Mental Health chapter 1

19th century

- Dr Benjamin Rush, a crusader for the insane, graduated from Princeton at 15 years old; signer of the Declaration of Independence. And author of "Diseases of the mind", the first psychiatric text written in the United States. It advocated for clean conditions (good air, lighting, and food) and kindness. As a result, mentally ill were no longer caged in hospital basements Only few institutions for mentally insane were available; mildly effected insane were sold as salves, violently effected insane remained in asylums that were combination with penitentiary 1830's: the "once insane; always insane" view began to diminish with the thought that cure may be possible By the late 1800's, a two-class system of psychiatric car had emerged: private care for the wealthy and publicly provided care for the remainder of Society—cure rates fell drastically due to overcrowding.

Saint Basil's hospital in England

-370 AD -offered services for sick, orphaned, crippled, and mentally troubled people

Greece and Rome: Plato

-427-347 BCE Recognized life as a dynamic balance maintained by the soul -believed "rational soul" resided in the head and the "irrational soul" was in the heart and abdomen— believed that if the rational soul was unable to control the undirected parts of the irrational soul, mental illness occured. -in theory, Plato had foreseen Sigmund Freud by 2000 years -by 300 CE, 6 epidemics killed thousands of thousands of people. Churches became sanctuaries for the sick

Psychoanalysis

-Introduced by Sigmund Freud - means "to explore to unconscious" -first comprehensive theory of mental illness based on observation - focused on behaviors of which the patient was unaware -evolves into theories about development, structure and dynamics of the personality

The renaissance

-began in Italy around 1400, spread through Europe within a century -economics, politics, education and commerce brought real world into focus -church slowly declined due to intense interest in material gain and worldly affairs developed -naked bodies became less sinful and more of celebration of human form by artists -thousand-year-old anatomy books replaced by realistic anatomical drawings -observation, rather than ancient theories, revolutionized into today's ideas -Sixteenth century physicians replied on observation and recorded what the saw. -mental illness finally being recognized without bias -mid-1500's, behaviors accurately recorded for melancholia (depression), mania, and psychopathic personalities -mental orders thought to be caused by brain disorders— except sexual fantasies, still considered gods punishment or possession by devil. -despite advance in knowledge, mentally ill still treated inhumanly

Reformation (1517)

-people displeased with clergy and church abuse -Martin Luther (1483-1546), dissatisfied monk and his followers broke away from Catholic Church and became Protestants. -this resulted in Catholic Church hospitals closing and mentally ill turned out onto streets

Community mental health centers act

-the joint commission on Metal illness and Health published a 338-page report titled "Action for Mental Health" that motivated president John Kennedy to appoint a special committee to study mental health and recommend special action. His committee suggested the idea of community mental health centers. -Community Mental Health Centers Act was passed in 1963.— this was designed to support construction of mental health centers in communities throughout the US. -the centers provided care to meet the needs of people experiencing mental or emotional problems, as well as those of acute and chronic mentally ill people. -Psychiatrists, nurses, and various therapists would establish a therapeutic relationship with clients and monitor their progress -"catchment area" refers to certain geographic regions of people which these mental health centers would provide care to. -in relation to these centers and the passage of the Medicare/Medicaid Bill of 1965; more than 75% of institutionalize mentally ill persons were released

Superstitions, witches and hunters

-women were thought as cause of men's lust and carriers of the devil -psychotic women with little control over voicing their sexual fantasies and sacreligous feelings were clearest form of demonic possession —this flames public's fear of mentally troubled people -in 1487, witch-hunting was launched with publication of the text book "the witches hammer", with pornography and psychopathology -Pope innocent VIII and the university of Cologne voiced support for this "textbook of inquisition" — as a result; women, children and mentally ill were tortured and burned at the stake by thousands.

