Health – a state of physical, mental and social well-being and not merely the absence of disease or infirmity (WHO)

Mental Health – relates to the strengths of a person, patterns of adaptation, situations, culture society, environment

- A person can adapt, solve problems and have a socially acceptable behavior- Implies mastery in the areas of life, involving life, involving love, work, and play. It is a

normality with happiness, adjustments to the world and maximum effectiveness, or ability to function acceptability in society with personal satisfaction.

Criteria for Positive Mental Health

1. Attitude toward the individual self This involves aspects related to a person’s self-awareness, acceptance, confidence, level of

self-esteem, sense of personal identification in relation to role, groups, other people, sex, vocation, strength and weakness.

2. Growth, development, self-actualization What a person does with her abilities and potentials are considered important. His

involvement in outside interests and relationships, concerns with an occupation or ideas and his goals in life are considered.

3. Integrative capacity Psychoanalyst views this concept as a balance of psychic forces, the id, the ego, and

superego. The core of this concept is the utilization of all processes and attributes in a person for unification of personal functioning and also the ability to tolerate anxiety and frustrations in stressful situation.

4. Autonomous behavior The individual’s ability to make his own decisions and react according to his own decisions

and react according to make his own decisions and react according to his own convictions regardless of outside environmental pressures and accept responsibility for his actions

5. Perception of reality This deals with how the person perceives his environment and other people as well as his

reactions towards them.

6. Mastery of one’s environment The ability to adopt, adjust, and behave appropriately in situations and in accordance with

culturally approved standards so that satisfactions are achieved in love, work, play and interpersonal relations involved.

General criteria for mental disorders are:

1. Dissatisfaction with one’s characteristics, abilities, and accomplishments2. Ineffective or unsatisfying interpersonal relationships3. Dissatisfaction with one’s place in the world4. Ineffective coping or adaptation to the clients in one’s life as well as a lack of personal growth

Historical View of Mental Illness

Labels applied to those who behave in defiant manners:

Sinner Lunatic Insane Mentally ill Mentally deranged, etc.

PRIMITIVE ERA/PRE-HISTORIC TIMES

- Cause of mental illness: demon possession due to punishment for sins. Evil spirits possess the body and must be driven from the body. They do magic and incarnation.

- Treatment during pre-historic times --- tribal rites, if measures proved unsuccessful, the individual is likely to be abandoned and starved or attacked by wild animals.

- Left to fend for themselves, can be found on the streets, or single room occupancy- Reflection of primitive measures in ancient times.

Method of Treatment:1. Trephine operation2. Starving3. Beating4. Abandoning in forests5. Burning

EARLY GREEK AND ROMAN ERA/ANCIENT CIVILIZATION

- Mental illness is a natural phenomenon - The Golden Age of Greece – noted for humane regard for the sick - Greeks used temples as hospitals with fresh air, pure water and sunshine.- Theaters, riding, walking and listening to the sound of waterfalls – methods to uplift the

mood- Also instances that treatment was harsh, chain, starving, bleeding, purging – sulfur baths

A. Hipopocrates - A Greek philosopher, known as “Father of Medicine”

- Described variety of personalities and attempted to classify people and their behavior

In Greece – humane regard for the sick was noted. Greeks used Temples as hospitals with an abundance of fresh air, pure water and sunshine. Theatres, riding, walking and listening to the sounds of waterfalls were the methods used to lift the mood.

B. Aristotle- According to him the mind was associated with the heart

C. Galen – the mind was associated with the brain

MIDDLE AGES

- Humanistic approach was forgotten. The mentally ill were locked/placed in almshouses, jails, and dungeons. They were starved, tortured.

- Collapse of Greek and Roman Civilizations – the care of the sick suffered an almost complete eclipse.

- Mentally ill care left to priest and superstitious beliefs flourished – beliefs that devils possessed them and could not be driven out.

- In some monasteries, exorcising the evil spirit was performed by the gentle hands instead of whip.

RENAISSANCE

- Decline in the belief of possession by evil spirits. Mental illness was view as irreversible. Scientific inquiry and humanism started.

- Patients were beaten for disobedience and they were enclosed in closets. - Mental patients were viewed as incompetent, defective and potentially dangerous. - Their caretakers were non-professionals.- During this time, they have no rights.

REFORMATION ERA

Sixteenth Century

- When the church and monastery gave up the care of insane, it was taken over by the so-called almshouse, the contract house and the secular asylum.

- Henry VIII – officially dedicated Bethlehem Hospital in London as lunatic asylum called “Bedlam”

o Patients were treated as animals and were kept chained. They were viewed by people who pay rents to see them.

- Keepers were allowed to exhibit the most boisterous of the patients for 2 pence a look and more harmless inmates were forced to seek charity on the streets of London.

- Violent person were placed in jails and dungeons.

- Paracelsus – rejected the belief that mental illness was caused by evil spirits. He believed that it is a natural phenomenon.

