Contents

Treatment Settings 00 Psychiatric Rehabilitation Programs 00 Special Populations of Clients With Mental Illness 00 Interdisciplinary Team 00 Psychosocial Nursing in Public Health and Home Care 00 Self-Awareness Issues 00

Unit

Curr ent Theo ries and Pract ice

Foundations of PsychiatricMental Health Nursing

Mental Health and Mental Illness 00 Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) 00 Historical Perspectives of the Treatment of Mental Illness Mental Illness in the 21st Century 00 Psychiatric Nursing Practice 00 Self-Awareness Issues

2
Neurobiologic Theories and Psychopharmacology
The Nervous System and How It Works Brain Imaging Techniques 00 Neurobiologic Causes of Mental Illness The Nurses Role in Research and Education Psychopharmacology Cultural Considerations Self-Awareness Issues

00

3
Psychosocial Theories and Therapy
Psychosocial Theories Cultural Considerations Treatment Modalities The Nurse and Psychosocial Interventions Self-Awareness Issues

00

4
Treatment Settings and Therapeutic Programs

6
Therapeutic Communication
What Is Therapeutic Communication? 00 0 Verbal Communication Skills 0 Nonverbal Communication Skills 00 Understanding the Meaning of Communication Understanding Context 00 0 Understanding Spirituality 0 Cultural Considerations 00 The Therapeutic Communication Session 00 Community-Based Care 00 Self-Awareness Issues 00

00

Unit

00

Build ing the Nurs e Clien 7 t Clients Response to Illness Relati Individual Factors 00 onshi Interpersonal Factors 00 Cultural Factors 00 p
Self-Awareness Issues 00

00

Therapeutic Relationships Assessmen Components of a Therapeutic Relationship t

Types of Relationships Factors Influencing Assessment 00 Establishing the Therapeutic Relationship How to Conduct the Interview 00 Avoiding Behaviors That Diminish the Content of the 00 Therapeutic Relationship Assessment Data Analysis 00 Relationship Roles of the Nurse in a Therapeutic Self-Awareness Issues 00 Self-Awareness Issues

00

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xiv

Contents

Unit 3

Current Social and Emotional Concerns

Legal and Ethical Issues

Legal Considerations 00 Ethical Issues 00 Self-Awareness Issues 00

00

10
Anger, Hostility, and Aggression
Onset and Clinical Course 00 Related Disorders 00 Etiology 00 Cultural Considerations 00 Treatment 00 Application of the Nursing Process Community-Based Care 00 Self-Awareness Issues 00

00

Community-based Care 00 Mental Health Promotion 00 Panic Disorder 00 Application of the Nursing Process: Panic Disorder Phobias 00 Obsessive-Compulsive Disorder 00 Application of the Nursing Process: Obsessive-Compulsive Disorder 00 0 Generalized Anxiety Disorder 0 Posttraumatic Stress Disorder 00 Acute Stress Disorder 00 Self-Awareness Issues 00

00

14
Schizophrenia
00 Clinical Course 00 Related Disorders 00 Etiology 00 Cultural Considerations 00 Treatment 00 Application of the Nursing Process Community-Based Care 00 Mental Health Promotion 00 Self-Awareness Issues 00

00

11
Abuse and Violence
Clinical Picture of Abuse and Violence 00 Characteristics of Violent Families 00 Cultural Considerations 00 Spouse or Partner Abuse 00 Child Abuse 00 Elder Abuse 00 Rape and Sexual Assault 00 Community Violence 00 Psychiatric Disorders Related to Abuse and Violence Application of the Nursing Process 00 Self-Awareness Issues 00

00

00

15
Mood Disorders and Suicide
Categories of Mood Disorders 00 Related Disorders 00 Etiology 00 Cultural Considerations 00 Major Depressive Disorder 00 Application of the Nursing Process: Depression 00 Bipolar Disorder 00 Application of the Nursing Process: Bipolar Disorder Suicide 00 Community-Based Care 00 Mental Health Promotion 00 Self-Awareness Issues 00

