History of psychiatry in India

Haque S Nizamie, Nishant GoyalCentral Institute of Psychiatry, Kanke, Ranchi - 834 006, Jharkhand, India

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Date of Web Publication 15-Sep-2010

      Abstract  

History is a screen through which the past lightens the present and the present brightens the future. Psychiatry by virtue of its ability to deal with human thoughts and emotions and provide a pathway for healthy minds provides an important platform towards being a mentally sound human being and largely the society. This review takes a sneak peek into the foundations of modern psychiatry in India. The description is largely based on the time frame, which provides a better understanding of the factual information in each period starting from the Vedic era and culminating in the post independence period.

Keywords: History, India, psychiatry

How to cite this article:Nizamie HS, Goyal N. History of psychiatry in India. Indian J Psychiatry 2010;52:7-12

How to cite this URL:Nizamie HS, Goyal N. History of psychiatry in India. Indian J Psychiatry [serial online] 2010 [cited 2011 Mar 9];52:7-12. Available from: http://www.indianjpsychiatry.org/text.asp?2010/52/7/7/69195

    Introduction  

0Mental Health by virtue of its ability to deal with human thoughts and emotions, and to provide a pathway for healthy minds is a vital resource for our development, and its absence represents a great burden to the economic, political, and social functioning of human beings, society and nation. [1] The scope of mental health is not only confined to the treatment of some seriously ill persons admitted to mental health centers, rather it is related to the whole range of health activities. [2] India has developed an endogenous, alternative body of knowledge which is more suited to Indian conditions. [3]

History is a screen through which the past lightens the present and the present brightens the future. The ancient Indian thought emphasized the theory of unity of body and soul and also explained how to deal with health and mental health problems in a psychosomatic way. [4] A

concern with mental health has long been a part of Indian culture, which has evolved in a variety of ways, attempting to understand and negotiate psychological disorder. [5] This review takes a sneak peek into the foundations of modern psychiatry in India which has sailed through tides of time across the world.

    History of World Psychiatry: A Prelude  

The occurrence of mental illnesses has been identified and documented since ancient times. The earliest predecessor of mental hospitals on record was a Greek sanctuary at Epidauros. The fourth century AD witnessed the establishment of institutions solely for the mentally ill in Byzantium and Jerusalem. [6] Thereafter, Christian and Muslim religious orders established places of refuge for the mentally ill and patients were treated by a variety of procedures with a religious coloring. The first psychiatric hospitals were built in the medieval Islamic world from the 8 th century. In the early 8 th century, the first hospital was built in Baghdad (705 AD) followed by hospitals built at Fes and Cairo. [7] The first major modern mental hospital, the Bethlehem Hospital, was started/opened in 1247 in London. By the late 18 th century, the condition of mentally ill patients in these institutions was one of neglect, restraint and abuse with poor clothing, unhygienic conditions, poor nutrition, restricted movements due to chaining of hands, feet and lack of stimulation, largely contributed to by scarcity of funds, lack of interest among the ruling aristocracy and over-crowding of mental hospitals. [8]

In the late eighteenth and early nineteenth century, Pinel revolutionized care of the mentally ill by propagating a humane approach to care. Around the same time the York retreat was established by William Tuke to provide a kind and tolerant approach towards the mentally ill. Dorothea Dix proposed setting up of State run hospitals for treatment of the mentally ill based upon Pinel's moral approach. [6] Mid 1950s saw emergence of two major forces which influenced the evolution of modern psychiatry as specific drugs like chlorpromazine were discovered for treatment of mental illnesses; the second being the antipsychiatry movement led by the likes of Goffman, Szaz and others, which along with the economic recession were motivating factors for deinstitutionalization of mentally ill persons and the evolution of the concepts of community psychiatry. [9]

    Psychiatry in Ancient Vedic India  

The descriptions of various mental illnesses in ancient Indian texts are probably the oldest such accounts. Two well-known Ayurvedic manuscripts, the Charaka Samhita by Charaka, and the Sushruta Samhita by Sushruta, have established the roots of modern Indian medicine. The ancient Indian scripture, Atharva-Veda, mentions that mental illness may result from divine curses. Descriptions of conditions similar to schizophrenia and bipolar disorder appear in the Vedic texts. A vivid description of schizophrenia is also found in Atharva-Veda. Other traditional medical systems such as Siddha, which recognize various types of mental disorders, flourished in southern India. Great epics such as the Ramayana and the Mahabharata made several references to disordered states of mind and means of coping with them. [10],[11] The

Bhagavad Gita is a classical example of crisis intervention psychotherapy. Another interesting contribution of the Ayurveda is its knowledge regarding the diet-disease relationship and the association of a disease with a specific physical constitution. Diagnosis was entertained by the five senses and supplemented by interrogation. According to the ancient system, diagnosis was based on cause (nidana), premonitory indications (purva- rupa), symptoms (rupa), therapeutic tests (upashaya) and natural history of the development of the disease (samprapti). According to Sushruta, the physician (chikitshak), the drug (dravya), the attendants or the nursing personnel (upasthata), and the patient (rogi) are the four pillars on which rests the success of the therapy. The highest patronage to the science of Ayurveda was given by the Buddhist kings (400-200 BC). [4]

Close to the roots of Hindu mythology, Najabuddin Unhammad (1222 AD), an Indian physician propagated the Unani system of medicine as he described seven types of mental disorders; Sauda-a-Tabee (Schizophrenia); Muree-Sauda (depression); Ishk (delusion of love); Nisyan (Organic mental disorder); Haziyan (paranoid state) and Malikholia-a-maraki (delirium). Psychotherapy was known as Ilaj-I-Nafsani in Unani Medicine. The great saga 'Agastya' formulated a treatise on mental diseases called as 'Agastiyar kirigai Nool', in which 18 psychiatric disorders with appropriate treatment methods were described. [12] Charak Samhita had described various attributes for a hospital including its location, details of equipments, food and cleanliness and model code of conduct for physicians, nursing staff and ward attendants. [13]

The tridoshic philosophy is still widely accepted among modern Indian patients. The history of psychiatry in India has witnessed major changes in the past. The first revolution occurred when it was believed that sin and witchcraft are responsible for mental illness and the mentally ill were chained in jails and asylums. Then with the advent of psychoanalysis, etiology of psychiatric disorders was explained. Third was the development of community psychiatry. [14]

