History of Psychiatry and Psychiatric Nursing

Sr.Poojitha MSJ

Psychiatry

• It is a branch of medicine that deals with the diagnosis, treatment and prevention mental illness.

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 health problems

(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 .

History of Psychiatry

Primitive beliefs regarding mental illness:

• Individual had been dispossessed of his/her soul

Mgt: Returning the soul to the client

• Broken a taboo or sinned against another individual or god

Mgt: Ritualistic purification

Evil spirits or super natural/magical powers

entered the bodyMgt: • Exorcism (prayer, noise making)• Brutal beating, starvation, Burning, amputated

and tortured• Oral preparation of a purgative made from

sheep dung and wine • Trephining (A circular opening made on the

skull by means of crude stone instruments to let out evil spirits)

Development of Psychiatry• Pythagoras (580-510 BC) : developed the concept

that the brain is the seat of intellectual activity

• Hippocrates (460-370 BC) : described mental illness as hysteria, mania and depression

• Plato (427-370 BC) identified the relationship between mind and body.

• Asciepiades, who is referred to as the father of psychiatry, made use of simple hygienic measures, diet bath, massage in place of mechanical restraints.

• Aristotle, a Greek philosopher, emphasized on the release of repressed emotions for the effective treatment of mental illness. He suggested catharsis and music therapy for the patient with melancholia

• St. Augustine who believed that although God acted directly in human affairs, people were responsible for their own actions

• Renaissance in Europe( 1300- 1600 AD): it was believed that demons were the cause of hallucinations, delusions and sexual activity

Mgt: Torture and even death

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

1912: Eugene Bleuler, a Swiss psychiatrist coined the term Schizophrenia

The Indian Lunacy Act passed

1927: Insulin shock treatment was introduced for schizophrenia

1936: frontal lobotomy was advocated for the management of psychiatric disorders

• 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.

• 1946: The Bhore committee presented the situation with regard to mental health services. Based on the recommendations 5 hospitals were set up at Amirtsar, Hyderabad, Srinagar, Jamnagar and New Delhi

• 1949: Lithium was first used for the treatment of mania

• 1952: Chlorpromazine was introduced which brought about a revolution in psycho-pharmacology

• 1963:The community Mental Health centres Act was passed

• 1978: The Alma –Ata declaration of ‘Health for all by 2000 AD’ posed a major challenge to Indian mental health professionals.

• 1981:Community psychiatric centres were setup experiment with primary mental health approach at Raipur Rani, Chandigarh and Sakalwara, Bangalore.

• 1982: The Central Council of India accepted the national Mental Health Policy and brought out the National Mental Health programme in India.

• 1987: The Indian Mental Health Act was passed

• 1990: The Govt.of India formed an Action Group at Delhi to pool the opinions of mental health experts about the National Mental health program

• NIMHANS Bangalore has taken up the leadership in orienting heath care professionals about the mental health programs of our country

Development of Modern Psychiatric Nursing

• 1872: First training school for nurses based on the Nightingale system was established by the New England Hospital for women and children,USA

• Linda Richards the first Nurse to graduate from the one year course,

• developed 12 training schools in the USA

• 1882: first school to prepare nurses to care for the mentally ill was opened at Mc Lean Hospital in Waverly

• Two year program was started but few psychological skills were addressed and much importance was given to custodial care such as personal hygiene, nutrition, medication etc

• 1913: John Hopkins became the first school of nursing to include a fully developed course for psy.nsg in the curriculum

• 1943: Psy. Nsg course was started for male nurses

• 1946: Health survey committee’s report recommended preparation of nursing personnel in Psy. Nsg also. The existing institutions like mental hospitals in Bangalore and Ranchi should start training

• 1952: Dr.Hildegard Peplau defined the therapeutic roles that nurses might play in the mental health setting.

• She described the skills and roles of the psy. Nurse in her book “interpersonal relations in Nursing” . It was the first systematic and theoretical frame work developed for Psy. Nsg.

• 1953: Maxwell Jones introduced therapeutic community.

• 1956: one year post certificate course in psy. nsg was started at NIMHANS, Bangalore

• 1960: 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.

• 1963: Journal of Psy. Nsg and Mental Health services was published.

• 1964: Mudaliar committee felt the need for preparing large number of Psy. Nurses and recommended inclusion of Psychiatry in the nursing curriculum.

• 1965: The Indian Nursing Council included psy. Nsg as a compulsory course in B.Sc Nsg program

• 1973: Standards of psychiatric and mental health nursing practice were enunciated to provide a means of improving the quality care

• 1975: Psy. Nsg was offered as an elective subject in M.Sc Nursing at the RAK College of Nsg, New Delhi

• 1980: Scientific advances in the area of psychobiology, brain imaging techniques, knowledge about neurotransmitters and neuronal receptors , molecular genetics related psychiatry etc. emerged.

• These contributed to the shift from psychodynamic models to more balanced psychobiological models of psychiatric care.

• 1986: The Indian Nursing Council made psy. nsg a component of General nursing and Midwifery course

• 1990: During these years integration of neuro sciences into holistic biopsychosocial practice of psychiatric nursing occurred

• 1994: The above mentioned changes led to the revision of standards of psychiatric and mental health nsg