BRIEF COMMUNICATIONS 1217

group psychotherapy members were homo- during the period of participation in group
geneous for sex, length of involvement in therapy.
therapy, and exposure to one therapist and
theoretical approach, and they were com- REFERENCES
pared with a control group. Each subject was
the mother of one son or daughter who met I. Bitter JA: Attitude change by parents of trainable
mentally retarded children as a result of group dis-
the criteria of moderate or severe retardation
cussion. Exceptional Child 30173.176, 1964
and who lived at home. 2. Rosen L: Selected aspects in the development of the
Ramsey (9) emphasized the necessity of mother’s understanding of her mentally retarded
objective measures in assessing changes in child. Amer J Ment Defic 59:522-528, 1955
parental attitudes toward retardates before 3. Coleman JC: Group therapy with parents of men-
tally deficient children. Amer J Ment Defic 57:700-
and after therapy. While our results were not
726, 1953
conclusive, they suggested a consistent trend 4. Appell MJ, Williams CM, Fishell KN: Changes in
toward a more favorable view of the retar- attitudes of parents of retarded children efl’ected
dates after group therapy(1). In view of the through group counseling. Amer J Ment Defic 68:
807-8 12. 1964
significant changes in ratings of security and
5. Blatt A: Group therapy with parents of severely re-
appearance, mothers in group therapy tarded children: a preliminary report. Group Psy-
seemed to experience greater acceptance of chother 10.133-140, 1957
their children, thereby affecting their per- 6. Cummings ST. Stock D Brief group therapy of
mothers of retarded children outside the specialty
ceptions.
clinical setting. Amer J Ment Defic 66:739-748,
The present investigation posed several 1962
problems for further study. An important is- 7. Rankin JE: A group therapy experiment with
sue concerned the difficulty of effecting atti- mothers of mentally deficient children. Amer J Ment
tude change itself. These mothers had lived Defic 62:49-55, 1957
8. Yates ML, Lederer RS: Short-term group meetings
with their children for approximately 20
with parents of children with mongolism. Amer J
years, coping with retardation severe enough Ment Deflc6S:467-472, 1961
to have been detected early. Twelve weekly 9. Ramsey GV: Review of group methods with par-
therapy sessions were perhaps minimally ef- ents of the mentally retarded. Amer J Ment Defic
fective in changing the mothers’ perceptions. 71:857-863, 1967
10. DiNola AJ, Kaminsky BP, Steinfeld AD: T.M.R.
A second area involved validating mothers’
Performance Profile for the Severely and Moderate-
ratings of the retardates’ social behavior ly Retarded, 2nd ed. Ridgefield, NJ, Reporting Ser-
against teachers’ ratings of the same behavior vice for Exceptional Children, 1965

Bernardino Alvarez: New World Psychiatric Pioneer

BY RUBEN D. RUMBAUT, M.D.

The author describes the life and assesses the left their countries for the virgin lands was
contributions to psychiatry of Bernardino an Andalusian from Utrera. Only 20 in 1537,
Alvarez, a Spaniard who founded the first he sailed to Mexico as a soldier seeking ex-
mental hospitals in the New World in the citement and fortune. His parents, Luis and
16th century. Ana Alvarez, noble Spaniards, had four
children: a boy, Bernardino, who died very
U NTIL COLUMBUS’ voyage, the Atlantic
young;
boy named
two girls; and a fourth
Bernardino
child,
in memory
another
of the
Ocean was a formidable geographical
and psychological barrier between the Old
World and the New. After it, a torrential Read at the 123rd annual meeting of the American
wave brought all kinds of men and goods Psychiatric Association, San Francisco, Calif., May
11-15, 1970.
from Europe to America. Dr. Rumbaut is Staff Psychiatrist. Veterans Adminis-
Among the innumerable adventurers who tration Hospital, 2200 Gage Blvd., Topeka. Kans. 66622.

