ABSTRACT
The aforementioned eclecticism of some psychiatrists and the ‘pre-history’ of medical psychiatry make it difficult to determine what constitutes a true alternative to medical psychiatry. For example, Thomas Withers, William Battie and Nathaniel Cotton, the eighteenth century British pioneers of a psychiatry based on the primacy of interpersonal relationships and social therapy, were physicians who happened to specialize in the treatment of mental illness (Nolan, 1993). On the Continent there is a long tradition of medical doctors using psychological approaches to the treatment of mental distress. This can be traced back through Alfred Adler (1870-1937), Carl Jung (1875-1961), Pierre Janet (1859-1947) and Sigmund Freud (1856-1939) to Jean-Martin Charcot (1835-1893) and, albeit ambiguously, to Franz Anton Mesmer (1734-1815)
(Ellenberger, 1970). Furthermore, notwithstanding the importance of the work of Emil Kraepelin (1856-1926) in developing an eclectic model of psychiatry based on neurology, brain anatomy, experimental psychology and the significance of life events (Ellenberger, 1970), a split remains within psychiatry between those who believe strongly in physical causation of mental distress and those who believe that social and emotional factors are of greater significance (see Clare, 1976; Cohen, 1989; Szasz, 1979b). As Diana Gittins observes in her detailed history of Severalls Hospital in Essex, such contradictions have often been evident in the tension between the prescriptions of social policy on mental health and contemporary practice in mental health care (Gittins, 1998a).