    Psychiatry in Pre-Colonial India  

During the reigns of King Asoka, many hospitals were established for patients with mental illness. According to the scribes of Asoka Samhita, hospitals were built with separate enclosures for various practices including keeping the patients and dispensing treatments prevailing during those times. [13] A temple of Lord Venkateswara at Tirumukkudal, Chingleput, Tamil Nadu, contains inscriptions on the walls belonging to the Chola period. There are some ancient evidences of propagation of alienation of mentally ill patients in Shahdaula's Chauhas in Gujarat and Punjab. Though there is not much evidence for development of psychiatry in the Moghul period, there are references to some asylums in the period of Mohammad Khilji (1436- 1469). There is also some evidence of the presence of a mental hospital at Dhar near Mandu, Madhya Pradesh, whose physician was Maulana Fazulur Hakim. [15] There are some historical evidences from the pre-colonial literature that modern medicine and modern hospitals were first brought to India by Portuguese during the seventeenth century in Goa, though documentary evidences are not in good shape to substantiate the claims. [16]

The political instability prevailing in the 1700s saw development of lunatic asylums in Calcutta, Madras and Bombay. It is interesting to observe that these three cities grew up in the beginning

largely with British enterprise which conceptualized the segregation of mentally ill patients in mental asylums and their supervision by trained people more in sync with the western conceptualization. The need to establish hospitals became more acute first to treat and manage Englishmen and Indian 'sepoyees' employed by the British East India Company. [4] Waren Hastings, the first Governor General, during his regime in 1784 introduced the 'Pitts India Bill' according to which the activities of the Government of the East India Company came under the direction of a "Board of Control" and systematic reforms and welfare actions were taken during Lord Cornwallis (1786-93) rule. [17] It was during his rule that there is a reference of the first mental hospital in this part of India at Calcutta recorded in the proceedings of Calcutta Medical Board on April 3, 1787, which became the reference point of inception of colonial influence on development of psychiatric care in India. [15]

    Psychiatry in Colonial India  

Ernst (1987) described the growth of mental asylums in British India as a 'less conspicuous form of social control'. [18] Mental hospitals (or asylums as they were called) in India were greatly influenced by British psychiatry and catered mostly to European soldiers posted in India at that time. Their function was more custodial and less curative. [19]

Development of lunatic asylums was apparent in the early colonial period from 1745 to 1857 till the first revolution for Indian Independence was started. The earliest mental hospital in India was established at Bombay in 1745, which was made to accommodate around 30 mentally ill patients. Surgeon Kenderline started one of the first asylums in India in Calcutta in 1787. Later, a private lunatic asylum was constructed, recognized by the Medical Board under the charge of Surgeon William Dick and rented out to the East India Company. [12] The first government run lunatic asylum was opened on 17 April 1795 at Monghyr in Bihar, especially for insane soldiers. [14] The first mental hospital in South India started at Kilpauk, Madras in 1794 by Surgeon Vallentine Conolly. During this period, excited patients were treated with opium, given hot baths and sometimes, leeches were applied to suck their blood. Music was also used a mode of therapy to calm down patients in some hospitals. [19] The mentally ill from the general population were taken care of by the local communities and by traditional Indian medicine doctors, qualified in Ayurveda and Unani medicine. [16]

The mid-colonial period from 1858-1918 witnessed a steady growth in the development of mental asylums. This period was significant for the enactment of the first Lunacy Act (also called Act No. 36) in the year 1858. [5] The Act was later modified by a committee appointed in Bengal in 1888. During this period, new asylums were also built at Patna, Dacca, Calcutta, Berhampur, Waltair, Trichinapally, Colaba, Poona, Dharwar, Ahmedabad, Ratnagiri, Hyderabad (Sind), Jabalpur, Banaras, Agra, Bareilly, Tezpur and Lahore. [18] Techniques of 'moral management' systems which were developed and implemented in this period in the west were also adopted in India. Drug treatments for psychiatric conditions were also introduced into India in this period, e.g., chloral hydrate. These were largely aimed at controlling patient behaviour and also of allowing the patient some respite from his/her condition through sleep. [20] The onset of World War I in 1914 signalled the beginning of a new and distinct period in which strands of continuity were pulled up, in which significant changes took off in the Indian psychiatric system.

[14]

Under the Indian Lunacy Act 1912, a European Lunatic Asylum was established in Bhowanipore for European patients, which later closed down after the establishment of the European Hospital at Ranchi in 1918. It was the far-sightedness, hard work and the persistence of the then superintendent of the European Hospital (now known as the Central Institute of Psychiatry), Col Owen A R Berkeley-Hill, that made the institution at Ranchi a unique centre in India at that time which attracted many European patients for treatment. Berkeley-Hill was deeply concerned about the improvement of mental hospitals in those days. [21],[22]

The years after 1914 were characterized by gradual expansion rather than building projects and the most significant of these of the period were hangovers from the pre-1914 period. Mental Asylum at Ranchi first opened in 1918 as a hospital for European patients. The sustained efforts of Berkeley-Hill not only helped to raise the standard of treatment and care, but also persuaded the government to change the term 'asylum' to 'hospital' in 1920. [22] The Parsees during that period were keen to spend large amounts of money to guarantee care in modern psychiatric institutions for those who were considered insane in their own community, often guided by financial rather than therapeutic reasoning. [23] The origins of psychiatric rehabilitation in India can be traced to innovative service programs, which were initiated at the Central Institute of Psychiatry (CIP) in 1922 when Occupational Therapy Unit started at this place. Hydrotherapy started in 1923 and during the same time the hospital started to raise interest of public in mental hygiene and prophylaxis, taking initiatives in preventive aspects of psychiatry. [24] Techniques similar to token- economy were first started in 1920 and called by the name "Habit Formation Chart". [25] Girindra Shekhar Bose first founded the Indian Psychoanalytical Association in 1922 in Calcutta and Berkeley-Hill started the Indian Association for Mental Hygiene at Ranchi. [22] He was one of the earliest practitioners of psychoanalysis in India who used this technique to help British patients to adjust to their lives after the ravages of World War I. [26] CIP was one of the first centers outside Europe to start Cardiazol-induced seizure treatment in 1938, Electroconvulsive Therapy (ECT) in 1943 and Psychosurgery in 1947. Rauwolfia extracts in the form of Santina, Serpasil and Meralfen were also used for treating psychotic conditions in late 1940s. [22],[27]

In the year 1922, CIP got affiliation from the University of London to start Diploma in Psychological Medicine. [22] Grant Medical College, Bombay (now Mumbai) had a Professor of Psychiatry, significantly an Indian, by the year 1936. A memo noted in the archives shows that the number of visits he was to make to the NM Mental Hospital, Thane was to be 'two per week during the term ,when he also gave instructions to the students of the Grant Medical College, Bombay . [5] A library on mental health started in 1918 at CIP with 300 books and journals which dated back to 1910. [22] Child guidance clinic was first established in 1937 at Sir Dorabji Tata Graduate School of Social Work in Bombay. [16] The establishment of Mental Health organization under the Directorate of Health Services was first recommended in 1946 by the health survey and development committee of the Indian Government. [28] The first psychiatric outpatient service, precursor to the present-day general hospital psychiatric units (GHPU), was set up at the R.G. Kar Medical College, Calcutta in 1933 by Ghirinder Shekhar Bose. [8] This was followed by a surge of such units with Masani opening one at JJ Hospital, Bombay in 1938 and Dhunjibhoy opening one day weekly clinic at Prince of Wales Medical College (now Patna

