 'alienists; an appellation which endured well into the late 19th century. It is interesting to note that the concept of mental illness as a disease only came about towards the end of the 18th century, and the term 'psychiatry' was coined by a French physician in 1808. Causes were not known but, apart from the functional psychoses of mania and schizophrenia, malnutrition, malaria, epilepsy, alcoholism and syphilis must have been causal. Treatment did not exist as such; it was purely a matter of ensuring the safety of the person and controlling violent or disruptive behaviour. The next development, intended to relieve the overcrowding at Somerset Hospital, was the transfer in 1836 of mental patients to Robben Island. This had been a convict station but now became a refuge for lepers, lunatics and the chronically sick. (2) It continued to be the main resource for the mentally ill in the Cape until the building of Valkenberg Hospital in 1892, although patients were still admitted there until its psychiatric facilities were finally closed in 1920. It is reported that living conditions in the early years were dreadful; 'buildings were decrepit, overcrowded and verminous', patients lived in squalor and management was unfeeling. 'It was quite usual to find them kept in dark insanitary cells, filthy, covered in festering sores and chained to iron rings'. (2) Things improved with the appointment of Dr J C Minto in the mid-1860s, who decreed that mechanical restraint was not to be used unless seclusion had been tried; he considered that 'kindness and decision is found generally to restore order' and he improved living conditions and instituted occupations for patients, making mats and baskets for sale. Treatment was entirely symptomatic, consisting mostly of sedatives and hypnotics; bromides were a standby to settle agitation, and in excess might well have induced psychotic symptoms. Calomel (which contained mercury) was used to produce the evacuation of so-called toxins: we are not told of its ill effects but they must have been common and serious. (3)

The psychiatric hospital phase

The situation changed towards the end of the 19th century when it became clear that temporary lock-up and restraint arrangements and containment in police cells were not adequate or in keeping with current ideas. The spirit of humanism underlying the Enlightenment in Europe and the French Revolution was seeping through to South Africa, which was largely under British control at that time. …