Amer. J. Psych/at. 127.9, March 197/ [137]

1218 BRIEF COMMUNICATIONS

first. This Bernardino Alvarez went to a is that he returned to Mexico City in 1556
small school where he learned “catechism (3) as a rich, ascetic, and melancholic gentle-
and numbers, reading and writing”(l). He man, driven by remorse and guilt to expiate
had a restless nature; as soon as he could he his past misdeeds.
entered the military to pursue wider hori-
zons in the fabulous countries that were Foundation of New Hospitals
then the talk of Europe.
Alvarez began his new activities by pray-
After arriving at what is now Mexico City ing, fasting, and offering himself for the care
he was sent to the countryside and fought of patients in two general hospitals that had
in several actions in the war against the chi-
been founded by Hern#{225}n Cort#{233}s. He
chimecas in the north of New Spain. Appar- completely withdrew from all social life,
ently he was a soldier without too many working unceasingly in the service of the
scruples, for a biographer says that “hate, sick, and contributed money to charitable
tears and curses” (2, p. 297) usually followed causes. About ten years after his return
him. He wanted a shortcut to wealth, how- Alvarez developed the strong conviction that
ever; he disliked discipline and had no taste more, better, and different institutions were
for the military life.
badly needed in New Spain. From then on
After this campaign Alvarez returned to he directed all his time, wealth, and energy
Mexico City, then a lively and tempting to the foundation of new hospitals.
emporium. Soon he was in trouble, gambling With his dedication, experience, and rep-
and robbing the gambling houses, drinking utation, Alvarez was now able to engage
heavily, rebelling against the law, joining other people in his plans. By then, he had
the delinquents of the city, and eventually only one thought in his mind:
being chosen the leader of a small gang. “A The institutions of charity of the city were not
handsome and perfidious demon”: this is the enough for the poverty in such a populated
way he was described at that time. Finally he place; madmen were roaming in the streets, their
and his band were apprehended, imprisoned, weird actions and sayings mocked and laughed
and sentenced to forced labor in China. They at; some were even stoned by the populace, be-
escaped from prison, though, killing three cause of supposedly being possessed by the devil;
the convalescents had to give way to others
guards in the process. Some of the band
sicker and in more dire need, while their symp-
were eventually caught again and hanged
toms, aggravated anew by lack of care, augmented
but Alvarez, through the aid of a close friend, their sufferings and sometimes ended in death (2,
a prostitute, got arms, money, and horses. p. 300).
He fled to Acapulco and then by sea to Peru. Friends gave him a small piece of land.
In Cuzco, Alvarez made a fortune. Al- The document donating the land was signed
though nobody seems to know exactly what on November 2, 1566. The license for con-
methods he used, it is said that he hung up struction of an institution was granted by
his sword and entered business. When he was Archbishop Montilfar. Then the viceroy
rich he wrote to his widowed mother, send- and the king approved it, and, as frequently
ing her money and asking her to come with happens in a project after it captures the pub-
his sisters to the New World and enjoy the lic attention and its feasibility is already ob-
wealth he had accumulated. His mother re- vious, gifts and help began to pour in. A
plied that after the death of her husband she better and definitive place was offered him
had entered a minor religious congregation, in the Calzada de Tlacopan, adjacent to the
her daughters had become nuns, and none of Hermitage of the Martyrs, which had been
them had any intention of leaving Spain. Al- erected in memory of a defeat suffered there
though she refused to come to Peru, she by the Spaniards. (Later, the Hermitage
admonished him to lead a Christian life was to be the San Hipdlito Church;
and to use his wealth in the service of God. Saint Hyppolitus was the city’s patron be-
There is not enough historical information cause the city of Mexico-Tenochtitlan of
to know what happened within Alvarez after the Aztecs-fell to Cortds on Saint
he achieved maturity, fortune, and promi- Hyppolitus’ day in 1521). The archbishop
nence, or how much his mother’s attitude wanted another name for the hospital, but
affected him. What is known with certainty the people called it San HipOlito and this

