Psiquiatria

REFORMANDO LA ASISTENCIA PSIQUIÁTRICA EN MÉXICO. LA GRANJA DE SAN PEDRO DEL MONTE: LOS PRIMEROS AÑOS DE UNA INSTITUCIÓN MODELO,1945-1948*
Ma. Cristina Sacristán**

SUMMARY
Our work analyzes the process of reflection that led to the founding of the first farm for the mentally ill in 1945, when psychiatry in Mexico was faced with the challenge of innovating its therapeutic services, creatingforms of psychiatric care that would serve to build bridges between psychiatry and the society in need of its services. Currently, rural hospitals are among the forms of psychiatric care most neglected by the Mexican State. Consequently, we find limited therapeutic, human and financial resources, a fact that explains how these hospitals have ended up as asylums for the chronically ill. Nonetheless,it is illustrative for us to study the past efforts in psychiatry done in Mexico, aimed at offering mechanisms for reinserting mentally ill persons back into society. The farm, established in the old San Pedro del Monte hacienda, located twelve kilometers away from León in the state of Guanajuato, and directed by doctor Angel Ortiz Escudero, would serve to begin to ease the pressure on the GeneralMental Hospital in Mexico City (1910-1968), popularly known as La Castañeda. In the 1940s this Mexico City mental hospital had more than 3,000 patients, 400 of whom would be the first to live in the San Pedro del Monte Farm. Since 1930, Mexican psychiatrists had expressed their concern about the therapeutic model in which large numbers of patients were treated in the same facility as in the LaCastañeda mental hospital which they no longer considered effective. These psychiatrists had developed a series of proposals aimed at improving psychiatric care; one of them was to establish agricultural production projects that would provide occupational therapy. Since there were plans at that time to transform La Castañeda into an authentic psychiatric hospital, with the creation of specializeddepartments for specific pathologies, it was decided that the San Pedro del Monte Farm would accept all those patients whose disturbances were considered to be chronic. Consequently, the patients with “acute illnesses” would remain at La Castañeda since there would be greater possibilities there for their recovery. By this decision, psychiatrists in Mexico were attempting to repeat the therapeuticalternatives that had been tested in other

countries. In fat, this type of agricultural setting had been proposed in France since the end of the nineteenth century in the context of the debate around reforming the mental hospital model. At that time the grouping together of large numbers of patients in mental hospitals and the meager results obtained —observable in the chronic progression ofmental illnesses—led to a process of questioning whether confinement should be the only form of treatment. The focus was therefore on therapeutic strategies differentiated according to illness, with mechanisms for reinsertion into society, while reducing the high costs of these institutions and providing patients with a system characterized by greater freedom. In addition to the farms, Mexicanpsychiatrists proposed other therapeutic alternatives aimed at preserving the mental patients’ links with their families that were easily lost through the system of isolation in mental hospitals. These alternatives included outpatient clinics, the addition of psychiatric units to general hospitals and open hospitals. The intention was to promote contact between the family environment and theinstitution. In La Castañeda, for example, the social service areas would be responsible for encouraging family participation, providing followup to patients after their release to ensure the continuation of treatment, as well as working in the area of prevention. In this same spirit, a group of sponsors would be established for the purpose of facilitating employment for patients to assist them in their...