From mysticism to neuroscience: the history of psychiatric service of the Bukovina region

Размещено на http://www.allbest.ru

Bukovinian State Medical University

From mysticism to neuroscience: the history of psychiatric service of the Bukovina region

Iryna Herasymiuk

Natalia Grinko

Bohdan Sumariuk

Буковинський державний медичний університет

Від містики до нейронауки: історія психіатричної служби Буковинського краю

Ірина Герасим'юк

Наталя Гринько

Богдан Сумарюк

Герасим'юк Ірина, Гринько Наталя, Сумарюк Богдан. Від містики до нейронауки: історія психіатричної служби буковинського краю. Зародження психіатричної допомоги на Буковині можна поділити на два етапи: перший етап - донауковий, другий етап - науковий або нозологічний. Під час донаукового періоду надання допомоги особам з ментальними порушеннями відбувалося при монастирях. Їх розцінювали як одержимих, тобто осіб з бісами. На теренах сучасної Чернівецької області знаходилося декілька таких монастирів, де могли отримати допомогу пацієнти з психічними розладами. З моменту проголошення Буковини коронним краєм австро-угорської імперії, надання психіатричної допомоги змінилося. Зародилася психіатрична служба та розуміння, що таке психічний розлад. Відбувся перехід до наукового тлумачення та підходу надання психіатричної допомоги.

Метою статті було висвітлення становлення психіатричної служби на Буковині, трансформація підходу надання допомоги хворим з психічними розладами, від містики до сучасної моделі. Наукова новизна полягає у аналізі історії психіатрії на Буковині від минулого до сьогодення та висвітлення основних історичних моментів, що дали поштовх до формування справжньої нейронауки. Методологічні засади дослідження: хронологічний та порівняльно-історичний підхід, системний міждисциплінарний аналіз. Висновки. Історія виникнення психіатричної служби на Буковині зазнавала злетів та падінь, що відповідали умовам часу. Трансформація ментальної служби змінювалася від світогляду та рівня розвитку тогочасної науки. Можна спостерігати зміни від містифікації до становлення психіатрії, як справжньої сучасної нейронауки з доказовою базою та гуманним ставленням до пацієнтів. psychiatric service patient

Ключові слова: психіатрія, історія медицини, психіатрична служба, Чернівецька психіатрична лікарня, Буковина, Чернівці, Еріх Кольбенгаєр, Франц Йозеф.

Формирование психиатрической помощи на Буковине можно разделить на два этапа: первый этап - донаучный, второй этап - научный или нозологический. Во время донаучного периода оказания помощи лицам с ментальными нарушениями происходило при монастырях, их расценивали как одержимых, то есть с бесами. На территории современной Черновицкой области находилось несколько таких монастырей, где могли получить помощь пациенты с психическими расстройствами. С момента провозглашения Буковины коронным краем австро-венгерской империи, оказания психиатрической помощи изменилось. Основалась психиатрическая служба и понимание, что такое психическое расстройство. Произошел переход к научному толкованию и подходу оказания психиатрической помощи. Целью статьи было освещение становления психиатрической службы на Буковине, трансформация подхода оказания помощи больным с психическими расстройствами, от мистики к современной модели. Научная новизна заключается в анализе истории психиатрии на Буковине от прошлого к настоящему и освещение основных исторических моментов, дали толчок к формированию настоящей нейронауки. Методологические основы исследования: хронологический и сравнительно-исторический подход, системный междисциплинарный анализ. Выводы. История возникновения психиатрической службы на Буковине испытывала взлетов и падений, соответствующих условиям времени. Трансформация ментальной службы менялась от мировоззрения и уровня развития тогдашней науки. Можно наблюдать изменения от мистификации к становлению психиатрии, как настоящей современной нейронауки с доказательной базой и гуманным отношением к пациентам.

Ключевые слова: психиатрия, история медицины, психиатрическая служба, Черновицкая психиатрическая больница, Буковина, Черновцы, Эрих Кольбенгаер, Франц Йозеф.

Introduction

Mental health service has gone through a radical transformation over the last century. The emergence of psychiatric care in Bukovina can be divided into two stages: the first stage - pre-scientific, the second stage - scientific or nosological. During the pre-scientific period, assistance to persons with mental disorders took place at monasteries. They were regarded as possessed, i.e. persons with demons. There were several such monasteries in the modern Chernivtsi region, where patients with mental disorders could receive help.