First English institution for mentally ill people

1247 Initially a hospice founded by the sheriff of London. By 1330, Bethlehem royal hospital (Bedlam) had developed into a lunatic asylum, famous for brutal treatments Violently ill were chained to walls in small cells and used for entertainment to the public, even being charged fees for tourist attraction and tour of asylum. Less violent were forced to wear identifying mental arms bands and beg on the streets -preferred burning at the stake

Dorothea Dix

1841, school teacher Exposed the sins of the system after working at a jail in Massachusetts and seeing criminals and mentally ill prisoners living in squalid conditions. She surveyed asylums, jails and almshouses. She found mentally ill people being confined to cages, closets, cellars, stalls, and pens. "Chained, naked, and beaten with rods"

John Cade

1949 Discovered that lithium carbonate was effective in controlling severe mood swings seen in bipolar (manic-depressive) illness. This led to the release of many chronically ill patients who were able to regain normal lives. Sparked the exploration of various new drugs to treat and control mental illnesses

Mental Health Systems Act

1980 Addressed community mental health care and clients rights and established priorities for research and training. However, federal funding for all mental health services were drastically reduced when political climate changed and the OBRA of 1981 was passed.

omnibus buget reconciliation act

1981 Resulted in "block grant funding" which each state would receive a "block" of federal money in which the state determined where and how the money was spent.

Middle Ages

500-1100 CE -priests cared for sick and church developed into highly organized and powerful institution -early Christians believed disease was punishment for sins, possession of the devil, or result of witchcraft -to cure mental illness, priests performed demonic exorcisms Medieval society decline -repeated attack's by barbaric tribes led to chaos -epidemics, natural disasters and overwhelming tax knocked out middle class -population declined, crime waves occurred, poverty, and tortured and imprisonment became prominent -monasteries last refuge of care and knowledge -in Middle Ages, medicine and religion were interwoven By 1130, laws passed forbidding monks to practice medicine —considered disruptive for their way of life. Responsibility for care of sick were passed to community.

Mental Health

Ability to cope with and adjust to the recurrent stresses of living in an acceptable way

Psychotherapeutic drugs

Also known as psychopharmacological agents, psychotropic drugs, and psychoactive drugs Chemicals that affect the mind. These drugs alter emotions, perceptions, and consciousness in several ways These opened the doors of institutions and set the stage for a new delivery system, community mental health care.

Clifford Beers

Attempted to commit suicide while attending Yale university— spent 3 years in mental hospitals in Connecticut -released in 1908, then wrote "A mind that found itself" describing the beatings, isolation, and confinement of a mentally ill person -Committee for Mental Hygiene was formed in 1909 —focusing on prevention and removing the stigma of mental illness

health-illness continuum

Behaviors relating to health exist over a broad spectrum

Mental health parity and Addiction Equity Act

Bill required insurance coverage for mental health and substance abuse conditions that was equal to the coverage of medical problems

Influences of war

During World War 1, many men were found to be too "mentally deficient" to fight and as a result, the federal government called on Beer's committee for Mental Hygiene to develop a master plan that included: early identification of problems, removal of mentally troubled personnel from combat duty, and early treatment close to the fighting front. -the committee recommended psychiatrists be assigned to station hospitals to treat combat veterans with acute behavioral problems new therapies emerged : -insulin therapy for schizophrenia induced 50-hour comas through administration of massive doses of insulin. -electroconvulsive therapy [ECT] passing electricity through patients head for severe depression -lobotomy (severs the frontal lobes of brain from thalamus) for violent behaviors. -class of drug that lifted spirits of the depressed called Amphetamines

