American Psychiatry After World War II (1944-1994)
This monumental volume about the history of psychiatry is a highly readable and superbly organized overview of psychiatry's movement during the past half century. It is a valuable resource for psychologists, social workers, and workers in allied disciplines, including medical historians.
The book is divided into six sections, each containing contributions by clinicians who had central roles in the areas covered. Four sections are primarily historical and roughly chronological, starting with World War II.
Psychiatry is a biomedical science but, unlike many other fields of medicine, it is affected by and has effects on the culture in which it resides. For example, the impact on psychiatry of changes in individual rights during the past half century has been enormous. Roy Menninger, M.D., summarizes psychiatry's complex movement as follows: "Affected by cultural definitions and values as well as by professional developments, psychiatry has moved toward and away from medicine, toward and away from the medical model of disease and treatment, toward and away from an individual focus to a broader public health focus, and, perhaps in a most basic way, toward and away from theories based on the biology of the brain versus theories rooted in the phenomenology of the mind." The direction psychiatry has taken in recent years suggests a movement toward a more integrated, biopsychosocial approach to treatment.
In an excellent chapter on the cultural impact of psychiatry, John Beahrs, M.D., discusses the dimensions of maturation both in interpersonal relationships—going from passive to active control, and from entitlement to reciprocity—and in functional dimensions—from immediate gratification to long-term planning and from multiple untapped potentials to a focused personal identity. He points out that the entitlement of unlimited freedom without responsibility in the 1960s caused some major problems, including the undermining of Erikson's concept of mental health as being able "to love and to work."
Dr. Beahrs describes how the unprecedented rapidity of social and technological change in the past half century has tended to contribute to the loss of both personal and social identity. He notes that even though we have seen continual improvements in information management, technology, and medicine, helping individuals to be more competent than ever, we still face enormous problems—child abuse, illicit drugs, political corruption, terrorism, and so on.
The section on public attitudes, public perceptions, and public policy covers the impact of deinstitutionalization, the development of community mental health centers (CMHCs), the use of new psychotropic drugs, and various other forces on the process of change in psychiatry. Deinstitutionalization came about very rapidly—so rapidly that often the communities and their CMHCs were not ready to effectively handle the people being released, or they were not treating the seriously chronically mentally ill. However, the section offers no discussion of the various states' or counties' responsibility to the individuals with mental illness who have fallen through the cracks. These departments of mental health function as a safety net for the least fortunate, who are to be found in shelters, jails, or on the streets. Most of these people urgently need multiple sources of help while they get back on their feet.
American Psychiatry After World War II should have a place on the shelf of anyone who is interested in the history of psychiatry. It is a quick reference source but also an excellent resource for anyone who wants to explore a particular subject in psychiatry in depth.
Dr. Ordway is affiliated with the Eastern Maine Medical Center and with the Maine Department of Mental Health, Mental Retardation, and Substance Abuse Services in Bangor.