The pre-scientific period is a period of mystification of psychiatry. Mentally ill people were treated differently. Aggressive patients were beaten, often tortured, tied up, stoned, considered possessed, and accordingly transferred to the protectorate of monasteries. The fate of other mentally ill people who had, for example, thinking disorders (delusional ideas of witchcraft, obsession, high origin), but at the same time had calm behaviour, could have been different. Sometimes their disorders received a special interpretation. Such people were considered molfars, connoisseurs, sorcerers, which gave them a more respectful attitude from society in those days. Since the proclamation of Bukovina as the crown land of the Austro- Hungarian Empire, the provision of psychiatric care has changed. A psychiatric service appeared and helped to understand what a mental disorder really is. There was a transition to a scientific interpretation and a scientific approach to providing psychiatric care1.

The main body of the article. The first department that assisted mentally ill people in Bukovina appeared in 1833 in Chernivtsi. Patients from different counties were treated. Sometimes they were refused because the hospital could not meet the needs of everyone. Patients were brought here from monasteries, from homes, most of whom were tied up or handcuffed. As of today, little information has been preserved about this institution. It is known that it accommodated about 25-30 beds for patients with mental disorders. Exactly where the department was located is now unknown. The hospital was built with donations from citizens, and the care and treatment of patients took place with the help of care and guardianship authorities. On January 21, 1879, the hospital was transferred under the protection of the regional administration of Bukovina. Every year the number of patients, both somatic and psychiatric, grew. Accordingly, there was an urgent need to build a new hospital. Between 1883 and 1886, a city hospital with 250 beds (now the regional clinical hospital) was built according to the design of Josef Liner, and its structure included beds for mentally ill patients Buklijas, T., Lafferton, E. Science, medicine and nationalism in the Habsburg Empire from the 1840s to 1918. 2007, Studies in history and philosophy of biological and biomedical sciences, Vol. 38(4), P. 679-686 [in English], https://doi.org/10.1016/j.shpsc. 2007. 09. 004; Buklijas, Tatjana, and Emese Lafferton “Science, medicine and nationalism in the Habsburg Empire from the 1840s to 1918”, Studies in history and philosophy of biological and biomedical sciences, Vol. 38 (4), 2007, P. 679-686 [in English], doi:10.1016/j.shpsc. 2007. 09.

004. Huchko O. I. Stanovlennia i rozvytok systemy okhorony zdorovia na Bukovyni (1775-1940 rr.) [Huchko O. I. Formation and development of the health care system in Bukovyna (1775-1940)], dissertation abstract... Candidate of Historical Sciences: 07.00.01, Chernivtsi, 2017, P. 90-94 [in Ukrainian].

Актуальні питання суспільних наук та історії медицини. Спільний українсько-румунський науковий журнал. (АПСНІМ), 2021, № 2(30), P. 6-8.

HerasymyukI., Hryn'ko N., SumaryukB. From mysticism to neuroscience: the history of psychiatric service...

In spite of opening of the second hospital, where they also treated people with mental disorders, the psychiatric service could not assist all those who needed it. The wards were overcrowded, and there was a need to expand the hospital or build another one. Many patients were sent to other crown lands of the empire for medical care. As a result, part of the Bukovinian psychiatry was received by Vienna.

The Central Medical Department of the Austro-Hungarian Empire, which monitored the situation of medical care for the population of the region, appealed to the Bukovina administration with an order to build a new psychiatric hospital. in 1897 a decision was made to establish a separate psychiatric hospital in Chernivtsi. The decision was made by the regional administration of Bukovina.

Leading specialists in the field of medical construction of the empire were involved in the development of the project, and several public hearings were held among the residents of the city. Professor Kolbengayer developed a master plan for the new building and submitted it to the Executive Committee of the Sejm on January 24, 1898. The regional president of Bukovina, Bourguignon, also took part in the discussion of the project. The draft was subject to a thorough review, after which it was generally approved and unanimously recommended for consideration at the session of the Seimas. It is known that the model of the regional psychiatric hospital in Chernivtsi was developed by the latest requirements for the construction of mental health facilities in Austria and other European countries of the time Topp L. The Modern Mental Hospital in Late Nineteenth-Century Germany and Austria: Psychiatric Space and Images of Freedom and Control, ed by Topp L, Moran J, Andrews J, Madness, Architecture and the Built Environment: Psychiatric Spaces in Historical Context, New York: Routledge, 2007, P. 241-261 [in English]..

