Let’s explore the History of Psychiatric Nursing. In ancient times, people with mental illnesses were not recognized as having a medical condition but were often seen as possessing supernatural and magical powers and were ostracized. Therefore, those with mental illnesses in early history faced harsh treatments and were not treated humanely. We will look into the history that led to the current forms of psychiatric care.
1. Historical Overview of Psychiatric Nursing
First, let’s look at the historical overview of psychiatric nursing. In ancient times, mental illness was perceived as the absence of the soul or due to supernatural forces, and over time, it started to be seen as a medical condition.
1) Ancient Concepts of Mental Illness: The Alteration of the Soul
In ancient times, it was believed that people with mental illnesses had lost their souls, and the only way to recover was to regain the soul.
In some cultures, it was believed that evil spirits and supernatural, magical powers had entered the body, so treatments for the mentally ill often involved painful methods like flogging and starvation.
In other cultures, people with mental illnesses were considered to have broken taboos or sinned against others or gods, requiring purification of the soul. Mental illnesses were associated with demons and magic, and sufferers could even be executed by burning.
2) Hippocrates: The Interaction of the Four Humors
As knowledge about mental illness increased and cultural, religious, and socio-political attitudes changed, understanding of mental diseases evolved.
Around 400 BCE, Hippocrates, known as the father of medicine from Greece, was the first to attribute mental illness to physical rather than supernatural causes.
He viewed mental derangement and mental illness as an imbalance among the four humors (blood, black bile, yellow bile, phlegm) which he referred to as ‘humors’ and related to specific temperaments.
Imbalances among these humors were thought to cause mental illness, and treatments often involved inducing vomiting or severe purgatives.
3) Medieval Concepts of Mental Illness
In Europe, during the Middle Ages (500–1500 AD), the association between magic, the supernatural, and mental illness continued. During this period, those with mental illness were sent to sea to find their lost minds, originating the term ‘Ship of Fools.’
In the medieval Islamic world in the East, there was a shift from viewing mental illness as a result of magic or supernatural causes to recognizing it as an actual illness.
This led to the creation of special spaces and residential facilities for the mentally ill, which can be considered the first psychiatric hospitals.
4) Evolution of Psychiatric Care in America
Colonial Americans reflected the attitudes of European society, particularly in New England during the witch trials, where behaviors believed to be magical were punished.
In the 16th and 17th centuries in America, there were no institutions for the mentally ill; care was the responsibility of families. Those without family or other resources were managed by the community, often confined in places where they could not harm themselves or others.
In the mid-18th century, the first hospital for the mentally ill was established in Philadelphia, with Benjamin Rush, known as the father of American psychiatry, as the attending physician.
He advocated for humane treatment and care, applying kindness, exercise, and socialization to treatments. However, contemporary treatments like bloodletting, violence, various forms of restraint, and extreme temperatures were also used.
5) Beginnings of Psychiatric Nursing
Linda Richards, known as the first American psychiatric nurse, graduated from a nursing program for women and children at New England Hospital in Boston in 1873.
She played a significant role in establishing the first psychiatric nursing school in 1882 at the McLean Hospital in Massachusetts Waverly.
The focus of the psychiatric school was on training how to provide custodial care to psychiatric patients without including psychological concepts. In 1955, psychiatric nursing courses were included as requirements for undergraduate nursing students.
The new nursing curriculum emphasized the importance of the nurse-patient relationship and therapeutic communication skills. Nursing interventions for physical therapies (insulin therapy, electroconvulsive therapy) served as catalysts for incorporating these concepts into the nursing knowledge system.
After World War II, as the demand for psychiatric nursing increased, the U.S. government passed the National Mental Health Act in 1946, providing funds for the education of psychiatrists, psychologists, social workers, and psychiatric nurses.
During this period, graduate-level education for psychiatric nursing was established, and with the introduction of antipsychotic drugs, psychiatric patients could receive treatment more easily in conjunction with nursing care.
2. History of Psychiatric Nursing in Korea
The history of psychiatric nursing in Korea began with the introduction of Western medicine during the Japanese colonial rule, when the Government-General established psychiatric wards and began nursing psychiatric patients for the first time.
At that time, nursing was primarily focused on the safety management and protection of patients. In 1953, with the development of antipsychotic drugs, nursing evolved from protective care to include treatments like insulin coma therapy, electroconvulsive therapy, patient observation, and medication administration.
After the mid-1960s, influenced by American psychiatry, environmental therapy and activity therapy were introduced, and nurses began to play a therapeutic role by applying the nursing process.
In 1995, with the enactment of the Mental Health Act, a psychiatric nursing training program requiring 150 theoretical hours and 850 practical hours was established. In 2004, the system was revised to create a qualification process for psychiatric specialist nurses.
After the Mental Health Act was enacted, Korea also shifted from hospital-based treatment and management of psychiatric patients to a community mental health concept. In 2004, the Psychiatric Nurses Association was established under the Korean Nurses Association.
3. Current Thoughts on Psychiatric Nursing
Looking at the history of psychiatric nursing, it is clear that the human rights of psychiatric patients have gradually improved. However, the extent to which human rights are recognized in current psychiatric medical treatments can vary depending on perspective.
Before considering human rights, the quality of treatment and nursing needs to improve, which requires adequate staffing and a stable environment. However, psychiatric treatment in hospitals in Korea is challenging to manage economically.
For this reason, university hospitals tend to avoid operating psychiatric wards. The economic benefits do not outweigh the staffing requirements, which can make it difficult to maintain a high number of staff and thus potentially lower the quality of treatment and care.
Depending on the size of the hospital, the form of treatment and nursing for patients can vary, so those seeking psychiatric treatment should consider this.
Psychiatric disorders can be broadly classified into two categories: psychosis and neurosis. Psychosis involves symptoms such as hallucinations and delusions due to a loss of reality testing, while neurosis can include anxiety, depression, and personality disorders.
Since psychosis involves a reduction in reality testing, pharmacological treatment should take precedence over psychotherapy, whereas neurosis can be primarily managed with psychotherapy, supplemented by pharmacological treatment.
4. Conclusion and Q&A
We have briefly explored the global and Korean histories of psychiatric nursing. In ancient times, mental illness was considered either a loss of soul or a magical state, but over time it transformed into a more professional form. Below, let’s look at some frequently asked questions and key points.
1) Can you briefly summarize the history of psychiatric nursing?
In ancient times, those with mental illnesses were seen as having lost their souls or being possessed by evil spirits, leading to painful treatments. As we moved into the Middle Ages, perceptions improved slightly, but it was not a significant improvement, and treatments often involved confining the mentally ill.
Over time, various facilities for the mentally ill were established, and treatments such as isolation, restraint, insulin therapy, and electrotherapy were conducted until the development of antipsychotic drugs allowed for the advancement of pharmacological treatments. In modern times, the human rights aspect for the mentally ill has improved, though the level can vary depending on the institution.
2) What is the process of psychiatric nursing history in Korea?
The history of psychiatric nursing in Korea began during the Japanese occupation, aligning with the introduction of Western medicine. Nursing evolved according to American treatment styles, but the professionalism of psychiatric nurses is still not fully recognized.
► Reference Sources and Recommended Reading
[Book] Psychiatric Mental Health Nursing 9th edition, History of Psychiatric Nursing Part / Mary C. Townsend∙Karyn I. Morgan, published by Hakjisa Medical
[Interview] Interview with a psychiatric ward nurse at OO University Hospital
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