Madness and crime in the history of psychiatry. Historical notes on the relation between psychiatric care and prison

Abstract

The paper examines the relations between psychiatry and prison between the beginning of the Nineteenth century and the first years of the Twentieth century to gather affinity and differences with the themes of today's debate. The Reunions of the Italian Scientists had the worth to represent an important moment of national scientific debate before the political realization of the unity of Italy. At the beginning of the forties of the Nineteenth century they studied, among many other themes, the effects of the different formes of detention (particularly the systems of Philadelphia and Auburn) on the health, and particularly on the mental health, of the prisoner. These matters were also debated passionately in that years in other European countries, with the intervention of some intellectuals as Alexis de Tocqueville, Gustave de Beaumont, Charles Lucas and Charles Dickens. During this debate it emerged with clarity the risk, for the physicians, to unconsciously involve themselves in  a punitive mission or in necessities of public order; but the prevailing orientation in the Reunions, nevertheless, was that to reject this tendency, and to ask to the physicians to assume as their principal task that to pronounce themselves on the salubriousness or unhealthiness of the prison systems. Subsequently, the psychiatrist Serafino Biffi studied with competence and passion to the issue of the psychological effects of the the juvenile incarceration, leaving us some suggestive texts in which he shows to prefere a management of the juvenile deviance based on small educational facilities, with a familial atmosphere, rather than on the concentration of the boys in greater institutions. The main attention of the Italian psychiatrists moved then, however, in greater measure from the reflexes of the incarceration on the mental health to the psychiatric examination during the judgement and to the search of the physical and psychological stigmates of the criminal. The attention for the consequences of the incarceration on the mental health appears testified by the Italian reflexes of the debate, that  involved in Italy a limited number of experts and was late in comparison to other European countries, as Germany, where the main psychiatrists as Ganser and Kraepelin were authoritatively dealt with the matter on the nosographic autonomy of the psychotic conditions beginning during the incarceration. During this debate, discussing on the nosographic autonomy of the psychoses beginning in the jail, they take in consideration four different possibilities:that the detention represents a possible risk factor for the mental illnesses; that it represents an environmental factor favouring the onset and making worse the course of the illness in subjects already predisposed, or sicks in a subclinical way; that it represents a morphological factor able, only, to give a particular coloring to some clinical pictures developing in prison in the same way in which they would develope elsewhere; or that it represents an irrelevant element so in determining, that in the offer of some environment favouring conditions, that in the morphology of the mental illnesses. The authors believe that the relation between psychiatry and jail among the Nineteenth and the Twentieth century doesn't have now only an interest on an historical ground, but that it is particularly actual today, when some new legislative orientations and an exigence of equity in the access to the health care determine a greater involvement of the Departments of Mental Health in the problemof the health care of the prisoners.