history of psychiatry in india

JAY PATIDAR (M.SC. NURSING)

HISTORY OF PSYCHIATRY IN INDIA

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INTRODUCTION

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’.

JAY PATIDAR (M.Sc. NURSING)

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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.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.


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SYSTEMS OF PSYCHOLOGICAL MEDICINE IN INDIA

AyurvedaUnani SystemSiddha System


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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’.


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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.


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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.


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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.


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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.


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MENTAL ILLNESS TO MENTAL HEALTH: INDIAN PERSPECTIVE

Indian culture has always given a great importance to spiritual life.

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).


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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 hospital was named as Sri Veera Cholaeswara hospital and contained 15 beds. Maulana zulur-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.


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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.


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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).


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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.

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.


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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).


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