Concepts of Mental Health

and Mental Illness

DR. JOHN CAMIL J. MAGNO, MA Ed, RN, LPT

MENTAL HEALTH
Health is a state of complete physical, mental and social well-
being not merely the absence of disease or infirmity. (WHO).
Mental health is described by WHO as: … a state of well-being in
which the individual realizes his or her own abilities, can cope
with the normal stresses of life, can work productively and
fruitfully, and is able to make a contribution to his or her
community
 Someone is mentally healthy when a person has a balance
between the integrated body, mind and spirit and the
environment.
 Mental health implies mastery in the in the areas of life
involving love, work and play. Some definitions include the
criterion of happiness
Components of mental health
Individual or personal factors
• Biologic make up
• Autonomy and independence
• Self esteem
• Capacity for growth
• Vitality
• Ability to find meaning in life
• Emotional resilience or hardness
• Sense of belonging
• Reality orientation
• Coping or stress management abilities
Components of mental health
Interpersonal or relationship factors
• Effective communication
• Ability to help others
• Intimacy
• Balance of separateness and connectedness
• Social cultural and environmental factors
• Sense of community
• Access to adequate resources
• Intolerance of violence
• Support of diversity among people
• Mastery of environment
• Positive yet realistic view of one’s world
Mental Illness or disorder
 State of imbalance characterized by disturbance in thought, feelings and
behaviour
 Clinically significant behavioural or psychological syndrome or pattern that
occurs in an individual and that is associated with present distress, disability
or with high risk of suffering pain, death or less of freedom
 Mental illness, also called mental health disorders, refers to a wide range
of mental health conditions — disorders that affect mood, thinking and
behavior that can affect the ability to relate to others and function each day.
 Mental distress – the mind expressing its discomfort through thoughts, feelings
and behavior
 Each of the mental disorders is conceptualized 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
disability (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.
Variables affecting Mental Health
 Individual factors
• Biologic make up
• Intolerable or unrealistic worries or fear
• Inability to distinguish reality from fantasy
• Intolerance of life uncertainties
• A sense of disharmony in life
• A loss of meaning in one’s life
Variables affecting Mental Health
 Interpersonal factors
• Ineffective communication
• Excessive dependency
• Withdrawal from relationships
• No sense of belonging
• Inadequate support
• Loss of emotional control
Variables affecting Mental Health
 Socio Cultural factors
• Lack of resources
• Violence
• Homelessness
• Poverty
• Unwanted negative view of the world
discrimination
Criteria for mental disorders
- Dissatisfaction with one’s characteristic, abilities and accomplishment
– Ineffective or unsatisfying interpersonal relationships

– Dissatisfaction with one’s place in the world

– Ineffective coping or adaptations to the events in one’s life as well as
lack of personal growth
Diagnostic and Statistical Manual of
Mental Disorders
1) Provide a standardized nomenclature and
language for all mental health
professionals.
2) To present defining characteristics or
symptoms that differentiate specific
diagnosis.
3) To assist in identifying the underlying cause
of disorders.
Multi Axial Classification System
• AXIS I for identifying all major psychiatric disorders except mental
retardation and personality disorders.
• AXIS II for reporting mental retardation and personality disorders as
well as prominent maladaptive personality features and defense
mechanism.
• AXIS III for reporting current medical conditions that are potentially
relevant to understanding or managing person’s mental disorder as well
as medical conditions that may contribute to understanding the person.
• AXIS IV for reporting psychosocial and environmental problems that
may affect the diagnosis treatment and prognosis of mental disorders. Ex
problems with primary support grp, social environment, education,
occupation, housing, economic access to health care and legal system.
• AXIS V this represents the clinicians assessment of the persons
current level of functioning
Definitions of mental disorders in the
DSM-5 consider these 5 factors:
 A behavioral or psychological syndrome or pattern that occurs in an individual
 Reflects an underlying psychobiological dysfunction
 The consequences of which are clinically significant distress (e.g., a painful
symptom) or disability (i.e., impairment in one or more important areas of
functioning)
 Must not be merely an expected response to common stressors and losses (ex.
the loss of a loved one) or a culturally sanctioned response to a particular
event (ex. trance states in religious rituals)
 Primarily a result of social deviance or conflicts with society
 Diagnostic and Statistical manual for mental health
 General Causes of Mental Illnesses
• Inherited traits

• Negative life experiences (traumatic)