00

00

12
Grief and Loss
Types of Losses 00 The Grieving Process 00 Dimensions of Grieving 00 Cultural Considerations 00 Disenfranchised Grief 00 Complicated Grieving 00 Application of the Nursing Process Self-Awareness Issues 00

00

00

16
Personality Disorders
00 Categories of Personality Disorders 00 Onset and Clinical Course 00 Etiology 00 Cultural Considerations 00 Treatment 00 Paranoid Personality Disorder 00 0 Schizoid Personality Disorder 0 Schizotypal Personality Disorder 00 Antisocial Personality Disorder 00 Application of the Nursing Process: Antisocial Personality Disorder 00 Borderline Personality Disorder 00 Application of the Nursing Process: Borderline Personality Disorder 00 Histrionic Personality Disorder 00 Narcissistic Personality Disorder 00 Avoidant Personality Disorder 00 Dependent Personality Disorder 00

00

Unit 4
Nursing Practice for Psychiatric Disorders

Anxiety and Anxiety Disorders

Anxiety as a Response to Stress Incidence 00 Onset and Clinical Course 00 Related Disorders 00 Etiology 00 Cultural Considerations 00 Treatment 00 00

13

00

Obsessive-Compulsive Personality Disorder 00 Depressive Personality Disorder 00 Passive-Aggressive Personality Disorder 00

Contents
Community-Based Care Mental Health Promotion Self-Awareness Issues 0 0 00 00

xv

Community-Based Care 00 Mental Health Promotion 00 Self-Awareness Issues 00

17
Substance Abuse
Types of Substance Abuse 00 Onset and Clinical Course 00 Related Disorders 00 Etiology 00 Cultural Considerations 00 Types of Substances and Treatment 00 Treatment and Prognosis 00 Application of the Nursing Process 00 Community-Based Care 00 Mental Health Promotion 00 Substance Abuse in Health Professionals 00 0 Self-Awareness Issues 0

20
00 Child and Adolescent Disorders
Autistic Disorder 00 0 Retts Disorder 0 Childhood Disintegrative Disorder 00 Aspergers Disorder 00 Attention Deficit Hyperactivity Disorder 00 0 Application of the Nursing Process: ADHD 0 0 Conduct Disorder 0 Application of the Nursing Process: Conduct Disorder Community-Based Care 00 mental health promotion 00 Oppositional Defiant Disorder 00 Pica 00 Rumination Disorder 00 Feeding Disorder 00 Tourettes Disorder 00 Chronic Motor or Tic Disorder 00 Separation Anxiety Disorder 00 0 Selective Mutism 0 Reactive Attachment Disorder 00 Stereotypic Movement Disorder 00 Self-Awareness Issues 00

00

00

18
Eating Disorders
Overview of Eating Disorders 00 Etiology 00 Cultural Considerations 00 Treatment 00 Application of the Nursing Process Community-Based Care 00 Mental Health Promotion 00 0 Self-Awareness Issues 0

00

00

21
Cognitive Disorders 00
00 Delirium 00 Application of the Nursing Process: Delirium Community-Based Care 00 Dementia 00 Application of the Nursing Process: Dementia Community-Based Care 00 mental health promotion 00 Role of the Caregiver 00 Related Disorders 00 Self-Awareness Issues 00 00

19
Somatoform Disorders
Overview of Somatoform Disorders Onset and Clinical Course 00 Related Disorders 00 Etiology 00 Cultural Considerations 00 Treatment 00 Application of the Nursing Process

00

00

00

Preface
understand. They highlight and empha-size important material to facilitate student learning. This text The uses the nursing second process edition framework and of emphasizes Psychia assessment, tric therapeutic Mental communication, Health neurobiologic Nurs- theory, and ing pharmacology continu throughout. es toInterventions have focus on all students aspects of client as thecare, in-cluding primary communication, focus. Itclient and family presents teaching, and sound community nursing resources, and theory, their practical therape appli-cation in utic various clinical modal- settings. ities, and clinical Organization applicat of the Text ions Unit 1: Current across Theories and the Practice provides treatme a strong nt foundation for continu students. It um. addresses current Chapter issues in s arepsychiatric short, tonursing, as well as the the many point, treatment settings and in which nurses easy toencounter clients. read It discusses and neurobiologic

