Transnational evolution of psychiatry and neurology: a European perspective from the enlightenment to the early 20th century
A evolução transnacional da psiquiatria e neurologia: uma perspectiva europeia do iluminismo ao início do século XX
Evolución transnacional de la psiquiatría y la neurología: una perspectiva europea desde la Ilustración hasta principios del siglo XX
1. Marleide de Mota Gomes
2. Cátia Mathias
3. Antonio Egidio Nardi
Filiação dos autores:
1 [Professora Titular de Neurologia aposentada, Laboratório de História da Psiquiatria, Neurologia e Saúde Mental, Instituto de Psiquiatria, Instituto de Neurologia, Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro, RJ, Brasil]
2 [Bibliotecária-Chefe, Laboratório de História da Psiquiatria, Neurologia e Saúde Mental, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, UFRJ, Rio de Janeiro, RJ, Brasil]
3 [Professor Titular de Psiquiatria, Laboratório de História da Psiquiatria, Neurologia e Saúde Mental, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, UFRJ, Academia Brasileira de Ciências, Academia Nacional de Medicina, Rio de Janeiro, RJ, Brasil]
Chief Editor responsible for the article: Marsal Sanches
Authors contributions according to the Taxonomia CRediT: Gomes MM [1,5,13,14], Mathias C, Nardi AE [14]
Disclosure of potential conflicts of interest: none
Funding: none
Approval Research Ethics Committee (REC): not applicable
Received on: 2024/11/25 | Accepted on: 2025/02/09 | Published on: 2025/02/21
How to cite: Gomes MM, Mathias C, Nardi AE. Transnational evolution of psychiatry and neurology: a European perspective from the enlightenment to the early 20th century. Debates em Psiquiatria, Rio de Janeiro. https://doi.org/10.25118/2763-9037.2025.v15.1379
Abstract
This paper investigates the historical evolution of psychiatry and its interrelationship with neurology from the Enlightenment to the early 20th century. It examines the transnational development of these disciplines primarily across Europe, with particular emphasis on key regions such as France, Germany, Britain, Italy, Spain and Portugal, while also including some related remarks about Brazil. The objective is to elucidate how advancements in scientific knowledge, medical practices, and societal perceptions of mental illness have influenced the trajectories of psychiatry and neurology. This analysis is grounded in a diverse array of historical sources, including scholarly literature. It critically examines prominent figures, institutional dynamics, and shifts in societal norms to uncover the intricate interplay of cultural, political, and intellectual forces that have shaped the evolution of these fields. The study reveals a complex tapestry of influences - such as the humanization of treatment, significant scientific breakthroughs, and interdisciplinary collaboration - that have contributed to the development of psychiatry and neurology. Our research underscores the necessity of contextualizing the historical framework within which these disciplines emerged and evolved, thereby offering insights into contemporary practices and policies in mental health care and neurological understanding. Through this historical analysis, we illuminate the nuanced narrative of psychiatry and neurology, highlighting their transnational development and the various factors propelling their evolution. By comprehending the historical foundations of these disciplines, we can glean valuable insights into the challenges and opportunities confronting contemporary mental health care and neurological research, thereby informing future directions in the field.
Keywords: psychiatry, neurology, history, comparative analysis, cultural context.
Resumo
Este artigo investiga a evolução histórica da psiquiatria e sua inter-relação com a neurologia desde a Ilustração até o início do século XX. Examina o desenvolvimento transnacional dessas disciplinas principalmente na Europa, com ênfase especial em regiões chave como França, Alemanha, Grã-Bretanha, Itália, Espanha e Portugal, incluindo também algumas observações relacionadas ao Brasil. O objetivo é elucidar como os avanços no conhecimento científico, nas práticas médicas e nas percepções sociais sobre as doenças mentais influenciaram as trajetórias da psiquiatria e da neurologia. Esta análise baseia-se em uma ampla gama de fontes históricas, incluindo literatura acadêmica. Examina criticamente figuras proeminentes, dinâmicas institucionais e mudanças nas normas sociais para desvendar a complexa interação das forças culturais, políticas e intelectuais que moldaram a evolução dessas áreas. O estudo revela um complexo conjunto de influências - como a humanização do tratamento, descobertas científicas significativas e a colaboração interdisciplinar - que contribuíram para o desenvolvimento da psiquiatria e da neurologia. Nossa pesquisa destaca a necessidade de contextualizar o quadro histórico no qual essas disciplinas emergiram e evoluíram, oferecendo assim insights sobre as práticas e políticas contemporâneas de cuidados com a saúde mental e a compreensão neurológica. Através dessa análise histórica, iluminamos a narrativa detalhada da psiquiatria e da neurologia, destacando seu desenvolvimento transnacional e os diversos fatores que impulsionaram sua evolução. Compreendendo as bases históricas dessas disciplinas, podemos obter valiosos insights sobre os desafios e as oportunidades que enfrentam os cuidados contemporâneos de saúde mental e a pesquisa neurológica, orientando assim as futuras direções no campo.
Palavras-chave: psiquiatria, neurologia, história, análise comparativa, contexto cultural.
