psychiatrist and neurologist, Antonio Labad, already retired, he has lived through the decisive changes in which the specialty of mental health was immersed during the second half of the last century. On the one hand, psychiatry went from depending on the provincial councils to doing so on Social Security. On the other, it was opened up to society in the form of community centers. During his career, Labad has been linked to the Joan XXIII Hospital in Tarragona, the Institut Pere Mata in Reus and the Faculty of Medicine of the Rovira i Virgili University (URV), institutions, the latter, with which he continues to be related. In fact, next May 6, in the final act of the course, he will appear in the fringes together with the new doctors, in a decision voted by the students themselves. Until last year, Labad was also president of the Ethics Commission of the Col·legi de Metges.
How has psychiatry changed?
Totally. Especially after the opening of the mental health centers in the early 1970s. In other words, the Pere Mata, with the collaboration of the Provincial Council of Tarragona, were pioneers in the creation of these clinics in Spain. The first one was opened in Asturias, later we and only ten years later they did it in Barcelona.
What did they guess?
From then on, we began to work in each locality with the families of the admitted patients so that they could receive them at their homes. We provided them with peace of mind and confidence, as well as close monitoring, which meant a very significant reduction in hospitalized patients in the province. This is also part of the treatment, as otherwise it seems that only medications are prescribed.
Are medications always necessary?
Medicines are at the service of treatment. The black-and-white binary approach is false. In fact, the concepts of family treatment or hospitalization continue today. Personally, I believe that the approach must be seen as a whole, it will depend on the disorder in question, the context of the patient and sometimes psychotherapeutic and psychopharmacological aspects must be combined.
What remains of the teachings of Dr. Tosquelles?
Many things. Shortly before Tosquelles died, I was with him in his house in France, where we reflected that psychiatry had ceased to be something different from the rest of medicine. He had joined her and there are good things about this and not so good things about it.
“Self-harm is almost never related to a suicide attempt. Sometimes it is a way of feeling a pain that neutralizes the psychological one»
The good news is that it is part of the entire medical structure. But what has been lost? The more psychological, more philosophical, more anthropological aspect has gone into the background. And it is a bit similar to what can happen in other specialties. We are continually striving for medicine to be humanistic, we must emphasize the doctor-patient relationship, care, attention and understanding, we must put ourselves in the place of the other.
I understood that psychiatry had improved in that aspect, if we look at it historically.
Historically, when patients suffered certain crises, the tendency was to isolate them so that they would not create problems. But since the French Revolution, the slogans of freedom, equality and fraternity were extended to the entire society, including the mentally ill. A more humane treatment was advocated, for talking to them, not for chaining them.
What do you think about electroshock therapy?
Currently I welcome medical internship students and I always explain to them that when the electroshock was invented it was of fundamental importance. However, its great fault was that it was prescribed for everything. And movies like One Flew Over the Cuckoo’s Nest and many others have wanted to show how badly it was done in psychiatry. But like everything, it has its good part.
Are they still used?
I have used them and Tosquelles too. But in May 1968 things began to change, especially in the United States. And they stopped doing it in some clinics, such as Pere Mata or Sant Boi, but not in others. The point is that it is well advised to do them in very precise and specific situations, such as biological depression or catatonia. Likewise, the way of making them has also changed, with its own protocol.
We are in the depression era. But what is it?
It is a very complicated issue. It is a symptom of sadness, you are discouraged, blocked, without interest at all. But the origin can be completely different. I mean, you can be grieving the loss of a job, a breakup, the loss of a loved one, a pet… and there’s a void. However, after a while this has to be compensated. Otherwise, we speak of depression linked more to the genetic or biological, not so much to aspects of the environment.
What can you say to parents with a child, usually a teenager, who self-harms?
Before saying, you must listen. When someone comes to the consultation for a self-harm, the first thing to do is listen and ask, but in the most naive sense of the word, since that person has to realize that there is an effort to understand him. And the health worker must try to address the context in which this situation has occurred. Because it is almost certainly not going to be resolved with pharmacological treatment, but rather by trying to rebuild those bridges that have been broken in that person’s desire to lead a happy life. Self-harm is almost never related to a suicide attempt, sometimes it is a way of feeling pain capable of neutralizing the deepest psychological one.