• Environmental exposures before birth

– Viruses, toxins, alcohol or drugs

• Brain chemistry
– Hormonal imbalances
 Activity 1
1. What does mental health mean to you? Think about how you feel physically and
emotionally when you're feeling mentally well. What activities, relationships, or thoughts
contribute to your positive mental well-being?
2. How do you think mental health and physical health are connected? Have you ever
noticed how your mental state can impact your physical health, or vice versa? Can you give
an example of this connection?
3. What are some common mental health challenges that people face? Think about what
you've heard or learned about mental illness. What are some of the difficulties individuals
might experience?
4. How can you practice self-awareness in your daily life? What are some ways you can pay
attention to your thoughts, feelings, and behaviors? How can you learn to better
understand yourself?
5. What are some healthy coping mechanisms you can use when you're feeling stressed,
anxious, or overwhelmed? Think about activities or strategies that help you manage
difficult emotions. What works well for you?
Activity 1
• SWOT Analysis for Self-Awareness
•
S: Strengths
•
What are you good at? What are your talents, skills, and abilities?
• What do you excel in? What makes you unique?
• What positive qualities do you possess? (e.g., resilience, creativity, empathy)
• What are you proud of? What accomplishments have you achieved?
•
W: Weaknesses
•
What areas do you need to improve? What are your challenges or limitations?
• What skills or knowledge do you lack?
• What habits or behaviors hold you back? (e.g., procrastination, negativity)
• What are you less confident in? What areas do you struggle with?
•
O: Opportunities
•
What are your goals? What do you want to achieve?
• What new skills or knowledge could help you grow?
• What resources are available to you? (e.g., mentors, courses, support groups)
• What changes or trends could benefit you? (e.g., new technologies, evolving career fields)
•
T: Threats
•
What obstacles or challenges might hinder your growth?
• What external factors could negatively impact you? (e.g., competition, economic changes)
• What are your fears or anxieties? What holds you back from pursuing your goals?
• What negative influences or distractions might affect you? (e.g., social media, unhealthy relationships)
 Assignment
• Search on Mental Healthcare delivery of the Philippines and
highlight its milestones.
• Search on the historical perspectives of mental illness and
mental health (worldwide).
 Mental Healthcare
Delivery system in the
Philippines
Three Levels of care in the Health Care
System
1) Primary - The primary health care tier serves as a patient's first point of contact
with a health professional who can provide outpatient medical care
2) Secondary - The secondary health care includes referrals to psychologists
and psychiatrists where short hospital visits and consultation-liaison services
to other medical departments are made. Services includes assessment,
counselling, and/or prescription drugs
3) Tertiary - The tertiary health care includes referrals to psychiatric institutions if
the mental illness needs specialized care and more severe mental illness
would require more rehabilitation. In the Philippines, most psychiatrists are in
private practice, although some work in government institutions such as in the
National Center for Mental Health.
Importance of Mental Health in the
community
1) Belonging. Community provides a sense of belonging — a
group that one can identify as being a part of. A true sense
of belonging includes the ability to feel that one is a part of
the community that will embrace and appreciate a
person’s unique qualities.
2) Support. Community provide support in times of difficult
situations. Knowing there are people, GO’s or NGO’s in
the community who support you can help one feel safe
and cared for, safe resulting to a positive outlook on life.
3) Purpose. In community, people fill different roles. These
roles can give one a sense of purpose through bettering
other people’s lives. Having purpose, and helping others,
helps give meaning to life.
Institutions and other mental health
services in the Philippines
Both private and public groups maintain mental health
facilities and institutions in the Philippines but access to
them remains uneven throughout the country.
- Most facilities are located in the National Capital Region
(NCR) and other major cities in the country, thus favoring
individuals who live near these urban areas.
Issues in the Delivery of Mental
Healthcare system
 Economic Crises
 Neglect on mental health (Loss of Human capital)
 Unresponsive governance / Government
 Underdiagnosis ( Lack of mental Health providers and facilities in the country)
 Mental Health is not well- established in our country (outdated practices,
inappropriate curricula)
 Lack of Research and technological innovations (More on empirical clinical
evidence)
Domains on the establishment of mental
health delivery system
 Policy and Legislative Framework
 Mental health services
 Mental health in primary health care
 Human resources
 Public education and link with other
 Monitoring and evaluation
Points for the realization of a mentally
healthy Philippines.
 First, mental health professionals must be mobilized to educate families about mental
health and mental disorders to eliminate stigma and discrimination. They must
participate in and contribute to the development of mental health policy and service
delivery guidelines. And very importantly, “family group conferencing” skills should be
included in the training and practice of psychiatry.
 Second, since mental disorders usually begin in adolescence, much attention on the
mental health of individuals in this age group must be given. Suicide intervention,
prevention, and response strategies with particular attention to the concerns of the
youth should be implemented.
 Third, the quality of mental health services should be based on the findings of medical
and scientific research. By doing so, a comprehensive and effective mental health
care system could be developed and established to provide the psychological,
psychosocial, and neurologic needs of the Filipino. Family members should also be
encouraged to participate in research, in formulating and developing mental health
policies, and in promoting mental health in the workplace and communities
RA 11036
- The Law proposes a mental health policy that
aims to:
a) Enhance the delivery of mental health services
b) Promote mental health services
c) Provide accessible mental health care –
Mental health services are proposed to be
accessible from large-scale hospitals down to
the barangay level.
d) Promote and protect the rights of the
individuals utilizing psychiatric, neurologic and
psychosocial health services
Mental Health Gap Action Programmed
(mhGAP) training
- MhGAP is a WHO program, launched in 2008, to scale up care for MNS disorders
• Mental disorders
• Neurological disorders
• Substance abuse disorders
- The program asserts that, with proper care, psychosocial assistance and medications,
millions of people around the world could be treated for psychoses, epilepsy, depression,
and suicide can be prevented, thus they may live a normal life.
- To meet this goal is to train non-specialist care to address the unmet needs of people
with priority MNS conditions.
- The mhGAP training is a collaboration between the World Health Organization, the
Department of Health, and local government units to strengthen the mental health
services in local communities in the Philippines. Over a few years, non-specialized
health workers in all 18 regions in the country have participated in the training,
empowering them to make decisions and manage mental health patients close to
where it is most needed. Leon is one of the first municipalities to have a comprehensive
community-based mental health program in the country.
Additional readings:

Republic act 11036

 An Act Establishing a National Mental Health Policy for the Purpose of
Enhancing the Delivery of Integrated Mental Health Services, Promoting and
Protecting the Rights of Persons Utilizing Psychosocial Health Services,
Appropriating Funds Therefor and Other Purposes
Basic Education Mental Health and Well being
Promotion Act
RA 12080
 Implementation and Strengthening of a School-Based Mental Health Program
 Establishment of Mental Health and Well-Being in every Schools Division Office
 Establishment of a care center in every School
 Creation of School Division Counselor for every SDO, counselor associates for
every school (Bachelors degree)

