THROUGH THE YEARS:
HISTORY OF PHILIPPINE PSYCHIATRY

Ma. Rubinia Torres-Yap, M.D

INTRODUCTION

The history of psychiatry in Phil., although relatively brief compared to the histories of European and Western countries, is nonetheless colourful. 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: from the pre-Spanish era, to almost 4 centuries of Spanish rule, followed by 4 decades under the American regime, the brief but tumultuous Japanese occupation, up to the subsequent liberation by the Americans.

PRE-SPANISH ERA

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:

•  Angry deities whom the victims have displeased;
• Witches or mangkukulam who cast by chanting incantations and pricking magic dolls; or by
• Devilmen or mangagaway who could make their enemies mentally sick by praying to Satan.

* Delivered during the opening ceremonies of the 20th Annual convention of the Philippine Psychiatric Association held last Jan 25, 1995 in Montebello hotel, Cebu City

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.

Unlike in other countries, there is no central figure in the evolution of Phil. Psychiatry. Thus, we continue to trace the history of psychiatry during the Spanish era, through the development of institutions for the mentally ill.

Documents reveal that the 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.

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. The wards of Hospicio were mainly natives and Chinese, with a sprinkling of Spanish residents who cannot afford to return home.

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

THE 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.

With the resurgence of psychiatric activities at NMH, other centers followed suit:

V. LUNA GENERAL HOSPITAL

The Neuropsychiatry service of the V. Luna General Hospital, a 100 bed unit in a general hospital setting was established in 1946. Notable achievements include the performance of the first pre-frontal lobotomy in the Phils. In 1947 by Major Romeo Gustillo, using his own improvised leucotone. This successful operation was done on a violent schizophrenic who failed to respond to ECT and other available therapies.

Two years later (Dec. 1949), the first transorbital lobotomy on a schizophrenic patient was performed by Major Jaime Zaguirre, who received training in Australia.

UP COLLEGE OF MEDICINE

At the UP College of Medicine, Dr. Marciano Limson, then professor of anatomy and neuroanatomy, took charge of teaching psychiatry in 1945. By 1950, Dr. Jorge Paras, A U. S trained psychiatrist on Rockefeller scholarship, returned and taught psychiatry.

Dr. Carl Bowman, then Chairman of the Dept. Of Psychiatry at the University of California Medical Center, made two brief visits to the college, under the sponsorship of the China Medical Board of New York. His task was to appraise and assist in the development of the undergraduate program in psychiatry. On Dr. Bowman recommendation, Dr. Baltazar V. Reyes, Jr., then a resident in the Department of undergo training in psychiatry, also under the sponsorship of the China Medical Board. Meanwhile, a succession of American psychiatrists visited the country to further develop the undergraduate psychiatry program of UP.

When Dr. Baltazar Reyes returned in 1958, he headed the newly established Neuropsychiatry section in the Department of Medicine. Three years later, Dr. Lourdes Vera Lapuz returned to the country from psychiatric training from New York, and joined the Section.

By 1959, a three psychiatric residency training program was formally initiated, with Dr. Benjamin Marte as its graduate. Other residents include Dr. Antonio Perlas, Cornelio Banaag and Lourdes Ignacio.

In 1964, a separate unit, the Department of Psychiatry was established while Neurology remained a section of the Dept. Of Medicine.

By 1982, the Division of child Psychiatry was established and fellowship training was started.

UST
At UST, the Section of Neurology and Psychiatry under the Department of Medicine was organized in 1947, with Dr. Leopoldo Pardo as chief. It was considered a vestigial section, with only four beds from the medical wards allotted to the section.

In 1950, the first privately-run institute of Neuropsychiatry was opened with a bed capacity of thirty, primarily for the diagnosis and treatment of acute mental disorders. The institute’s first two resident physicians were sent to the Universidad Central de Madrid for specialized training. Dr. Gilberto Gamez who was then teaching experimental psychology chose psychiatry training, Dr. Gamez also completed a residency training in Neurology at the Neurologic Institute of the Columbia-Presbyterian Medical Center.

Despite these achievements, the Institute of Neuropsychiatry was closed with a change in rectorship of the university.

On March 1968, the section on Neurology and Psychiatry became a Department with Dr. Gamez as its first chairman. The Dept. Was divided into two sections, and formal combined residency training program in psychiatry and neurology was organized, with Dr. Leonor T. Feliciano as its first graduate.

UERMMC

The increasing story emerged at UERM. In the mid-fifties (1956), a Dept. Of Psychiatry, separate from Neurology and Medicine was established at the UERM hospital under the chairmanship of Dr. Jaime Zaguirre. Dr. Zaguirre held this post till his retirement 20 years later. After which, Psychiatry was merged with Neurology in 1977, under the newly created Neuroclinical Services, only to regain its Department status in the late 1980s.

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.

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.

PSYCHIATRY FROM THE 70’S TO THE 90’S

The psychopharmacological revolution abroad ushered in the use of tranquilizers, antidepressants and non-barbiturate sedatives in the country. More sophisticated drugs followed after the newer discoveries regarding neurotransmitters. Thus, these events in the 70’s to the 90’s heralded the move towards more biological approach to psychiatric illness.

The last two decades also saw growth in the number of psychiatrists despite the rapid increase in the number of teaching/training institutions. It was observed, that most the psychiatrists were concentrated in Metro Manila and other urban centers of the country.

Psychiatry stagnated particularly in the 70’s to the 80’s, was characterized by government neglect and public apathy towards mental illness.

The Aquino administration in the 1986, tried to address these problems by drumming up multi-sectotal involvement and focusing on community-based interventions. The Task Force on Mental Health, later named Project Team on Mental Health, was created by the Dept. Of Health, composed mainly of psychiatrists. It aimed to formulate a new program on mental health and recommend much needed organizational reforms. Its first initiative was the reorganization of the National Mental Health, now given a new name, the National Center for Mental Health, signifying its envisioned role as the country’s repository of technical and administrative expertise on mental health.

In 1989, the Project Team was instrumental in proposing 2 mental health bills in the legislature that will give priority to community based mental health care activities, and create a national coordinating body for mental health. It is unfortunate, that even after the Aquino administration, these bills have  not yet been promulgated.

FUTURE DIRECTIONS
To conclude, a revisiting of the history of Philippine Psychiatry, its beginning and development, begs the following questions:
” What have we learned from the triumphs and travails of our predecessors?
” Where do we go from here?”
” What kind of history do we want to create in the next five years and beyond the year 2000?”

It is hoped that in the next three days of this convention, we could as individual psychiatrists, and as an association, 300 strong, find the answers to these questions.

*end*

Sources
Catindig, Cesar T. “Psychiatry in the Phils. “PMA Journal. Vol.4 No. 12, 1966.
Manguigad, L.C. ” Psychiatry in the Phils.” American Journal of Psychiatry. Vol. 121 No1, July 1964.
Reyes, Baltazar V.. ” History of the Dept. Of Psychiatry in the College of Medicine, UP.” Manual of the Structural and functional Oraganization of the Dept. Of Psychiatry, UP-PGH Medical Center, 1968.
Santiago, Luciano P.R. ” Rizal and the Beginnings of Philippine Psychiatry.” Acta Medica. Oct-Dec. 1965.
Interviews with Dr. Baltazar V. Reyes and Gilberto Gomez.
Acknowledgement