History of Psychiatry by Naeem dood ppts

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HISTORY OF PSYCHIATRY
& PSYCHIATRIC NURSING
Noem Dawood
Lecturer
Dow Institute of Nursing And Midwifery ,
DUHS.
1

INTRODUCTION OF TEACHER AND
ROLE IN INSTITUTE
Noem Dawood
Lecture – DIONAM,DUHS
RN, Post RN BSN, MSN, PB, Psych
Specialization.
In BSN Semester VI- I will teach and facilitates
mental health nursing theory as well as clinical
rotation in different psychiatric setting at both private
and public sectors hospitals of Karachi .
2

LEARNING OBJECTIVES
How psychiatry has evolved over the ages
Pioneers of modern Psychiatry
How modern psychiatric treatments
developed
3

INTRODUCTION OF THE
HISTORY OF MENTAL ILLNESS
The history of mental illness is probably
as old as the origin of mankind.
People suffering from mental disorders were
mentioned in the holy books of various
ancient religions such as Christianity, Islam,
Judaism and Buddhism.
The term “psychiatry” is a Greek word which
literally means “medical treatment of the
soul”. It was coined by Dr. Johann Christian
Reil In the early 19th century.
4

PSYCHIATRY
 It is branch of medicine that deals with the diagnosis , treatment and
prevention mental illness.
5

PSYCHIATRIC NURSING
 It is a specialized area of nursing practice employing theories of human
behavior, as a science and the purposeful use of self as an art in the
diagnosis and response to actual or potential mental problem.
 American Nurses Association 1994.
 Psychiatric nursing deals with the promotion of mental health, prevention of
mental illness, care and rehabilitation of mentally ill individuals both in hospital
and community.
6

HISTORICAL DEVELOPMENT OF PSYCHIATRY
 Period of persecution;
In this period, black spirit is considering for cause of mental illness.
No treatment is available for mental illness.
 Period of segregation;
In this period, all mentally ill patients are placed in asylum.
First asylum – Bethlem asylum” which is in England.
 Period of Humanitarian;
in this period, many asylum are established & physician took interest in mentally ill patient.
 Period of scientific;
After 1856, during this period mental patient is considered & treat as a general patient.
 Period of prevention;
In the 20th century after 1960 first would wide mental health year celebrate from 1960 – to till period
is considered as period of prevention.
10th OCT. – Would Mental Health Day.

ANCIENT TIMES
 People of ancient times believed that any sickness indicated displeasure of the gods and in
fact was punishment for sins and wrongdoing.
 Those with mental disorders were viewed as either divine or demonic, depending on their
behavior.
 Later, Aristotle attempted to relate mental disorders to physical disorders and developed
his theory that the amounts of blood, water, and yellow and black bile in the body controlled
the emotions.
 These four substances, or humors, corresponded with happiness, calmness, anger, and
sadness; imbalances of the four humors were believed to cause mental disorders, so
treatment was aimed at restoring balance through bloodletting, starving, and purging.

CONT….
 In early Christian times, all diseases were again blamed on demons, and the mentally ill
were viewed as possessed; priests perform exorcism to rid evil spirits.
 During the Renaissance, people with mental illness were distinguished from criminals in
England; those considered harmless were allowed to wander the countryside and or live in
rural communities, but the more “dangerous lunatics” were thrown in prison, chained, and
starved.
 In 1547, the Hospital of St. Mary of Bethlehem was officially declared a hospital for the
insane, the first of its kind; by 1775, visitors at the institution were charged a fee for the
privilege of viewing and ridiculing the intimates, who were seen as animals, less than human.

HISTORY OF PSYCHIATRIC NURSING
 In fourth century AD,
 during the period of Emperor Ashoka, hospitals with 15 beds for mentally ill with two male and two
female nurses.
 In1964-65 Psychiatric nursing was included in curriculum. (Reddemma K & Nagarajaiah, 2004)
 For the first time in India,
 11 British nurses along with one matron were brought from the UK to work in the mental hospital at
Ranchi in the 1930s.
 Short training courses of three to six months were conducted in Ranchi in 1921, which were
recognized by the Royal Medical Psychological Association.
 During 1948-50 four nurses were sent to the U.K.by Govt. of India for mental health nursing diploma.
 From 1943, the Chennai Government organized a three months’ psychiatric nursing course
(subsequently stopped in 1964), for male nursing students at
the Mental Hospital, Chennai (in lieu of midwifery).

