Mental hospitals history

Psychiatrists, psychologists, philosophers, politicians, and others who labor to assimilate mental illness to body illness systematically fail to acknowledge that an intrinsic function—I would say primary function—of the mental hospital has always been the psychiatric segregation and control of unwanted persons, justified by their alleged dangerousness to themselves and/or others. This contention is confirmed by the whole history of psychiatry the so-called psychiatric abuses in National Socialist Germany and the Soviet Union and the continued popularity, in the West, of psychiatric rationales and facilities for imprisoning individuals whose detention cannot be justified as punishment for crime.Recent opinions by Justices of the Supreme Court amply support this interpretation. 

Szasz, T. S., ed. The Age of Madness A History of Involuntary Mental Hospitalization Presented in Selected Texts. Garden City, NY Doubleday Anchor, 1973. 

The decree of Louis XIII was not a solitary occurrence. It has been repeated time and again through the history of psychiatry. The German mental hospital system, for example, was inaugurated in 1805 with the following declaration by Prince Karl August von Hardenberg ... 

In short, even without counting those persons who are deprived of liberty because of mental retardation, more than twice as many Americans lose their freedom on account of mental illness than on account of crime. This loss of freedom, moreover, cannot be morally justified as either protection for the community or as treatment for the patient. Nevertheless, the American Civil Liberties Union has not only failed to oppose this practice but, on the contrary, has actively supported it. In his book on the history of the Union, Charles Markmann relates, with what seems to me badly misplaced pride, that toward the end of the Second World War, The [American Civil Liberties] Union. . . began to draft model statutes for the commitment of the insane.. . . Twenty years after the first Union draft of a model bill for commitments to mental hospitals. Congress enacted for the District of Columbia a law closely following the Union s proposals. ... 

Consider, for example, Zilboorg s History of Medical Psychology First published in 1941, and widely accepted as a classic in medical and psychiatric historiography, it is a volume composed of 606 closely set pages, the last 16 of which make up the Index. Yet this Index lists no entry for Jews, for anti-Semitism, or for the Spanish Inquisition. The single entry for Spain is a laudatory reference to the establishment of mental hospitals there in the fifteenth century. ... 

The idea that the mental hospital is harmful for the inmates, serving primarily the Interests of the patient s relatives or those of society, is more easily traced to specific individuals in the history of psychiatry than is the idea that mental illness is not a disease. This is because the mental hospital system is only about three hundred years old, whereas man s views on madness are as old as recorded history. 

A patient receiving an antianxiety drug may be treated in the hospital or in an outpatient setting. Before starting therapy for the hospitalized patient, the nurse obtains a complete medical history, including mental status and anxiety level. In the case of mild anxiety, patients may (but sometimes may not) give a reliable history of their illness. 

TO, a 77-year-old male nursing home resident is admitted to the hospital with a 3-day history of altered mental status. The patient was unable to give a history or review of systems. On physical examination the vital signs revealed a blood pressure of 100/60 mm Hg, pulse 110 beats per minute, respirations 14/minutes, and a temperature of 101°F (38.3°C). Rales and dullness to percussion were noted at the posterior right base. The cardiac exam was significant for tachycardia. No edema was present. Laboratory studies included sodium 160 mEq/L (160 mmol/L), potassium 4.6 mEq/L (4.6 mmol/L), chloride 120 mEq/L (120 mmol/L), bicarbonate 30 mEq/L (30 mmol/L), glucose 104 mg/dL (5.77 mmol/L), BUN 34 mg/dL (12.14 mmol/L), and creatinine 2.2 mg/dL (194.5 pmol/L). The CBC was within normal limits. Chest x-ray indicated a right lower lobe pneumonia. 

Past psychiatric history (PPH) a listing of prior episodes of mental illness, treatment, hospitalizations. 

George M. is a 32-year-old man you saw briefly a number of years ago for several intensive therapy sessions following the death of his mother. You know of no other psychiatric history. His family history is significant for his mother being hospitalized twice with "some sort of mental problem." George was in law school at the time and was not informed of the specifics of his mother s illness. His paternal uncle committed suicide when George was 14. 

The initial assessments of the outpatient are basically the same as those for the hos pitalized patient. The nurse obtains a complete medical history and a history of the symptoms of the mental disorder from the patient, a family member, or the patient s hospital records. During the initial interview, the nurse observe the patient for what ipear to be deviations from a normal behavior pattern. The nurse also should assess the patient s vital signs and body wei t. 

An unusual and isolated report describes painful, intermittent and transient myoclonic j erking of the arms and legs as the predominant manifestation of the disulfiram reaction in one patient." Another unusual case has been reported in which a woman with a history of bipolar disorder and alcoholism, who was taking disulfiram, was admitted to hospital with a 3- to 4-day history of changes in her mental state, including difficulties with orientation, concentration and visual hallucinations. The confusion-al state was attributed to alcohol consumption while taking disulfiram, and the probability of this was supported by an earlier similar, though shorter, episode experienced by the patient. Some alcoholics find that disulfiram potentiates the euphoric effects of low doses of alcohol, which alone would be relatively ineffective. ... 

An example of the impact of an age extreme on planning for and providing appropriate patient care is found in the situation of Mr. Suarez, age 82, admitted to the hospital on June 15 with altered mental status. In the admission history, the nurse learns that Mr. Suarez lives alone in his own home. 

Parents mental health score History of depression, anxiety or other psychiatric problem, general practitioner, outpatient or inpatient hospital care, prescription of psychotropic drugs, chronic mental illness in last 10 years. Scored for both parents and combined. Single-parent score is doubled. 

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