Additional Readings:
RA 12080
History of Philippine Psychiatry
 The development of Philippine psychiatry is punctuated
and propelled by personalities, institutions and events.
 The transitions in psychiatry can be gleaned through
different historical periods:
1. from the pre-Spanish era,
2. to almost 4 centuries of Spanish rule,
3. followed by 4 decades under the American regime,
4. the brief but tumultuous Japanese occupation,
5. up to the subsequent liberation by the Americans.
Pre Spanish period
 Prior to the Spanish period, there is a dearth of
information on the incidence of mental illness, as
well as to the kind of treatment given, if at all.
 It is surmised that each illness, whether of
psychiatric nature or otherwise, was
attributed to inanimate objects or to
natural and supernatural
phenomena.
Spanish period
 Concepts on mental illness during the early Spanish period
carried with it some of the pre-Spanish concepts, as well as
religious influences from our colonizers.
 Mental illness or conditions effecting thought
and behaviour were perceived to be caused by
supernatural forces such as:
1. Angry deities whom the victims have displeased;
2. Witches or mangkukulam who cast by chanting incantations and
pricking magic dolls; or by
3. Devilmen or mangagaway who could make their enemies
mentally sick by praying to Satan .
Spanish period
 The mentally ill wee either brought to churches for purification and
exorcism, or to folk healers or herbolaris who, in order to alleviate
their patient’s mental distress, subjected the victims with physical stress. For
example, as a means of driving the evil spirits away, the patient was
wrapped in mats and whipped with a bamboo stick or the tail
of the stinger fish. Hot pots were placed on top of their heads
and they were made to drink bitter concoctions of herbs and
tree bark. There were times when the mentally ill was taken for a
boat ride, only to the unexpectedly thrown in the middle of
the river. Surprisingly, this shocking experience often produced favourable
results in cases of hysteria, that is if the patient escaped drowning.
 Documents reveal that the institutional care and treatment of the mentally ill
in the country began at the start of 19th century at the Hospicio de San Jose.
Spanish period
 Hospicio de San Jose was founded in 1782 to attend to the needs of
the aged and the orphaned, as well as serve as a place for
recuperation for the patients of San Juan de Dios Hospital.
 At around 1810, this institution assumed a new task of caring for
the insane upon the request of the Spanish Naval authorities for
confinement of its mentally ill sailors. Although there was one
doctor among its staff, the Hospicio was ran by nuns and primarily
provided custodial care.
 The Hospicio, then already located in a small island along the Pasig
river in the San Miguel district, was considered an idyllic place for the
treatment and recuperation of the mentally ill because of its isolation
and fresh air.
Spanish period
 Records of the Hospicio revealed a set of admission procedures for the mentally
ill. To wit:
 Complaints, usually involving disturbance of public peace were lodged by
relatives or the towns people, and subsequently, the Guardia Civil took custody
of the mentally ill. The patient is examined by a medico titular to ascertain
mental illness, who in turn drafted a letter to the governor general requesting
admission of the patient to Hospicio. Once admitted, the doctor of Hospicio again
examines the patient.
 Due to the limited number of staff and facilities at the Hospicio the Carcel de
Bilibid had to manage Hospicio’s overflow, particularly those who were violent
and have committed criminal acts.
 As to causation, documents showed that insanity or enagenacion mental, a term
used to refer to all forms of insanity or dementia, was due to person’s inability to
face reality or handle life’s pressure. Sisa, the tragic character in Rizal’s Noli
Me Tangere, illustrates this concept.
 Insanity due to ana organic cause, although not clearly delineated from functional
illness, was already acknowledged during the late Spanish period. The term for an
organic type of illness was neurosis con trastornos mentales . This thinking was
largely influenced by changes that were happening in Europe.
American regime
 During the American regime, mental illness was perceived
to be just
like any disease and a more humane approach towards
the mentally ill was advocated. The change in orientation
reflected the transitions occurring in the United States regarding perceptions
of mental illness.
 In addition, there was an increase in the number of hospitals since health
care was seen as means of subjugation by the American colonizers
American regime
1. Insane Dept. Of San Lazaro Hospital

