HISTORY OF PSYCHOPATHOLOGY IN INDOPAK

Name:mehreenClass:b.s 5th semester

Mental illness :Mental illness refers to a wide range of mental health conditions — disorders that affect your mood, thinking and behavior.

GLOBAL MENTAL HEALTH ISSUES

More than two fifths of the total disabilities are due to mental illnesses

(WORLD HEALTH REPORT, 2001)

HISTORY OF PSYCHOPATHOLOGY IN INDOPAK

Till about 17th century all abnormal behavior was believed to be act of the ‘devil’ i. e. ‘Against God’, evil & described as witches.

Gradually over the passing time, mental illness was considered as ‘deviant behavior & mentally ill were considered socially unacceptable & put in jails along with other criminals.

In the modern era, there was a shift from ‘evil’ to ‘ill. Mentally ill were called as ‘mad’ or ‘insane’ and were placed in special places called as ‘asylums’.

gradually these asylums became the place for human exploitation.

Phillipe Pinel was the first Psychiatrist to free these mentally ill from asylum.

In the 20th century, the work of Freud and ‘B. F. Skinner & J. B. Watson’ gave a scientific combination of biological & social theories to explain the etiology of mental illness.

Ayurveda SystemUnani SystemSiddha System

Ayurveda

Ayurveda (Sanskrit Āyurveda आयु�र्वे�द, "life-knowledge“) Ayurvedic medicine is a system of Hindu traditional medicine of Vedic tradition native to the Indian subcontinent, and a form of alternative medicine. Some of the oldest known Ayurvedic texts include the Suśrutha Saṃhitā, Charaka Saṃhitā. These Sanskrit texts are among the foundational and formally compiled works of Ayurveda.

Treatment and health protection•deal with surgery• building a healthy metabolic system, attaining good digestion and proper excretion lead to vitality. Ayurveda also focuses on exercise, yoga, and meditation. •To maintain health, a Sattvic diet can be prescribed to the patient.•Concepts of Dinacharya are followed in Ayurveda; dinacharya stresses the importance of natural cycles (waking, sleeping, working, meditation etc.) for a healthy living. 

•Hygiene, too, is a central practice of Ayurvedic medicine. Hygienic living involves regular bathing, cleansing of teeth, skin care, and eye washing.

Eight components of AyurvedaIn classical Sanskrit literature, Ayurveda was called "the science of eight components1.Kayachikitsa (General medicine): "cure of diseases affecting the body".2.Kaumāra-bhṛtya and Bala Roga : "treatment of children".3.Shalya tantra: surgical techniques.

4.Śālākya-tantra (Ophthalmology): cure of diseases of the teeth, eye, nose or ear etc.

5.Bhuta-vidyadeals with the causes, which are directly not visible and not explained directly from tridosha.:pertaining to micro-organisms or spirits.

6.Agada-tantra : Gada means Poison. "doctrine of antidotes"

7.Rasayana-tantra (Geriatrics)/(Anti Agings) : Doctrine of Rasayana/Rejuvenation.

8.Vajikarana tantra (Aphrodisiacs): deals with healthy and desired progeny.

Unani SystemUnani-tibb or Unani Medicine also spelled Yunani Medicine in (Arabic, Hindustani, Pashto and Persian) is a form of traditional medicine practiced in middle-east & south-Asian countries. It refers to a tradition of Graeco-Arabic medicine,

which is based on the teachings of Greek physicians Hippocrates and Galen, and developed into an elaborate medical system in middle age era by Arabian and Persian physicians, such as Rhazes (alRazi) , Avicenna (Ibn Sena), Al-Zahrawi, and Ibn Nafis.

Unani medicine is based on the concept of the four humours: Phlegm (Balgham), Blood (Dam), Yellow bile (Ṣafrā') Black bile (Saudā').The time of origin is at circa 1025 AD, when Avicenna wrote The Canon of Medicine in Persia.

While he was primarily influenced by Greek and Islamic medicine, he was also influenced by the Indian medical teachings Of Sushruta and Charaka.