Medical College) in 1939. [29]

In 1946, a health survey and development committee, popularly known as the "Bhore Committee," surveyed mental hospitals. The Health Survey and Development Committee report submitted by Col. Moore Taylor in 1946 reported numerical and professional inadequacy and suggested a focus on training of personnel and students in psychiatry, promotion of occupational and diversionary therapies, and separate child psychiatry units. The committee suggested improvisation and modernization of most hospitals, attachment to medical colleges, and establishment of proper mental health. [28] The World War II saw a separation of military psychiatry from psychiatry in general in India in which the history of modern psychiatry in India seemed to have returned to its origins.

    Psychiatry in Independent India: The Formative Years  

A new phase of development of mental hospitals started after India's independence in 1947. The government of India focused upon the creation of GHPUs rather than building more mental hospitals. Emphasis was placed upon improving conditions in existing hospitals, while at the same time encouraging outpatient care through these units. A few new mental hospitals, notably at Delhi, Jaipur, Kottayam and Bengal, were added. Mid-1950 witnessed rapid development in the spread to GHPUs in India. In 1957, Dutta Ray started a psychiatric out-patient service at Irwin Hospital (now G.B. Pant Hospital), in New Delhi. In 1958, N.N. Wig started the first GHPU at Medical College, Lucknow, with both in-patient and out-patient psychiatric services and a teaching program as part of the Department of Medicine. Neki started a similar unit at Medical College, Amritsar a few months later. In the next 25 years most of the teaching hospitals and major general hospitals in the private or government sector had GHPUs which were managed by emerging mental health professionals joining services after completing their post graduation in psychiatry. [30]

By the 1960s, traditional institutions like CIP (Ranchi) and Madras Mental Hospital/Asylum offered a range of specialized services, including child and adolescent clinics. Geriatric, epileptic and neuropsychiatric services were added to complete the range of comprehensive OPDs. Another important innovation in the 1960s was the concept of a day hospital. Slowly, alternative accommodations were explored for patients who had recovered, but could not return to their families. [29] CIP started the Department of Clinical Psychology in 1949 which happens to have the first clinical psychology laboratory in the country. CIP also took initiatives in community mental health services as one of the earliest rural mental health clinic was started at Mandar near Ranchi in 1967.

An industrial psychiatric unit was started at Heavy Engineering Corporation (HEC) at Hatia, Ranchi in 1973. [22] Opening of psychiatry units in general hospitals gave psychiatrists an opportunity to demonstrate their knowledge and skills in the management of neurotic and psychosomatic disorders. [30]

On the recommendation of the Bhore committee, All India Institute Mental Health was set up in 1954, which became the National Institute of Mental Health and Neurosciences (NIMHANS) in

1974 at Bangalore. The first training program for Primary Health Care was started in 1978-79. [12]

During 1978-1984 Indian Council of Medical Research funded and conducted a multicentre collaborative project on 'severe mental morbidity' in Bangalore, Baroda, Calcutta and Patiala. Various training programmes for psychiatrists, Clinical Psychologists, Psychiatric Social Workers, Psychiatric nurses and Primary Care doctors were conducted at Sakalwara unit during 1981-82. [30] Combating stigma and widening the social network of patients were regarded as core elements of a successful rehabilitation programme. During the last 50 years mental health activities have moved from care of the mentally ill to include prevention and promotion of mental health. [31] Keeping with the reforms in community psychiatry, the first psychiatric mental health camp in India was organized in 1972, at Bagalkot, a taluka of Mysore. [12]

Mention must be made of attempts by Wig to use yoga as a therapeutic tool. This period also witnessed efforts to define the core elements of an Indian approach to psychotherapy in the form of a guru-chela relationship. [32] The efforts continued in the 1960s at NIMHANS as there was widespread international acceptance of such approaches, which are known under the rubric of 'family interventions'. [30]

    Psychiatry in Independent India: Era of Consolidation  

As the Government of India embarked on an ambitious national health policy that envisioned "health for all by the year 2000," early drafts of the National Mental Health Program were formulated, subsequently adopted by the Central Council of Health and Family Welfare, in 1982. Since its inception, there has been development of a model District Mental Health Program, and development of training materials and programs for practitioners and academicians. [33]

The first draft of Mental Health Act that subsequently became the Mental Health Act of India (1987) was written at Ranchi in 1949 by R.B. Davis, then Medical Superintendent of CIP, S.A. Hasib, from Indian Mental Hospital, Ranchi and J Roy, from Mental Hospital, Nagpur. [22] Initial attempts by the Indian Psychiatric Society to bring about change were unsuccessful. In 1959-60, reforms were considered but no consensus was reached. In the 1980s, there was a resurgence of activity resulting in the passage of the Mental Health Act in 1987. [22],[34]

The Erwadi tragedy

In 2001 a horrific incidence took place at Erwadi in which 26 persons with mental illness died in a tragic fire accident. The response of the general population, the administrators, the politicians, the press and the professionals was one of shock and outrage. The press seized the moment and wrote about similar situations, in Hyderabad, Ranchi, Ahmedabad, and Patiala. The National Human Rights Commission called for a Report. The Supreme Court initiated action on the matter. As a result, many changes not only in Erwadi but also in the different parts of the country started taking shape, which proved to be a yardstick which revamped mental health services in the country. [35]

Research in psychiatry started rolling with commencement of publication of first journal dedicated to mental health, The "Indian Journal of Neurology and Psychiatry" in 1949. The

Indian Journal of Psychiatry started in 1958 and has now completed 50 golden years of continuous enrichment in the field of psychiatry in India. [36] The journal got indexed in National Library of Medicine, the Catalogue of Index Medicus as the present review has been written in 2009. Psychoanalytically oriented literature and theoretical texts dominated the research literature from 1947 to 1960. During the second phase of psychiatric research (1960- 1972), a distinctive trend emerged as research publications moved from individual psychopathology to the interface between the individual and society and group behaviour.