18th century

During the latter part of the 18th century, psychiatry developed as a separate branch of medicine— inhumane treatment was openly questioned. In 1792, Philippe Pinel, director of 2 Paris hospitals, liberated patients from their chains and advocated for acceptance of mentally ill as human beings in need of medical assistance, nursing care, and social services. -during this time, quakers established asylums of humane care in England. •••••• -in American colonies, Philadelphia Almshouse erected in 1731 and accepted sick, infirm, and insane patients as well as prisoners and orphans -1794, Bellevue hospital in New York City was opening as a pest house for victims of yellow fever— by 1816, it enlarged to contain an almshouse for poor people, wards for sick and insane, staff quarters and even a penitentiary Unfortunately, care and treatment just as harsh as in Europe— slowly abandoned and finally improved by the arrival of Alice Fisher, a Florence nightingale trained nurse, in 1884 •••••• By the end of the century, bloodletting, purging, confinement, demon-expelling tranquilizing chairs, and whirling devices still used.

Presidents commission on Mental Health

Established in 1978 by president Jimmy Carter Task was to assess the mental health needs of the nation and recommend possible courses of action to strengthen and improve existing community mental health efforts Final report resulted in 117 specific recommendations grouped into four broad areas: coordination for services, high-risk populations, flexibility in planning services, and least restrictive care as possible

Imipramine

First antidepressant

Sigmund Freud

First person to successfully explain human behavior in psychological terms and in demonstrating that behavior can be changed under proper circumstances.

Mental illness

If behaviors interfere with -Daily activities -impair judgment -alter reality Are said to be mentally ill Mental illness is a disturbance in ones ability to cope effectively

Middle Ages continued

In late 1100, strong Arabic influence was felt in Europe. -Greek legacy retained and improved by Arabic's -they had extensive knowledge about drugs, mathematics, astronomy, and chemistry -awareness between emotions and disease Arabic influence results in establishment of learning centers called universities— many people devoted to study of medicine, surgery and care of sick. However, problems of mind received only spiritual attention -church doctrine still believed that person with insanity was influenced by external forces such as the moon leading to term "Lunacy"— the disorder caused by lunar body -mentally ill placed in "lunatic asylums" -magic still used to explain torments of the mind - church scholars suggested witches might be source of human distresses

Mental health influenced by what 3 factors?

Inherited characteristics, childhood nurturing, and life circumstances

Chlorpromazine (Thorazine)

Introduced in 1956 and proved to control many bizarre behaviors observed in schizophrenia and other psychoses

National institute of Mental Health

Organized to provide research and training related to mental illness.

Early Years (primitive societies)

People with mental illness thought to be possessed by demons or forces of evil Treatment was focused removal of evil spirits. -Magical therapies (frightening masks and noises, incantations, vile odors, charms, spells, sacrifices, and fetishes) -physical treatment (bleeding, massage, blistering, inducing vomiting, and the practice of trephining— cutting holes into skull to to encourage evil spirits to leave) Mentally ill individuals allowed to remain with society as long as they're behavior was not disruptive. Severely ill or violent people were driven into wilderness to fend for themselves.

National Mental Health Act 1946

Provided funding for programs in research, training of mental health professionals, and expansion of state mental health facilities.

Hill-Burton Act 1937

Provided funds to construct psychiatric units

17th century

Reason slowly began to replace magical thinking, but strong belief in demons persisted Knowledge of secrets of nature brought a sense of self-reliance resulting in "witch-hunting" as a means of self protection against the unexplainable *Conditions for mentally ill were at their worst*— patients were bled, beaten, starved and purged into submission

Affordable care act of 2010

Requires all insurers to cover 10 essential health benefit groups—mental health is included.

Greece and Rome: Hippocrates

Superstitions and magical beliefs dominated thinking until Greeks introduce idea of mental illness could be rationally explained through observation -6th century BCE (460 BCE), Hippocrates was first to base treatment on belief that nature had strong healing force -felt that physicians should assist in, rather than direct, the healing process -proper diet, exercise, and personal hygiene were his mainstays of treatment. -viewed mental illness as imbalance of humors— the elements air, fire, water and earth (each element had a related humor or part of the body) - overabundance or lack of one or more of these elements resulted in illness ( humoral theory of disease)