top of page

The importance of history

Updated: Jul 11

Specialist competence should be grounded in a knowledge of the principles and foundations, along with a basic understanding of the historical development of the field, and not only detailed memorization of guidelines and diagnostic manuals. In the field of psychiatry, a lack of understanding of history and the progress that has been made means that one may not appreciate how far we have come. Although the history of modern psychiatry is not very long, it is rife with examples which, viewed through the lens of 2025, can seem like tales from the dark ages, if put forward in a certain manner. Only when they are placed in historical context can they be appreciated as steps in the progression of a field that is interconnected with societal and ideological changes.



One illustrative example is the way we perceive and discuss the surgical procedure known as lobotomy. It is frequently cited as a symbol of psychiatry’s “dark past,” often accompanied by a knowing look of disapproval. Yet, this treatment was developed in an era before the advent of modern psychopharmacology, making it difficult to interpret by today’s standards. Indeed, António Egas Moniz, who pioneered the technique of leucotomy, was awarded the Nobel Prize in 1949 for his work.¹ A more controversial figure is Walter Freeman, who likely performed over 3,000 procedures and developed a simplified method via a transorbital path.² Freeman is often wrongly depicted as a knife-wielding-maniac rather than as someone, according to his biographer Jack El-Hai, who engaged meaningfully with his patients and maintained high clinical standards. While lobotomy should not be reintroduced as a mainstream treatment for depression, anxiety, or psychosis, it is equally misguided to categorically reject all forms of psychosurgery based on a superficial understanding of an oversimplified historical example. Too often, lobotomy is invoked as a cautionary tale without acknowledging the transformative impact of psychopharmacological treatments that emerged in the following decades, treatments that rendered such invasive procedures obsolete due to their efficacy and reversibility.


António Egas Moniz in his office in 1918.
António Egas Moniz, who pioneered the technique of leucotomy, was awarded the Nobel Prize in 1949 for his work. António Egas Moniz in his office in 1918. Image by Wikimedia Commons.

A second example concerns psychiatric diagnoses, which are often portrayed in overly simplistic terms as entirely invalid social constructs, tools of pharmaceutical industry manipulation, or punitive instruments. While there are definitely cases of misdiagnosis or misuse, these should not be viewed as failures of the scientific method itself, but rather as evidence of the need for ongoing dialogue and revision when new evidence, values, and treatments arise. As historian Yuval Noah Harari notes, the removal of homosexuality from diagnostic manuals should be celebrated as a testament to psychiatry’s scientific and self-correcting nature.³ It is a historical fact that homosexuality was once classified as a mental illness and treated as such. Instead of denying this past, we should commend the profession (and society) for removing this diagnostic category and working toward providing inclusive mental healthcare for marginalized groups. Furthermore, the very structure of psychiatric nosology, which allows for debate and revision, is vital for attaining diagnostic validity, reliability, and clinical relevance.⁴ The inclusion of post-traumatic stress disorder (PTSD) in the DSM-III in 1980, for example, was influenced not only by empirical evidence but also by political advocacy related to veterans’ healthcare benefits.⁵ As philosopher Miriam Solomon suggests, not every change in scientific discourse signifies a clear improvement or decline; instead, such changes can be viewed as neutral shifts in a process, and understanding their historical context offers important insights.⁶


There are many more examples worth exploring, but my main point is this: while it's important to critically examine past practices like lobotomy or the pathologization of homosexuality, we should avoid applying these critiques to all aspects of psychiatry and resist falling into the trap of Whig history. A modern psychiatrist benefits from having some knowledge of this history in order to form a nuanced historical perspective which allows us professionals to appreciates the field’s progress without romanticizing or condemning its past entirely. This view also helps us discuss current challenges more rationally, seeing them not as unique anomalies but as part of a developmental journey into the future. □


 

References


  1. https://www.nobelprize.org/prizes/medicine/1949/moniz/facts/

  2. El-Hai J. (2005). Lobotomist. A Maverick Medical Genius and His Tragic Quest to Rid the World of Mental Illness. John Wiley & Sons Inc.

  3. Harari YN. (2024). Nexus. A Brief History of Information Networks from the Stone Age to AI. Vintage Publishing.

  4. Chang H. (2017). Epistemic iteration and natural kinds: Realism and pluralism in taxonomy. Chapter in: Philosophical Issues in Psychiatry IV: Classification of Psychiatric Illness, editors Kendler KS & Parnas J. Oxford University Press.

  5. Decker H. (2013). The Making of DSM-III. A Diagnostic Manual's Conquest of American Psychiatry. Oxford University Press.

  6. Solomon M. (2001). Social Empiricism. MIT Press.

bottom of page