IMPORTANT MILESTONES
 1773: The first mental hospital in the US was built in Williamsburg, Virginia
 1793: Philip Pinel removed the chains from mentally ill patients confined in Bicetre, a hospital
outside Paris i.e. the first revolution in psychiatry
 1812: The first American text book in psychiatry was written by Benjamin Rush, who is
referred to as the father of American Psychiatry
 1812: Clifford Beers, an ex- patient of mental hospital wrote the book, “The Mind That found
itself” based on his bitter experiences in the hospital

LATE 18TH CENTURY
 Led to the advent of moral treatment which was characterized by:
Kindness
Compassion
Humane treatment of mentally ill patients

CONT….
 1912: Eugene Bleuler, a Swiss psychiatrist coined the term Schizophrenia
 In 1913 Johns Hopkins University was the first college of nursing in the United States to offer psychiatric
nursing as part of its general curriculum.
 In 1920, The first psychiatric nursing text book, Nursing Mental Diseases was authored by Harriet Bailey. The
registration of psychiatric nurses was done by 1920 in the UK and degree courses in psychiatric nursing
began in the USA.
 1927: Insulin shock treatment was introduced for schizophrenia
 1936: frontal lobotomy was advocated for the management of psychiatric disorder
 1938: Electro Convulsive Therapy (ECT) was used for the treatment of psychoses
 1939: development of psychoanalytical theory by Sigmund Freud led to new concepts in the treatment of
mental illness.
 1949: Lithium was first used for the treatment of mania
 1952: Chlorpromazine was introduced which brought about a revolution in psycho-pharmacology
 In 1961, Psychiatric nursing was included in the basic nursing curriculum by the International Council of
Nurses.
 1963: The community Mental Health centers Act was passed

20TH CENTURY
 There were two opposing views regarding mental illness:
Biological view stated that mental illness was due to biological causes and could be
treated with physical treatments.
Psychological view stated that mental illness was due to factors such as social stresses.

HISTORY OF PSYCHIATRIC NURSING
 Prior to 1860, psychiatric treatment was by custodial
care whereby untrained persons controlled mentally ill
patients. There was no concept of psychiatric care.
 Florence Nightingale: Her philosophy of treating a
patient as a member of the family and part of the
society laid the foundation of psychiatric nursing.
 She emphasized on:
Holistic care
Therapeutic communication
Sensitivity to human emotions
Development of independence in patients

CONT…..
In 1873,
Dr. Edward Cowles, who encouraged Linda Richards, US’
first trained nurse, to start training for mental health nursing.
The first mental health training school for nurses was set
up in 1882 at the McLean Hospital.
Effie Taylor combined general and mental health nursing.
Mary Adelaide Nutting emphasized the role of the
psychiatric nurse and conceptualized nursing care in terms
of:
Diagnosis
Care
Treatment

CONT…..
 Hildegarde E. Peplau:
a. She is known as the Mother of Psychiatric Nursing.
b. She developed the first graduate psychiatric nursing
programmer in 1954 at Rutgers University.
c. Her emphasis was on the nurse–patient relationship.
d. First to identify psychiatric nursing as an essential
element of general nursing and as a specialty area.
e. First to describe the nurse–patient relationship as the
foundation of nursing practice.
f. Her model represented a shift from traditional
treatments to interpersonal relational model of practice

CONT…..
 Dr.Hildegard Peplau defined the therapeutic roles that nurses might play in the
mental health setting.
 She described the skills and roles of the psychiatric Nurse in her book
“interpersonal relations in Nursing”.
 It was the first systematic and theoretical frame work developed for Psychiatric
nursing.