theories students to begin working with and psycho clients both in health phar- mental macolo settings and in all gy andother areas of psychos nurs-ing practice. ocial The chapter on clients theories the response to illness and a therapy provides for thoroug framework hly as aunderstanding the basis individual client. An entire chapter for underst is devoted to asanding sessment, mental emphasizing its in illness importance nursing. and its Unit 3: treatme Current Social nt. and Emotional Concerns covers Un it 2: topics that are not to Buildin exclusive mental health g the Nurse settings, including Client legal and ethical anger, Relatio issues; aggression, and nship abuse presents hostility; and violence; and the basic grief and loss. element Nurses in all practice settings s essentia find themselves l to theconfronted with practice issues related to these topics. of mental Additionally, health many legal and nursing. ethical concerns interwoven Chapter are s onwith issues of therape violence and loss. utic relation ships and therape utic commu nication prepare

U nit 4: Nursin g Practic e for Psychi atric Disorders covers all the major categor ies identifi ed in the DSMIV-TR. Each chapter provide s current informa -tion on etiolog y, onset and clinical course, treatme nt, and nursing care.

New Featu res in the Seco nd Editi on

0 A

new cha pter on Leg al and Ethi cal Issu es addres ses som e curr ent dile mm as in psyc hiatr ic nurs ing toda y. 0 Sect ions on Men tal Hea lth Pro moti on in Unit s 3 & 4 incl ude the lates t rese arch . 0 Add ition al NC LE

X Gui de st secti y ons. l 0 Upd e ates m in u phar lt mac i olog p y l incl e ude new c drug h s o curr i entl c y e bein q g u teste e d and s FD A ti Blac o k n Box s War a ning r s for e psyc f hotr o opic u med n icati d ons. i 0 Add n ition t al h artw e ork C illus h trate a s p key t term e s r and S con t cept u s. d y Pedagogical

Featu res
Psychia tric Mental Health Nursin g incorpo rates several pedago gical features designe d to facilitat e student learning : 0 L e a r n i n g O b j e c ti v e s t o f o c u s t h e st u d e n t

s read -ing and stud y 0 Key Ter ms that iden tify new term s used in the cha pter. Eac h term is iden tifie d in bold and defi ned in the text. 0 App licat ion of the nurs ing proc ess usin g the assess men t fra me wor k pres ente

d i n C h a p t e r 8 , s o st u d e n ts c a n c o m p a r e a n d c o n tr a st t h e v a ri o u s d is o r d e r s

mor e easil y 0 Criti cal thin king ques tion s to stim ulat e student s thin king abo ut curr ent dile mm as and issu es in men tal heal th 0 Key poin ts that sum mari ze cha pter cont ent to rein forc e imp orta nt con cept s 0 Cha pter

S t u d y G u i d e s t h a t p r o v i d e w o r
ix

kbo okstyl e ques tion s for stud ents to test their kno wledg e and und erst andi ng of each cha pter

PREFACE

To the Student

Special Features
0

0 0

0 0

0 0 0

This textbook has been written for you. Above all, it is designed to be student-friendly. Chapters are easy to read Clinical vignettes are provided for each majorand understand, and pertinent infor-mation about caring for disorder discussed in the text to paint a pic-clients is presented in a practical, hands-on approach. Mental health nurs-ing is an exciting and challenging field, and hopeture for better understanding. Drug alerts highlight essential points aboutfully that attitude comes through in this text. The knowledge and skills you develop while studying mental health nursing psychotropic drugs. Cultural considerations are emphasized in awill promote your growth as a nurse and improve the care separate section of each chapter in response toyou provide to clients in all settings. increasing diversity. Therapeutic dialogues give specific examples of nurseclient interaction to promote thera- In addition to the text itself, we are including a free CDROM in the back of the book. This CD contains an interactive peutic communication skills. Internet resources with URLs are located at theCase Study on Anxiety, helpful additional NCLEX review end of each chapter to further enhance study. questions, view guides to accompany films depicting Client and family education checklists arecommon psychiatric disorders, and printable psychotropic highlighted to strengthen students roles asdrug monographs. Also, for more psychiatric-related materials to enhance your learning, be sure to visit educators. Symptoms and interventions are highlighted forhttp://connection.lww.com all chapters in Units 3 and 4. Sheila L. Videbeck, PhD, RN Sample nursing care plans are provided for all chapters in Units 3 and 4. Self-awareness feature at the end of each chapter encourages students to reflect upon themselves, their emotions, and their attitudes as a way to foster both personal and professional development.

