Imbalances in body humors often • In 1656, Hópital Générale in Paris

Preliterate Times 
corrected by bloodletting founded to confine the mad, poor, and
Era of Magico – Religious Explanation various deviants
The Medieval Period • The “insane” have no recourse to appeal
 Mental and physical suffering not
• Madness not linked to medicine; could
differentiated. Era of Alienation
only be mastered by discipline and
 “Spirits of torment” acting outside the
 Return to the magic, brutality
body are responsible for ills.
mysticism, and • Radical physicians like Johann Weyer
 No distinctions made between medicine,
demonology of preliterate (1515-1588) believed that “those
magic, and religion.
times. illnesses whose origins are attributed to
 Primitive healers address spirits by
 Madness viewed as witches come from natural causes.”
appeal, prayer, bribery, intimidation,
dramatic encounter with
appeasement, punishment.
secret powers and influenced by the The 18th and Early 19th
 Healing methods include exorcism,
moon (lunacy).
magical ritual, incantation
 Malleus Maleficarum (The Witches’
Centuries
Hammer) by Dominican monks Johann
Early Civilization Era of Moral Treatment
Sprenger and Heinrich Kraemer
• Physicians classify symptoms of mental
Era of Organic Explanations published in 1487 rationalized mental
disorders without
illness in terms of magical explanation.
 Hippocrates (460-370) rejects understanding the
 Violent insane shackled in prisons or sent
demonology and proposes that sources of mental
to sea “in search of reason.”
psychiatric illnesses are caused by suffering.
imbalances in “body humors”: blood, The Renaissance
black bile, yellow bile, and phlegm
 Psychiatric suffering comes within the Era of Confinement
realm of medical practice.
 • In 1794 Philippe Pinel (1745-1826) psychiatry and the formation of child • The gains made in research-based
treated inmates in the French institutions guidance clinic knowledge about the epidemiology,
Bicetre and Salpetriere with humanity diagnosis, treatment, and prevention of
and was thus considered mad. Early 20th Century major mental illnesses constitute a
• In England, William Tuke (1732-1822) quantum leap in
Era of Psychoanalysis
focused on “moral treatment” in a understanding the
humane milieu called the York Retreat to  Emil Kraepelin (1856-1926) creates brain.
counter conditions in settings such as system of distinct disease entities and • Client advocacy
“Bedlam.” differentiates bipolar disorder from groups welcome
• In America, Benjamin Rush (1746-1813) schizophrenia psychiatry’s shift
focused on moral treatment and  Sigmund Freud (1856-1939) explains toward psychosocial
humanitarianism at the Pennsylvania human behavior in psychological terms rehabilitation for client self-care.
Hospital. and demonstrates that behavior can be • The National Alliance on Mental Illness
changed through psychoanalysis (NAMI) established a separate research
Late 19th and Early 20th  Pavlov’s discovery of the conditioned foundation to study the biologic basis of
response forms the basis for modern-day
Centuries cognitive-behavioral therapy
major mental illness.

Era of Public Mental Hospital The New Millennium

1990s
• Dorothea L. Dix (1802-1887) founds or Era of Health Care
enlarges over 30 mental hospitals. The Decade of the Brain
 Reform of psychiatric care has decreased
• Moral treatment replaced by custodial • The primary innovation of the 1990s is length of hospital stays and increased
care. the “biologic revolution”: collaboration of client acuity.
• Clifford Beers (1876-1943) published his science and technology to expand  The advancing explosion in neuroscience
book describing his own intense concepts of mental disorder proposed by has reshaped our conception of the
suffering and mental anguish, leading to psychological, behavioral, and bases of mental disorders.
the development of preventive psychoanalytic theories.
  Innovations in technology have informed  Florence Nightingale founds school at Saint
diagnostic practices such as brain Thomas Hospital in London. Nightingale
among the first to note that the influence of
imaging.
 The array of available Evolution of Mental 
nurses on their clients transcends physical care
Linda Richards directs the first American school
psychopharmacologic treatments for psychiatric nurses at the McLean Psychiatric
continues to expand. Health and Asylum in Waverly, Massachusetts.
 Populations of psychiatric clients include
growing numbers of mentally ill elders, Psychiatric Nursing 1890s
more people with coexisting substance  Trained nurses attend to the physical needs of
use disorders, more comorbidities with Practice clients and do not pursue systematic
interpersonal work.
chronic illnesses, and expanding racial
 Psychiatric nursing practice is primarily
and cultural diversity.
custodial, mechanistic, and directed by
 A yearning for spirituality has been
psychiatrists.
reawakened in clients as well as health
care providers.
 The study of genomes and the biology of
the brain touch ethical, moral, and
political nerves.
Sources:

Kneisl, C., & Trigoboff, E. (2013). Contemporary

Psychiatric—Mental Health Nursing. (3rd ed). Upper
Saddle River, NJ 07458: Pearson Education