Resumen
Este artículo investiga la evolución histórica de la psiquiatría y su interrelación con la neurología desde la Ilustración hasta principios del siglo XX. Examina el desarrollo transnacional de estas disciplinas principalmente en Europa, con especial énfasis en regiones clave como Francia, Alemania, Gran Bretaña, Italia, España y Portugal, incluyendo también algunos comentarios relacionados con Brasil. El objetivo es esclarecer cómo los avances en el conocimiento científico, las prácticas médicas y las percepciones sociales sobre las enfermedades mentales han influido en las trayectorias de la psiquiatría y la neurología. Este análisis se basa en una amplia variedad de fuentes históricas, incluyendo literatura académica. Examina críticamente figuras prominentes, dinámicas institucionales y cambios en las normas sociales para descubrir la compleja interacción de las fuerzas culturales, políticas e intelectuales que han dado forma a la evolución de estos campos. El estudio revela un complejo conjunto de influencias, como la humanización del tratamiento, avances científicos significativos y la colaboración interdisciplinaria, que han contribuido al desarrollo de la psiquiatría y la neurología. Nuestra investigación subraya la necesidad de contextualizar el marco histórico en el que estas disciplinas surgieron y evolucionaron, ofreciendo así perspectivas sobre las prácticas y políticas contemporáneas en el cuidado de la salud mental y la comprensión neurológica. A través de este análisis histórico, iluminamos la narrativa detallada de la psiquiatría y la neurología, destacando su desarrollo transnacional y los diversos factores que impulsaron su evolución. Al comprender los fundamentos históricos de estas disciplinas, podemos obtener valiosos conocimientos sobre los desafíos y oportunidades que enfrentan los cuidados contemporáneos de salud mental y la investigación neurológica, orientando así futuras direcciones en el campo..
Palabras clave: psiquiatría, neurología, historia, análisis comparativo, contexto cultural.
Introduction
This paper critically examines the transnational evolution of
psychiatry and neurology in Europe, tracing their intertwined
development from the Enlightenment to the early 20th century.
Psychiatry's progression is analyzed through Shorter’s paradigms -
humanitarian, psychological, sociocultural, and biological - rooted in
moral therapy, a practice emphasizing compassionate care and
recognizing the social determinants of mental disorders. Shorter’s
framework identifies three pivotal stages in European mental health
services: the establishment of therapeutic asylums, the
mid-20th-century expansion of institutional care, and the transition
to community-based care beginning in the 1970s
[1,
The development of psychiatry and neurology reflects a dynamic interplay of cultural, political, and intellectual influences. During the Enlightenment, figures such as Philippe Pinel in France and William Tuke in England revolutionized mental health care by advocating for asylum reform and promoting compassionate treatment. These efforts marked a pivotal shift in societal approaches to mental illness. Building on this foundation, the 19th century saw psychiatry emerge as a distinct medical discipline, embracing a scientific framework centered on the brain's role in mental disorders. Concurrently, neurology evolved as a specialized field, driven by groundbreaking contributions from figures such as Jean-Martin Charcot in France, Moritz Heinrich Romberg in Germany, and John Hughlings Jackson in England, who advanced the understanding of neurological conditions and established clinical practices that continue to shape modern medicine.
The rise of biological psychiatry in the 19th and 20th centuries
highlights the significant impact of clinical and laboratory
observations. Kraepelin’s classification systems, which form the basis
for modern diagnostic tools, exemplify the growing integration of
psychiatry and neurology. This integration is further evidenced by the
contributions of pioneers such as Charcot and Alzheimer, whose
groundbreaking work bridged the two fields and significantly advanced
the understanding of mental health [3,
Expanding on these foundations, this paper explores the regional
evolution of psychiatric institutions, analyzing how cultural
attitudes and governmental policies shaped mental health care systems
across Europe [5
A historical overview of neuroscience enhances this transnational
perspective, highlighting early innovators who bridged psychiatry and
neurology, thereby catalyzing major advancements in the field
[8
The convergence of psychiatry and neurology has given rise to interdisciplinary fields such as neuropsychiatry, which explore the biological underpinnings of mental illness. This integration underscores the necessity of bridging these disciplines to develop a more holistic understanding of complex conditions, thereby improving diagnosis and treatment. Significant progress in treatment approaches, exemplified by the introduction of moral therapy during the Enlightenment, further emphasized the importance of compassion and dignity in patient care. Advocates from France and England played a crucial role in embedding these principles into practice, laying the groundwork for modern therapeutic methods that prioritize humanity alongside medical efficacy.
The transnational landscape of psychiatry has significantly shifted in
the latter half of the 20th century, with American psychiatry emerging
as a dominant force, shaping both theoretical and clinical approaches
worldwide [1,
Through synthesizing these diverse perspectives, the paper offers a comprehensive analysis of the regional and transnational factors shaping European neuropsychiatry. Focusing on key nations such as France, Germany, Britain, Italy, Spain, and Portugal, with some issues raised about Brazil, it evaluates foundational Enlightenment ideas, the evolution of psychotherapeutic and neurological practices, and the transformative shifts of the 20th century, including community-based care and neurobiological advancements. Finally, it addresses enduring challenges such as stigma, disparities in access to care, and the ongoing need for multidisciplinary collaboration, highlighting the dynamic forces driving progress in mental health care.