Among the major epidemiological studies of the early days included those of Surya, Sethi, Ganguli and Gopinath, which helped to establish the magnitude of mental health problems in the community. Mental health researchers in this decade were also active in the field of psychological testing. [37] Clinical studies form a substantial bulk of research in last 25 years. The year 1980 saw a fresh surge in mental health research programmes as many projects were started in various parts of the country in collaboration with Indian Council of Medical Research and World Health Organization (WHO). The researchers in last two decades have matured, and studies on diverse subjects including mental health in children, have been published. Biological psychiatry has been a woefully neglected area in Indian research though in recent years some original work has been published, but it is nowhere near the contemporary work from West. [38]

The Mudaliar Committee also noted the serious shortage of trained mental health manpower and recommended the development of the European Mental Hospital at Ranchi (now CIP) into a full-fledged training institute. A formal training program for clinical psychologists (Diploma in Medical Psychology) also commenced at NIMHANS in the year 1955 and was later converted into an M. Phil in Medical and Social Psychology in 1978. In keeping with the recommendations of the Mudaliar Committee, the Central Institute of Psychiatry started training for clinical psychologists in 1962. [22]

Girinder Shekhar Bose founded the Indian Psychoanalytical Association in 1922 in Calcutta. Berkeley-Hill, in 1929, founded the Indian Association for Mental Hygiene. D. Satyanand was another analyst who received his personal analysis by Berkeley-Hill. In 1935, the Indian division of the Royal Medico-Psychological Association was formed due to the efforts of Banarasi Das. In 1946, Nagendra Nath De consulted R. B. Davis of the European Mental Hospital, Ranchi and T. A. Munro, an advisor in Psychiatry to the Indian Army and decided to revive the association. [36] The decision to form the Indian Psychiatric Society, the national organization of psychiatrists in India was taken in the meeting convened by R.B. Davis in Delhi on 7 th January 1947 during the annual congress of Indian Science Congress at Delhi University. [36]

    Conclusion  

The amalgamation of mental health, primary health care has led to a major shift from the concept of custodial care to one that emphasizes on care and treatment, although a huge gap between the rhetoric of this new policy and its implementation still remains. Mental hospitals, with all their inherent flaws and drawbacks, are powerful institutions for the proper care of a subset of mentally ill persons, especially those with severe forms of illness and poor familial/social

supports. [33]

The last two decades have seen an explosion in the knowledge base of the neurosciences, epidemiology and therapeutics. There has also been a parallel growth in interdisciplinary linkages, which support integrated socially and culturally appropriate approaches to mental health interventions. It is sometimes difficult for contemporary practitioners to fully comprehend the wide ranging challenges that confronted mental health professionals in the period following India's independence. However, it is important to remember that the foundations for the current knowledge base were laid during those early years.

History of psychiatry in India.

SR Parkar, VS Dawani, JS ApteDepartment of Psychiatry, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, India., India

Correspondence Address:S R ParkarDepartment of Psychiatry, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, India. India

PMID: 11590303

Keywords: Community Mental Health Services, history,History of Medicine, 15th Cent., History of Medicine, 18th Cent., History of Medicine, 20th Cent., History of Medicine, Ancient, History of Medicine, Medieval, Hospitals, Psychiatric, history,Human, India, Mental Disorders, history,therapy,Mental Health, Psychiatry, history,organization &administration,Psychology, history,organization &administration,

How to cite this article:Parkar SR, Dawani VS, Apte JS. History of psychiatry in India. J Postgrad Med 2001;47:73

How to cite this URL:Parkar SR, Dawani VS, Apte JS. History of psychiatry in India. J Postgrad Med [serial online] 2001 [cited 2011 Mar 9];47:73. Available from: http://www.jpgmonline.com/text.asp?2001/47/1/73/226

Till about 17th century all abnormal behavior was believed to be act of the ‘devil’ i. e. ‘Against God’, ‘ Mentally ill’ were considered evil & described as witches. Gradually over the passing time, mental illness was considered as ‘deviant behavior & mentally ill were considered socially unacceptable & put in jails along with other criminals. In the modern era, there was a shift from ‘evil’ to ‘ill. Mentally ill were called as ‘mad’ or ‘insane’ and were placed in special places called as ‘asylums’. However, gradually these asylums became the place for human exploitation. Phillipe Pinel was the first Psychiatrist to free these mentally ill from asylum. Clifford Beers work ‘ The mind that found itself’ brought in light the treatment meted out to these people in asylums, resulting in a strong reaction to the plights of mentally ill. This uproar resulted in starting of ‘mental-hygiene’ movement.

In the 20th century, the work of Freud and ‘B. F. Skinner & J. B. Watson’ gave a scientific combination of biological & social theories to explain the etiology of mental illness.

  ::   Systems of psychological medicine in india  

Ayurveda

Mental disorders are represented in Ancient India in various types of literature. The aetio-genesis of these disorders was thought to be endogenous because of provoked humours like vatonmad, Pittonmad & Kaphonmand. Exogenously the causes were attributed to sudden fear or association with ill influence of certain mythological gods or demon, Charak Samhita designated Psychiatry as ‘Bhuta Vidya’.

The description of personality is to be in terms of sathvik, Rajasik & Tamasik representing intellectual & moral, emotional & passionatic & impulsive respectively & Tamsik is more or less near mental subnormality or angry. Treatment of mental disorders mainly included psychotherapy, physiotherapy, shock, drug treatment, hypnotism & religious discourses by Sages. Psychotherapy used to be in the form of talismans, charms, prayers & sleeping in temples with rituals. The indigenous manner of giving shock to the patient was terrorizing them by snakes, lions, elephant or men dressed as bandits. Then use of 10 to 100 years old medicated ghee, Drugs Cordfolia, horse radish (shigru) with asafetida & rock salt, centella Asiatic (brami) with catechu & honey & powder of roots of serpentine were widely used.

Unani System

Najabuddin Unhammad (1222 A. D), an indian physician, described seven types of mental disorders viz. :-Sauda-a- Tabee(Schizophrenia); Muree Sauda (depression); Ishk ( delusion of love); Nisyan (Organic mental disorder); Haziyan (paranoid state); Malikholia-a-maraki (delirium). Psychotherapy was known as Ilaj-I-Nafsani in Unani Medicine.

Siddha System

‘Siddhi’ means achievement and Siddhas are men who have achieved results in medicine, as well as yoga and tapas. The great saga ‘Agastya’, one of the 18 Siddhas has contributed greatly to the

Siddha system of medicine of the South. He formulated a treatise on mental diseases called as ‘Agastiyar kirigai Nool ‘, in which 18 psychiatric disorders with appropriate treatment methods is described.

Revolution In Psychiatry

The history of psychiatry had witnessed 3 major revolutions that have given its present status. First Revolution occurred when it was believed that sin & Witchcraft are responsible for mental illness and mentally ill were chained in jails & asylums. They were considered as outcaste from society. Second revolution was the advent of psychoanalysis; that explained the etiology of psychiatric disorders. Third revolution was the development of community Psychiatry that resulted in the integration of mental health care in the community.

