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m Mental illness the result

of supernatural forces
"ods (communication)
Spirit or Demonic
possession
m Ão separation between
medicine, religion, &
magic
m „ecause mental illness was perceived of as having
supernatural origins, treatments for mental illness often
involved exorcism (casting out of demons),
witchcraft/sorcery, or other ³supernatural´ cures.
m ×nother very popular
method of ³curing´
mental illness was
w  (i.e. the
surgical boring into the
skull) to allow the
³spirits´ to escape.
m îhe Ebers Papyrus (dated
1550 „ ) is believed to be
a copy of an even earlier
text dated 3400 „ ). îhe
Ebers Papyrus contains a
wealth of ancient Egyptian
medical knowledge
including chapters on
mental illness (inc.
depression and dementia)
m Ôippocrates claimed that
epilepsy was the result of
natural causes and not a
divine disease
m laimed mental illness was
caused by increased humidity
in the brain
m ×lso claimed that hysteria
was caused by the female
womb becoming detached
and wondering around the
body Ôippocrates
460 ± 355 „
m Ôippocrates
recommended
treatments for
mental illness
included:
„eatings
onfinement
Medications
m 0n ×ncient "reece, the mentally
ill were taken to the îemple of
×sclepius ("od of Medicine) to
be healed.
m ×long with magical treatments,
the mentally ill person would
routinely sleep in the temple
0t was thought that "od would
appear to the person in their sleep
and cure them
m 610 ×D
„eginning of the revelation of the Qur'an
M Sura 4:5 states:

M ’ w   w w


ww 

w  ww w
w   ww     w
M îhis gave rise to the first legal protection of persons with a
mental illness, the mentally ill deemed incapable of
premeditation in 0slamic sharia
m Girst dedicated psychiatric hospital built in 705 ×D
in „agdad (i.e. present-day 0raq)
ènlike their European counterparts who still adhered to
the supernatural causation of mental illness, early 0slamic
doctors relied on clinical observations
m Ñhile 0slamic rationalism and
Muslim physicians held the
mental illness was caused by
diseases of the brain, animist
pre-0slamic based cultures still
held that mental illness was
caused by 9 
îhis gave rise to the ?  in
Ãorth ×frica and  in South
East ×sia as traditional sources of
mental health care
m îhroughout Europe,
the atholic and
Protestant belief in
witchcraft led to many
oddly behaving
people (esp. mentally
ill) being accused to
witchcraft and
subsequently burned
at the stake
m „  

