Learn about history of psychiatry and mentalhealth nursing

1. History of Psychiatry and Psychiatric
Mental Health Nursing

2. Early History( Ancient times)
• Society has always adopted measures designed to change
behavior of persons with mental illness
• In pre historic times;
Medicine was intertwined with religion and priests served
as physicians
Earliest records of a person believed to have suffered from
mental illness is King Nebuchadnezzar
Mental illness was thought to reflect spiritual disturbance
and associated with demonic possessions (Demonological
period)
Mental illness also associated with cyclic patterns of the
moon( origin of the word lunatic)
In African societies, mental illness was attributed to
supernatural powers and spirits of dead ancestors, sorcery
and witchcraft

3. Early History( Ancient times)
• In pre historic times;
Mental illness was perceived as incurable
and treatment of the insane often inhuman
and brutal
Healers extracted unseen spirits through
rituals using herbs, ointments and precious
stones
Other methods of treatment included
trephining, blood letting, purging and
flogging and chaining

4. Contributions of Hippocrates and Plato
Hippocrates(460-370 BC);
• Believed in holistic approach to medicine i.e. social,
spiritual, physical and psychological factors involved
in illness
• Proposed the interaction between body humours;
blood, black and yellow bile and phlegm as cause of
mental illness
• He classified personality into four temperaments;
sanguine-Blood;(optimistic), choleric-Yellow
bile;(irritable), melancholic-Black bile;(sad,
introverted) and phlegmatic-Phlegm;(calm, cool,
composed)

5. Contributions of Hippocrates and Plato
• Plato(428-348 BC), described health as
harmony between body and mind and
therefore mental illness occurred due to
disharmony

6. Middle ages
• Plight of mentally ill continued to be poor
• Mentally ill people;
 were often imprisoned and forced to live in the streets
and beg for food.
 Depended on charity of religious groups who dispensed
alms, food and other donations
• Demonology and superstitions on mental illness
persisted
• In 1487 AD; Two Dominican monks published a book
called malleus maleficarum - the witches hammer which
outlined how witches and mental patients were to be
punished

7. Middle ages
• Almshouses( combination of jail and asylum) were
established for example St. Mary's of Bethlehem
built in London in 14th century
• Mental patients were used for exhibition and
entertainment at a fee in the almshouses
• Treatment in the almshouses included purging,
bleeding and whipping
In the 15th and 16th century;
• Continued skepticism about the curability of mental
illness
• Asylums became the repositories for prolonged
enclosure of the mentally ill
• They lived in poor states; often chained and caged,
deprived of heat and sunlight

8. Political period
• Associated with King Edward II of England
• 1403: law passed in parliament to protect property
of mentally ill
• Sisters of the order of Saint Mary started a facility
at Bedlam which accommodated only six patients
• Believes and treatment was same as
demonological period
Overcrowding of patients and risk for infectious
diseases
Male and female patients mixed
Patients used for entertainment and amusement

9. 18th century; period of enlightenment
and humane treatment
• Marked by improved treatment of the insane and
wave of change (Humanitarian period)
• Major contributions attributed to;
• Benjamin Rush
• Philippe Pinel
• William Tuke
• Dorothea Lynde Dix
• Andrew Duncan
• Vincenzo Chiarugi and others

10. Benjamin Rush(1745- 1813)
• Father of American psychiatry
• Emphasized the need for pleasant surrounding
and diversional and moral treatment of mentally
ill
• Treatment included blood letting, administration
of cold and hot baths, harsh purgatives and
emetics, use of tranquilizer chair and gyrator for
induction of shock

11. Gyrator and tranquilizer chair

12. Philippe Pinel (1745-1862)
• Believed that mental illness was related
to immorality and faulty upbringing
• Advocated kindness and moral treatment
• Released insane from chains
• Used work, music and other diversions
• Used attendants who were kind to
patient

13. 18th century; period of enlightenment
and humane treatment
William Tuke (1732- 1822): British
• Advocated humane treatment of mentally ill
• Pressurized government to improve mental
health services
• Established the York Retreat hospital for
mentally ill in 1796
Franz Anton Mesmer( 1734- 1815): renewed the
art of suggestive healing that stemmed from
ancient use of trance( the basis of hypnosis)

14. 18th century; period of enlightenment
and humane treatment
• Vincenzo Chiarugi (1759-1820); Italy:
advocated for the rights of mentally ill
• 1792; Andrew Duncan influenced the
establishment of Royal Edinburg Mental
hospital

15. Late 18th and Early 19th century
• Saw establishment of mental hospitals
which were overcrowded and patients
institutionalized
• Continuous search for ways to improve
care e.g. use of nurses instead of
attendants
• Schools of nursing established in the
mental asylums

16. 18th century; period of enlightenment
and humane treatment
Dorothea Lynde Dix(1802-1887)
• Retired school teacher who volunteered to
tutor individuals confined in jails and asylum
• started campaigns to influence legislation to
establish suitable hospitals and not jails for
mental patients

17. Late 19th and 20th century(scientific period)
• At the beginning of 20th century, treatment
was limited to restraint, isolation, dietary
regimens, early sedatives and shock
treatment
• Exploration of the reasons for mental
disease
• Contributions of numerous theories and
researches who laid foundation for
understanding and demystifying mental
illness

18. Late 19th and 20th century(scientific period)
Adolph Meyer( 1866- 1950)
• Instituted psychological theory and
dynamic concepts of psychiatric care
• Theory centered on treatment rather than
disease and integrated biochemical,
genetic, psychosocial and environmental
stress in mental illness

19. Late 19th and 20th century(scientific period)
Clifford Beers(1876-1943)
• Himself a recovered mental patient
• Contributed to preventive care
• Published a book in 1908(A mind that found
itself)
• Promoted early detection and treatment
Emil Kraeplin(1856-1926): devised a classification
of mental disorders into dementia
praecox(premature dementia in reference to
schizophrenia) and mania

20. Late 19th and 20th century(scientific period)
• Eugen Blueler (1857- 1939): coined the
term schizophrenia and included its
characteristics into 4 As: affective
disturbance, autistic thinking,
ambivalence, and looseness of association.
• Sigmund Freud(1856-1939): Developed
psychoanalysis, psychosexual theory and
used the theories to treat neurosis

21. Late 19th and 20th century(scientific period)
• Carl Gustav Jung(1875-1961): founded analytical
psychology and originated the concepts of
introverted and extroverted personality
• Harry Stack Sullivan(1892-1940): proposed the
interpersonal theory; use of multidisciplinary
approaches to treatment of mental illness;
proposed that anxiety could be reduced through
meaningful relationships and stressed the
process of effective communications

22. Late 19th and 20th century(scientific period)
• Hildegard Peplau(1909-1999): Published
interpersonal relations in nursing in 1952
which emphasized on the nurse patient
therapeutic relationship as a treatment
model

23. Other developments in the 20th century
• Deinstitutionalization of care and community
mental health with emphasis on prevention,
decentralization and involvement of families
• ECT first used in 1938
• Diagnostic and statistical manual of mental
disorders(DSM) published in 1952
• Effective chemotherapy introduced in the
1950s: Largactil((1952) and Imipramine(1957)

24. History in Kenya
• 1910: Former small pox isolation centre converted to
mental hospital (Mathari mental hospital- Nairobi
Lunatic Hospital)
• Laws on mental health services borrowed from the
British( Mental treatment act)
• 1950s: decentralization of mental health services to
six provincial hospitals
• At independence, few psychiatric nurses trained in
Britain through international corporation.
• 1964: enrolled mental health nursing course started
at Mathari.
• 1979: registered psychiatric nursing course started.