Mental Illness To Mental Health: Indian Perspective

Indian culture has always given a great importance to spiritual life . Wig (1990 :73) stated that religious texts in India have stressed the search for the spiritual meaning of life and detachment from material thing.

One of the earliest Indian Psychiatrists to explain the importance of health was Govindaswamy in 1948. He gave 3 objectives of mental health - regaining of the health of mentally ill person; prevention of mental illness in a vulnerable individual; and protection & development at all levels, of human society, of secure, affectionate & satisfying human relationships & in the reduction of hostile tensions in persons & groups (Govindaswamy, 1970).

According to one aspect, put forward by Govindaswamy (1970) selfishness on the psychological side & starvation on the Physical side are responsible for the disorganization of individual & society. The second aspect stressed the importance of culture to understand the personality functioning. Carstairs & Kapur (1976) & Chakraborty (1990) found the relation between social stress, modernization & occurrence of mental disorder. The third aspect is the use of traditional concepts of therapy eg. Yoga by Patanjali’ & fourth aspect is importance of family in therapy .

  ::   Institutionalisation of mentally ill in india  

During the reigns of King Ashoka, many hospitals were established for mentally ill. A temple of Lord Venkateswara at Tirumukkudal, Chingleput District, Tamil Nadu, contains inscription on the walls belonging to Chola period. The inscription mentioned a hospital and a school. The hospital was named as Sri Veera Cholaeswara hospital and contained 15 beds.

Maulana Fazulur-Lah Hakim, an indian physician was in charge of the first Indian mental asylum, i. e. Mandu Hospital opened by Mahmood Khilji (1436-1469) at Dhar, M. P. First lunatic Asylum, Bombay Asylum, was built in modern India in approximately 1750 A. D. at the cost of 125/-, no traces of it is present today. In 1794, a private lunatic asylum was opened at Kilpauk, Madras. The central mental hospital, Yerwada, Pune was opened in 1889. First asylum for insane soldiers was started at Monghyr, Bihar and was known as Monghyr Asylum(1795).

Maxell Jones in 1953 introduced the concept of Therapeutic community resulting in the improvement in the Mental Hospital conditions. Subsequently other facilities such as Occupational Therapy, Recreational facilities, Outdoor games and Picnics were started in Mental Hospitals . Lt. Col. Berkley Hill Was the pioneer in starting Occupational Therapy at the European Mental Hospital, Kanke, Ranchi, in 1935. However inspite of all these facilities, the adjustment of the mentally ill patients was poor in these hospitals (Bhattacharya And Chatterjee 1978).

  ::   National institute of mental health and neuro sciences  

On the recommendation of Bhore committee (in 1946), All India Institute Mental Health was set up in 1954, which became the National Institute of Mental Health And NeuroSciences in 1974 at Bangalore.

An expert committee of WHO in 1974, made several important recommendations, urging its members to consider mental disorder as a high priority problem. The recommendations included : to undertake pilot projects to assess existing mental health care program in a defined populations and training program for health workers and to devise a manual for the same (Isac 1986).

Hence, first community Mental Health unit (CMHU) was started with the Dept. of Psychiatry at NIMHANS in 1975. For short term training of primary care personal, a Rural Mental Health Center was inaugurated in Dec’1976 at Sakalwara, 15 km from Bangalore. Mental Health clinic was opened in a General Hospital in Bangalore to involve General Practitioners in Mental Health, Seminars and orientation programs for General Practitioners & school teachers were conducted. The first training program for Primary Health Care was started in 1978-79. During 1978-1984 Indian Council of Medical Research funded & conducted a multicentre collaborative project on ‘severe Mental Morbidity’ in Bangalore, Baroda, Calcutta & Patiala. Various training programs for psychiatrists, Clinical Psychologists, Psychiatric Social Workers, Psychiatric nurses and Primary Care doctors were conducted at Sakalwara unit between 1981-82 (Ministry of health & family welfare, 1989).

  ::   National mental health programme (nmhp)  

Due to results obtained by all these research efforts, NMHP was launched in 1982. Certain studies were undertaken under NMHP to integrate mental health with PHC. These included : Raipur Rani Project (1975-1981), Sakalwara project (1975), ICMR project, Jaipur Project (1982-84) and Bellary Project .

The specific vulnerable population, children, disaster population, tribal population, the elderly population, and homeless mentally ill, is included for mental health care planning.

  ::   General hospital psychiatric units (ghpu)  

Till early sixties Mental Hospitals were the only place available for the treatment of mentally ill. However, as compared to the number of mental ill patients, the services available were very less. Hence General Hospital Psychiatric Units were started to deal with the Increasing number of patients.

The first GHPU was started in R. G. Kar Medical College & hospital, Calcutta in 1933 & GMC R. J. J. group of Hospital Bombay in 1938. (khanna et al 1974). The number has gradually increased since then. Gradually GHPU started the PG training centres at Delhi, Chandigarh, Lucknow, Bombay, Madurai etc resulting in development of District Psychiatrist unit.

Community Psychiatry

Mental Health Camps In India

The first psychiatric mental health camp in India was organised in 1972, at Bagalkot, a taluka town of Mysore. Earlier some service centers were organized by members of team of Kripamayee Nursing Home, Miraj. Following this, Indian Psychiatric Society also started taking active interest in Mental Health camp organization and various health camps were arranged in different parts of India (such as Nandi, Ghosh, Sarkar, Banerjee in 1978, Luktuke in 1976).

Voluntary Health Sector (VHS) in Mental Health

There have been strong mass media movement all over India in last decade where various issues related to Mental Health are brought in public domain. The social movements in relation to Darubandi are doing commendable work and are very well known. Other organization like SCARF (Chennai), Richmond fellowship foundation (Banglore), Cadbum are also helping people in rehabilitation and integrating them in the society

In these various organizations, active efforts have been taken to improve quality of care of patients & rehabilitate them in society. Various self help groups such as Alcohol Anonymous, Narcotic Anonymous, have been organized by people. The major effort of VHS is evident in the area of suicide & Deaddiction where various kind of activities are being carried out to help people in crisis eg : Sanjeevani in Delhi, Sneha in Madras, Prerna in Mumbai.

Psychiatric Social Work

The establishment of Mental Health organization under the directorate of Health services was first recommended in 1946 by the health survey & development committee of the government of India. The first Psychiatric Social worker was appointed in the Child Guidance Clinic started in 1937 by Sir Dorabji Tata Graduate School of social work (now Known as Tata Institute Of Social Sciences) in Mumbai. Banerjee was the pioneer of Psychiatric Social Work training in India; Institute of training in America appointed her the leader of Department of Medical & Psychiatric Social Work established in 1948. The other Social Workers & psychiatrists who gave

a major boost to Psychiatric Social Work in India were Vidyasagar, Sarada Menon, U. B. Kashyap, B. D. Bhatia, P. B. Buckshey.

