Reformando la asistencia psiquiátrica en México. La Granja de San Pedro del Monte: los primeros años de una institución modelo,1945-1948

• Autores: Cristina Sacristán
• Localización: Salud mental, ISSN 0185-3325, Vol. 26, Nº. 3, 2003, págs. 57-65
• Idioma: español
• Enlaces
  • Texto completo (pdf)
• Dialnet Métricas: 4 Citas
• Resumen
  • español

    En este artículo se analiza el proceso de reflexión que condujo a la fundación de la primera Granja para enfermos mentales de México, en 1945, cuando la psiquiatría mexicana se vio ante el reto de innovar su oferta terapéutica creando formas de atención que tendieran puentes entre la psiquiatría y la sociedad que demandaba sus servicios.

    Nos interesa conocer las características tanto del proyecto que llevó al establecimiento de la Granja, situada en la antigua hacienda de San Pedro del Monte, a 12 kilómetros de León, en el estado de Guanajuato, como de su funcionamiento durante los primeros cuatro años de su existencia (1945-1948), con el fin de poder vislumbrar por qué la alternativa terapéutica ofrecida por las Granjas-hospitales fue tan bien acogida e impulsada por el Estado mexicano.

    Esta pregunta posiblemente ha quedado en el olvido porque actualmente los hospitales campestres, herederos directos de las Granjas, son quizás el dispositivo de atención psiquiátrica más abandonado por el Estado, y por ende los que cuentan con menores recursos financieros, terapéuticos y humanos: de ahí el carácter custodial de estas instituciones. Hoy en día nos puede parecer extraño que la Granja de San Pedro del Monte fuera en algún momento de su historia una granja modelo, pues la imagen que hemos conservado de ella y de las restantes, nos impide imaginarlas en un estado de prosperidad como el que en algún momento tuvieron. Nos mueve también la convicción de que puede ser aleccionador para nuestro presente conocer los esfuerzos realizados por la psiquiatría mexicana en el pasado para ofrecer mecanismos de reinserción social a los enfermos mentales.

    Desde 1930 los psiquiatras mexicanos expresaron su preocupación por el agotamiento terapéutico del modelo masificador que representaba el manicomio de La Castañeda, y elaboraron una serie de propuestas encaminadas a mejorar la asistencia psiquiátrica, entre ellas, el establecimiento de explotaciones agrícolas basadas en la terapia ocupacional. La Granja de San Pedro del Monte fue tan exitosa durante sus primeros años que este proyecto se convirtió en uno de los pilares de la política de salud mental en México durante cinco periodos presidenciales, entre 1945 y 1968, años durante los cuales se establecieron en el país once Granjas inspiradas en ella.

    Este hecho no deja de ser curioso porque de todas las opciones que los psiquiatras mexicanos se plantearon para superar el modelo asistencial del manicomio, las cuales intentaban acercar la psiquiatría a la sociedad, la única que parecía ir contra este movimiento general era precisamente la de las granjas. La Granja, establecida en el campo y por ende, al margen de la vida urbana, industrial y comercial, suponía la creación de un microcosmos social cerrado en sí mismo, con muy poco contacto con el exterior y relativamente autosuficiente, pues en ella se producían gran parte de los insumos que requería para su buen funcionamiento.

    Este trabajo sostiene la hipótesis de que el establecimiento de las Granjas para enfermos mentales se convirtió en política de salud mental en México gracias a varios factores que singularizaron a la de San Pedro del Monte, pionera en su momento, y que posiblemente no se volvieron a repetir. En primer lugar, dicha Granja siempre contó con una reserva de pacientes procedentes de La Castañeda que contribuían con su trabajo al sostenimiento de la institución y justificaban el subsidio federal, y con un número indeterminado de enfermos, procedentes de las poblaciones vecinas, que pagaban una cuota. En segundo término, el director nunca desdeñó los avances médicos; de ahí que hiciera uso tanto de la terapia ocupacional como de los tratamientos de choque, sobre todo entre los enfermos originarios de la región, quienes, de esta manera, evitaron que la institución perdiera su carácter médico, ya que la mayoría de las altas se daba entre ellos. Finalmente, al centralizar el director en su persona, tanto la dirección médica como la administrativa, fue posible evitar los seculares conflictos que conocemos entre el administrador y el director y lograr una independencia que pocas instituciones psiquiátricas mexicanas tuvieron en su tiempo.

  • English

    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, creating forms 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 General Mental 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 La Castañeda 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 specialized departments 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 therapeutic alternatives 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 of mental 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, Mexican psychiatrists 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 the institution. 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 reinsertion into the society. In addition, psychiatrists were also interested in gaining the population’s confidence in order to do away with common prejudices leading to the stigma attached to confinement in mental hospitals. As time went by, some of these ideas materialized and others were forgotten, however the project most broadly accepted by the Mexican State was that of creating farms. This is somewhat ironic, since of all the options proposed by Mexican psychiatrists for overcoming the “charity-oriented” mental hospital model by bringing psychiatric services closer to society, the only option that seemed to be contrary to this general tendency was precisely that of farms. The farm was established in a rural setting, and thus separated from urban, industrial and commercial life. It was based on the creation of an enclosed, social microcosm with very little outside contact and relatively self-sufficient, on behalf that a significant portion of the products needed to cover effectively the daily needs would be produced on the farm. Curiously, even though this project apparently would separate psychiatry even more from those potentially receiving these services, it became one of the pillars of mental health policy in Mexico, throughout five presidential terms. Between 1945 (the year the first farm was founded) and 1968 (the year that La Castañeda mental hospital was demolished), eleven farms were established in different areas of the country and modeled after the San Pedro del Monte Farm, consistently viewed as the best model to follow. This work supports the hypothesis that the establishment of farms for the mental ill became mental health policy in Mexico due to a number of facts particularly present at the San Pedro del Monte Farm—a pioneer in its time—but which were possibly not found in other farms. First, this particular farm always had a reserve of patients from La Castañeda, who contributed with their work to the continuation of the institution and justified federal assistance, and also an undetermined number of mentally ill patients who belonged to the neighboring communities and paid fees for receiving services at the facility. Secondly, the director consistently took note of medical advances, and used both occupational therapy and shock treatments, for instance, especially with patients from the local region. In this way he prevented the institution from losing its medical character, because most of the patients who were released were those that come from the local area. Lastly, by having a single person to work both as medical and administrative director, it was possible to avoid the well-known conflicts experienced between administrators and medical directors, and to achieve a level of independence that few psychiatric institutions in Mexico had at that time.