To the Faculty
The following ancillary materials have been pre-pared to help you plan class and clinical learning activities, and evaluate students learning: 0 Instructors Resource Manual will include a variety of instructional support features for each chapter, including chapter summa-ries, lecture outlines, and teachinglearning strategies that involve classroom, clinical, and selfawareness activities. In addition, guide-lines are provided for leading class discussion relating to Critical Thinking Questions in-cluded in the textbook. Transparency masters provide summary lists of symptoms, interven-tions, and Client and Patient Teaching check-lists for each of the 12 disorder chapters. 0 CD-ROM, included in the Instructors Resource Manual, contains: 0 Testbank containing 350 NCLEXstyle test-ing items 0 Lecture outlines for each chapter 0 Powerpoint slide presentation

Contributor
Chapter 12 Charlotte M. Spade, MS, RN, CS
Associate Professor of Nursing Community College of Denver Denver, Colorado

vii

Reviewers
Nursing and Director, Center for Nursing Scholarship Georgia Southern University School of Nursing Linda Barratt, Statesboro, RN, BA, MA Georgia Instructor British Columbia Lesly Curtis, RN, Institute of BS, MS, MA Technology Burnaby, British Assistant Professor of Clinical Nursing Columbia, Director, Entry to Canada Practice Program Columbia University Carolyn R. school of Nursing Pierce Buckelew, BSN,New York, New York
MA, APN, RNCS,

NCC, ChP

Pamela Farley,
RN, PhD

Nursing Instructor CE Gregory School of Nursing Raritan Bay Medical Center Perth Amboy, New Jersey

Professor and Chairperson Berea College Berea, Kentucky

Lucindra Campbell,
MSN, APNP

Assistant Professor of Nursing Houston Baptist University Houston, Texas

Pattie Garrett Clark, RN, MSN

Associate Professor and Nursing Outreach Coordinator

Abraham Baldwin College Tifton, Georgia

Carol Cornwell, PhD,

MS, RN, CS

Assistant Professor of

Canton, Ohio

Alice Grady, MSN,

RN, FNP

Assistant Professor Nursing Department Tennessee Wesleyan College, Fort Sanders Suzette Knoxville, Farmer, RN, MS Tennessee
Assistant Professor, Mary Ann Helms, Assistant MSN, MRE, RN Program Director Assistant Professor

Utah Valley State College Orem, Utah

Cynthia Foust, PhD, RN

Tennessee State University School of Nursing Nashville, Tennessee

Associate Barbara A. Jones, Professor DNSc, RN Division of Associate Professor Nursing School of Nursing Southwestern Gwynedd-Mercy Oklahoma State College University Gwynedd Valley, Weatherford, Pennsylvania Oklahoma

Nancy G. McAfee, Judith A. MSN, RN Gardner, MSN, Program Director,

RN, CNS

Full-Time Nursing Faculty and Consultant Stark State College

Upward Mobility Program Lamar State College Orange Orange, Texas

vi

REVIEWERS

Elaine Mordoch, RN, BN, MN

Lecturer, Faculty of Nursing University of Manitoba Winnipeg, Manitoba, Canada

Charlotte D. Taylor RN, MSN

Associate Professor of Nursing University of ArkansasMonticello Monticello, Arkansas

Susan R. Seager, RN, MSN, EdD

Associate Professor, Nursing Tennessee State University School of Nursing Nashville, Tennessee

Arlene Wandel Zawadzki, MS, RN, CS, HNC

Part-time Instructor Niagara County Community College Sanborn, New York

Margaret R. Swisher, RN, MSN

Assistant Professor of Nursing Montgomery County Community College Blue Bell, Pennsylvania

