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 accomplishments

2. Ineffective or unsatisfying interpersonal relationships

3. Dissatisfaction with one’s place in the world

4. 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 operation

2. Starving

3. Beating

4. Abandoning in forests

5. 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 18th
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 disorder

1882 – first school of nursing was established in McLean Hospital,

Massachusetts

Sigmund 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 of

dynamic 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 diagnosis

o Short and long term treatment programs

o Crisis oriented therapy

o Therapeutic community – milieu-group processes

o Open door hospital – doors of the unit were unlocked, allowing

patients to move freely within the hospital and community

o 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 Elderly

o Children

o Chronically mentally ill persons

o Cultural minorities

o 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, Mandaluyong

Renamed National Psychopathic Hospial

Later renamed National Mental Hospital

Now 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.