Chapter 1

Introduction to Psychiatric Nursing

Psychiatric-Mental Health Nurses Association of the Philippines, Inc. (PMHNAP)

Learning Objective

Explain the history of psychiatry in the Philippines as a foundation for current psychiatric nursing practice.

Keltners Psychiatric Nursing Philippine edition

The Pre-Spanish Regime

Concept of physical or mental illness was based on the belief in such material and spiritual worlds. The treatment relied heavily on valid and authentic rituals and ceremonies. The Filipinos relied on their faith in healers like the babaylan (shaman) and sorcerers of healing.

Keltners Psychiatric Nursing Philippine edition

The Spanish Rule (1565 to 1898)

Filipinos believed that mental illness was caused by an act of sorcery. Santiago (1995) wrote that the mangkukulam (or the witches) pricked the heads of the antigua (voodoo dolls) with their magic pins, while the manggagaway (the devil men) solicited satanic powers that can cause the mental illness.

Keltners Psychiatric Nursing Philippine edition

The Spanish Rule (1565 to 1898)

Unwell individuals were treated by herbolarios (herbmen). They were also brought to the church for exorcism or purification. Some patients were wrapped with mats and whipped by bamboo sticks or the tail of buntot pagi (stinger fish). Those who suffered from hysteria were unexpectedly thrown into the river.

Keltners Psychiatric Nursing Philippine edition

The Spanish Rule (1565 to 1898)

The concept of mental illness as biological and psychological entities was acknowledged during this era. In the early nineteenth century, the Hospicio de San Jose established after the Spanish naval authorities requested for a place of confinement of their mentally ill sailors.

Keltners Psychiatric Nursing Philippine edition

The American Era (1898 to 1942)

The concept of mental illness was founded on the biomedical phenomenon. Treatments were scientific and mechanistic in approach. Also, the discovery of somatic therapies strengthened the biological explanation of psychiatric illness. Several treatment centers for mentally ill individuals in the Philippines were established.
Keltners Psychiatric Nursing Philippine edition

The American Era (1898 to 1942)

Early 1900s: Two American physicians provided treatment for mentally ill patients of the Civil Hospital located on Calle Iris (now known as Claro M. Recto Avenue). 1904: The Insane Department at San Lazaro Hospital was opened for mentally ill patients, with Dr. Elias Domingo as its head unit. He was assisted by Filipino and American nurses who were trained in psychiatric nursing care.
Keltners Psychiatric Nursing Philippine edition

The American Era (1898 to 1942)

1918: The City Sanitarium was erected in order to provide psychiatric treatment solely for Manila residents. 1928: The Insular or National Psychopathic Hospital (NPH) was erected in Mandaluyong, Rizal. This was the first hospital that catered exclusively to the treatment of mentally ill patients in the Philippines. Manic patients were treated with fever therapy, metrazole shock, insulin shock therapy, prolonged narcosis, R1651 hyoscine injections (bromides), and hydrotherapy.
Keltners Psychiatric Nursing Philippine edition

The American Era (1898 to 1942)

Schizophrenic patients were also given Locks sol or insulin injections. Patients with general paresis, a syphilitic dementia, were given fever therapy, tryparsamide, and neo-salversamized serum. Patients who had epilepsy were given phenobarbital, magnesium sulfate, spinal drainage, and ketogenic diet. Depressed patients were given Locks Sol, barbiturates and electroshock treatment.
Keltners Psychiatric Nursing Philippine edition

The Japanese Occupation (1942 to 1945)

The NPH continued to operate though many of its patients were fetched and taken home by their families. Unfortunately, a number of patients were left in small rooms and died from starvation and lack of medicines.

Keltners Psychiatric Nursing Philippine edition

The Japanese Occupation (1942 to 1945)

The Japanese Imperial Army before they left the NPH donated an electroshock apparatus. This apparatus was a big help to the patients and it was a real breakthrough in their treatment. Since then, the electroshock treatment became the principal and famous treatment modality. The use of local medicinal plants and products and the practice of self-denial and fortitude were also promoted.
Keltners Psychiatric Nursing Philippine edition

The Liberation Period and the Era of the Republic (1945 to 1960)
With the return of the Americans to the Philippines, the development and growth in the treatment of the mentally ill patients began. They helped in providing the immediate needs for the rehabilitation, expansion of psychiatric facilities, and training of hospital personnel. Moreover, training in psychiatry for medical personnel and psychiatric care for patients were more facilitated and made available.