French Psychiatry and Neurology Intersection
The intersection of psychiatry and neurology in France has driven
collaboration, innovation, and advancements in mental health.
Enlightenment ideals fostered humane, scientific approaches to mental
illness, shaping modern psychiatry and neurology. Key institutions and
figures are highlighted in updated literature
[1,
Foundations from the 19th Century
During the Enlightenment, French physicians reframed mental illness as
a subject for scientific inquiry. Philippe Pinel, at Bicêtre Hospital,
championed humane treatment, emphasizing observation and
classification of mental disorders. His pivotal work, Traité
médico-philosophique sur l'aliénation mentale (1801), laid the
foundation for clinical psychiatry [2
Psychotherapy and Neurological Insights
France’s intellectual openness spurred interest in psychological
theories. Freud’s concepts significantly influenced artistic and
literary movements. However, psychoanalysis gained traction in France
only post-World War II, largely due to Jacques Lacan, who
reinterpreted Freudian ideas, emphasizing language, the unconscious,
and symbolism. France presents an alternative origin story for
psychotherapy, diverging from the narrative centered on Freud's
psychoanalysis in Vienna. However, the emergence of psychotherapeutic
practices can be traced back to the early 19th century with figures
such as Philippe Pinel advocating for moral treatment. The cultural
environment was shaped by hypnosis and trauma discourse, which
facilitated the growth of psychotherapy throughout the 20th century.
[9,
Continued Evolution and Challenges
Political and social upheavals, including the French Revolution, the
Franco-Prussian War, and World War I, shaped evolving understandings
of mental health. Philippe Pinel’s reforms laid the groundwork for
humane treatments, while Joseph Babinski’s research on soldiers during
World War I challenged hysteria’s gendered diagnosis, marking a
critical shift in psychiatric paradigms
[5,
The 20th century saw biological psychiatry’s rise through advancements
in genetics, neurochemistry, and brain imaging. Psychoanalysis, led by
Lacan, coexisted with psychodynamic psychotherapy as
psychopharmacology emerged. France played a pivotal role in
psychopharmacology, with Henri Laborit, Jean Delay, and Pierre Deniker
introducing chlorpromazine in the 1950s, revolutionizing schizophrenia
treatment and psychiatric care [16,
Despite challenges posed by centralized systems, language barriers,
and the growing dominance of American psychiatry, France contributed
significantly to psychiatric classifications, including Bouffée
Délirante and chronic delusional psychoses. Post-World War II reforms
focused on community-based care, although slower than those in Italy.
French psychiatry remains influential globally, reflected in its
contributions to modern classifications (DSM-5, ICD-11) and its
innovative integration of psychopharmacology with psychotherapeutic
practices [4,
German Psychiatry and Neurology Intersection
The history of German psychiatry and neurology reflects a profound
legacy shaped by scientific progress and philosophical inquiry. In the
19th century, influenced by Romantic mentalism and Naturphilosophie,
psychiatry shifted from moralistic to biomedical perspectives,
advancing institutional care and research through pioneers like Johann
Christian Reil and Wilhelm Griesinger
[1,
Foundations from the 19th Century
German psychiatry in the early 19th century embraced Enlightenment
ideals and Romantic mentalism, fostering a scientific approach to
mental illness. Reil, who coined "psychiatry," advocated integrated
psychological and physiological treatments, forming modern psychiatric
foundations [3,
Institutions like Berlin’s Charité Hospital became hubs for modern
psychiatric practice under Griesinger, where Carl Wernicke advanced
neuroanatomy and aphasia studies [20,
Psychotherapy and Neurological Insights
Germany’s intellectual tradition profoundly shaped psychoanalysis, the
birthplace of Sigmund Freud and his revolutionary concepts
[3,
German psychiatry integrated biological and psychosocial approaches,
advancing neuroscience and psychiatric research. Modern German
analysts, while maintaining Freudian foundations, have incorporated
empirical research, balancing classical principles with contemporary
clinical innovations [11,
Continued Evolution and Challenges
The Nazi regime (1933–1945) profoundly scarred German psychiatry,
enforcing eugenics policies under figures like Ernst Rüdin and Hans
Asperger. Rüdin, a key proponent, justified forced sterilization
programs and oversaw the T4 euthanasia initiative, which killed
approximately 200,000 individuals with mental illnesses or
disabilities. Institutions were complicit, with patients subjected to
lethal injections and gas chambers
[13,
Notable psychiatrists, including Alfred Hoche (Freiburg), Max de
Crinis (Cologne), and Carl Schneider (Heidelberg), supported or
coordinated euthanasia operations. Werner Heyde, the T4 program’s
medical director, played a central role. Researchers like Julius
Hallervorden and Viktor von Weizsäcker conducted brain studies on
euthanasia victims, intertwining academic research with atrocities
[14,
Post-war reckoning led to ethical reforms emphasizing patient rights
and humane treatment. Despite historical disruptions, Germany’s
psychiatry evolved, advancing neurobiological insights and holistic
mental health approaches. However, the dark legacy of the Nazi era
underscores the peril of aligning medicine with ideological extremism
[3,
British Psychiatry and Neurology Intersection
The evolution of British psychiatry reflects a commitment to
scientific progress, compassion, and patient-centered care, spanning
from Enlightenment ideals to modern practices. This legacy has shaped
psychiatric policy and practice while highlighting key institutions
and influential figures
[1,
Foundations from the 19th Century
Enlightenment pioneers like William Cullen and Robert Whytt
underscored the clinical importance of mental illness, establishing
foundations for modern diagnostic methods [1,
Psychotherapy and Neurological Insights
The term "psychotherapy" gained prominence through figures like Walter
Dendy and Daniel Tuke, with the York Retreat embodying ethical care
models. Overcrowded asylums necessitated innovative therapies that
combined moral principles with scientific advancements. Psychoanalysis
later gained ground, notably after World War I, through David Eder and
Bernard Hart, with the Tavistock Clinic emerging as a key training
center [23
Freudian psychoanalysis entered Britain gradually, facing initial
skepticism. However, figures like Melanie Klein legitimized it,
particularly in child psychology. The UK's historical narrative in
psychotherapy is significantly marked by the contributions of the
Tavistock Clinic and figures like John Bowlby and Donald Winnicott.