Unani medicine: first arrived in India around 12th or 13th century with establishment of Delhi Sultanate (1206–1527) and Islamic rule over North India and subsequently flourished under Mughal Empire.• Alauddin Khilji had several eminent Unani physicians (Hakims) in his royal courts.In the coming years this royal patronage meant development of Unani practice in India, but also of Unani literature with the aid of Indian Ayurvedic physicians.

TREATMENT

•laj-Bil-Tadbeer wa Ilaj-Bil-Ghiza (Regimenal Therapy).

•Ilaj-Bil-Advia (Pharmacotherapy). 

•Ilaj-Bil-Yad (Surgery)

•Jarahat (Surgery)

Siddha System

Siddha Medicine  is usually considered as the oldest medical system known to mankind. Contemporary Tamil literature holds that the system of Siddha medicine originated in Southern India, in the state of Tamil Nadu, as part of the trio Indian medicines -ayurveda, siddha and unani. Siddha is reported to have surfaced more than 10,000 years ago.

In reigns of King Ashoka, many hospitals were established for mentally ill.

A temple of Lord Venkateswara at Tirumukkudal, Chingleput District, Tamil Nadu, contains inscription on the walls belonging to Chola period.

•The hospital was named as Sri Veera Cholaeswara hospital and contained 15 beds.

•Maulana zulur-Lah Hakim, an Indian physician was in charge of the first Indian mental asylum, i. e. Mandu hospital opened by Mahmood Khilji (1436-1469) at Dhar, M. P. First lunatic Asylum

•Bombay Asylum, was built in modern India in approximately 1750 A. D. at the cost of 125/-, no traces of it is present today.

1794, a private lunatic asylum was opened at Kilpauk, Madras. The central mental hospital, Yerwada, Pune was opened in 1889.First asylum for insane soldiers was started at Monghyr, Bihar and was known as Monghyr Asylum(1795).

Maxell Jones in 1953 introduced the concept of Therapeutic community resulting in the improvement in the Mental Hospital conditions.

Calcutta University :established the firstDepartment of Psychology in 1915 under the leadership of Dr N.N. Sengupta who had worked under Professor HugoMunsterberg, a former student of Wundt.

• first centre of psychological research and teaching in India

Before independence British universities greatly influenced the directions that psychological research took in the country .

•psychology, transplanted to India as part of the total imperialist domination by the West, came as a ready-made intellectual package in the first decade of the century

it almost replaced the •intellectual traditions

•indigenous systems

•religious

• metaphysical systems.

Indian psychologyAfter partition

Indian culture has always given a great importance to spiritual life.

One of the earliest Indian Psychiatrists to explain the importance of health was Govindaswamy in 1948.

Govindaswamy gave 3 objectives of mental health –

1. regaining of the health of mentally ill person;

2.prevention of mental illness in a vulnerable individual

3.protection & development at all levels, of human society, of secure, affectionate & satisfying human relationships & in the reduction of hostile tensions in persons & groups (Govindaswamy, 1970).

•All India Institute Mental Health was set up in 1954, which became the National Institute of Mental Health And Neurosciences in 1974 at Bangalore.

•An expert committee of WHO in 1974, urge its members to consider mental disorder as a high priority problem.

The recommendations included :

1. to undertake pilot projects to assess existing mental health care program in a defined populations

2.training program for health workers

3.to devise a manual for the same (Isac 1986).

•first community Mental Health unit (CMHU) was started with the Dept. of Psychiatry at NIMHANS in 1975. •For short term training of primary care personal, a Rural Mental Health Center was inaugurated in Dec’1976 at Sakalwara, 15 km from Bangalore.

•The first training program for Primary Health Care was started in 1978-79.

•During 1978-1984 Indian Council of Medical Research funded & conducted a multicentre collaborative project on ‘severe Mental Morbidity’ in Bangalore, Baroda, Calcutta & Patiala

Various training programs for psychiatrists, Clinical Psychologists, Psychiatric Social Workers, Psychiatric nurses and Primary Care doctors were conducted at Sakalwara unit between 1981-82 (Ministry of health & family welfare, 1989).