 This shift in orientation was marked by the establishment of the

Insane Department of San Lazaro Hospital in November 1904, under
the newly created Bureau of Health. This was considered the
country’s first hospital unit for the mentally ill.
 During its first year operation, it had about 77 patients and with the
increasing demand in subsequent years, additional wards were
constructed to accommodate 250 additional patients, including those
transferred from Hospicio de San Jose.
American regime
2. The First Filipino Psychiatrist
 In 1917, dr. Elias Domingo ( a graduate of UP Class of 1913), then chief resident in Medicine,
was sent tp Pennsylvania, as Rockefeller scholar for two years to undertake training in
Psychiatry. Upon his return to the country, Dr. Domingo headed the Insane Department of San
Lazaro hospital. He is considered the first Filipino psychiatrist.
3. The City Sanitarium
 By the year 1918, the City of Manila had already established its own mental hospital, the City
Sanitarium at San Juan del Monte under Dr. Telesforo Ejercito.
 Thus, there were two institutions that cared for the mentally ill: the Insane Department,
with American and Filipino nurses providing psychiatric nursing care mostly for patients from
the provinces, and the City Sanitarium, later transferred to San Pedro Makati, to handle the
“insane of the city”.
 Despite the presence of institutions, there continued to be an unprecedented increase in the
mentally ill population. This may be attributed to many factors such as the increased
awareness for the need of institutional care and treatment for mental illness, as well as
increased incidence due to the socio-economic difficulties of the period.
 As a means of addressing the increasing demand, several Filipino physicians were successively
sent to Harvard University in the early 1920’s for training in psychiatry and neurology. It
should that majority, if not all of the existing psychiatric training programs were combined
with neurology. These physicians which included Dr. Jose a. Fernandez, Toribio Joson,
Leopoldo Pardo and Catalina Policarpio, later joined the staff of the Insane Department upon
their return.
American regime
3. National Psychopatic Hospital
 In addition, the government decided to establish a hospital exclusively for the treatment of patients with
mental and nervous diseases. Substantial government appropriation allowed for the purchase of 64 hectares
of land in Barrio Mauway, Mandaluyong, Rizal, adjoining the grounds of Welfare Village.
 By December 18, 1928, around 400 patients of the Insane Dept. Were transferred to the new hospital,
marking the formal opening of the Insular Psychopathic Hospital. Dr. Elias Domingo became the first chief of
hospital, assisted by the nursing staff from San Lazaro.
 The Insular or National Psychopathic Hospital was about 10 kms. from downtown Manila, surrounded by
farmlands, relatively secluded from the adjoining towns. When the City Sanitarium closed in 1935, all its
patients transferred to this hospital, further aggravating the overcrowded state of its wards. In an effort to
match the unabated increase in the number of patients, additional pavilions were constructed thereby
increasing its total bed capacity from an initial 400, to 1,600 by the end of 1935.
 The growth of medical institutions for training in psychiatry somehow paralleled the development of
hospitals for the mentally ill.
4. U.P COLLEGE OF MEDICINE
 In the early 1900’s the Civil Hospital was established at Calle Iris (now C.M. Recto) two American physicians
Dr. Donald Gregg and Dr. Charles B. May trained in medicine, managed the mentally ill patients of the
hospital. Around the same time, the Phil. Medical School, a medical school patterned after the American
training institutions was established.
 By 1908, the University of the Phils. Have been established and the Philippine Medical School became its
College of Medicine. By 1910, the Phil. General Hospital was opened alongside the school initially handling
all patients transferred from civil Hospital. At that time, Two American physicians Dr. Almond T. Gough and
Dr. Samuel Tretze taught Psychiatry to medical students and gave demonstrations at the Insane Dept. Of San
Lazaro Hospital, where the medical students briefly rotated. When the Psychopathic Hospital opened, the
students rotated for two weeks in this hospital.
 Dr. Elias Domingo and the other U.S trained Filipino psychiatrists also lectured at the U.P. college of
Medicine.
American regime
5. UST
 Although the Faculty of Medicine and surgery had already been established at
the University of Sto Tomas in 1871, psychiatry was not formally taught in its
medical school. Its fourth year medical school. Its fourth year medical students
were given exposure to psychiatric patients during their short rotation at the
Insular Psychopathic Hospital.
 Instruction in both these institutions was carried out in English, and American
textbooks were used.
6. Training at Psychopathic Hospital
 Young staff members of the Psychopathic Hospital were sent for training as a
means of upgrading service delivery. In addition, Dr. Maximillian Silverman from
Vienna was hired as foreign consultant to the hospital.
American regime
7. Other Centers
 Aside from the Insular Psychopathic Hospital, later called National Psychopathic Hospital, psychiatric services were delivered at
other centers. At the Sternberg General Hospital in Manila, an American captain, a psychiatrist, attended to the neuropsychiatric
cases of the U.S Army.
 At the Phil, Army General Hospital of Camp Murphy, Lt. Jaime Zaguirre, a young doctor with inclinations to psychiatry, likewise
provided treatment for Filipino soldiers.
Interestingly, empirical somatic therapies for the mentally ill were the most common modes of treatment during the American
regime. These included:
 For manics
• Fever therapy – inducing fever by protein injections, bite of malaria infected mosquitoes
• Metrazol shock – inducing chemical shock by injection of camphor oil
• Insulin shock – inducing hypoglycaemic coma
• Lock’s Sol for Schizophrenics (?)
• Prolonged Narcosis
• R1651 (Bromides) hyoscine injections
• Hydrotherapy
 For general paretics (brain syphilis, thought to be functional during that time)
• Fever therapy
• Tryparsamide
• Neo-Salversamized serum-giving i.v. mercury preparations
American regime
 For epileptics
• Phenobarbital
• Magnesium sulphate
• Spinal drainage
• Ketogenic diet
 The depressed were also given Lock’s sol, barbiturates and electroshock
treatments.
 Prior to World War II, psychotherapy sessions were generally not conducted.
However, adjunct therapies such as occupational and recreational therapies were
already in vogue.
8. The Phil. Society of Psychiatry and Neurology
 In 1935, the Phil. Society of Psychiatry and Neurology was organized with Dr. Jose
Fernandez as the elected president. The society released a monthly publication, the
Journal of Psychiatry and neurology, which documented local researches and
discourse, as well as the Society’s activities
Japanese Occupation
 The development of psychiatry in the country expectedly came to a standstill
with the outbreak of World War II on Dec. 1941. Majority of the patients were
brought home by their families; however, the Psychopathic Hospital managed
to continue its operation under Japanese rule.
 Since some of its were used by the Japanese Imperial army in stockpiling their
supplies, the remaining patients were herded in small rooms and subsisted on
limited food and medicines. Electroconvulsive treatment became the
principal therapeutic modality via an outmoded Japanese apparatus,
and local medicinal plants were made use of.
Liberation period
 The large number of emotional casualties after the war led to an increased
awareness and appreciation of the importance of psychiatry.
 As a consequence, the end of World War II was characterized by the
rehabilitation and expansion of psychiatric facilities as well as training of
personnel. The National Psychopathic hospital was renamed National Mental
Hospital (NMH) in July 1946. Under the leadership of Dr. Jose Fernandez, and
with the help of donors, a building for pay patients was constructed, as well as
additional charity pavilions.
Liberation period
 With the resurgence of psychiatric activities at NMH, other centers followed
suit:
1. V. LUNA GENERAL HOSPITAL
2. UP COLLEGE OF MEDICINE
3. UST
4. UERMMC
Liberation period
The Phil. Mental Health Association
 The increasing mental health needs of the country and the overburdening of the
local mental institution spurred the organization of a private agency, the
Philippine Mental Health Association (PMHA). The association was founded in
1949 by Dr. Toribio Joson of NMH and Dr. Manuel Arguelles. It aimed to
promote the mental health activities in the country through the provision of
clinical services and public education.
 In 1951, it pioneered a nationwide educational movement through the
promotion of the first National Mental Health Week, which later became an
annual event. In the same year, the first community mental health clinic in the
country was initiated located in Cavite, later adding both rural and urban based
rehabilitation services.
 In 1965, the PMHA funded the earliest known epidemiologic survey of mental
disorders in the country in Lubao, Pampanga which obtained a 36 per 1,000
population prevalence rate of mental illness in the community.
 National mental health month: OCTOBER
Liberation period
The Phil. Mental Health Association
 - The Philippine Mental Health Association, or PMHA, is "a private, non-stock, non-profit organization
dedicated to the promotion of mental health and prevention of mental disorders. Its headquarters is
located in Quezon City with nine chapters all over the Philippines:
 • PMHA Bacolod-Negros Occidental,
 • PMHA Baguio-Benguet,
 • PMHA Cabanatuan-Nueva Ecija
 • PMHA Cagayan de Oro-Misamis Oriental
 • PMHA Cebu,
 • PMHA Dagupan-Pangasinan
 • PMHA Davao
 • PMHA Dumaguete-Negros Oriental
 • PMHA Lipa-Batangas.
 - It was established on January 15, 1950 with Dr. Manuel Arguelles as president due to the call for
assessment of mental health problems induced by WW II. At present, their programs range from
Education and Information Services (EIS), Clinical and Diagnostic Services (CDS), and Intervention
Services (IS).
Liberation period
The Phil. Society of Psychiatric and Neurology
 The Phil. Society of Psychiatry and Neurology which was inactive during the war
years, resumed its activities in 1946, with Dr. Leopoldo Pardo as President.
 Of the 167 registered members of the society in 1964, 11% have been certified
by American Boards, with another 10% eligible for the same. Only 20% practice
Psychiatry as a sole specialty because local conditions and attitudes limit the
opportunities for psychiatric practice.
The Philippine Psychiatric Association
 When the distinctions between Psychiatry and Neurology became clearer and
separate departments and training programs were established, the society’s
psychiatrists decided to form a separate association. By 1972, the Philippine
Psychiatric Association was organized with Dr. Lourdes Ignacio as its founding
president.
Other Institutions