Keltners Psychiatric Nursing Philippine edition

The Liberation Period and the Era of the Republic (1945 to 1960)
It was during this period when the National Psychopathic Hospital (NPH) was renamed National Mental Hospital (NMH) with Dr. Jose Fernandez as the officer-in-charge from October 1946 to April 1961. Recognizing the need to improve the basic services for patients, he required the development of infrastructure with the construction of an infirmary and additional building to house for nonpaying and paying patients.
Keltners Psychiatric Nursing Philippine edition

The Liberation Period and the Era of the Republic (1945 to 1960)
Recognizing the growing need for the management of mentally ill patients, other institutions and agencies in the country set up their own treatment centers and programs. 1946: The V. Luna General Hospital, which rendered services to the Armed Forces of the Philippines, established a neuropsychiatry service. Electroconvulsive therapy, insulin therapy, and narcoanalysis were the initial modes of treatment.
Keltners Psychiatric Nursing Philippine edition

The Liberation Period and the Era of the Republic (1945 to 1960)
1947: The University of Santo Tomas opened a Section of Neurology and Psychiatry, with Dr. Leopoldo Pardo as its chief. 1947: The Philippine Mental Health Association was founded by Drs. Eduardo Krapf, Toribio Joson, and Manuel Arguelles. 1956: The University of the East Ramon Magsaysay Memorial Medical Center established a Department of Psychiatry headed by Dr. Jaime Zaguirre.

Keltners Psychiatric Nursing Philippine edition

The Liberation Period and the Era of the Republic (1945 to 1960)
1968: The Philippine General Hospital of the University of the Philippines established its own neuropsychiatry section headed by Dr. Baltazar Reyes, Jr. The emphasis of treatment for the mentally ill was psychotherapy and chemotherapy. Psychoanalysis gained its popularity that the general public often equated it with psychiatry. However, despite this dominance of the psychoanalytic treatment, the biological orientation continues to maintain its position.
Keltners Psychiatric Nursing Philippine edition

The Liberation Period and the Era of the Republic (1945 to 1960)
Insulin coma in schizophrenia and electric shock in depression were commonly used. Psychopharmacology changed the practice of psychiatry in 1953. The use of chlorpromazine has apparently shortened the hospital stay of psychotic patients. Most importantly, its use facilitated the early discharge and early reintegration of patients to their families in the community.

Keltners Psychiatric Nursing Philippine edition

Present Day Psychiatry (1960 to Present)

The use of somatic therapies became most popular. In the early 1960s, the following drugs for the treatment of mental disorders were introduced: Lithium, for mania Benzodiazepines, for nonpsychotic anxiety Imipramine-like drugs and monoamine oxidase inhibitors, for depression and severe states of anxiety Serotonin-specific reuptake inhibitor and serotoninnorepinephrine reuptake inhibitors, for depression
Keltners Psychiatric Nursing Philippine edition

Present Day Psychiatry (1960 to Present)

During the same period, other forms of antipsychotic agents known as atypical antipsychotics were introduced in the treatment of mental disorders. These medications have the advantage of causing few side effects compared to other forms of medication being used. In later years, other forms of somatic treatment were considered obsolete except electroconvulsive therapy.

Keltners Psychiatric Nursing Philippine edition

Present Day Psychiatry (1960 to Present)

The thrust in psychiatrys movement and attention have now focused on interventions for people who are not necessarily suffering from mental illness. The growing interest in psychiatry is geared toward assisting individual or group of individuals who are vulnerable to develop mental health disturbances. These are people who are victims of either domestic or nondomestic violence, victims of disaster, abandoned children, overseas workers, and others.
Keltners Psychiatric Nursing Philippine edition