Gradually training for social work started in various centers such as National Institute of Neuropsychiatry in Bangalore (now known as NIMHANS) Indian Council of Mental Hygiene (Institute of Psychiatry & Mental hygiene).

  ::   Mental health act  

Lunatic Asylum act, Act 36 of 1856 was modified to form Indian Lunacy Act, Act 4 of 1912. The enactment of act resulted in opening of new asylums and improvement in the condition of asylums. The name lunatic asylum was changed to mental hospital in 1920. In 1946, the Bhore committee recommended changes in Indian Lunacy Act 1912, as it had become outdated. Indian Psychiatric Society formed in January 1947 quickly acted on the recommendation and a committee consisted of Dr. J. Roy, major R. B Davis, Dr. Hasib was formed. It was finally enacted on 22nd May 1987.

Special Issues

Drug Dependence : Alcohol

In Rig Veda, 2 types of beverages are described :-Soma Juice : According to vedic hymns, soma was a mushroom & a cannabis like substance (Sethi 1979) and ‘Sura’ – a drink that was obtained from fermented barley after distillation. In Atharva veda ‘Sura’ was mentioned as a reward for performance of sacrifices. In the sutra period (800-300 BC) besides sura, many other drinks were widely prevalent, eg:- Kilala – a drink prepared from Brown Sugar, wines imported from Afghanistan were commonly known as “Kapisayani’.

Consumption of alcholic drink was looked down upon by Buddha & Lord Mahavira, use of alcohol was prohibited among ‘Muslims & owing to this, ban on use of alcohol was first excised during Moghul period. However, use of alcohol on religious grounds was allowed to the ‘Tantrik’ section of saktas among Hindus.

According to Charak, moderate drinking was pleasing, digestive, nourishing & providing intelligence, but excessive drinking causes ‘various elements’.

Ala-u-din khilji tried to control the manufacture & sale of alcohol. His successors Mubarak Shah & Akbar followed him.

Other Drugs

The use of cannabis in Indian culture is reported more than 2000 years ago. Cannabis was known to increase concentration during meditation, hence was used by Hindu saints, its use was widespread in religious places like Hardwar, Varanasi, Puri etc. use of cannabis is also mentioned in ‘Atharva Veda’. Opium use became popular during Moghul period.

Gradually in the modern era there was a gradual increase in the drug abuse and the associated complications and antisocial activities. Due to this various laws, Opium act 1857, Opium act 1878, Dangerous Drugs act, 1930, Certain provisions of Cr. P. C. 1973, were enacted to deal with drug abuse

Alternative patterns of care of mental health in community have developed which include GHPU at district level, Home Care Programme, Foster care, Partial Hospitalization etc.

Psychotherapy

Psychotherapy in Ancient India dates back to the times of Pandavas. In ‘Bhagvad Geeta ‘ there is an incidence of counseling in the battle-field given by Lord Krishna to Arjuna. Guru- Chela relationship is another example of psychotherapy in Ancient India. Neki (1973, 1974) examined the Guru-Chela relationship as therapeutic paradigm.

Dr. Girinder Shekhar Bose founded the Indian Psychoanalytical Association in 1922 in Calcutta. A training institute of psychoanalysis to train young psychoanalysts was started. Satyananda was another analyst who was greatly influenced by Melanie Klein and had received his personal analysis from Berkley Hill. A. V. Vasavada was the only Jungian analyst in India. Dr. N. S. Vahia contributed in the research on the role of Yoga in promotion of mental health.

Research

Various aspect of research work was carried out in India during the period 1947-1972. Wig and Akhtar in 1974 reviewed the research work and found that focus was on mental health and illness in India. Lots of work was done on the phenomenology and natural history eg General Paresis of Insane, relationship between leprosy and mental illness, Indian adaptation of Psychological tests and construction of Intelligence tests to suit Indian needs. Remarkable work was done in the fields of epidemiology, phenomenology and treatment of mental illnesses. However, there was no up to date laboratory research and hardly any attention was paid to psychotherapy education.

ICMR contributed greatly in the research work in the form of “strategies for research on mental health”(ICMR 1981).

  ::   Continuing medical education (cmes)  

On the 35th anniversary of the Indian Psychiatric Society, in 1983, Dr. L. P. Shah in Mumbai started the first of the series of Continuing Medical Education. The first mid-term CME was held in1990. Since then Indian Psychiatric Society and West Zone conduct annual and mid-term CME every year on various novel issues .

Psychiatric Associations In India

Indian Psychiatric Society (IPS)

Berkeley hill in 1929, founded the Indian Association for mental hygiene. In 1935, the Indian division of the royal Medico- Psychological Association was formed due to the efforts of Dr. Banarasi Das. In 1946, Dr. Nagendra Nath De consulted Major R. B. Davis of the Hospital for Mental disease, Kanke, Ranchi & Brigadier T. A. Munro, Advisor in Psychiatry to the Indian Army and decided to revive the association. Due to their efforts the Indian Psychiatric Society was inaugurated at Delhi on 7th January 1947. The rules & regulations were framed by the eminent Psychiatrist such as Dhunjibhoy, Rosie, Kenton, Llyodo, Dr. Masani, Shah, Johnson, Govindaswamy & Kak. Dr. N. N. De presided over the first annual meeting of association on 2nd january 1948 at Patna. Since then annual meetings are held at different places.

Indian Journal of Psychiatry

It was started in 1949 as Indian Journal Of Neurology and Psychiatry, was edited by Dr. Nagendra nath De. After 6 issues publication was stopped in 1954. It was renamed as Indian Journal of Psychiatry in 1958 and Lt. Col. Bardhan, a pathologist was appointed as it’s editor

The other specific associations which were formed by psychiatrist in India are also very active such as Indian Association of Social Psychiatry and Indian Association of suicide in 1996

  ::   Present scenerio of psychiatric services in india  

National Mental Health Programme was implemented to provide services to rural as well as urban population. However even today 80% of the rural population do not get these services. Multidisciplinary approach for the treatment of mentally ill is confined to only few institutions. Importance is attached to treat the mentally ill patients & not much thought is given to prevent mental illness & promote mental health. More importance is given to biological psychiatry and psychopharmacology, and psychology and social psychiatry are not given due importance.

History of Psychiatry; Psychiatric Nursing79rate or flag this page Tweet this

By jagged81

History of psychiatric mental health

The history of psychiatric mental health has come a long way or it would be better said that the study of psychiatric mental health has come a long way. Skulls recovered and dated back to 5000 BC have large holes drilled into the sides of their head to release the demon spirits that possessed them.