Psychoanalysis became entwined with the concept of a liberal psyche
following WWII, helping to shape the welfare state's psychological
foundations [11,
Continued Evolution and Challenges
Post-World War I, institutions like the Maudsley Hospital, under
leaders such as John Conolly and Henry Maudsley, became pivotal in
advancing psychiatric care [2,
The mid-20th century marked significant transformations, including the
deinstitutionalization movement and the creation of the National
Health Service (NHS) in 1948, which expanded access to mental health
services. Key milestones included integrating mental hospitals into
the NHS and founding the Royal College of Psychiatrists in 1971.
Tracing its origins to 1841 as the Association of Medical Officers of
Asylums and Hospitals for the Insane, the College symbolizes Britain’s
ongoing efforts to enhance psychiatric care
[2,
Italian Psychiatry and Neurology Intersection
Despite Italy's political divisions, its Renaissance legacy fostered
advancements in psychiatry and neurology. The country’s rich
psychiatric history reflects innovation, resilience, and compassion,
shaped by historical, cultural, and scientific developments. Italy has
also emerged as a leader in critiquing mental health care systems that
perpetuate exclusion and segregation. This evolution, highlighted by
key figures and institutions, is summarized in Figure 4
[2,
Foundations from the 19th Century
Italian psychiatry prioritized humane treatment during the
Enlightenment, exemplified by Vincenzo Chiarugi and therapeutic
asylums in Florence [2,
Psychotherapy and Neurological Insights
In Italy, the professional landscape of clinical psychology saw the
integration of psychoanalytic concepts, particularly through the
influence of Freud's ideas introduced in the 1920s. This gradual
assimilation has informed therapeutic practices in Italy, which are
characterized by a mix of psychoanalytic tradition and local cultural
practices [11,
In 1971, the Società Italiana di Neurologia (SIN) congress formalized
the separation of psychiatry and neurology, aligning neurology with
internal medicine while psychiatry evolved with neuroimaging and
genetic research [25,
Continued Evolution and Challenges
The Fascist regime (1922–1943) deeply influenced psychiatry, promoting
eugenics and using psychiatric institutions for social control.
Critics like Cesare Lombroso, with his theories on "born criminals,"
saw their ideas adapted to serve state ideology
[28,
Ugo Cerletti’s 1938 introduction of electroconvulsive therapy marked a
milestone in psychiatric treatment [24,
Spanish Psychiatry and Neurology Intersection
Spain’s evolution in psychiatry and neurology reflects the complex
interplay of historical, cultural, and scientific influences. As a
former global empire, Spain contributed significantly to these
disciplines, with figures like Santiago Ramón y Cajal shaping modern
neurology through groundbreaking research. His work continues to
influence clinical practices and policies today, as summarized in
Figure 5 [2,
Foundations from the 19th Century
Spanish psychiatry traces its roots to early mental health facilities
like the Hospital de los Inocentes (Valencia, 1404) and similar
establishments in Zaragoza (1425) and Toledo (1480). Psychiatry
emerged as a distinct medical field in the 19th century, reflecting
European trends toward the medicalization of mental illness. During
this time, Spanish physicians adopted and advanced mental health
practices, influenced by European thinkers like Philippe Pinel, who
incorporated insights from Spanish hospitals into his reforms in
France [35
Psychotherapy and Neurological Insights
In Spain, studies on psychotherapy emphasize the rise of
psychoanalytic concepts through Freud's influence on
neuropsychiatrists during the 1920s and their dissemination by Emilio
Mira y Lopes through a journal based in Barcelona
[11
Cajal’s Nobel Prize-winning research on the nervous system laid the
foundation for understanding psychiatric disorders, advancing both
psychiatry and neurology. The "Spanish Neurological School," centered
around Cajal, fostered significant clinical progress, with pioneers
like Lluis Barraquer Roviralta conducting groundbreaking research in
Barcelona [36,
Continued Evolution and Challenges
The Spanish Civil War (1936–1939) and Francisco Franco’s regime
(1939–1975) deeply impacted psychiatry [32
Following Franco’s death in 1975, Spain implemented the Psychiatric Reformation Act, which emphasized community-based care and deinstitutionalization, integrating psychiatric services into the national healthcare system. This marked a shift toward modern mental health practices, addressing the challenges of Franco’s oppressive legacy.