- Most major hospitals (both public and private) In the National Capital Region
(NCR), have a psychiatric department which caters to the need of people with
mental illness.
a) The Medical City
b) Philippine General Hospital (PGH)
c) Manila Doctors Hospital (MDH)
d) University of the East Ramon Magsaysay Memorial Medical Center (UERMMMC)
 Suicide Prevention Hotlines in the Philippines
 - Those who are in need of immediate assistance may opt to call a suicide hotline:
 •Natasha Goulbourn Foundation (NGF). The NGF suicide hotline can be reached at
(02) 804-HOPE (4673), 0917 558 HOPE (4673) or 2919 (toll-free for GLOBE and TM
subscribers).
 •Manila Lifeline Centre (MLC). The MLC can be reached at (02) 8969191 or 0917
854 9191.
Additional readings:

Psychiatry in the Philippines:

 https://philippinepsychiatricassociation.org/ppa-history/
Historical perspectives of treatment of
mental illness (worldwide)
 Ancient times
 Greco-Roman Period
 Christian Times
 Renaissances times
 Period of enlightenment
 Modern psychiatry
Greco-Roman Period
 Hippocrates – mental disorder is related to physical disorders and had natural
causes (Humorism)
 Specifically, he suggested that they arose from brain pathology, or head
trauma/brain dysfunction or disease, and were also affected by heredity.
Hippocrates classified mental disorders into three main categories – melancholia,
mania, and phrenitis (brain fever) and gave detailed clinical descriptions of each
 He also described four main fluids or humors that directed normal functioning and
personality – blood which arose in the heart, black bile arising in the spleen,
yellow bile or choler from the liver, and phlegm from the brain. Mental disorders
occurred when the humors were in a state of imbalance such as an excess of
yellow bile causing frenzy/mania and too much black bile causing
melancholia/depression. Hippocrates believed mental illnesses could be treated as
any other disorder and focused on the underlying pathology.
 Plato – mental disorder is related to diminishing power of judgment due to illness
 Aristotle- mental disorder is related to norms of human nature. (Control of
emotions
Ancient times
 displeasure coming from God, punishment to
Sickness is a
sin and wrong doing
 Mental disorder is divine and demonic
 supernatural view of abnormal
Prehistoric cultures often held a
behavior and saw it as the work of evil spirits, demons,
gods, or witches who took control of the person. This form of demonic
possession was believed to occur when the person engaged in behavior
contrary to the religious teachings of the time.
 Trephination
Christian Times
 Priesthood
 Primitive beliefs and superstitious
 All disease created by demons
 Mentally ill, possessed, failed treatment
 Treatment should be dungeons, starving and brutal
 Mental illness was yet again explained as possession by the Devil and methods
such as exorcism, flogging, prayer, the touching of relics, chanting, visiting
holy sites, and holy water were used to rid the person of the Devil’s
influence. In extreme cases, the afflicted were confined, beat, and even
executed.
Renaissance
 Renaissance was the rise of humanism, or the worldview that emphasizes
human welfare and the uniqueness of the individual. This helped continue the
decline of supernatural views of mental illness.
 Harmless are allowed to wander and live countryside/ rural
 Dangerous/ lunatics – thrown in prison, chained and starved

