Classification, cause and symptoms of mental illness 1890-1900 in Ontario

Abstract

There appeared to be considerable agreement between historical documents and actual case records of Canadian psychiatrists during the nineteenth century. In both instances mental disease classification could only be described as complicated, despite simplified diagnostic categories. Patients admitted to a psychiatric hospital during this period were likely to be diagnosed as manic or melancholic. Classifications were essentially symptom-based, with melancholic patients being more likely to have suicidal tendencies and manic patients more likely to be aggressive. However hallucinations were the main symptom of most patients regardless of classification. Symptom descriptions for all patients were overly simplified involving either hallucinations, suicidal tendencies, or aggressiveness. During the period of psychiatry studied, mental illness was regarded as a singular disease, varying only in intensity, hence the system of classification was perhaps not regarded with the same degree of importance as today. As well, there appeared to be a great deal of confusion regarding the separation of cause, classification, and symptomatology. Worry or anxiety was treated only as a precipitating factor, and not as a symptom; epilepsy was both a cause of some disorders and a classification for another; and senility was a precipating cause of dementia rather than a symptom. The classification system of the 1890s clearly left a lot to be desired, and there was an obvious need for a grand overhaul of the diagnostic categories and their definitions. The notions of predisposing and precipitating causal factors are still very much in evidence today, even though factors such as masturbation, menstruation, and overwork might be given less credence in today's notions of etiology. It is interesting to note, however, that despite not being enlightened by the current community mental health ideology, these nineteenth century practitioners still gave considerable importance to ''problems in living'' (family relationships, etc.) as precipitating causes of illness.