  (1337)
is one of the
oldest surviving
psychiatric
hospitals and
one of the first to
appear in Europe
m „y the of the 17th century,
mental illness was
increasingly being
regarded as an organic
disorder ³ w
   w ww   w
   ´
îhis let to the treatment of
the mentally ill as animals
with whips, chain, and other
painful and degrading
actions
m 18th entury:
„eginning of the ³
  ´ movement
M ombined psychosocial
and religious treatment
M Reduced brutalisation of
mentally ill inpatients
M „ecame popular after
successful treatment of
King "eorge 000
m 18th entury:
0ncreasing number of
institutions led to the
development of the
specialization of linical
Psychiatry
Rediscovery of hypnotism
by Granz Mesmer
m Girst „ritish Lunacy ×ct introduced in 1808
State has legal obligation to provide care for mentally ill
persons
èse of restrains, handcuffs, straight jackets, and chains
m ¬  ¬  was a school
teacher who, in 1840,
became an advocate the
improved standards of care
for people with a mental
illness
×dvocated that the government
should support people with
mental illness financially, with
housing, food, etc.
îheorised that many criminals
were mentally ill
m „ritish olonial "overnment established health
services focusing on the general health of estate
workers and treating tropical and nutritional
diseases
m Ão mental health services
m Development of health services motivated by need
to offset financial losses cause by lost productivity
due to malaria and dysentery
m Linda Richards was the
first ×merican-trained
nurse
m Developed the first school
of mental health nursing in
1882
8 years later, more than 30
asylums throughout the èS
had established similar
training schools.
m 0n 1896, Emil Kraepelin ("erman
psychiatrist), describes
 w (now called
³schizophrenia´) and 
    (now called
³„ipolar Disorder´)
m Kraepelin¶s descriptions of
schizophrenia continued to be
highly influential until the late
1990¶s
m Girst psychiatric nursing course commenced 1913
m Publication of the first textbook for psychiatric
nursing:
à w    
M Ôarriet „ailey (1920)
m Girst mental health service
in Malaysia was the
³Penang Lunatic ×sylum´,
used to confine mentally
ill sailors of the olonial
Ãavy
m × second asylum
operated until 1910 at the
site of the current îaiping
Ôospital (Perak)
m Established by Dr Ñ.G. Samuels in 1910 at îanjung
Rambutan (0poh)
Ãamed ÿ   w w  ÿ
w
m 0nitially built with three male wards and one female
ward
m 1928: Renamed ³ entral Mental Ôospital´
m 1970¶s: Renamed ³Ôospital „ahagia èlu Kinta´
m urrently:
54 male wards
25 female wards
Over 2,600 beds
m Girst introduced in 1930¶s
×dministration without
anaesthesia or muscle
relaxants
M Significant physical injuries to
many patients
³Modified´ E î with
anaesthesia and muscle
relaxants introduced in 1951
m 0ntroduced 1933
Did not gain widespread acceptance until 1940¶s & 1950¶s
0nvolved repeated overdosing of schizophrenic patients
with insulin in order to induce coma
×t higher doses, comatose patients would experience
seizures which were thought to be helpful in treating
psychotic conditions
M Sometimes combined with E î to
produce even great seizure effects
m Lobotomy procedure first
introduced in 1935
m ³0ce-pick´ lobotomy method
made popular throughout
the èS by Dr Ñalter
Greeman
m Procedure involved
hammering a small ice-pick
through the orbits of the
eye, into the brain to sever
the connections to and
from the prefrontal cortex
m Rumah Sakit Otak îampoi established 1936
Renamed Permai Ôospital, Johor
atchment:
M Johor
M Melaka
M Ãegeri Sembilan
M Kelantan
M îerangganu
M Pahang
m Publication of DSM-0 in 1952 by the ×merican
Psychiatric ×ssociation (×P×) to standardise the
use of diagnoses used by psychiatrists and the èS
Dept. Veteran ×ffairs for pension payments
m DSM became the standard reference due to its
adoption by the Ôealth 0nsurance industry and the
ability of the five axis diagnostic system to identify
social and preventable causes of mental disorders
m urrently DSM-0V-îR
m Publication of w   
ÿ w à  by Peplau
(1952)
×malgamated theories from
psychiatry, nursing, and
communications
m Ñith no medications available,
psychiatric nurses were often
the pioneers of psychosocial
treatments
m ³Ñhich is more important, what
nurses do w patients or what
they do w patients´?
m 1952 ± "overnor of the East 0ndia ompany in
Malaya pressured the Rulers of the Malay
Gederated States accept the Mental Disorders
Ordinance ³to regulate proceedings in cases of
mental disorders´
Ãote the language used at the time. îhe concept of
caring was distinctly absent!
m Relates to ³reception and detention of persons of
unsound mind in mental hospitals´
×gain, note the language used. îhere is no mandate for
treatment or rehabilitation.
m 0ntroduction of phenothiazine psychotropic's in
1955
Resulted in a substantial reduction in the severity of
psychiatric symptoms for most patients
m Most countries which introduced the use of
psychotropics reported 50% reduction in
number of patients needing to be hospitalized
0ncreasing optimism of psychiatrists and nurses that
patients can ³get better´
„eginning of ³deinstitutionalization´ movement
m Established 1967
m ommunity based Ã"O dependant on public
donations and a grant from the Department of
Social Ñelfare
m Objectives:
to advocate for positive attitudes towards mental health;
to plan and implement mental health programmes;
to provide rehabilitation services.
m 1976: 25 Psychiatrists in Malaysia (50% of
which planned to leave Malaysia and
migrate elsewhere)
m 1977: MP× inaugurated by the Ôonourable
Minister of Ôealth îan Sri Lee Siok
Yew on 19th March 1977 at Ôospital
„ahagia
Dato Seri M. Mahadevan was elected
as the MP׶s Girst President
m "overnment move to have "eneral Ôospitals and
District Ôospitals establish psychiatric units and
clinics
urrently 12 units attached to "eneral Ôospitals
Provides continuity of care and follow-up after discharge
from main psychiatric hospitals
Gunction as short-stay and assessment units
M Example:
M Jalan Perak, Penang
m Early Psychosis Prevention and 0ntervention
entre (EPP0 ) began operations to detect early
signs of potential schizophrenia
Discovery of      
M Period of approx. 2 years in which minor psychotic
symptoms, behavioural symptoms, or cognitive deficits may
emerge but do not meet criteria for actual schizophrenia
diagnosis
M Diathesis-stress model used, symptoms may disappear in
the absence of the stressor (e.g. academic stress, drug
abuse, etc.)
m Malaysian ×ct of Parliament introduced for the
care and protection of people with mental
disorders
m Relates to:
Ôospital admissions
0nvoluntary detention
Lodging
are
îreatment
Rehabilitation
ontrol & protection
m Established 2003
m Purpose:
to determine the disease burden attributable to mental
disorders;
to identify subgroups in the population at high risk of
mental disorders to whom prevention effort should be targeted;
to identify potential risk factors involved in mental disorders;
to evaluate the treatment, control and prevention of mental
disorders;
to facilitate epidemiological research on mental disorder
m Established 2005 for the purposes of collecting data
regarding suicide in Malaysia
m Database is updated daily by Dept. Gorensic Medicine
upon receipt of Death ertificate acknowledging
suicide as cause of death
Difficulties collecting accurate data due to false reporting of
³sudden death´ to cover-up actual suicides
m Data used to inform government and social policies
m 0n prehistoric times mental illness was thought to be
caused by supernatural forces, gods, spirits, or
demons
m 0n ancient times, mental illness was thought to be
caused by various bodily diseases (real or imagined)
which would be treated in temples
m Middle Eastern and ×sian schools of medicine held
that mental illness was caused by medical conditions;
while Ñestern schools of thought regarded mental
illness still has largely supernatural and spiritual in
origins
m ×dvent of moral treatment brought more humane care
and compassion to the mentally ill and triggered the
birth of psychiatry as a specialization
m „eginnings of the „iological Psychiatry movement with
the success of psychosurgery, E î and
pharmacological agents
m Ôildegarde Peplau is regarded as the founder of
modern psychiatric mental health nursing
m Mental health services, both in Malaysia and
0nternationally, continue to evolve stressing the
importance of human rights for people with mental
illness