Emergence of the Discipline of  A ratio of 1 trained nurse to 140 clients is not

unusual
Psychiatric Nursing
1920s
1860s
  Nursing Mental Diseases, the first psychiatric  Nursing leaders recommend elimination of expanded and specialized roles in a variety of
nursing text, is written by Harriet Bailey and single-focus schools marking the beginning of community settings
remains the standard textbook in psychiatric the mainstreaming of psychiatric nursing.  First textbook to address group therapy
nursing for 20 years.  National Institute of Mental Health (NIMH) techniques in nursing practice written by
 Most textbooks are written by psychiatrists; established; National Mental Health Act helps Shirley Armstrong and Sheila Rouslin.
only a few pages address psychiatric nurses in develop psychotherapeutic roles for nurses  Shirley Burd and Margaret Marshall write and
such procedures as tube and rectal feeding and edit the first compilation of papers suitable for
preparing treatment trays. Confirmation of Psychiatric graduate students in psychiatric nursing
 First psychiatric nursing journals Perspectives in
Movement Of psychiatric Nursing as a Specialty Psychiatric Care and Journal of Psychiatric
Nursing and Mental Health Services published.
Nursing into the Mainstream 1950s
of Nursing  Hildegard Peplau emphasizes psychodynamic 1970s
concepts and counseling techniques and
 The first certification programs for advanced
1930s develops first master’s program to prepare
psychiatric nursing practice are developed by
clinical specialists in psychiatric nursing.
 National League for Nursing Education the New Jersey and New York State Nurses
 Gwen Tudor Will demonstrates nursing
recommends that psychiatric nursing content Associations
interventions with a socio-psychiatric base.
and clinical experience be part of the  The psychiatric nurses who developed and
 National League for Nursing introduces the
curriculum in all basic nursing programs implemented the early certification programs
concept of psychiatric nurse specialists; first
 Psychiatric nursing activities continue to be (Marian Pettingill, Sheila Rouslin Welt, and
NIMH grants to integrate mental health
custodial nursing care, including housekeeping Carol Ren Kneisl) recognized the need to
concepts into nursing curriculum.
tasks and keeping the keys to locked wards, acknowledge expertise, distinguish generalist
from specialist roles, and safeguard the public
cabinets, and even toilet tissue containers Confirmation of Specialist  Certification in psychiatric nursing becomes the
1940s Roles responsibility of the ANA
 Standards of Psychiatric-Mental Health Nursing
 New medical surgical procedures (deep sleep
therapy, insulin shock therapy, psychosurgery, 1960s published by ANA. • Issues in Mental Health
Nursing published
and electroshock therapy) promote the role of  The Community Mental Health Centers Act
psychiatric nurses as participants in psychiatric pushes trend in psychiatric nursing toward
treatment.
 Psychopharmacology Guidelines for As knowledge continues to explode in
Period of Decline and 
Psychiatric-Mental Health Nurses, intended to

psychobiology, genetics, and human behavior,
Retrenchment increase knowledge of psychopharmacology psychiatric nursing leaders focus on the need
and improve patient care, published by ANA. to integrate the biological, psychological,
1980s  Journal of the American Psychiatric Nurses social, spiritual, and environmental realms of
Association published the human experience into mental health
 ANA Council of Specialists in Psychiatric and  Psychiatric nursing leaders urge nurses to use services while remaining centered in the
Mental Health Nursing develops a classification the challenging circumstances posed by nursing domain with its focus on caring.
system for Psychiatric Nursing Diagnosis. burgeoning information, reduced funding, and  Primary care becomes a significant point of
 Standards of Child and Adolescent Psychiatric health care reform to clarify nursing’s unique entry for psychiatric care.
and Mental Health Nursing and Standards of contribution to mental health care  Nurse practitioner and clinical nurse specialist
Addictions Nursing Practice published by ANA titles for APRNs.
 American Psychiatric Nurses Association Beginning of a New Sources:
formed. • Archives of Psychiatric Nursing and
Journal of Child and Adolescent Psychiatric and Millennium Kneisl, C., & Trigoboff, E. (2013). Contemporary
Mental Health Nursing published. Psychiatric—Mental Health Nursing. (3rd ed). Upper
 Psychiatric nursing leaders recommend 2000 Saddle River, NJ 07458: Pearson Education
incorporating new psychobiologic knowledge
 American Nurses Association, in collaboration
into clinical practice
with the American Psychiatric Nurses

Decade of the Brain Association and the International Society of

Psychiatric-Mental Health Nurses, publishes
(2000) and revises (2007) the Scope and
1990s Standards of Psychiatric Mental Health Nursing
 Several psychiatric nurses appointed to Practice.
President Clinton’s task force on health care  An increase in the numbers and types of
reform alternative and nontraditional treatment
 Standards of Psychiatric Consultation Liaison settings provide new opportunities for
Nursing published by ANA psychiatric-mental health nurses to provide
 Revised Standards of Psychiatric-Mental mental health care in primary care
Health Clinical Nursing Practice published by environments as well as in psychiatric settings.
ANA
History of Psychiatric
– Mental Health
Nursing