•On 12 December1968 an autonomous organization named the Indian Council of Social Science•Research (ICSSR) was established – its now considered one of the biggest achievements of Indian democracy .•The Council provides valuable help and encouragement to scholars from all over the country through fellowships and project and conference grants.

Indian Council of Social Science Research (ICSSR)

•Today good-quality research is conducted in areas such as clinical psychology, educational psychology, organizational psychology, social psychology, forensic psychology, Indian (traditional) psychology, cross-cultural and comparative psychology ,defence psychology (includes psychological research on terrorism) and counseling psychology.

•There are approximately 15,000 psychologists in the country(study of 2005)

•Until the mid-1980s the public viewed psychology primarily as a remedy for abnormal behavior.

•However, the popularity of psychology has been increasing since then, with its application in areas such as education, work and counseling.

Where is psychology taught and research?

•Training for psychologists takes place in universities.

•Most universities offer general degrees such as MAs in psychology or applied psychology, and students do specialized training in their chosen areas, mainly clinical, organizational, counseling and social in the second year.

•Those who wish to become clinical psychologists do a PhD in clinical psychology, lasting five years. Some universities such as the National Institute of Mental Health and Neurosciences conduct specialized two-year courses in clinical psychology, which postgraduate students pursue

University of Allahabad: is the prime department of psychology ,research and publications.

University of Mumbai: (formerly Bombay) instituted department of Applied Psychology to train research.

Psychological Research Wing (PRW): In the post-independence period the government, particularly the Defense Ministry, began emphasizing the need for the inclusion of psychologists on research and selection boards was established in 1949 .

The future of psychology in India

•has been expanding rapidly.

•number of psychologists and institutions offering courses in psychology, research publications and journals is increasing.

•With new policies of the government together with the awareness of Indian psychologists of the societal demands and their roles, it is hoped that a conducive environment for faster growth of an appropriate and proper psychology in India will develop.

Roots of psychology in Pakistan :

•According to Ansari (1987), the earliest teachers of psychology were philosophers ,so Pakistani psychology was influenced much more by philosophy than by the academic areas such as biology and sociology that have penetrated Western psychology.

•Originally philosopher, Dr Mohammad Ajmal (1920–1994) has left a profound influence on the field of psychology in Pakistan, giving it a philosophical and analyticalorientation. •Gradually there was a shift towards a more behaviorist and quantitative orientation, and computer use, in part due to the training of some Pakistani psychologists in British and American universities.

ORGANISATIONS AND PUBLICATIONS:

The Pakistan Psychological Association (PPA) is the oldest academic and professional organization of Pakistani psychologists, established in March 1968 at Dacca.

•It has a membership of about 300 psychologists working in various fields of life, including college and university teaching, clinical practice, the Public Service Commission and the armed services.

•The Journal of Psychology was the first such publication, started in 1964 by Dr Mohammad Ajmal. It was replaced after two years by the Psychology Quarterly.

•GCU Lahore now publishes the Pakistan Journal of Social and Clinical Psychology, and other refereed journals are published by Karachi University, the National Institute of Psychology and Punjab University

Government College University Lahore

(arguably the best undergraduate and postgraduate institution in the country) •the Department of Psychology is the oldest in Pakistan offering master’s level studies.•The department was established in 1932,well before the partition of the subcontinent, under the headship of G.C.Chutterji, at which time it offered master’s classes in collaboration with Foreman Christian College Lahore. The first master's student (in fact, the only student In the class of 1932) was Professor Abul HaiAlvi, who died in 2001 at the age of 92.

•In 1976 the Federal Education Ministry decided to establish a National Institute of Psychology (NIP) as an autonomous organization with a mandate to carry out research and teaching in the discipline of psychology.