Authorities were divided into two groups:

1. Psychic – mental illness was a result of personal guilt and it was an atonement for sin.2. Organics – mental illness was caused by internal organs. Through blood letting it will be

released.

Seventeenth Century

- Superstition about mental illness took a horrible turn in 17th century- God and Satan were still thought to be engaged in a ceaseless battle for possession of one’s

soul.- Beliefs that witches and magicians can cure and can cause most disease.- Seeking out and executing witches became a sacred religious duty.- 20,000 persons were burned in Scotland.- During those days, society was interested in its own self-security, not in welfare of mentally

ill persons. - Drastic purging and bleedings were favorite therapeutic procedures of the day and whip,

were applied religiously by cell keepers.

Eighteenth Century

- The political and social reformations in France toward the end of the 18 th century influenced the hospitals and jails in Paris.

- Chains were removed. The need for medical care was recognized. Mentally ill patients were treated in the hospital.

1. Franz Mesmer – pioneered in the therapeutic approach of maladaptive behavior. “Universe is a field with magnetic forces.” Patient will be healed when he hold an iron rod filled with iron fillings.

2. Philippe Pinel – was a medical director of Bicetre Asylum outside Paris; was given permission by the revolutionary Commune to liberate the inmates of 2 largest hospitals. Some had been chained for 2years. - Began the movement toward more humane treatment of mentally ill when he removed

the chains of patients at Bicetre Hospital.- He recognized the need for medical care and advocated freedom, useful work and

kindness to mentally ill patients.- If this experiment was a failure, he has to be beheaded by guillotine. Fortunately he was

right. - Attempted to classify mentally ill patients according to their behavior.

3. Pupil Esquirol – first French regular teacher in Psychiatry- Continued his reforms and founded 10 asylums - In America, the Pennsylvania hospital was completed in 1756, under Benjamin Franklin –

clean beddings, warm rooms, relegated to cellars.4. Dr. Benjamin Rush – Father of American Psychiatry and prime humanitarian, began his

defies at the Pennsylvania Hospital in 1783. He believed that the phases of the moon influence behavior (The lunar theory of insanity) and invented the inhumane restraining device called the tranquilizer. He insisted on more humane treatment.- Organized the first course of lectures in Psychiatry

5. Dr. Edward Cowler – organized the first course in Psychiatric Nursing in Massachusetts.

Nineteenth Century

- The first public psychiatric hospital in America was built in Williamsburg, Virginia in 1773 and is known today as the Eastern Psychiatry Hospital.

- Placing the poor and mildly demented on the duction block, and sold to the highest bidder. The returns from the sale being assigned to the township treasury.

- 1830 – vigorous movement for erection of suitable state hospitals. - 1841 – a 40-year old, Dorothea Lynde Dix (1802-1887) effected reforms, and aroused public

conscience, and she played an important part in founding of St. Elizabeth’s Hospital in Washington D.C.

- She directed the opening of two large institutions in Canada, completely reformed the asylum system in Scotland and in several other foreign countries, and organizing the nursing forces of the northern armies during the civil war.

- In 1901, the US Congress characterized her as among the noblest examples of humanity in all history.

Location – institution was built in remote areas, for tranquility – soothing to disturbed individuals; protect society from inmates, both physically and emotionally.

- Design of institution – desire to provide a homelike environment and safe- Staff lives in adjoining quarters, evolved in a self-contained community- This activity is therapeutic - promote self-esteem and group cohesiveness- In some hospitals, patients are invited to dine in with superintendents and make them

comfortable.- However, there were abuses, as these people were not paid for their work. - In addition to exploitation, another negative outcome is the institutionalization. Due to

remoteness, family members gave up seeing their family members. Patients resisted attempts to return to their community.

In the middle of nineteenth century, the big house on the hill, or the asylum, became a familiar landmark. Although care of mentally ill slowly attaining decent humanitarian standards, there was no classification of mental disorders.

1845 – the first authentic textbook on mental disease was published, aligning the treatment of mental illness with the treatment of other illnesses.

- In the mid-nineteenth century, waves of immigrants exploded United States, and enlargement of the cities have made state hospitals no longer remote – system was confronted with huge numbers of individuals believed to need mental health. Because of cultural backgrounds and language of immigrants were sufficiently different from those of mainstream, behavior of many was poorly tolerated by society and increase in admission of patients in state hospital. Human treatment was impossible to continue and hospital system turned to an inefficient, expensive and inhumane system does little to protect inmates from each other.