 The number of asylums, or places of refuge for the mentally ill

where they could receive care, began to rise during the 16th
century as the government realized there were far too many
people afflicted with mental illness to be left in private homes.
Hospitals and monasteries were converted into asylums. - (1790 Phillippe
Pinel, Wlliam Tukes formulate the concepts of assylum as
safe refuge or haven for the mentally ill in the institution
from being whipped beaten and starved)
 Dorothea Dix – connection of people to asylums, began a crusade to reform
treatment of mental illness after a visit to Tukes instition.
Period of Enlightenment
 Reform movement and the rise of moral treatment movement
 Reform in the United States started with the figure largely considered to be
the father of American psychiatry, Benjamin Rush (1745-1813). Rush
advocated for the humane treatment of the mentally ill, showing
them respect, and even giving them small gifts from time to time.
Despite this, his practice included treatments such as bloodletting and
purgatives, the invention of the “tranquilizing chair,” and a reliance on
astrology, showing that even he could not escape from the beliefs of the time.
 Sigmund Freud – personality and mind disorder theory
 Emil Kraepelin – Classify Mental Disorder based on natural scientific concept
 Eugene Bleuler- Schizophrenia
Modern Psychiatry
 I1913- John Hopkins 1st school of nursing to include psychiatric nursing in the curriculum
 1920 1st psychiatric nursing textbook published, nursing mental disease by Hariet Bailey
 In 1950’s –some psychotropic drugs were introduce (Thorazine, Lithium)
• Chlorpromazine (thorazine) anti-psychotic drug
• Haldol anti-psychotic
• Lithium anti manic agent
• MAO inhibitor anti-depressant
• Tricyclic antidepressant
• Benzodiazepines anti-anxiety agents
 In 1963 – community mental health centers (Deinstitutionalize)
 1968 introduction of nursing therapy by June Mellow
 1973 – more focuses on standards of care (determination of safe and accountable practice
and assess the quality care)
 1990- more on reform on mental health
 Linda Richards – 1st American psychiatric nurse , improve nursing care in psychiatry, mentally
sick should at least well cared for as Physically sick, foundation of nursing hospital care
 Hildegard Peplau- mother of modern psychiatric nursing because of her interpersonal
relations in nursing.
Psychiatric Nursing
 Interpersonal process whereby professional nurse practitioner through the
therapeutic use of self assists an individual, family, group, or community to
promote mental health, prevent mental illness and suffering.
 It is both science and art
 Therapeutic use of self- positive use of one’s self in the process of therapy
 The core here is – INTERPERSONAL PROCESS- human to human relationship
Self Awareness:
It is the process by which nurse gains recognition of his or her own feeling,
beliefs and attitudes. It may be realized through reflection of feelings,
discovering self methods, discussion, role play and enlarging one’s experience
Johari Window and Self-Awareness
 The Johari window is a model of interpersonal awareness. It’s a useful tool for
improving self awareness and, through it, our abilities to work well with others.
It works by helping us understand the differences between how we see
ourselves and how others see us.
 The four quadrants of the window are
Self Awareness Techniques
 Journaling
 Bibliotheraphy
 Write a personal manifesto
 Create a Bucket List
 Know and understand your personality type
 Autobiography
Importance of Self- Awareness
 -It can make us more proactive, boost our acceptance, and encourage positive self-
development (Sutton, 2016).
 -Self-awareness allows us to see things from the perspective of others, practice SELF-
CONTROL, work creatively and productively, and experience pride in ourselves and our
work as well as general self-esteem (Silvia & O’Brien, 2004).
 -It leads to better decision making (Ridley, Schutz, Glanz, & Weinstein, 1992).
 -It can make us better at our jobs, better communicators in the workplace, and
enhance our SELF-CONFIDENCE and job-related wellbeing (Sutton, Williams, &
Allinson, 2015).
 Being self-aware can enable the counselor to mark their ‘ego boundaries,’ and
successfully discriminate between what belongs to them and what belongs to their
clients.
 self-awareness enables the counselor to make a ‘conscious use of the self’. Being self-
aware can make the counselor feel empowered in delivering therapeutic interventions,
as they will feel more conscious and thought of, rather than spontaneous and
awkward.
 Being aware of yourself also helps in identifying what your stressors are, so you can
utilize the information to build effective coping mechanisms.
Classification of Mental Illness
(Psychiatric Nursing)
1) Psychosis. It is characterized by loss of reality testing, altered thought process
ad presence of psychotic manifestation such as hallucination and delusions
2) Neurosis. It is refers to a class of functional mental disorder involving
distress but not delusion or hallucination, where behavior is not outside socially
acceptable norms. It is also known as psychoneurosis or neurotic disorder. No
loss of reality testing
3) Functional. It is characterized by unknown underlying cause or has no clear-
cut etiologic factor to account for the impairment because it is difficult to
investigate brain function during life.
4) Organic. It is a disturbance caused by injury or disease affecting brain tissues
as well as by chemical or hormonal abnormalities. Exposure to toxic materials,
neurological impairment, or abnormal changes associated with aging can also
cause these disorders
Questions
 If you are about to introduce yourself, how will you do it?
 What is the importance of therapeutic use of oneself?
 Why is it necessary to understand the basic history of psychiatry?
 What do you think are the problems in our mental health care delivery
system? Not only in the Ph. But to the world?
 Have you experienced mental health breakdown? How do you cope with it?
 What are the fundamentals in understanding mental health and mental
illness?
 What do you think is the emphasis of growing or historical views of psychiatric
nursing?
 If you are about to do or introduce your own principle or model in psychiatric
nursing what is that and why?
 Psychobiologic
Basis of Behavior
 Neural Bases of Psychology

• Neuroscience:
interdisciplinary field studying how
biological processes relate to behavioral
& mental processes
Neural Bases of Psychology (Continued)

• Our nervous system

consists of neurons
(cells responsible
for receiving &
transmitting
electrochemical
information).
 Mind and Body Problem
Important Psychological Issue
➢ The mind and body problem deals with three important
philosophical views.
➢ Idealism
➢ Realism
➢ Materialism
 Techniques of Studying the Brain
Lesion or Abrasion Stimulation methods-
methods- cutting, extensively used- electric
severing, or destroying a stimulation, electrode
part of the brain. How implants.
does it effect behavior?
➢ Stimulation to certain parts of
➢ Used on animals-Not on
humans except after the fact brain have been shown to
cause: aggression, submission,
➢ After WWI many men who
had suffered brain injuries and extreme sexual pleasure.
were studied. ➢ Science Fiction has already
explored some concerns of
using stimulation to reward or
punish humans.
Techniques for Studying the Brain