•Dr Iftikhar-u-Nisa was appointed as its first director. •In 1994 the institute was renamed the Dr Mohammad Ajmal Institute of Psychology after its founder. •The NIP was initially a research centre, but now offers quality postgraduate teaching.

Research in psychology:•In 1987 Ansari reported the staggering fact that there were fewer than 40 psychologists with a PhD in Pakistan. •That number has not risen much since, although current PhD registrations should soon increase it by 50per cent.

•Poor library resources are a major hindrance in the production of high-quality and large-scale psychological research in Pakistan.

•The majority of postgraduate departments do not publish any psychological journals, but international journals are taken by Government College University Lahore, and Punjab, Karachi, and Quaid-i-Azam Universities.

•The library of GCU Lahore is computerized, available online and provides access to PsycINFO.

•Research limitations mean that many basic data are not available for Pakistan, such as the prevalence rates of psychiatric disorders.

It is a matter of concern that Pakistan was never included in the World Health Organization surveys conducted in different regions of the world regarding the epidemiology of psychiatric disorders andestimates of mental health resources.

•India is usually included as the regional representative country, but although India and Pakistan share some cultural values and traditions, they also differ in many important respects, such as religious convictions and style of life (Indians are more influenced by the Western media).

Religious influences

Clinical psychology has been informally practiced in this part of the world over an extended period of time: religious leaders, Sufis, saints and wise old men and women have always been able to provide counseling and at times opportunities for catharsis and outlet.

Modern practitioners of clinical psychology in Pakistan usually adopt •an eclectic approach to treatment,

•but behavior therapy and cognitive behavior therapy are the most popular paradigms, and the use of Western models reflects the training of Pakistani psychologists in US and European universities.

However, indigenous constructs(including many derived from religious teaching) play an important role in psychotherapy.

shaped largely by an indigenous culture that is collectivist, family-oriented and male-led, and 97 percent Islamic (Murray, 2002).

Dr Ajmal and many other Pakistani therapists interpret mental illness as distance from God.

The norm of mental health, therefore, is psychological closeness to God.

•The Holy Quran (the religious book of Muslims) discusses mental illness in terms of dissociation, doubt, envy and deceiving others. •Therefore, the man who becomes aware of this disease has to withdraw himself from his secular relations and to turn his gaze inwards (Ajmal, 1968)

MENTAL HEALTH SCENARIO IN PAKISTAN

Total Population169,954,000

(July 2010 est.)

Psychiatrists 400

Clinical Psychologists 200

Psychiatric Social Workers 30

Pakistan has an estimated population of 14 million Mentally ill patients, the majority of which are women

6000-8000 people commit suicide every year in Pakistan and the trend in increasing (Doesn’t include Suicide Bombers)

Mental Hospital in Lahore

(Punjab Institute of Mental

Health).Mental Hospital in Hyderabad

(Sir Cows Jee Mental Hospital)

Mental Hospital Peshawar 1950

Mental Hospital Dodial 1963

MENTAL HEALTH FACILITIES AT THE TIME after INDEPENDENCE (1947)

•Pakistan has only one psychiatrist for every 10,000 people.

•one child psychiatrist for four million children who are estimated to be suffering from mental-health issues.

• only four major psychiatric hospitals in a country of 165 million and only 20 such units attached to teaching hospitals

Once a psychiatric patient forever a psychiatric patient

Possession (any bizarre behaviour) Conversion Reaction Schizophrenia Puerperal Psychosis

No improvement

Primary psychiatric care▪ GPs▪ Clergymen & Faith Healers▪ Hakeems▪ Homeopaths▪ Shrine/Mosque / Church / Temple

Secondary psychiatric care Tertiary Psychiatric Facilities

(Teaching Hospitals)

DILEMMA OF PSYCHIATRIC CARE IN PAKISTAN

Stigma

Shortage of mental health professionals

Insufficient psychiatric beds

Brain drain

Inadequate psychiatric services in periphery

Mental Health Act (2001)

Activities of mental health NGOs

Recognition of mental health in general health care ?

International collaborations- Training- Research

THE END