The Intersection of Portuguese Psychiatry and Neurology
The development of psychiatry and neurology in Portugal was shaped by
historical and political influences, particularly during the Estado
Novo regime (1933–1974), when psychiatry was at times instrumentalized
as a tool of political repression. Despite these challenges, the late
19th and 20th centuries witnessed significant advancements, driven by
key figures and institutions [38-43
Among the most influential figures, Júlio de Matos, António Maria de Sena, and Miguel Bombarda played a crucial role in reforming psychiatric education, shaping legislation, and improving patient care. António Egas Moniz revolutionized both fields with his pioneering work in cerebral angiography and the controversial prefrontal leucotomy. Meanwhile, José de Matos Sobral Cid advanced psychiatric knowledge by integrating semiology with psychodynamic theories, and Corino de Andrade made a landmark contribution to neurology with the discovery of Familial Amyloidotic Polyneuropathy (FAP).
Institutions such as the Miguel Bombarda and Júlio de Matos hospitals were at the forefront of psychiatric and neurological progress, aligning with European trends while addressing Portugal’s specific needs. A key figure in modernizing psychiatric policies, Henrique João de Barahona Fernandes reinforced Portugal’s influence in global mental health discourse.
The evolution of these disciplines was further enriched by transatlantic exchanges with Brazil, strengthened by shared linguistic and cultural ties. Figure 6 highlights the major institutions and personalities that shaped the field, underscoring their contributions to medical thought, institutional expansion, and international collaboration.
Brazilian Connections with Psychiatry and Europe
Brazilian neurology and psychiatry were heavily influenced by European traditions, particularly from France and Germany, with additional ties to Portugal, rooted in shared cultural and linguistic heritage [Figure 6].
Academic interest in the history of Brazilian psychiatry has grown,
focusing on its colonial roots, the transformative 19th and 20th
centuries, and contemporary challenges and innovations
[44,
The Emergence of the Asylum System
Psychiatric care in Brazil initially relied on healers and priests. The establishment of the Pedro II Asylum in Rio de Janeiro in 1852, modeled after European institutions, marked a turning point. Despite its significance, issues like overcrowding underscored the tensions between scientific exploration and public welfare.
In the early 19th century, Brazilian psychiatry adopted French
alienist principles but prioritized social over scientific concerns.
The centralized monarchy and religious institutions shaped Brazil’s
asylum system. A partir da inauguração do Hospício Pedro II,
iniciou-se a construção de diversos hospitais ao longo do século XIX.
Em São Paulo, foi erguido o Hospício Provisório em 1852, seguido pelo
Hospício do Juquery, em 1898. In Pernambuco, the Recife-Olinda
Hospice, under the patronage of Visitação de Santa Isabel, was
established in 1864, followed later by the Tamarineira Hospice. In the
state of Pará, the Provisional Hospice was founded in 1873 in Belém,
near the Lázaros Hospice. Meanwhile, in Bahia, the São João de Deus
Asylum was inaugurated in Salvador in 1874 [51
Transformations in Brazilian Psychiatry
Early 20th-century reformers, including Juliano Moreira and Ulisses
Pernambucano de Melo Sobrinho, improved care despite limited
treatments [44
Inspired by international models, deinstitutionalization in the 1980s and 1990s promoted community-based care networks. However, these reforms faced political and ideological hurdles, especially during the Brazilian military dictatorship.
Collaboration and Progress
Brazilian psychiatry’s evolution highlights a journey of challenges,
reforms, and international collaboration. Main milestones include the
1852 founding of the National Hospice for the Insane
[48
Conclusion
This paper explores the historical development of psychiatry and its intersection with neurology, focusing on their evolution in various European nations and their influence on Brazil. The Renaissance and Enlightenment periods provided fertile ground for advancements in science, medicine, and philosophy, laying the foundation for understanding mental health and its connection to brain function. These intellectual movements inspired the creation of the first asylums and introduced an institutional approach to mental health care. Simultaneously, growing advocacy for human rights and more compassionate treatment set the stage for transformative reforms in the centuries to follow.
In the 19th century, European countries spearheaded significant advancements in medical science, which fostered the recognition of mental illnesses as medical conditions. The widespread establishment of psychiatric hospitals during this period marked a pivotal shift from custodial care to structured medical models. These institutions also became platforms for early therapeutic interventions, such as ECT and insulin shock therapy, signaling a commitment to scientific approaches in treatment. However, the cultural and political climates of individual nations influenced the governance and development of these hospitals, leading to diverse approaches to mental health care across Europe.