[138] Amer. J. Psych/at. 127.9, March 197/

BRIEF COMMUNICATIONS 1219

became its official name. his own life, gave special, attention in his in-
On January 28, 1567, the Hospital y Asilo stitutions to debilitated elderly con quista-
de Convalescientes de San HipOlito dores who had no place to go, to stow-
(Saint Hyppolitus’ Hospital and Convales- aways, and to infirm and senile clergymen
cent Asylum) was inaugurated. Its purposes who had retired after a missionary life in the
were multiple and ambitious: it would serve countryside. Eventually Alvarez exhausted
convalescents without means, madmen, his wealth in religious and social endeavors;
infirm and lonely old people, and illiterate the hospitals continued to function with funds
and poor school children, for whom teachers from contributions, gifts, and government
were to be provided (4). With Alvarez’ capi- help, as well as the efforts of the congrega-
tal and efforts the institution grew rapidly. tion. Alvarez took its habit and moved to a
He also bought 100 mules and periodically little cell in the San HipOlito hospital,
sent hospital volunteers to the port of San where he was available night and day to the
Juan de Ultia to pick up people who got brothers and patients.
sick on the long voyage to the New World. By the end of his life (at the age of almost
He spent about 100,000 pesos on each ex- 70), the gentle, steadfast, and ascetic Fray
pedition, a great deal of money even by Bernardino Alvarez, so different from the
modern standards. “handsome and perfidious demon” of his
More and more people contributed gen- youth, was “loved by all Mexico” and
erously, and other hospitals began to flour- known as the “evangelical fellow” (2, pp
ish, each planned to care for specific diseases. 301-302). Slowly, quietly, he died on
The Hospital of San Hipdlito was then de- August 2, 1584, the eve of St. Hyppolitus’
voted exclusively to mental patients. day. His funeral was attended by a great
Alvarez then planned two chains of hospi- crowd, headed by all the civil and religious
tals: one reaching the Pacific Ocean, another authorities of Mexico City; the eulogy
reaching the Atlantic Ocean. Toward the was preached by “a most eloquent orator”
Pacific were the hospitals founded in Oaxte- in the San Hipdlito Church. There to this
pec and Acapulco; toward the Atlantic, the day lie the remains of Fray Bernardino
hospitals founded in Puebla, Perote, Jalapa, Alvarez, our predecessor in the psychiatric
and Veracruz. Eventually one more was movement in the Americas.
built farther to the east in Havana, Cuba. All
of them were under the jurisdiction of the Background
first, San HipOlito in Mexico City. It was
When studying a historical figure it is
an incredible chain of hospitals, especially
always illuminating to look at his time and
if we consider that all this happened in the
his country, so that we can understand the
16th century (5).
man in the light of his contemporary en-
viron ment.
The Order of Saint Hyppolitus
In pre-Colombian times, the Indians
Helpers, volunteers, and workers in the were disseminated all over North, Central,
ir’stitutions were doing so much work and and South America. In the central valley of
living lives of such sacrifice and devotion that Mexico, human life was present at least
Alvarez, in the spirit of the time, sought to as far back as 10,000 B. C. It is known that
create a religious congregation for those four different civilizations flourished in
willing to enter it. A brown habit was Mexico between the fourth and the ninth
adopted and a provisional constitution pre- centuries. Of them, only the Mayas re-
pared. The members were called “HipS- mained for any length of time. On an island
litos,” a name that was later formally in the middle of Lake Texcoco, the ancestors
adopted. A pope approved their constitu- of the Aztecs established Tenochtitlan,
tion. Later, in 1700, Pope Innocent XIII capital of the future Aztec empire, which was
promoted the congregation to the Religious in reality a loose association of city-states.
Order of Saint Hyppolitus. The congregation It was not an idyllic empire by any means,
eventually took over hospitals in Oaxaca, although the Aztecs were noted for their
Quertaro, and Guatemala. agriculture, architecture, sculpture, handi-
Alvarez, probably influenced by events in crafts, religion, written language, calendar,

Amer. J. Psych/at. 127.9, March /97/ [139]