Chemical Stimulation- A Biochemical Technique- used to

cannula, small tube, is inserted map out various
into the brain and crystalline neurotransmitter systems.
forms of neurotransmitters are Example- How levels of
transmitters is linked to
introduced. depression. Drug therapy can
Recording Technique- Measures alter these levels.
the activity of neurons. Imaging Technique- New-Uses
Recorder is inserted into axon. forms of energy and computers
Electrode stimulates cell’s to create detailed pictures of
activity. Example-EEG- the brain. Example-MRI
electroencephalogram. (magnetism), CAT Scan (X-
rays), and PET Scan
(metabolic activity).
 Neurons
The Basic Unit of the Nervous System
➢ Estimated 10-12 billion or ➢ Three Types of Neurons:
higher! ➢ Afferent or Sensory- run from
➢ Large number of neurons= sense organs to central nervous
more complex nervous system. system.
➢ One Neuron can connect to as ➢ Efferent or motor- run from the
many as 75 more neurons. central nervous system to the
➢ Pyramidal neuron located in muscles.
➢ Hippocampus. ➢ Interneurons or multipolar-
 Found within the brain and are
multiply connected to other
 neurons.
 The Neuron

http://faculty.washington.edu/chudler/synapse.html
 Parts of the Brain:
Frontal Lobe (Forebrain)

Location: serendip.brynmawr.edu/bb/kinser/
 Frontal Lobe
➢ Location- In the anterior most part of the brain (under
the forehead)
➢ Function:
➢ Determines our consciousness of our environment.
➢ Determines how we initiate and respond to our environment.
➢ Daily decisions in our daily lives.
➢ Controls emotional responses and expressive language.
➢ Assigns meanings to the words we use.
➢ Involves word association.
➢ Controls memory for habits and motor activities.
➢ Emotional control center.
 Parietal Lobe
➢ Location- Near the back and top of the head (Near the
back and top of the head)
➢ Functions:
➢ Contains the location for visual attention.
➢ Contains the location for touch perception.
➢ Controls goal directed voluntary movements.
➢ Controls the manipulation of objects.
➢ Integrates different senses to allow for understanding a single
concept.
➢ If not functioning correctly epileptic behavior can occur.
Illustration of the Occipital Lobe
 Occipital Lobe
➢ Location- Located in the most posterior (Back of the
head).
➢ Functions:
➢ Center of the visual perception center.
➢ Contains the primary visual cortex.
➢ Receives projections from the lateral geniculate nucleus of the
thalamus.
➢ Numerous visual functions.
 Temporal Lobe
➢ Location- at the side of the head and above the ears
➢ Functions:
➢ Auditory sensation and perception
➢ Organization and categorization of verbal material
➢ Long term memory
➢ Personality and sexual behavior
➢ Organization of sensory input
➢ The brain has two temporal lobes, one on each side of the brain
➢ The two are interchangeable, so if one is damaged, the other is
usually able to takeover the other's duties
Biological Foundations of Psychology
Divisions of the Brain
 The Brain Stem
(Medulla oblongata, the Midbrain, and the Pons.)
➢ Medulla Oblongata
➢ Location:
➢ Last part of the brain before reaching the spinal cord.
➢ Continuation of the spinal cord
➢ Function:
➢ Many cranial nerves enter and leave the brain through the Medulla.
➢ Centers for cough, gag, swallow, and vomit.
➢ Cardiac Center.
➢ Respiratory Center.
Illustration of the Medulla
Oblongata
 Midbrain
➢ Location:
➢ The Midbrain is located in the anterior most continuation of the
brain stem that still maintains the tubular structure of the spinal
cord (at the top of the brainstem)
➢ Functions:
➢ The top portion contains important nuclei for visual and
auditory systems
➢ It is here that these pathways cross so that each half of the brain
controls the opposite side of the body
➢ Deep within the brain stem is the reticular formation within
which lies the basic life support systems
➢ The bottom portion contains nuclei for the cranial nerves that
control eye movement and the lower portion of the brain
➢ The Substania Nigra is found here. It is a large red nucleus
involved in movement
 Pons
➢ Location:
➢ The Pons (meaning "bridge") lies above the medulla, and is so
named because many axons cross sides within this region of the
hindbrain
➢ Functions:
➢ Arousal
➢ Assists in Controlling Autonomic Functions
➢ Relays Sensory Information Between the Cerebrum and
Cerebellum
➢ Sleep
➢ Features of the pons are: a) basis pontis, b) middle cerebellar
peduncle, and c) the superior cerebellar peduncle
➢ All are linked to the cerebellum which sits on the posterior side of
the pons. Damage to any of the structures would result in impaired
coordination of movement and/or posture
 Cerebellum
➢ Location:
➢ Two peach-size mounds of folded tissue at the base of the brain
➢ Overlies the pons
➢ Functions:
➢ The cerebellum ("little brain") has convolutions similar to those
of cerebral cortex, only the folds are much smaller. Like the
cerebrum, the cerebellum has an outer cortex, an inner white
matter, and deep nuclei below the white matter
➢ New skills are learned by trial and error and then coded into the
cerebellar memory
➢ Coordinates movement of muscles and joints by synthesizing
data from the brain stem, the spinal cord, and another brain areas
such as cerebral cortex
➢ The cerebellum fine tunes our motor activity or movement
 Thalamus
➢ Location:
➢ The Thalamus is shaped like two footballs; each is located deep
in the hemispheres of the forebrain
➢ A large mass of gray matter deeply situated in the forebrain.
There is one on either side of the midline
➢ Functions:
➢ It relays to the cerebral cortex information received from diverse
brain regions. Sort of a requisite 'last pit stop' for information
going to cortex
➢ Axons from every sensory system (except olfaction) synapse here
as the last relay site before the information reaches the cerebral
cortex
➢ Information from all sensory receptors except smell is processed
in the thalamus before being sent to the cerebral cortex
 Hypothalamus
➢ Location:
➢ The hypothalamus is a midline, structure, shaped like a funnel
below the thalamus
➢ It connects to the pituitary gland
➢ Functions:
➢ The hypothalamus has many regulating functions
➢ The autonomic nervous system, emotions and behavior, body
temperature, hunger, thirst, sleep-waking cycles
➢ Controls the release of hormones under its control: growth,
prolactin, thyroid, corticotropin, and gonadotropins
➢ Regulation of sex hormones, blood pressure, body temperature,
water balance, respiration, and food intake, while it also plays a
role in regulating complex moods, such as anger, placidity, and
fatigue.
 Hippocampus
➢ Location:
➢ The Hippocampus is tucked out of sight on the medial side of the
temporal lobe
➢ Its shape resembles that of a 'seahorse'
➢ Functions:
➢ Stores and processes memories
➢ Helps find memories
➢ Affects emotions
➢ The hippocampus helps to encode memories, and then helps to
find them when you want to remember something
➢ Main relay station that determines whether a new memory should
go into long-term storage or be deleted after its short-term
usefulness is over
Illustration of Hippocampus
 Basal Ganglia
➢ Location- The basal ganglia surrounds the thalamus and is
enclosed by the cerebral cortex and cerebral white matter.
➢ The name includes: caudate, putamen, nucleus accumbens, globus
pallidus, substantia nigra, subthalamic nucleus
➢ Functions:
➢ Controls voluntary movements and establishing postures.
➢ Controls voluntary limb movement, eye movement, and cognition.
➢ Lesions in specific nuclei tend to produce characteristic deficits. One
well-known disorder is Parkinson's disease, which is the slow and
steady loss of dopaminergic neurons in synapses.
 Neural Bases of Psychology:
Applying Psychology to Everyday Life
– Key neurotransmitters:
• Serotonin (Inhibitory)
• Acetylcholine (ACh) (excitatory)
• Dopamine (DA) (excitatory)
• Norepinephrine (NE) (Excitatory)
• Epinephrine (adrenaline) (Exci)
• GABA (gamma aminobutyric acid)
(Inhi)
• Endorphins (inh)
• Histamine (exci)
• Glutamate (Exci)
©John Wiley & Sons, Inc. 2010
 Neural Bases of Psychology:
Applying Psychology to Everyday Life
Depression ( D Norepinephrine, D, Serotonin, D, Dopamine
Mania (I Dopamine, D GABA)
Anxiety ( D Serotonin, D Norepinephrine)
Schizophrenia (I Dopamine, I Serotonin, I or D Glutamate)
Alzheimer Disease (D Acetylcholine, I Glutamate)
A Tour Through the Brain