The early 20th century brought further transformation, driven by Freud’s psychoanalytic theory, which originated in Europe and revolutionized the understanding of the human psyche. At the same time, European researchers were at the forefront of developing psychotropic medications, such as chlorpromazine, which greatly enhanced treatment efficacy. These advancements, coupled with increased awareness and advocacy for mental health, catalyzed significant reforms across the continent to address the growing burden of mental illnesses.
By the mid-20th century, psychiatry in Europe had evolved to integrate psychodynamic theories with the advancing field of biological psychiatry. This period also saw the rise of deinstitutionalization, a landmark shift in mental health care, as many European nations transitioned from large-scale asylums to community-based care systems. The publication of the DSM provided a shared diagnostic framework, which was often adapted to reflect regional needs. Concurrently, the "golden age" of psychopharmacology and the emergence of CBT expanded the range of therapeutic options, enriching mental health care practices throughout Europe.
In recent decades, Europe has suffered extraordinary progress in neuroscience, which has profoundly influenced psychiatry and neurology. Advances such as functional magnetic resonance imaging (fMRI) and a deeper understanding of neurobiological mechanisms have paved the way for targeted and personalized treatments. The convergence of these fields has not only enhanced the understanding of mental health disorders but also positioned European researchers as some of the main leaders in these innovations.
Globalization has further shaped psychiatry by influencing diagnostic systems, treatment methods, care delivery, and the preservation of regional traditions. Despite these achievements, challenges such as resource constraints, persistent stigma, and systemic inequalities continue to impede equitable access to mental health care. Each nation’s unique historical and cultural context plays a critical role in shaping current practices, impacting the integration of services and the formulation of public health strategies. Moving forward, addressing these disparities while building on Europe’s rich legacy of innovation in psychiatry and neurology will be essential to creating patient-centered, multidimensional care systems.
References
1. Shorter E. A history of psychiatry: from the era of the asylum to the age of Prozac. Hoboken: John Wiley & Sons; 1997.
2. Shorter E. The historical development of mental health services in Europe. In: Knapp M, McDaid D, Mossialos E, Thornicroft G, editors. Mental health policy and practice across Europe. Maidenhead: Open University Press; 2006. p. 15-33.
3. Gach J. Biological psychiatry in the nineteenth and twentieth centuries. In: Wallace ER, Gach J, editors. History of psychiatry and medical psychology. Boston: Springer; 2008. p. 381-418. https://doi.org/10.1007/978-0-387-34708-0_12
4. Shorter E. The history of nosology and the rise of the Diagnostic and Statistical Manual of Mental Disorders. Dialogues Clin Neurosci. 2015;17(1):59-67. https://doi.org/10.31887/dcns.2015.17.1/eshorter PMID:25987864 PMCID:PMC4421901
5. Le Bonhomme F, Le Bras A. Psychiatric institutions in Europe, nineteenth and twentieth century. Paris: Digital Encyclopedia of European History; 2021. https://ehne.fr/en/encyclopedia/themes/political-europe/control-and-discipline/psychiatric-institutions-in-europe-nineteenth-and-twentieth-century
6. Kendler KS, Tabb K, Wright J. The emergence of psychiatry: 1650-1850. Am J Psychiatry. 2022;179(5):329-35. https://doi.org/10.1176/appi.ajp.21060614 PMID:35331024
7. Sánchez-Marcos F. Historiography of the 20th and 21st Centuries. [place unknown]: Culturahistorica.org; 2020. http://culturahistorica.org/historiography/historiography-of-the-19th-and-20th-centuries/
8. Tandon PN, Chandra PS. Evolution of neurosciences: a historical review with brief biographies of some of its selected pioneers. Neurol India. 2022;70 Suppl 1:S1-113. https://journals.lww.com/neur/citation/2022/70001/evolution_of_neurosciences__a_historical_review.1.aspx
9. Buchanan RD, Haslam N. Psychotherapy. In: Sternberg RJ, Pickren WE, editors. The Cambridge handbook of the intellectual history of psychology. Cambridge: Cambridge University Press; 2019. p. 468-94. https://doi.org/10.1017/9781108290876.019
10. Marks S. Psychotherapy in Europe. Hist Human Sci. 2018;31(4):3-12. https://doi.org/10.1177/0952695118808411 PMID:30595623 - PMCID:PMC6297894