1220 BRIEF COMMUNICATIONS

astronomy, and mathematics. The tribes his own hospitals. Pinel, in France, was to
fought fiercely among themselves, and come 200 years later. In North America,
human sacrifices to cruel and insatiable the first hospital that provided care for
gods reached enormous proportions. Slavery mentally ill people was established in Phil-
was part of the caste system. It is estimated adelphiain 1751.
that the preconquest Mexican Indian popu- By the 17th century San HipOlito had
lation fluctuated between four and 11 made a special agreement with the provinces
million. In February 1519, Cort#{235}s set of New Spain by which any mental patient
sail from Cuba to the coast of Mexico. could be accepted by the institution if the
Through a series of initially favorable cir- provincial authorities paid his transporta-
cumstances, the help of the Tlaxcalan tion, room, and board (9). Muriel affirms,
Indians (enemies of the Aztecs), and dis- “We know with certainty that lunatics were
sensions among the Aztecs themselves, sent to San HipOlito from Cuba; also
Cort#{233}s was able to conquer Tenochtitlan from Guanajuato, Quer#{233}taro, San Miguel
and to subdue the empire in less than two el Grande, Salvatierra, Colima, Tula, Val-
years. The area was then renamed New ladolid, Celaya, Durango, Guadalajara,
Spain, and Tenochitlan became the City COrdoba, LeOn, and Orizaba” (5). The hos-
of Mexico. pital admitted both Spaniards and Indians.
The development of New Spain was in-
The HipOlitos worked in the spirit of
deed fabulous. In for example,
1521, there what later was to be called moral treatment.
was not a single head of cattle in the area;
According to Robles, “Their methods
seven decades later hundreds of thousands would be classified now as persuasive and
were roaming the land. Some of the in- logotherapeutic” (10). As DIaz de Arce,
numerable buildings erected were magnifi-
quoted by Viqueira, said, “When the patients
cent. The city of Mexico enjoyed plenty of were calm, they led a community life, stroll-
water and well built aqueducts, food and ing in the gardens, yards and patios, eating
supplies abounded, and hospitals and cen-
and sleeping in communal wards. Only the
ters of advanced culture were established.
furious ones, during their seizures, were put
It is fascinating to read a description of the
in closed seclusion to avoid harming them-
city in a book written by a university pro-
selves or others (9, p. 20).
fessor, Cervantes de Salazar, and printed
in 1554 by the first printing press of the New A reconstruction of the hospital-some-
World (6, pp. 22-81). He mentions the San what damaged by uninterrupted use and the
HipOlito Church, “thronged yearly on his passage of time-took place in 1777. Jos#{233}
day by a multitude and a great solemn pro- G#{225}lvez, a Spanish gentleman who at-
cession from the whole city.” tended the ceremonies as a delegate of the
Royal Court, wrote to King Charles III:
Thus Mexico can boast of the first public
“The edifice has no equal in any of the
general hospitals on the continent, founded
hospitals of its kind that I have seen in
by Cort#{233}s himself; the first hospital for
Europe” (9). More than 220 patients could
venereal diseases; the first doctor of medi-
be treated on its two floors (1, p. 72). In
cine licensed to practice in the Americas,
1821 the San HipOlito was secularized,
Dr. Pedro LOpez, considered “a very
although the order still continued caring
skilled physician” (6, p. 50); the first uni-
versity, which opened in 1553; the first for patients until 1842.
school of medicine, in 1578; and the first San HipOlito (as well as La Canoa)
mental hospitals, San HipOlito and one gave almost continuous care to mental
for women, La Canoa, founded in 1690(7). patients from their foundings until 1910 in
If we look at Europe at the time of the spite of vicissitudes of all kinds.
opening of San HipOlito in 1567, we The Republic of Mexico opened one of
find almost nothing with which to compare its most modern mental hospitals in 1967,
it, except for several famed institutions in exactly four centuries after San HipOlito
Spain (8). In those asylums, enlightened opened its doors for the first time. The
treatment for mental patients was provided. name selected for the new institution was
Alvarez used some of them as models for “Fray Bernardino Alvarez,” thus fittingly