Unit 1
Current Theories

and Practice

1
Learning Objectives
After reading this chapter, the student should be able to

1. Describe characteristics of mental health and mental illness. 2. Discuss the purpose and use of the Diagnostic and Statistical Manual of Mental Disorders (DSMIV-TR). 3. Identify important historical landmarks in psychiatric care. 4. Discuss current trends in asylum the treatment of people case management with mental illness. deinstitutionalization 5. Discuss the American Nurses Association stan- Diagnostic and Statistical dards of practice for Manual of Mental psychiatric-mental health Disorders (DSM-IV-TR) nursing. 6. Describe common studentmanaged care concerns about psychiatricmanaged care organizations nursing.

Foundations of PsychiatricMental Health Nursing

Key Terms

mental disorder mental health

phenomena of concern psychotropic drugs revolving door self-awareness standards of care

utilization review firms

FOUNDATIONS OF PSYCHIATRIC -MENTAL HEALTH NURSING

responsibilities, function As you begin the study ofeffec-tively in daily life, and psychiatric-mental healthare satisfied with their internursing, you may be excited,personal relationships and uncertain, and even a littlethemselves. anxious. The field of mental No single, universal health often seems a little unfamiliar or mysterious, making definition of mental health it hard to imagine What is thisexists. Generally a persons experience going to be like? orbehavior can provide clues to What does a nurse do in thishis or her mental health. area? This chapter ad-dressesBecause each person can have different view or these and other questions bya providing an overview of theinterpretation of behavior history of mental illness,(depending on his or her advances in treatment, currentvalues and beliefs), the deissues in mental health, and thetermination of mental health may be difficult. In most role of the psychiatric nurse. cases, mental health is a state of emotional, psycho-logical, and social wellness evidenced MENTAL HEALTH by satisfying interpersonal AND MENTAL ILLNESS relationships, effective Mental health and mental illnessbehavior and coping, positive are difficult to de-fine precisely.self-concept, and emotional People who can carry out theirstabil-ity. Mental health has roles in society and whosemany components, and a wide behavior is appropriate and adap-variety of factors influence it tive are viewed as healthy.(Mohr, 2003): Conversely those who fail to 0 Autonomy and fulfill roles and carry out independence: responsibilities or whose The person can behavior is inappropriate are look within for viewed as ill. The cul-ture of any guiding values society strongly influences its and rules by values and beliefs, and this in which to live. turn affects how that society deHe or she fines health and illness. What considers the one society may view as opinions and acceptable and appropriate, wishes of others another society may see as but does maladaptive or inappropriate. not allow them to dictate decisions and behavior. The person Mental Health who is autonomous and independent can The World Health Organization (WHO) defines health as a state work interdependently of complete physical, mental, and social wellness, not merely the absence of disease or infirmity. This definition emphasizes health as a pos-itive state of well-being, not just absence of disease. People in a state of emotional, physical, and social well-being fulfill life

tation. He or she uses support or cooperatively with from family and others without losing friends to cope his or her autonomy. 0 Maximization of with crises, ones potential: knowing that The person is the stress will oriented toward not last forever. growth and selfThese factors constantly actualization. He interact; thus, a persons or she is not content with the mental health is a dynamic or ever-changing state. status quo and Factors influencing a continually strives persons mental health can be to grow as a categorized as individual, person. and so0 Tolerance of interpersonal, cial/cultural. Individual factors lifes include a persons biologic uncertainties: The person can makeup, sense of harmony in face the life, vitality, ability to find challenges of meaning in life, emotional or hardiness, day-to-day living resilience and positive with hope and a spirituality, positive outlook identity (Seaward, 1997). despite not Interpersonal factors include communication, knowing what effec-tive ability to help others, lies ahead. 0 Self-esteem: The intimacy, and a balance of person has a separateness and connection. realistic aware- Social/ cultural factors include ness of his or her a sense of community, access adequate resources, abilities and to intolerance of violence, and limitations. support of diversity among 0 Mastery of the Individual, interenvironment: The people. personal, and social/cultural person can deal with and influence factors are discussed in the environment in Chapter 7. a capable, competent, and creative manner. 0 Reality orientation: The person can distinguish the real world from a dream, fact from fantasy, and act accordingly. 0 Stress management: The person can tolerate life stresses, appropriately handle anxiety or grief, and experience failure without devas-