©John Wiley & Sons, Inc. 2010

 Conclusion
The study of physiology has made possible for
better understanding of human behavior and
function, as well as, the function and behavior of
other species we share our world with.
 Additional readings:
 Read cranial nerves
 Interrelationship between mind, body and hormones
 Importance of psychobiologic bases of human behaviour
Concepts and Patterns of
Human Behavior
Human Behavior
 Human behaviour is among the major determinants of the
health of individuals, families or communities.
 Healthy behaviours contribute to the overall health of
individuals and communities and unhealthy behaviours
adversely affect the quality of life people at different levels.
 The promotion of health and prevention of diseases will usually
involve some changes in life styles or human behaviour.
 Behaviour is an action that has a specific frequency, duration
and purpose whether conscious or unconscious. People stay
healthy or become ill, often as a result of their own action or
behaviour.
 In health education it is very important to be able to identify
the practices that cause, cure, or prevent a problem.
Biology and Behavior
 -Behavior is determined by biology. There is a genetic
basis to all behaviors. Most behavior has an adaptive or
evolutionary function. Behaviors have their origins in
specific locations of the brain.
 -In order to understand human behavior, it is necessary to
include animal studies.
 -Biology is 100% involved in all the variance in what we
think, what we feel, and how we behave
Related terminologies for behavior

 Life style: refers to the collection of behaviours that make up a person’s way
of life-including diet, clothing, family life, housing and work.
 Customs: It represents the group behaviour. It is the pattern of action
shared by some or all members of the society.
 Traditions: are behaviours that have been carried out for a long time and
handed down from parents to children.
 Culture: is the whole complex of knowledge, attitude, norms, beliefs, values,
habits, customs, traditions and any other capabilities and skills acquired by
man as a member of society.
Factors affecting behavior

 Knowledge
 Belief
 Attitudes- Attitudes the way you think and feel about someone or
something feeling or way of thinking that affects a person's behavior
 Values- Values are broad ideas and widely held assumptions regarding what
are desirable, correct and good that most members of a society share.
Reinforcing factors for behavior

 Reinforcing factors: these factors subsequent to the behavior

 They are important for persistence or repetition of the behavior.
 The most important reinforcing factors for a behavior to occur or avoid
includes:
 Family
 Peers, teachers
 Employers, health providers
 Community leaders
 Decision makers
Important thing to remember when
dealing behavior
 Identify helpful, neutral and harmful beliefs in your locality.
 Discuss the enabling factors for latrine construction by a family, and
contraception use by a woman.
 Give examples of important human behaviors, which contribute to primary,
secondary and tertiary prevention of diseases.
Family Dynamics

 - Family dynamics are all about the functioning of a family in a good and bad
situation. It also includes the ways of decision-making, problem solving, or
even sharing their feelings. Thus, it helps individuals to judge themselves as
well as the outside world.
 - Types of Family Structures & Family Dynamics
1) Nuclear family
2) Single Parents
3) Extended Family
4) Childless Family
5) Grandparent Family
6) Stepfamily
Needs and Behavior
 - Needs are internal motives that
energize, direct and sustain
behavior. They generate strivings
necessary for the maintenance of
life as in physiological needs and for
the promotion of growth and
wellbeing as in psychological and
implicit needs.
 - According to humanist psychologist
Abraham Maslow, to our actions are
motivated in order to achieve
certain needs
Assignment

 Search on the salient features of the following therapeutic models:

1. Psychoanalytic model
2. Developmental model
3. Interpersonal model
4. Cognitive model
5. Stress model