Images in Psychiatry
ajp.psychiatryonline.org Am J Psychiatry 167:3, March 2010
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LORENZO LIVIANOS ALDANA, M.D., Ph.D.
PILAR SIERRA SAN MIGUEL, M.D., Ph.D.
LUIS ROJO MORENO, M.D., Ph.D.
O n the morning of Feb. 24, 1409, while Friar Jofré (1350–
1417) was heading to the Cathedral of Valencia to preach the
sermon on the first Sunday of Lent, he saw a crowd mistreating
and making fun of a mentally ill man. Outraged, he spoke in his
sermon about the need for an institution for the mentally ill (1,
2). Ten merchants offered to provide the necessary funds to carry
out Friar Jofré’s request, and on March 15, 1410, the building of a
hospital, Spital Dels Folls, Orats, e Ignocents (Hospital of the Lu-
natics, Insane, and Innocents), began (2).
Friar Jofré rescued Christian captives as a Mercedarian friar
in North Africa. In his missions he may have heard about hos-
pitals for the mentally ill that already existed in the Arab world
(3). He may also have met Christians admitted to such hospitals
suffering from pellagra (2). Although some hospitals in England
and Germany admitted mentally ill patients, this hospital was the
first one built only for that purpose (4). The Spanish humanistic
tradition regarding the mentally ill spread throughout Iberia and
then to the Hispanic Americas (5, 6). Philippe Pinel would later
praise the occupational therapy used for treatment in this institu-
tion (7). For over six centuries, the Spital Dels Folls, Orats, e Igno-
cents of Valencia has been a beacon institution for the treatment
of mental illness.
The Foundation of the First Western Mental Asylum
Address correspondence and reprint requests to Dr. Sierra, Psychiatry Service, Hospital la Fe, Avda. de Campanar 21, Valencia 46009, Spain;
firstname.lastname@example.org (e-mail). Painting reproduced with the permission of the Diputación de Valencia, Valencia, Spain (Fray Gilabert Jofré ampa-
rando a un loco [Father Gilabert Jofré protecting an insane person], by Joaquin Sorolla Bastida, 1887, oil on canvas, 202×150 cm). Image ac-
cepted for publication May 2009 (doi: 10.1176/appi.ajp.2009.09030371).