Mental Illness
The American Psychiatric Association (APA, 2000) defines a mental disorder as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disabil-ity (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss

of freedom (p. xxxi). General in-effective or nonsatisfying criteria to diagnose mentalrelationships; dissatisfac-tion disorders include dissatisfactionwith ones place in the world; with ones characteristics,ineffective coping abilities, and accomplishments;

Unit 1

CURRENT THEORIES AND PRACTICE

with life events; and lack of personal growth. In ad-dition, the The DSM-IV-TR has three purposes: persons behavior must not be culturally expected or 0 To provide a standardized nomenclature and sanctioned, nor does deviant behavior necessarily indicate a language for all mental health professionals mental disorder (APA, 2000). 0 To present defining characteristics or symptoms that differentiate specific diagnoses Factors contributing to mental illness also can be viewed within individual, interpersonal, and social/ cultural 0 To assist in identifying the underlying categories. Individual factors include bio-logic makeup, causes of disorders anxiety, worries and fears, a sense of disharmony in life, and A multi-axial classification system that involves a loss of meaning in ones life (Seaward, 1997). Interpersonal assessment on several axes, or domains of informa-tion, factors include in-effective communication, excessiveallows the practitioner to identify all the factors that relate to dependency or withdrawal from relationships, and loss ofa persons condition: 0 Axis I is for identifying all major psychiatric emotional control. Social and cultural factors include lack of disorders except mental retardation and re-sources, violence, homelessness, poverty, and discrimpersonality disorders. Examples include ination such as racism, classism, ageism, and sexism. depression, schizophrenia, anxiety, and substance-related disorders. DIAGNOSTIC AND STATISTICAL 0 Axis II is for reporting mental retardation MANUAL OF MENTAL DISORDERS and personality disorders as well as promi(DSM-IV-TR) nent maladaptive personality features and defense mechanisms. The Diagnostic and Statistical Manual of Men-tal 0 Axis III is for reporting current medical Disorders-Text Revision (DSM-IV-TR), now in its fourth conditions that are potentially relevant to edition, is a taxonomy published by the APA. The DSM-IVunderstanding or managing the persons mental TR describes all mental dis-orders, outlining specific disorder as well as medical condi-tions that diagnostic criteria for each based on clinical experience and might contribute to understanding the person. research. All mental health clinicians who diagnose psychiatric disorders use the DSM-IV-TR. 0 Axis IV is for reporting psychosocial and environmental problems that may affect the diagnosis, treatment, and prognosis of men-tal disorders. Included are problems with primary support group, social environment, education, occupation, housing, economics, access to health care, and legal system. 0 Axis V presents a Global Assessment of Functioning (GAF), which rates the persons overall psychological functioning on a scale of 0 to 100. This represents the clinicians assessment of the persons current level of functioning; the clinician also may give a score for prior functioning (for instance, high-est GAF in past year or GAF 6 months ago). All clients admitted to a hospital for psychi-atric treatment will have a multi-axis diagnosis from the DSM-IVTR. Although student nurses do not use the DSM-IV-TR to diagnose clients, they will find it a helpful resource to understand the rea-son for the admission and to begin building knowl-edge about the nature of psychiatric illnesses.