At the beginning of the 20th century, the Bukovynian psychiatric hospital was extremely modern, equipped with all the necessary equipment and the location of the wards in accordance with the standard of the time. Leading doctors were involved, as well as local ones, who had the opportunity to train at the University of Vienna and psychiatric hospitals. 15 hectares of land were allocated for the territory of the hospital, which was located outside the city on the territory of the former Strazagasse (Storozha) and Maisgasses (Kukurudziana) streets, now Mussorgsky Street Vasylieva N., Yaremchuk O. Rozvytok psykhiatrychnoi dopomohy v Pivnichnii Bukovyni pid vladoiu avstriiskoi monarkhii [Development of psychiatric care at the Northern Bukovina under the authority of the austrian monarchy], Current issues of social studies and history of medicine, 2016, Vol. 1, N 2, P. 86-90. URL: http://nbuv.gov.ua/UJRN/apcnim_2016_2_17 [in English]; Vasylieva N. Yaremchuk O. “Rozvytok psykhiatrychnoi dopomohy v Pivnichnii Bukovyni pid vladoiu avstriiskoi monarkhii” [“Development of psychiatric care at the Northern Bukovina under the authority of the austrian monarchy“], Current issues of social studies and history of medicine, T. 1, N 2, 2016, P. 86-90, URL: nbuv.gov.ua/UJRN/apcnim_2016_2_17 [in Ukrainian]..

In 1900, the project of a psychiatric hospital was approved, the executor of which was the architect Erich Kolbenhayer. Speaking on the occasion of the celebration of the construction of the regional psychiatric hospital, he thanked everyone involved and ended his speech with the words: “May fate be friendly to this institution of mercy and love of neighbour. The institution itself must strive to fully and completely meet its lofty task - to work for the benefit of suffering people and the glory of the Bukovyna region and its generous residents” Nykyrsa M. D. Chernivtsi. Dokumental'ni narysy z istoriyi vulyts' i ploshch [Chernivtsi. Documentary essay on the history of streets and squares], Chernivtsi: Zoloti lytavry, 2008, P. 450 [in Ukrainian]..

For temporary assistance in making detailed plans, he invited architect Moritz Jasner. To implement the construction work, the competition was won by a local developer - Julius Bochner and other companies. Heating and water supply were provided by Kreting (Vienna) and Gulmer & Schwabe (Blitz) implemented the hospital's power supply. Pittel Brauzevetter (Chernivtsi) has implemented a sewerage system. Several locally-produced shops were also set up to supply the psychiatric hospital with furniture, textiles and other necessary raw materials. Karl Gabenicht's company (Vienna) created sewage treatment plants. The construction of the hospital was financed by the Franz Josef Foundation and voluntary contributions from citizens Derzharkhiv Chernivets'koyi oblasti [Chernivtsi State Archive], file 286, op. 2., spr. 20..

The opening of the regional psychiatric hospital in Bukovina took place on May 1, 1902. The structure of the psychiatric hospital included 6 buildings, as well as the administration building and other technical facilities. Each branch was two-story. On the first floor, there were mostly medical offices, and on the second floor, there were wards and a space for rest. The wards were differentiated: 25 beds for primary care patients, 30 beds for patients in need of constant care, and 45 beds for restless patients who were dangerous to themselves and others. All buildings of the psychiatric hospital were connected by underground passages. The hospital grounds were planted with cultivated trees and equipped with benches, footpaths and garden for recreation of patients and walks with relatives. The treatment was carried out mainly at the patient's own expense, as well as from the Foundation of Emperor Franz Joseph, which paid for the treatment of patients who could not pay for themselves. Another way for such patients is the help of patrons. An interesting fact is that the health care system of the Austro-Hungarian Empire provided that landowners who employed employees must pay for treatment in the event of a worker's illness Derzharkhiv Chernivets'koyi oblasti [CHSA], file 2, op. 1, spr. 295. 7.

Carl Tsurcan became the first director of the psychiatric hospital. Under his supervision, two more buildings of the psychiatric hospital were completed.

Leon Kobylyansky became the next director of the psychiatric hospital. During his tenure, new hospital buildings were built in 1912. The number of beds is also increasing by another 240. Accordingly, the hospital administration is buying the surrounding plots of land where vegetables and fruits were harvested to feed patients. Farms were set up to keep domestic animals. The area of the hospital covered the modern boundaries of the Formarket, the Regional Psychiatric Hospital, the City Children's Polyclinic, the surrounding residential buildings, the Chernivtsi Regional Center for Emergency Care and Disaster Medicine and Zhovtnevy Park, including the lakes.

During Bukovina's stay in Romania, the psychiatric hospital declined. There was a lack of funding for the maintenance of the hospital and patients. Accordingly, the main funding of the hospital was received with the help of donors, food was provided by the work of patients on the land of the hospital, where crops were grown.