Psychiatric mental health history

Hippocrates later would try to rationalize the existence of mental health, he refused to believe that they were possessed by the demons or that God was responsible.  Hippocratic medicine as it was coined by his peers revolved around the theory of ‘humours’, no not humors as in funny.  “Humours” as in basic juices or fluids health or illness was a result of these juices included blood, choler (yellow bile), phlegm, and melancholy.

Before the asylum, from the beginning of time to as early the 1800’s another “treatment” was to lock up the mentally ill and to treat them basically like animals. They were chained up in basements to keep them safe from themselves and others.  Most of the time the family members had done this because there family member hadn’t always been like this and they still love them deeply.

Hippocrates in the Flesh

See all 12 photos

Yes! This is a real photo of Hippocrates.

First Asylum in U.S.

Public Hospital for Persons of Insane and Disordered Minds in Colonial Williamsburg, VA

Dorothea Dix

Rather Stunning.....uh maybe we just need a color photo?

The First "Asylum" for the Insane!

The first asylum was introduced in the 1730 in the U.S. but it was hardly close to the civilized facilities that we run today.  This asylum as it was called was the typical dungeon looking castle on the hill the one you find in the horror movies, perhaps the one the created the stigma behind the psychiatric mental health.  Unfortunately, the stigma is part of the history and the history is part of the stigma that we as nurses and other healthcare professionals are trying to escape.

The first hospital for the mentally ill was established in Williamsburg, VA, and brought us one step closer to the ever evolving area of psychiatric mental health.  Another key area were the crusades of the famous Dorothea Dix where she was responsible for the organization of 32 mental hospitals, and transfer of those with mental illness from asylums and jails.

Clifford Beers

Clifford Beers.

Adolf Meyer

Adolf Hitler sure did mess over all the great people with his first name.

The work of Clifford Beers and Adolf Meyer.

Clifford Beers (1876–1943) was hospitalized in several mental hospitals after a nervous breakdown and he describes his accounts of this in his autobiography A Mind That Found Itself (1913). Basically he founded the principles of “mental hygiene movement” which included emphasizing early intervention, prevention, and the promotion of mental health. These ideas were later crafted into the basic ideas of mental hygiene which were founded by the psychoanalysis of Adolf Meyer (1866–1950). He believed that the treatment of early forms of maladjustment could prevent more serious problems later on. His ideas also contained suggestions for preventive measures. 

President Truman signed the National Mental Health Act

Great President!

On July 3, President Truman signed the National Mental Health Act, which for the first time in history funding for psychiatric education and research was available.  This lead to the establishment of the National Institute of Mental Health (NIMH) in 1949, also in 1949 lithium was discovered and greatly reduced the symptoms of bipolar disorder although the FDA wouldn’t approve the drug until 1970.

Lithium

So call "Happy Pills"

Chlorpromazine (Thorazine)

John F. Kennedy

Three years after the discovery of lithium in 1949, the first psychotropic drug was discovered. Chlorpromazine (Thorazine) alleviated symptoms of hallucinations, delusions, and agitation and thought disorders. This discovery greatly improved the condition of consumers with psychosis and delusion paving the way for the beginning of psychotropic drug discovery.

Congress back the funding of twelve million dollars for research in the clinical and basic aspects of drugs that would help to treat individuals with a mental illness and so the Psychopharmacology Service Center was birthed. The number of mentally ill in mental hospitals declined due to the response of the disease processes to the newly discovered psychotropic drugs.

With a growing need to continue to help those discharge from the institutions and to maintain that they continue to respond well to the new treatments the Health Amendments Act authorized the support of community services for the mentally ill, such as halfway houses, daycare, and aftercare.

In 1961the Action for Mental Health was proposed to Congress. This proposal assessed mental health conditions and resources throughout the United States “to arrive at a national program that would approach mental illness and treat each person with a mental illness as a unique individual.

This opened the door in 1963 when President Kennedy proposed and signed legislation that started the community mental health center movement. These facilities today are the backbone of psychiatric nursing care because this is the system used when deinstitutionalizing somebody and integrating them back into the community. This legislation was also used to substitute comprehensive community care for institutional care.

The Community Mental Health Center Act Amendments of 1965 were passed and included changes that would allow funds to be granted to facilities that served clients with alcohol and substance abuse construction and staffing grants to centers were extended and facilities that served those with alcohol and substance abuse disorders.

Grants were also handed out to support and provide facilities’ that reached out to poverty areas to establish mental health services in those areas. Further grants were used to facilitate further establishment of psychiatric mental health children services.

Electroconvulsive Therapy

Patient needs to sign an informed consent for any ECT that is to be given. The same as you would do for a surgery.

Over that flew over the cuckoo's nest

Wow, Jack looks younger!

President Jimmy Carter

Electroconvulsive therapy (ECT) which has place in mental health today was struck with a fiery dart from Hollywood in the movie “One that Flew Over the Cuckoo’s nest” in 1975.  In the movie it depicted ECT as a form of punishment rather than a means to reach a therapeutic outcome in the mental wellness of patients.  The account of ECT had nothing to do with what actually occur during ECT, but it did not matter, during that generation people believed ECT must be stopped.

 This would be overcome however and in 1987 the APA published a report that stated ECT was not just for desperate cases anymore but as an effective treatment for bipolar disorder.  ECT has widespread use and apart from the stigma that still covers it, it still has a therapeutic outcome.  Today informed consent must be signed before an ECT can be done to a patient and the post-ECT recovery is much like what would occur during general anesthesia recovery.

During the President Jimmy Carter’s term in 1980 he proposed the Mental Health Systems Act which updated the federal community mental health center program by strengthening the bonds between the federal, state, and local governments to ensure that they were all on the same page. This Act was the final result of many recommendations made by Jimmy Carter’s Mental Health Commission.

Grant programs were authorized for the CMHCs to assist in expanding services to meet an array of populations that were needed to be reached with mental health needs such as lower income households.  These grants also included expanded development of services for the severely mentally ill as well as severely emotionally disturbed, and grants that was intended for expanding education on mental wellness and to get patient input and participation of mentally ill patients.

The role of the nurse in psychiatric nursing is to establish a client-nurse relationship that is both therapeutic and goal oriented.  Nurses have the task to assess clients to see if they are progressing as they should with their current treatments.  Cultural influences as far as the history of Psychiatric mental health is due to early dealings with the mental health patients.  Many stigmas about how the mentally ill are treated and what they are capable of have been erroneously molded by society and consequently has become a part of the history of psychiatric mental health that we are trying to escape.

As the history of psychiatric mental health has told us, the world has come a long way in treating the mental illness once they have been identified.  Now the goal of mental health is to catch somebody before they begin to exhibit symptoms of a mental illness through screenings.  Psychiatric mental health is something used throughout our nursing careers whether or not we are working with a mentally ill patient or not.  It is in our everyday lives as a nurse that we use psychiatric mental health that has evolved so well throughout history.

