Psychiatry, Burnout, and Dictatorship, Pt.1

This is a two part blog, as I somehow managed to think of two only partially connected things at the same time, which came from spending most of last week finishing a century- and discipline-spanning essay. During my research last week I found two realisations/theories, the first of which is being written about today. This is about how I underestimated late 19th/early 20th century psychiatrists and owe them an apology, and also how their experience could be linked to why political leaders become dictators.

Some background for this story; the report was on the history of psychiatry, and how it had pretty much broken by the end of the 19th century. So many people were being put in asylums that psychiatrists couldn’t treat them in the humane ways they had planned to and ended up being just as cruel as they had been 100 years earlier.

Before this week, this had always been really confusing; while I could understand that the level of care dropped because of overcrowding, I couldn’t understand how the psychiatrists could change their hearts so quickly. It made no sense that psychiatrists could finally gain compassion for their patients and for the first time believed they could be healed, only to quickly return to seeing them as animals, detached from all of their dignity and respect. When I first heard about this my reaction was, to be honest, kind of hatred for them for being able to turn their backs on their patients and ignore their humanity, especially after they had already known it.

It was only after thinking about it a bit more that I realised things weren’t that simple- the collapse of humane treatments was not just a setback, it crushed the hopes and ideals of a generation of humanist psychiatrists who were trying to convince everyone that the mentally ill still had souls. It isn’t difficult to imagine the psychological effects of having such an idealistic and strived-for goal crushed in that way; made even worse because its downfall was created by its previous success, meaning the humanists would never be able to achieve what they had aimed in their lifetimes.

Based on this, it is also not difficult to see the impact this would have on the individual humanists; my theory is that in today’s terms they would probably have developed a form of psychological burnout known as compassion fatigue. Some of the results of this are hopelessness, negativity, and eventually cynicism towards people’s suffering- which matches the neglect and lack of care shown to patients, and the cynical, nihilistic attitude towards trying to cure their illnesses. The leading view after humanist methods collapsed was known as “theraputic nihilsm”, basically the belief that mental illness could not be cured and people couldn’t be changed, which is more support.

An extension of this theory could explain a proportion of one of the most difficult to understand groups of people in society- dictators, e.g. those who take sole control over a country in an attempt to improve it, but end up lowering their populations quality of life, even to the point of committing atrocities. Said theory and extension will be written about in pt.2

3 thoughts on “Psychiatry, Burnout, and Dictatorship, Pt.1

  1. Firstly, in the two years since I've seen anything (excluding the EPQ) written by you, your writing style has really matured.

    Secondly, as well as being coherant and cogent, this post is utterly fascinating. You shall be a brilliant psychoanalyst.


  2. What I find interesting about the history of mental health care is the therapy revolution of the '50s and '60s. Carl Rogers, Fritz Perls, and Albert Ellis all created theories of talk therapies that ventured away from the Fruedian roots of their training.

    However, the idea of everybody being genrally 'good' shows up in these theories, thus making the idea of dictatorship (and perhaps oligarchary) as an inconvienient truth.

    Looking forward to part 2, Ms H.


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