CONT…..
 Maxwell Jones introduced therapeutic community.
 The focus began to shift to primary prevention and
implementing care and consultation in the community
 The name psychiatric nursing changed in to mental
health nursing.1970’s when it was known as
psychosocial nursing.

PERIOD OF ENLIGHTENMENT AND CREATION OF
MENTAL INSTITUTIONS
 In the 1790s, a period of enlightenment concerning
persons with mental illness began.
 Phillipe Pinel in France and William Tukes in England
formulated the concept of asylum as a safe refuge or
haven offering protection at institutions where people had
been whipped, beaten, or starved just because they were
mentally ill (Gollaher, 1995).
 In the United States, Dorothea Dix (1802-1887) began a
crusade to reform the treatment of mental illness after a
visit to Tukes’ institution in England; she was instrumental
in opening 32 state hospitals that offered asylum to the
suffering.

SIGMUND FREUD AND TREATMENT
OF MENTAL DISORDERS
 The period of scientific study and treatment of mental
disorders began with Sigmund Freud (1856-1939) and
others,
such as
 Emil Kraeplin (1856-1926) and
 Eugene Bleuler (1857-1939).
 With these men, the study of psychiatry and the diagnosis
and treatment of mental illness started in earnest.
 Freud challenged society to view human beings
objectively; he studied the mind, its disorders, and their
treatment as no one had before.
 Kraeplin began classifying mental disorders according to
their symptoms, and Bleuler coined the
term schizophrenia.

DEVELOPMENT OF PSYCHOPHARMACOLOGY
 A great leap in the treatment of mental illness began in about 1950 with the development of
psychotropic drugs, or drugs used to treat mental illness.
 Chlorpromazine (Thorazine) an antipsychotic drug, and lithium, an antimanic agent, were the
first drugs to be developed.
 Over the following 10 years, monoamine oxidase inhibitor antidepressants, haloperidol
(Haldol), an antipsychotic; tricyclic antidepressants; and antianxiety agents,
called benzodiazepines, were introduced.

PRINCIPLES OF PSYCHIATRIC NURSING
 Allow client opportunity to set own pace in working with problems.
 Nursing interventions should center on the client as a person, not on control of the symptoms.
Symptoms are important, but not as important as the person having them.
 Recognize your own feelings toward clients and deal with them.
 Go to the client who needs help the most.
 Do not allow a situation to develop or continue in which a client becomes the focus of attention in a
negative manner.
 If client behavior is bizarre, base your decision to intervene on whether the client is endangering self or
others.
 Ask for help—do not try to be a hero when dealing with a client who is out of control!

CONT….
 Avoid highly competitive activities, that is, having one winner and a room full of losers.
 Make frequent contact with clients—it lets them know they are worth your time and effort.
 Remember to assess the physical needs of your client.
 Have patience! Move at the client’s pace and ability.
 Suggesting, requesting, or asking works better than commanding.
 Therapeutic thinking is not thinking about or for, but with the client.
 Be honest so the client can rely on you.
 Make reality interesting enough that the client prefers it to his or her fantasy.
 Compliment, reassure, and model appropriate behavior.

THEORIES APPLIED IN PSYCHIATRIC NURSING
 Psychiatric nursing uses theories of human behavior as its scientific framework and requires
the use of the self as its art or expression in nursing practice.
 Some of the theories applied in psychiatric nursing are
 Hildegard Peplau - Theory of interpersonal relations
 Psychoanalytic theory
 Behaviorism
 Jean Piaget: Theory of Cognitive Stages of Development
 Humanistic Theories - Abraham Maslow, Carl Rogers

ROLE OF A PSYCHIATRIC NURSING
 Providing a safe therapeutic milieu
 Working with patients or clients on the real day-to-day problems they face
 Identifying and caring for the physical aspects of the patient's problems
 Assuming the role of social agent or parent for the patient in various recreational, occupational, and
social situations
 Conducting psychotherapy
 Providing leadership and clinical assistance for other nurses and health care workers.

THANK YOU
Noem Dawood
Noem.dawood@duhs.edu.pk
Phone # 0343-3057812

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