[The problem of the indigent chronic mental disease patient: a historical analysis]

The history of the treatment of the severely chronically mentally ill since Pinel and the French Revolution is reviewed in order to demonstrate that a persistent and cyclical pattern of neglect followed by periods of protest and reform, has characterized the treatment and management of the chronic patient. The roots of the pattern of neglect are many, to understand them a historical and psycho-dynamic approach is necessary. The roots of neglect are found to be in the patients themselves, the therapists, society and the methods of treatment. The review of the literature and pertinent research reveal fragmentation and incoherencies reminiscent of the psychiatric illness itself. An integrated biopsychosocial approach which would give clinical coherence and some conceptual clarity is suggested to facilitate clinical work and more research.