11. Marks S. Psychotherapy in Europe. Hist Human Sci. 2018;31(4):3-12. https://doi.org/10.1177/0952695118808411 PMID:30595623 - PMCID:PMC6297894
12. Crocq MA. French perspectives on psychiatric classification. Dialogues Clin Neurosci. 2015;17(1):51-7. https://doi.org/10.31887/dcns.2015.17.1/macrocq PMID:25987863 PMCID:PMC4421900
13. Gomes MM, Engelhardt E. Hysteria to conversion disorders: Babinski's contributions. Arq Neuropsiquiatr. 2014;72(4):318-21. https://doi.org/10.1590/0004-282x20130229 PMID:24760098
14. Gomes MM, Mendlowicz MV, Nardi AE. Psychiatric nosological historiography - Part I: until the rise and fall of psychodynamic theory. Debates Psiquiatr. 2023;13:1-25. https://doi.org/10.25118/2763-9037.2023.v13.1031
15. Gomes MM, Mendlowicz MV, Nardi AE. Psychiatric nosological historiography - Part II: psychopharmacology and somatogenic perspectives. Debates Psiquiatr. 2023;13:1-15. https://doi.org/10.25118/2763-9037.2023.v13.1032
16. Pichot P. The history of psychiatry as a medical speciality. In: Gelder M, Andreasen N, Lopez-Ibor J, Geddes J. New Oxford textbook of psychiatry. 2nd ed. Oxford: Oxford University Press; 2009. p. 17-27. https://doi.org/10.1093/med/9780199696758.003.0005
17. Kunz E. Henri Laborit and the inhibition of action. Dialogues Clin Neurosci. 2014;16(1):113-7. https://doi.org/10.31887/dcns.2014.16.1/ekunz PMID:24733976 PMCID:PMC3984888
18. Chase R. The making of modern psychiatry. Berlin: Logos Verlag; 2018. https://doi.org/10.30819/4718
19. Gaebel W, Zielasek J, Müller U. Psychiatry in Germany. Int Psychiatry. 2007;4(3):61-3. PMID:31507898 - PMCID:PMC6734760
20. Karenberg A, Fangerau H, Steinmetz H, Berlit P, Grond M. Historical review: a short history of German neurology - from its origins to the 1940s. Neurol Res Pract. 2019;1:14. https://doi.org/10.1186/s42466-019-0019-z PMID:33324880 PMCID:PMC7650065
21. Lindert J, Stein Y, Guggenheim H, Jaakkola JJK, Strous RD. How ethics failed — the role of psychiatrists and physicians in nazi programs from exclusion to extermination, 1933–1945. Public Health Rev. 2012;34:8. https://doi.org/10.1007/BF03391660
22. Rose FC. Chapter 39: an historical overview of British neurology. Handb Clin Neurol. 2010;95:613-28. https://doi.org/10.1016/s0072-9752(08)02139-8 PMID:19892142
23. Royal College of Psychiatrists. Through the decades: a deep dive through 75 years of NHS history. London: Royal College of Psychiatrists; 2023. https://www.rcpsych.ac.uk/news-and-features/blogs/detail/history-archives-and-library-blog/2023/07/05/through-the-decades-a-deep-dive-into-nhs-history
24. Coccanari de' Fornari MA, Iannitelli A, Biondi M. Storia della Clinica Psichiatrica della Sapienza Università di Roma nel Policlinico Umberto I. Riv Psichiatr. 2017;52(1):1-8. https://doi.org/10.1708/2631.27048 PMID:28287191
25. Gomes MM. História da neurologia mundial e seus protagonistas. Rio de Janeiro: Letra Capital; 2021. Escola Neurológica Italiana e a Universidade de Roma La Sapienza; p. 103-10.
26. Gomes MM. Luigi Luciani (1840-1919) - the Italian Claude Bernard with German shaping, and his studies on the cerebellum with projections to nowadays. Rev Bras Neurol. 2019;55(3):33-7 https://doi.org/10.46979/rbn.v55i3.29774
27. Federico A. Italian neurology: past, present and future. Funct Neurol. 2011;26(2):73-6. PMID:21729588 - PMCID:PMC3814448
28. Fiorillo A, Ventriglio A. The legacy of Italian psychiatry. Int Rev Psychiatry. 2018;30(2):118-9. https://doi.org/10.1080/09540261.2018.1435771 PMID:29757028
29. Bentivoglio M, Mazzarello P. Chapter 44: history of neurology in Italy. Handb Clin Neurol. 2010;95:719-35. https://doi.org/10.1016/s0072-9752(08)02144-1 PMID:19892147
30. Gomes MM. Jean-Alexandre Barré (1880-1967): his detection sign of subtle paresis due to pyramidal deficit (1919) and his work in line with that of Giovanni Mingazzini (1859-1929). Neurol Sci. 2019;40(12):2665-9. https://doi.org/10.1007/s10072-019-03988-z PMID:31338617
31. Orlandi F. Reassessing the legacy of Cesare Lombroso. In: Ruberg W, Bergers L, Dirven P, Martínez SS. Forensic cultures in modern Europe. Manchester: Manchester University Press; 2023. p. 147-68. https://doi.org/10.7765/9781526172358.00011
32. Huertas R. Spanish psychiatry: the Second Republic, the Civil War, and the Aftermath. Int J Ment Health. 2006;35(4):54-65. https://doi.org/10.2753/IMH0020-7411350407