During the Soviet period, the psychiatric hospital underwent many changes from ups and downs. It is worth mentioning that in 1945 the Department of Psychiatry of the Chernivtsi State Medical Institute was opened on the territory of the hospital, which was headed by Doctor of Medical

Sciences, Professor N.P. Tatarenko. The department conducted several clinical studies on the occurrence of endogenous psychoses, including schizophrenia and bipolar disorder, and also researched the organic cause of mental disorders Boichuk T. M., Bilous V. I. “Vid Kyieva do Bukovyny protiahsia istorychnyi shliakh Bukovynskoho derzhavnoho medychnoho universytetu” [The historical path of Bukovynian State Medical University stretched from Kyiv to Bukovyna], Misto, 2019, URL: http:// dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/9097 [in Ukrainian]..

Chernivtsi Psychiatric Hospital had the status of a republican hospital from 1952 to 1957. At that time the number of beds increased significantly to 1000. The psychiatric hospital served not only patients within the modern Chernivtsi region but also Ternopil, Ivano-Frankivsk, Khmelnytsky regions and the northern regions of Moldova.

In 1950, the psychiatric hospital №2 was established on the territory of the farm of the Chernivtsi Psychiatric Hospital in the village of Chortory, Kitsman district, Chernivtsi region, for patients with chronic mental illness, where there were 2 departments (now the Chortory psychoneurological boarding house).

During the Soviet period, the hospital flourished under the leadership of Natalia Chubynets (a chief physician from 1949 to 1963) who substantiates methods of treatment in psychiatry, as well as recognizes rehabilitation and occupational therapy. Several labour and production workshops were opened based on the psychiatric hospital, including a greenhouse, sculpting and wickerwork workshops, a sewing shop, workshops for making hats, shoes, brooms and textiles.

It is known that flowers from the greenhouse of the psychiatric hospital were often used during celebrations and as gifts for the holidays. As a result of the sale of goods of its own production, the psychiatric hospital receives significant profits.

The hospital used the saved funds to open a water hospital. Now, this building is located on the territory of the modern Sevastopolskaya Street, Chernivtsi. Moreover, it is known that a recreation centre on the Black Sea coast was purchased for a team of doctors and junior medical staff of the mental hospital.

In 1963, Pavlo Bulba became the chief physician. The Psychiatric Hospital significantly reduced its funding and reduced production workshops. The territory decreases lose its fields and garden, the hospital's land plots are being built up with multi-storey buildings, a city hospital and a park is being opened Vid Frantsa Yosyfa do Muntiana. Deshcho z istorii chernivetskoi psykhiatrii [From Franz Joseph to Muntian. Some of the history of Chernivtsi psychiatry], Shpalta [The Page], URL: https://shpalta.media/2019/08/07/vid-franca-josifa-do-muntyana-deshho-z-istorii- cherniveckoi-psixiatrii, Accessed 14 Apr. 2021) [in Ukrainian]..

Today Chernivtsi Regional Psychiatric Hospital has 500 beds. The structure of the hospital includes three men's psychiatric departments (№1,7,9), two women's psychiatric departments (№2,8), Child and Adolescent Psychiatric Department (6th), Department of Anesthesiology and Intensive Care (4th), Department for Patients with Borderline Mental Disorders (5th), Dispensary (10th), Reception Room (11th), Somato-Psychiatric Department (13th), Psychiatric Infectious Diseases Department (14th) and Crisis Department (15th). The structure of the hospital also includes dental, radiological and functional diagnostics rooms, Physiotherapy Department and Day hospital Chernivtsi Regional Psychiatric Hospital website, URL: http://bukmental.com.ua/, Accessed 14 Apr. 2021 [in Ukrainian].8.

Besides, on the basis of a psychiatric hospital is the S.M. Savenko Department of Nervous Diseases, Psychiatry and Medical Psychology of Bukovynian State Medical University, which is a powerful regional mental health research centre.

Conclusions. The history of the emergence of psychiatric services in Bukovina has experienced ups and downs that corresponded to challenging conditions of the time. The transformation of mental service changed from the worldview and level of development of contemporary science. We can observe changes from mystification to the formation of psychiatry, as real modern neuroscience with an evidence- based approach and humane treatment of patients. Through the ages, different countries and changes in the understanding of the etiology and pathogenesis of mental disorders, Chernivtsi remains the centre of mental health in Bukovina.

Размещено на Allbest.ru