34 JANUARY 2002 / PSYCHIATRIC TIMES

FAR-FLUNG CORRESPONDENCE by José L.G. de Rivera, M.D., FRCP(C) Psychiatry in Spain

Spain has been called were other forms of psychological in- where he was soon the director of a "the cradle of psychia- tervention. progressive psychiatric hospital; and try" because the In the late 1920s, Berlin-trained Juan de Ajuriaguerra became univer- world's first psychia- Angel Garma founded Spain's first sity professor and chair of the Univer- tric hospital, the Hos- psychoananalytic institute, and José sity of Geneva's Psychiatric Services. pital de los Inocentes, Ortega y Gasset, Spain's most cel- Meanwhile, Spanish psychiatry was founded in Va- ebrated philosopher, devoted a long was dominated by Vallejo Najera, lencia in 1404. This foundation initi- study to psychoanalysis. This was not army commander and first chair of ated a trend, as it was soon followed unusual, as psychological matters psychiatry at Madrid University, and by other psychiatric hospitals in Zara- were the dominant theme of his phi- Juan Jose Lopez-Ibor, for whom a goza (1425), Sevilla and Valladolid losophy. Ortega y Gasset observed chair of medical psychology was (both in 1436), Mallorca (1457), and that, given the Spanish interest and created. After the death of Vallejo Na- Toledo (1480). Most of these hospitals sensibility to psychological matters, it jera, Lopez-Ibor assumed both chairs were in operation for centuries, form- is not surprising that the central char- and kept Spanish academic psychiatry ing an early nucleus of humanitarian acter in the first great novel of the under close rein. In the early 1970s, psychiatric care. The French psychia- western world, Don Quijote de la the psychiatric establishment was up- tric reformer Philippe Pinel visited the Mancha, was a mental patient. set by new, young professionals train- mental hospital in Zaragoza and re- The rapid and promising pace of ed in North America or Switzerland, portedly incorporated some of his ob- Spanish psychiatry was abruptly inter- interested in community psychiatry servations into his revolutionary pro- rupted by the Spanish Civil War, de- and psychoanalysis, who repulsed gram in France. spite some interesting developments both authoritarian institutions and the However, we cannot properly forced by the war itself. The first uni- outdated Spanish version of German speak of Spanish psychiatry as such versity chair of psychiatry was created psychiatry. The split was formalized until the second half of the 19th cen- in 1934 in Barcelona and bestowed on by the creation of a new psychiatric tury, when several physicians took the Emilio Mira y Lopez, a gifted man association, the Sociedad Española de care of mental disorders as their main most noted for his work on psycho- Psiquiatría, with the traditional Aso- practice and started to develop stand- metrics. As the war started two years ciación Española de Neuropsiquiatria ards for research and teaching. By the later, Mira was put in charge of the now in the hands of the new doctors. beginning of the 20th century, psy- psychiatric services in the republican Under their influence, soon after Fran- chiatry was highly developed in army. Mira put into operation a well co's death, the Psychiatric Reforma- Spain, with its biological center in the thought plan for facilitating psycho- tion Act was promulgated, creating brain studies of Nobel Laureate San- logical ventilation, as well as an mental health cars centers and general tiago Ramon y Cajal. Psychological excellent program for early detection hospital departments of psychiatry, psychiatry was not lagging behind, as and treatment of psychiatric disorders. thus initiating the development of an illustrated by the local fame Ramon y Unfortunately, his effort was lacer integrated network of psychiatric care. Cajal achieved as a gifted psycho- scorned by the psychiatrists of Gener- Organized postgraduate training in therapist in his early medical years. al Francisco Franco's victorious army, psychiatry, as in other medical spe- As the story goes, before he was a who claimed that they did not have cialties, was implemented in the mid- world-renowned professor, he used to psychiatric casualties on their own 1970s, with residency programs regu- complement his meager university side during the war. As an explana- lated on a national basis. Now fully salary with a promising private prac- tion, they advanced the theory that absorbed by the National Health Pro- tice in which he made extensive use of being a republican was, in itself, a gram, modern Spanish psychiatry is hypnosis – a technique that he had psychiatric disorder. Heavily influ- becoming more effective and commu- casually learned during his military enced by fascist theorizations, Spanish nity-centered. Nevertheless, three is- service as an army physician in Cuba. psychiatry came to a halt. Most of its sues of the recent past wait to be re- As a mark of the medical profes- prominent practitioners were forced solved: unfair cronyism in university sions interest in and receptivity to psy- into exile, and Spain's loss became the appointments, dependency on the chiatry, Freud's first paper on hysteria world's gain. pharmaceutical industry and the intel- was translated and published by a Angel Garma went to Argentine, lectual laziness of otherwise gifted of- Spanish journal the same year it was where he soon became the president ficial leaders. originally published in German. Many of the Argentine Psychoanalytic Asso- Dr. de Rivera is professor of psy- other translations followed, and psy- ciation; Miguel Prados went to Cana- chiatry and director of the Institute of choanalysis was soon well-known and da, where he co-founded the McGill Psychotherapy and Psychosomatic discussed – not only by psychiatrists University psychiatry department; Research in Madrid, Spain. but also by intellectuals at large – as François Tosquelles went to France,