[140] A mer. J. Psych/at. 127.9, March /971

 BRIEF
honoring COMMUNICATIONS
the New World psychiatric pioneer 1221

REFERENCES
and his durable work. 1.Delgado-Roig J: Fundaciones Psiqui#{225}tricas en
Sevilla y el Nuevo Mundo. Madrid, Paz Montalvo,
1948
Conclusion
2. Valle-Arizpe A: Por Ia Vieja Calzada de Tlapocan.
Mexico, DF, Tipografia Cultura, 1937
3. Ram Irez-Moreno 5: The first psychopathic
Bernardino Alvarez was a precursor, a hospital of the American continent. Amer J
man of courage, generosity, vision, and dedi- Psychiat 99:194-195, 1942
cation. At a surprisingly early time, he 4. Alfaro R: Breve Noticia Histdrica del Hospital
de Dementes San Hipdlito de Mexico, vol 2.
founded enlightened institutions for mental
Mexico, DF, Gaceta MCdica, 1866, p 238
patients on our continent while in the rest
5. Muriel J: Hospitales de Ia Nueva Espa#{241}a. Mex-
of the world such institutions were either ico, DF, Editorial Jus, 1956, p 196
nonexistent or, with only a few outstanding 6. Cervantes de Salazar F: Life in the Imperial and
exceptions in Spain, backward and cruel. Royal City of Mexico and the Royal and Pontifical
University of Mexico, 1554 (facsimile). Austin, Tex,
Alvarez is still insufficiently known by the University of Texas Press, 1953, pp 22-81
English-speaking scientific world. George 7. CalderOn-Narv#{225}ez G: Hospitales Psiqui#{225}-
Mora, in a chapter of a recent historical tricos de Mexico desde Ia colonia hasta Ia
actualidad. Revista Mexicana de Neurologla y Psi-
book, wrote briefly about Alvarez and the
quiatria 7:1113, 1966
foundation of San HipOlito, the Amer- 8. Chamberlain AS: Early mental hospitals in Spain.
icas’ first mental hospital. He said, “... AmerJ Psychiat 123:143-149, 1966
such a hospital was opened in Mexico City, 9. Viqueira C: Hospitales para locos e inocentes en
HispanoamCrica y sus antecedentes espa#{241}oles.
an event which should be properly remem-
Revista de Medicina y Ciencias Afines 270’.18-21,
bered today in discussing the historical devel- 1965
opment of mental hospitals” (11). This paper 10. Robles 0 Panorama de Ia Psicologla en MCxico,
was written partly in answer to that call, vol 45-46. MCxico, DF, FilosofIa y Letras,
in the hope that it will help to restore Ber- 1952, p 242
II. Mora G: From demonology to the narrenturm, in
nardino Alvarez, until yesterday a forgotten
Historic Derivations of Modern Psychiatry. Edited
figure, to his proper, significant place in the by Galdston I. New York, McGraw-Hill Book Co,
history of medicine and psychiatry. 1967, pp 41-66

Aversive Therapy of Homosexuality:

Measures of Efficacy

BY NATHANIEL MeCONAGHY, M.D.

The author describes three investigations that orientation was used in addition to the pa-
attempted to give objective evidence of the tients’ subjective reports to determine
value of several types of aversion therapy in changes in their sexual feelings.
the treatment of homosexuality. The results The subjects watched a travelogue-type
were favorable but they showed little differ- film into which the following were inserted at
ence in the efficacy of the various aversion approximately one-minute intervals: ten seg-
therapies. The findings did suggest, however, ments of ten-second shots of an orange circle
that aversion therapy does not act by setting followed by ten-second shots of a nude young
up conditioned reflexes, as is generally sup- woman, alternating with ten segments of ten-
posed.
Read at the 123rd annual meeting of the American
Psychiatric Association, San Francisco, Calif., May
T HIS PAPER reports three studies of aver- 11-15,
Dr.
1970.
McConaghy is Associate Professor of Psychia-
sion treatment of homosexuality. In the try, the University of New South Wales, Little Bay.
investigations, an objective measure of sexual N. 5. W. 2036, Australia.

Amer. J. Psych/at. 127:9, March 1971 [141]