In Paris:Jean Martin Charcoat – French neurologist – initiated the first steps in the growth of modern scientific psychotherapy. Used suggestive powers in the form of hypnotism to treat hysteria

In Germany:Emil Kraeplin – devised a classification of mental disorder1882 – first school of nursing was established in McLean Hospital, MassachusettsSigmund Freud – Austrian neurologist

- Formulated Psychoanalysis – deals with the dynamics of the unconscious- Psychosexual theory

Twentieth Century

- Dr. Adolf Meyer – initiated the psychobiologic theory and stimulated the development ofdynamic concept of psychiatry. He studied the effect of environment upon one’s total personality

- 1908 – Over change in state hospital system of mental health care began when Clifford Beers, a psychiatric patient who was hospitalized several times wrote a book, A Mind That Found Itself, directed to founding the National Committee for Mental Hygiene and emphasis was placed on prevention of mental illness and early prevention.

- Simultaneously with the mental hygiene movement contributions of Sigmund Freud, revolutionized the concepts of the mind, brought the subject of human behavior to the attention of every intelligent man and woman.

- Psychiatry at last left the closed doors of the asylum and participated in everyday human activity.

- Harry Stack Sullivan – postulated the Interpersonal theory. He emphasized the effect of one’s culture and social influence upon the personality development.

- 1946 – National Mental Health Act was passed- Establishment of National Institute of Mental Health

- The government expressed their beliefs that it was necessary to acquire more knowledge concerning the cause, prevention and treatment of mental illness and that more professionally trained workers were needed to improve the care and treatment of mentally ill persons

- Financial support for education of psychologist, psychiatric social workers, psychiatrist, and psychiatric nurse was provided in US through the National Mental Health Act

- During the World War II – armed forces were disabled by mental illnesses than by all other problems related to actual military action. Soldiers with acute and chronic mental illness alerted the nation to improve treatment techniques.

- Because of nations increased attention to problem of mental illness, 1940-1950 saw development of new methods for treating persons in need of mental health care. These includes:

o Family diagnosiso Short and long term treatment programso Crisis oriented therapyo Therapeutic community – milieu-group processeso Open door hospital – doors of the unit were unlocked, allowing patients to move

freely within the hospital and communityo These were first developed in England and were most successful with patients with

not severely or chronically ill- Major changes occur with the development of psychotropic drugs, particularly the

antipsychotic agents, which alter the chemistry of the brain and therefore the emotions and behavior of those who take them. These medicines were first used experimentally in 1953.

- 1955 – The Congress of the United States passed the Mental Health Study Act. This provided study for a 5-year plan of problems of mental illness in the United States.

- February 5, 1963 – when President John F. Kennedy delivered his special messages to the Congress on mental illness and mental retardation. On the same year, 1963, the Community Mental Health Centers Act was passed.

- 1965 – Staffing Act for the Community Mental Health Centers. This is to revolutionize the provision of mental health care by emphasizing prevention and decentralized local community treatment as opposed to institutional care, even with patients who have severe psychiatric difficulties.

- 1975 – The Congress of the United States enacted the Community Mental Health Centers Amendments

- This law provided continuation of federal funds to Community mental health centers and designated specific guidelines for services that must be provided, that is, inpatient, outpatient and emergency services.

- 1977 – President Jimmy Carter called for the development of a Presidents Commission on Mental Health, identifying the mental needs of the nation.

- Special emphasis was placed on meeting the needs of underserved and high risk population as:

o Elderlyo Childreno Chronically mentally ill personso Cultural minoritieso Rural communities

o Inner city neighborhoods

Development in the Philippines

- Hospicio de San Jose – first known institution to care and treat the insane in the Philippines during the 19th century

- San Lazaro – 1904 – patients who were not accommodated in Hospicio de San Jose due to large numbers were housed in this institution

- 1917 – All charity patients were admitted in San Lazaro Hospital while all psychiatric patients remained in Hospicio de San Jose. This is the result of the passage of Jones Law providing for the separation of church and the state

- December 17, 1928 – Insular Psychopathic Hospital was constructed in Mauban, MandaluyongRenamed National Psychopathic HospialLater renamed National Mental HospitalNow named National Center for Mental Health

- 1962 – MA in Psychiatric Nursing was started at UPCN- 1980 – Doctoral Program in Psychiatric Nursing was first offered at the UP

Community Mental Health Act of 1963 - was an attempt to release chronically ill clients from institutions and place them back into community rehabilitation setting as a result of deinstitutionalization of clients from long term residential hospitals

1990s: The DECADE of the BRAIN

The US Congress declared the 1990s as the decade of the brain based on the fact that 50 million Americans were afflicted by disorders that involve the brain, ranging from familial illnesses to prenatal trauma to affective and addictive disorders. The need for knowledge and expertise in biological and psychological sciences continues to be essential because of new psychopharmacologic

agents and comprehensive psychotherapeutic interventions. The expansion of technological advances such as brain imaging has provided direct examination of the living brain. These techniques, which assess the brain structure and some aspects of brain functions include computed tomography, positron emission tomography, magnetic resonance imaging, and single photon emission computerized tomography

DSM-IV Text Revision (2000)

Historically, the DSM IV has been useful as a teaching tool particularly concerning diagnostic criteria sets for mental disorders.