On September 1, 1910, more than two thousand people celebrated the one hundredth anniversary of Mexico's Proclamation of Independence with the inauguration of a psychiatric hospital. According to the event's official chronicler, the 25 buildings constructed by order of president Porfirio Díaz on the site of the former Castañeda Hacienda would place Mexico among the leading countries in the world in treating mental health pathologies. But, what had been Mexico's development in this field during the XIX century? Could we consider La Castañeda <<the birthplace of public psychiatry>> in Mexico? This work analyzes La Castañeda's contribution to the professionalization of psychiatry in Mexico, not only by looking at the place that research and teaching traditionally had in hospitals, but also by looking at other mechanisms that help to form a discipline, such as the capacity to bring light to scientific societies and to bring credibility to a new medical field such as psychiatry, so much in need of therapeutic successes in those years. In the XIX century around 400 articles, theses and books by Mexican, Hispanic and foreign authors were published that dealt with topics associated with psychiatry. The old hospitals of the colonial system such as San Hipólito and La Canoa established a form of treatment called <<moral treatment>>, precursor to psychiatry, and were directed by a doctor substituting a director-administrator. Between 1865-1910, five projects for a modern mental hospital were made, one of which saw fruition in the form of La Castañeda. In 1887 the first course dealing with mental illness was taught and in 1906 the first specialization in psychiatry was brought about. Nonetheless, this movement was cut short by the Revolution of 1910 which assailed the country for almost a decade and provoked that La Castañeda be left without state support. The professionalization of Mexican psychiatry can be divided in three stages: 1910-1925, a period marked by the decomposition brought on by the war; 1925-1945, characterized by the major medical and administrative reform of the hospital, and 1945-1968, a stage which included the slow dismantling of La Castañeda. In the first stage, La Castañeda saw a certain level of deterioration in its assistance practices, as 25% of patients who entered between 1914-1916 were not diagnosed, and 45% of patients of those entering between 1917-1920 were not diagnosed either. This fact is explained by the institution's instability in those years. Between 1910-1923, La Castañeda had twelve directors. Academic courses in mental illness continued to be offered and a medical society was formed, but with few results. In 1925 Public Welfare asked doctor Enrique Aragón to inspect the Asylum and present a detailed report of any reforms needed. The three most serious problems he discovered were: the deficient way in which doctors handled patient's clinical records, shortages and poor training of personnel and the fact that there was almost no research being done. From 1925-1945, La Castañeda experienced great reforms thanks to three doctors who wanted to professionalize psychiatry in Mexico and place it at a competitive level with hospitals around the world, which they had seen in visits to Europe and the U.S. These doctors were Samuel Ramírez Moreno, Alfonso Millán Maldonado and Manuel Guevara Oropeza, who received support from the federal government. In 1929 a system of occupational therapy was established as a means of rehabilitation, and outpatient services were offered to those not needing hospitalization. In 1932 a Children's Ward was inaugurated and the following year the School for Abnormal Children, both directed by Mathilde Rodríguez Cabo, the first woman psychiatrist in Mexico. Alongside Ramírez Moreno, she began a project offering courses in psychiatric nursing and caregiving. In 1935 the Drug Addicts Unit was inaugurated, and in the years following shock therapies were introduced. A laboratory was established to perform traditional clinical analyses, as well as bacteriological and pathological analyses, and microphotography, both to improve diagnoses and to move research forward. All was influenced to a great extent by Spanish neurobiology which came about after the Spanish Civil War, when exiles such as Dionisio Nieto were received in Mexico. In order to strengthen the guild, at this stage there were important initiatives. In 1934, the Revista Mexicana de Psiquiatría, Neurología y Medicina Legal, the first journal in its field in Mexico, was published. In 1937 the Sociedad Mexicana de Neurología y Psiquiatría was founded, as well as its official organ, Archivos de Neurología y Psiquiatría de México. Around 1943, a project which would become Mexico's policy of mental health for the years 1945-1968 began to be conceived. This policy would lead to the demolition of La Castañeda, and replace it with farms or field homes for the mentally ill. This therapeutic model, with chronic patients in mind, was based on recreational and occupational therapies, and its intention was to place patients in contact with nature, under a regimen of liberty and dedicated to productive and dignified activities. Ye t these farms were located far from urban centers, isolating patients even further from family. In fact, psychiatry itself was also isolated from the rest of the medical world. La Castañeda closed on June 29, 1968, and with it more than 68 000 lives, could they talk today, might well tell this story differently.
El 1 de septiembre de 1910 más de dos mil personas conmemoraron el Centenario de la Proclamación de la Independencia de México con la inauguración de un manicomio. Según la opinión del cronista oficial de los festejos, los 25 edificios que mandó a construir el presidente Porfirio Díaz en la antigua hacienda de La Castañeda pondrían a México a la altura de los países más avanzados en el tratamiento de las enfermedades mentales. Pero ¿qué desarrollo había tenido en México este campo durante el siglo XIX? ¿Podemos considerar a La Castañeda como <<la cuna de la psiquiatría pública>> mexicana? En este trabajo se analiza la contribución de La Castañeda a la profesionalización de la psiquiatría mexicana mediante el lugar que tradicionalmente le han dado los hospitales a la enseñanza y la investigación, pero también a través de otros mecanismos que forjan una disciplina, como la capacidad para alumbrar en su seno sociedades científicas y para dotar de credibilidad a un nuevo campo médico tan necesitado de éxitos terapéuticos, como lo fue la psiquiatría en esos años. Durante el siglo XIX se publicaron alrededor de 400 títulos de tema psiquiátrico entre artículos, tesis y libros de autores mexicanos e hispanos, así como traducciones de autores extranjeros. Por otro lado, los viejos hospitales coloniales como San Hipólito y La Canoa establecieron el tratamiento moral, la terapéutica con la que nació la psiquiatría, y fueron dirigidos por un médico en sustitución del director-administrador. Entre 1865 y 1910 se elaboraron cinco proyectos de <<manicomio moderno>>, uno de los cuales culminó finalmente en La Castañeda; en 1887 se impartió por primera vez la cátedra de enfermedades mentales y en 1906 se estableció la especialidad en psiquiatría. Sin embargo, esta gran vitalidad fue atropellada por la contienda revolucionaria que asoló al país durante casi una década y provocó que el Manicomio creciera sin el apoyo del Estado, de un Estado fuerte que sucumbió muy pronto cuando en mayo de 1911 Porfirio Díaz tomó el camino del exilio. La profesionalización de la psiquiatría mexicana se puede dividir en tres etapas. La primera, de 1910 a 1925, se caracterizó por un relajamiento de sus prácticas asistenciales a causa de la inestabilidad institucional que vivió el Manicomio. La segunda, de 1925 a 1945, conoció la mayor reforma médica y administrativa que permitió instaurar a gran escala la terapia ocupacional como un medio de rehabilitación, se empezó a dar consulta externa a pacientes que no necesitaran hospitalización, se inauguró el Pabellón Infantil, la Escuela para Niños Anormales y el Pabellón de Toxicómanos, se impartieron clases de enfermería psiquiátrica, se publicó la primera revista de la especialidad y se fundó la Sociedad Mexicana de Neurología y Psiquiatría. Hacia 1943 comenzó a idearse el proyecto que se convertiría en la política de salud mental del Estado mexicano entre 1945 y 1968, la tercera etapa, y que llevaría al lento desmantelamiento de La Castañeda hasta su demolición: las Granjas para enfermos mentales. El Manicomio se cerró el 29 de junio de 1968 y con él más de 68 000 vidas que, si hablaran, contarían esta historia de otra manera.
