Dr. Alexandru Sutzu (1837–1919): A Pioneer of Romanian Psychiatry and Forensic Psychiatry


Dr. Alexandru Sutzu was born in Bucharest, Romania, on November 30, 1837, into the Greek aristocratic Soutzos family. He studied medicine in Athens, Greece, from 1856 to 1862 and after graduating in 1863, went on to study at the University of Paris in France where he completed a doctorate in medicine in 1865. He then returned to his native Romania and found employment at the Mărcuța asylum, the region’s first psychiatric hospital, in 1866. He would go on to become the institution’s director only a year later (1, 2).


Aside from discharging his regular duties at the asylum, Dr. Sutzu was appointed professor of both legal medicine and psychiatry (known as alienism at the time) at the medical faculty in Bucharest (3). He was also a prolific writer, publishing an impressive array of articles and monographs during his career. He founded the country’s third medical journal, Gazetta Spitalelor, and cofounded another, Gazetta Medico-Chirurgicală a Spitalelor, in which the bulk of his publications appeared (1).


Alienatul în Fața Societății și a Științei (alienation under the scrutiny of society and science) remains his most well-known work. Published in 1877, it is widely considered the first Romanian textbook of clinical and forensic psychiatry, which may be likened to Dr. Isaac Ray’s seminal 1838 text (A Treatise on the Medical Jurisprudence of Insanity) in the Anglosphere. A quick glance through the textbook shows Dr. Sutzu’s familiarity with contemporary and near-contemporary authors and concepts that were in vogue during the period. He cites a number of authorities on psychiatry and neurology—Pinel, Esquirol, Georget, Morel, and Griesinger to name a few. He was also familiar with English-speaking authors and sometimes alludes to Marshall Hall, Henry Maudsley, and J. T. Sabben (1, 3).


He commenced his text by reproducing and discussing the Romanian regulations relevant to forensic psychiatry, such as giving expert evidence and determining criminal responsibility. To assist the physician in these medico-legal tasks, he outlined a nosological classification of mental illnesses that despite sharing much of the same nomenclature found in other pre-Kraepelinian systems (4), was distinctly systematized. Dr. Sutzu postulated a trichotomized nosology of mental “alienation,” which he categorized into simple, complicated, and cerebral infirmities. Each of these was then further subdivided as follows: simple alienation comprised mania (acute, partial, and chronic) and melancholy (simple, delirious, and stuporous); complicated alienation encompassed nervous disorders (e.g., epilepsy), intoxication (e.g., alcoholism), idiopathic mania (e.g., general paresis), and sympathetic mania (e.g., puerperal insanity); and cerebral infirmities included intellectual disabilities and dementia. He also mentions several disorders that are now rarely encountered in the developed world but are prevalent in other parts (e.g., co-occurring tuberculosis and psychosis) (5).


Dr. Sutzu was instrumental in the eventual inclusion of psychiatry within the medical syllabus of the time in Bucharest, and thanks to this effort, he increased the number of intern students from the medical faculty assigned to train in the Mărcuța asylum. He also campaigned successfully for the construction of new psychiatric hospitals. The Caritatea Institute being one such example; its blueprint was included at the end of his aforementioned textbook (1). He wrote about therapeutic labor and work—ideas now associated with occupational therapy. Because Romanian society back then was mostly agrarian, he deemed an agricultural model suitable (i.e., patients employed on farmlands in or around asylum grounds) (6).


In summary, Dr. Sutzu was an important figure and a towering personage in the history of Romanian psychiatry. He was the first to methodically write and lecture on forensic psychiatry in Romania, thereby laying the groundwork for future development of the field. His works, despite remaining untranslated into English, are essential reading for anyone interested in the development and evolution of psychiatry in Romania and Eastern Europe.