Introduction to Psychiatric Nursing This page was last updated on March 1, 2011

Introduction

"A specialty nursing practice focusing on the identification of mental health issues, prevention of mental health problems, and the care and treatment of persons with psychiatric disorders." - The American Psychiatric Nurses Association

The scope of psychiatric nurses may be in general psychiatry care and specialised areas like child-adolescent mental health nursing, geriatric-psychiatric nursing, forensics, or substance-abuse.

History of Psychiatric Nursing

In the 1840s, Florence Nightingale made an attempt to meet the needs of psychiatric patients with proper hygiene, better food, light and ventilation and the use of drugs to chemically restrain violent and aggressive patients. ( (Reddemma K & Nagarajaiah, 2004))

 Linda Richards, the first psychiatric nurse graduated in the United States in 1882 from Boston City College.

In 1913 Johns Hopkins University was the first college of nursing in the United States to offer psychiatric nursing as part of its general curriculum.

The first psychiatric nursing textbook,Nursing Mental Diseases was authored  by Harriet Bailey, in 1920.

The registration of psychiatric nurses was done by 1920 in the UK and degree courses in psychiatric nursing began in the USA.

Psychiatric nursing was included in the basic nursing curriculum by the International Council of Nurses in 1961.

In 1963, President John F. Kennedy in United States passed the Community Mental Health Act which proposed the deinstitutionalization of mentally ill persons.

History of Psychiatric Nursing

In fourth century AD, during the period of Emperor Ashoka, hospitals with 15 beds for mentally ill with two male and two female nurses. In1964-65 Psychiatric nursing was included in curriculum. (Reddemma K & Nagarajaiah, 2004)

For the first time in India, 11 British nurses along with one matron were brought from the UK to work in the mental hospital at Ranchi in the 1930s.

Short training courses of three to six months were conducted in Ranchi in 1921, which were recognized by the Royal Medical Psychological Association.

During 1948-50 four nurses were sent to the U.K.by Govt. of India for mental health nursing diploma.

From 1943, the Chennai Government organised a three months’ psychiatric nursing course (subsequently stopped in 1964), for male nursing students atthe Mental Hospital, Chennai (in lieu of midwifery).

During 1954 Manzil Medical Health centre, Lucknow gave psychiatric nursing orientation course of 4 - 6weeks duration.

Govt. of India decided to start training psychiatric nurses during 1953-54 and started the first organized course at All India Institute of Mental Health (presently NIMHANS).

In 1964–1965, the Indian Nursing Council (INC) made it a requirement to integrate psychiatric nursing in the nursing diploma and degree courses.

In 1967, a separate Psychiatric Nursing Committee was formed in the Trained Nurses Association of India.

Diploma in Psychiatric Nursing is conducted in three institutions in India. Master of Psychiatric Nursing (MPN) programme is conducted in many institutions.

o Visit Psychiatric Nursing Profession in India Doctoral programme in psychiatric nursing (Ph.D.) at NIMHANS, Bangalore.

Principles of Psychiatric Nursing

Allow client opportunity to set own pace in working with problems. Nursing interventions should center on the client as a person, not on control of the

symptoms. Symptoms are important, but not as important as the person having them. Recognize your own feelings toward clients and deal with them. Go to the client who needs help the most. Do not allow a situation to develop or continue in which a client becomes the focus of

attention in a negative manner. If client behavior is bizarre, base your decision to intervene on whether the client is

endangering self or others. Ask for help—do not try to be a hero when dealing with a client who is out of control! Avoid highly competitive activities, that is, having one winner and a room full of losers. Make frequent contact with clients—it lets them know they are worth your time and

effort. Remember to assess the physical needs of your client. Have patience! Move at the client’s pace and ability. Suggesting, requesting, or asking works better than commanding. Therapeutic thinking is not thinking about or for, but with the client. Be honest so the client can rely on you. Make reality interesting enough that the client prefers it to his or her fantasy. Compliment, reassure, and model appropriate behavior.

Ancient History of NursingBy Michelle Fortunato, eHow Contributor updated: May 17, 2010

Gods and goddesses were thought to influence healing in ancient Rome and Greece.

Civilizations throughout history viewed nursing in diverse ways. In ancient times, nursing care was practiced within families and not considered a vocation in some cultures. While Roman women of nobility tended to the sick, gods and goddesses were deemed to influence healing in Rome and Greece. Hired nurses assisted in childbirth in ancient Egypt.

Early Nursing

1. In ancient times, caring for the infirm sometimes fell on slaves, destitute women or prostitutes. Christianity brought a measured amount of respect to females in the role of nursing in the first century, with the Order of the Deaconesses providing some of the earliest care. However, in some parts of the world men were considered to be more capable than women in caring for the sick.

Male Nurses

2. The first nursing school, established around 250 B.C. in India, allowed no women in attendance. Females were thought to be less pure than males, so men were the main caregivers, helping patients to walk, massaging their limbs, bathing, cooking, feeding and making the beds. In Arab cultures, women were regarded as incapable of performing nursing duties. At the time of the Crusades, military men cared for ailing and wounded soldiers.

Medieval Times

3. Male organizations formed in medieval times were exclusively for patient care. In the third century, the Parabolani of Rome tended to Egyptians in Alexandria who were afflicted with the great plague. Men dominated this small group of Christians and jeopardized their own lives by providing unprecedented nursing care to those who were ill or dying from the highly contagious disease.

Middle Ages

4. During the Middle Ages, nursing care became closely connected to religion and the church. Both men and women provided nursing care, but only to members of the same gender. Assemblages of men belonged to groups such as the Knights Hospitalers, Knights of Lazarus, the Teutonic Knights, and the Alexian Brotherhood. Attending to injured comrades was the main purpose of the members of these organizations. These groups set a precedent in establishing the administration of prominent battlefield hospitals in Europe. Christianity during the Middle Ages led to the formation of the Augustinian Sisters, the first female nursing society.

16th Century

5. According to California's Porterville College, formal nursing experience was still not required by the beginning of the 16th century. However, during the ensuing years of the 1500s, population growth, along with outbreaks of epidemics, led to the need for more nurses with proper training. During this period, the Sisters of Charity established the first nursing society with an organized educational curriculum.

First Nurse in America

6. Around 1550, Mexican Friar Juan de Mena became the first identified nurse in what would someday be the United States, according to the Male Nurse Magazine website. Shipwrecked off the southern coast of Texas, the friar was shot by an arrow and died shortly thereafter. A revered nurse, Friar Juan diligently tended to the sick before setting sail from Mexico in what would be his final voyage.