33. Ristol EGA, Martín JGA. Giné y Partagás (1836-1903), precursor de la neurología en España. Neurosci Hist. 2015;3(1):19-29. https://nah.sen.es/vmfiles/abstract/NAHV3N1201519_29ES.pdf
34. Alarcón RD, Lolas F, Mari JJ, Lázaro J, Baca-Baldomero E. Latin American and Spanish-speaking perspectives on the challenges of global psychiatry. Braz J Psychiatry. 2020;42(1):77-86. https://doi.org/10.1590/1516-4446-2018-0397 PMID:31269096 PMCID:PMC6986483
35. Rivera JLG. Psychiatry in Spain. Psychiatr Times. 2002:34. https://luisderivera.com/wp-content/uploads/2012/02/2002-PSYCHIATRY-IN-SPAIN.pdf
36. Castro F. Cajal and the Spanish neurological school: neuroscience would have been a different story without them. Front Cell Neurosci. 2019;13:187. https://doi.org/10.3389/fncel.2019.00187 PMID:31178695 PMCID:PMC6542961
37. Barraquer Bordas L. The history of Spanish clinical neurology in Barcelona 1881-1949. J Hist Neurosci. 1993;2(3):203-15. https://doi.org/10.1080/09647049309525568 PMID:11618456
38. Barata L. Professor Egas Moniz - The portuguese nobel prize in medicine and physiology. Lisboa: Faculdade de Medicina da Universidade de Lisboa; 2019. https://www.medicina.ulisboa.pt/en/newsfmul-artigo/93/professor-egas-moniz-portuguese-nobel-prize-medicine-and-physiology
39. Gama Marques J, Bento A. Júlio de Matos (1856-1922): cem anos após a sua morte. Rev Port Psiquiatr Saude Ment. 2021;7(3):92-3. https://doi.org/10.51338/rppsm.2021.v7.i3.214
40. Palha A, Marques-Teixeira J. The emergence of psychiatry in Portugal: from its roots to now. Int Rev Psychiatry. 2012;24(4):334-40. https://doi.org/10.3109/09540261.2012.695279 PMID:22950773
41. Pereira JMM. A psiquiatria em Portugal: protagonistas e história conceptual (1884-1924) [tese]. Coimbra: Universidade de Coimbra, 2015. https://hdl.handle.net/10316/29514
42. Jacobina RR. Médicos de Portugal sob olhar de Juliano Moreira historiador. Rev Fontes Documentais. 2020;3:648-67. https://periodicos.ufba.br/index.php/RFD/article/view/57717/31209
43. Miranda CS, Grilo FJA, Pinho JMBC. Classicismo nos hospitais da misericórdia e da beneficência na segunda metade do século XIX: trânsito entre Brasil e Portugal. ARTis ON. 2015;(1):231-7. https://doi.org/10.37935/aion.v0i1.30
44. Miranda-Sá Jr. LS. Breve histórico da psiquiatria no Brasil: do período colonial à atualidade. Rev Psiquiatr Rio Gd Sul. 2007;29(2):156-8. https://doi.org/10.1590/S0101-81082007000200005
45. Oda AMGR, Dalgalarrondo P. O início da assistência aos alienados no Brasil ou importância e necessidade de estudar a história da psiquiatria. Rev Latinoam Psicopatol Fundam. 2004;7(1):128–41. https://doi.org/10.1590/1415-47142004001012
46. Gomes MM, Cavalcanti JL. The brazilian neurology centenary (1912-2012) and the common origin of the fields of Neurology and Psychiatry. Arq Neuropsiquiatr. 2013;71(1):63-5. https://doi.org/10.1590/s0004-282x2013000100014 PMID:23338164
47. Gomes MM, Engelhardt E. Historical sketches of the beginnings of the academic "Mental and Nervous Diseases" in Brazil, and European influences. Arq Neuropsiquiatr. 2013;71(8):562-5. https://doi.org/10.1590/0004-282x20130095 PMID:23982017
48. Casa de Oswaldo Cruz. Dicionário Histórico-Biográfico das Ciências da Saúde no Brasil (1832-1970): Hospício de Pedro II. Rio de Janeiro: Casa de Oswaldo Cruz; 2024. https://dichistoriasaude.coc.fiocruz.br/
49. Instituto Municipal de Assistência à Saúde Nise da Silveira. Base de dados história e loucura. Rio de Janeiro: Instituto Municipal de Assistência à Saúde Nise da Silveira; [citado em 23 de dezembro de 2024]. http://historiaeloucura.gov.br/index.php/instituto-municipal-de-assistencia-saude-nise-da-silveira
50. Oliveira PHFD. O tratamento dos alienados na América Latina: a recepção dos preceitos alienistas no além-mar. Bilros. 2018;6(12): 262-81. https://www.arca.fiocruz.br/handle/icict/58535
51. Piccinini WJ. Notas para uma história da psiquiatria na América Latina. Psychiatry on Line Brazil. 2010;15(4). www.polbr.med.br/ano10/wal0410.php#:~:text=As%20primeiras%20c
52. Venâncio AT. Ciência psiquiátrica e política assistencial: a criação do Instituto de Psiquiatria da Universidade do Brazil. Hist Cienc Saude Manguinhos. 2003;10(3):883-900. https://doi.org/10.1590/s0104-59702003000300005 PMID:14994710
53. Biblioteca Virtual em Saúde, História e Patrimônio Cultural das Ciências e da Saúde. Profissionais que atuaram no Hospital Nacional dos Alienados. Rio de Janeiro: Biblioteca Virtual em Saúde; [citado em 23 de dezembro de 2024]. https://hpcs.bvsalud.org/vhl/temas/historia-saberes-psi/galeria-de-personagens/