HISTORICAL PERSPECTIVES OF THE TREATMENT OF MENTAL ILLNESS Ancient Times

People of ancient times believed that any sickness indicated displeasure of the gods and in fact was punishment for sins and wrongdoing. Those with mental

Demons

FOUNDATIONS OF PSYCHIATRIC -MENTAL HEALTH NURSING

ing the inmates, who were disorders were viewed as beingseen as animals, less than either divine or de-monichuman (McMillan, 1997). depending on their behavior. During this same period in the Individuals seen as divine werecolonies (later the United worshipped and adored; thoseStates), the mentally ill were seen as demonic were ostracized,considered evil or possessed punished, and sometimes burnedand were pun-ished. Witch at the stake. Later Aristotlehunts were conducted, and (382322 BC) at-tempted to relateoffenders were burned at the mental disorders to physical dis-stake. orders and developed his theory that the amounts of blood, water, and yellow and black bile in the Period of body controlled the emotions. These four substances, orEnlightenment and humors, corresponded withCreation of Mental happiness, calmness, anger, andInstitutions sadness. Imbalances of the fourIn the 1790s, a period of humors were believed to causeenlightenment concerning mental disorders, so treatment persons with mental illness aimed at restoring balance began. Phillippe Pinel in through bloodletting, starv-ing,France and William Tukes in and purging. Such treatments England formulated the persisted well into the 19thconcept of asylum as a safe century (Baly, 1982). refuge or haven of-fering protection at institutions where In early Christian times (1people had been whipped, 1000 AD), primitive beliefs andbeaten, and starved just superstitions were strong. Allbecause they were mentally ill diseases were again blamed on(Gollaher, 1995). With this demons, and the mentally illmove-ment began the moral were viewed as possessed.treatment of the mentally ill. Priests performed exor-cisms toIn the United States, Dorothea rid evil spirits. When that failed,Dix (18021887) began a they used more severe measurescrusade to reform the such as incarceration in dun-treatment of mental illness geons, flogging, starving, andafter a visit to Tukes other brutal treatments. institution in England. She During the Renaissance was instrumental in opening (13001600), people with mental32 state hospitals that offered illness were distinguished fromasylum to the suffering. Dix criminals in England. Thosebelieved that so-ciety was considered harmless wereobligated to those who were allowed to wander thementally ill countryside or live in rural communities, but the more dangerous lunatics were thrown in prison, chained, and starved (Rosenblatt, 1984). In 1547, the Hospital of St. Mary of Bethlehem was of-ficially declared a hospital for the insane, the first of its kind. By 1775, visitors at the institution were charged a fee for the privilege of viewing and ridicul-

1950 with the development of and promoted adequate shelter, psychotropic drugs (drugs used to treat mental illness). nutritious food, and warm Chlor-promazine (Thorazine), clothing (Gollaher, 1995). The period of enlightenmentan antipsychotic drug, and was short-lived. Within 100lithium, an antimanic agent, years after establishment of thewere the first drugs to be first asy-lum, state hospitals weredeveloped. Over the following in trouble. Attendants were10 years, mono-amine oxidase antidepressants; accused of abusing the residents, inhibitor haloperidol (Haldol), an the rural location of hospitals antipsychotic; tricyclic was viewed as isolating patients and from fam-ily and their homes,antidepressants; antianxiety agents called and the phrase insane asylum were took on a negative connotation. benzodiazepines introduced. For the first time, drugs actually reduced Sigmund Freud and agitation, psychotic thinking, Treatment and depression. Hos-pital stays of Mental Disorders were shortened, and many The period of scientific studypeople were well enough to go and treatment of men-talhome. The level of noise, disorders began with Sigmundchaos, and violence greatly Freud (18561939) and othersdiminished in the hospital such as Emil Kraepelin (1856setting (Trudeau, 1993). 1926) and Eugene Bleuler (18571939). With these men, the study of psychiatry and theMove Toward diagnosis and treatment ofCommunity mental illnesses started in Mental Health earnest. Freud challenged society to view human beingsThe movement toward treating objectively. He studied the mind,those with mental ill-ness in its disorders, and their treatment less restrictive environments as no one had before. Many othergained momen-tum in 1963 theorists built on Freuds pi-with the enactment of the oneering work (see Chap. 3).Community Mental Health Act. Kraepelin began classi-fyingCenters a mental disorders according toDeinstitutionalization, shift from their symptoms, and Bleulerdeliberate coined the term schizophrenia. institutional care in state hospitals to community facilities, began. Community men-tal Development of health centers served smaller Psychopharmacology geographic catch-ment (service) areas that provided A great leap in the treatment of mental illness began in aboutless restrictive

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