Harrington commends physicians who charted a middle course. In , Bleuler left the International Psychoanalytical Association. As the century progressed, the schism between the biological camp and the psychoanalytic camp widened.
With advances in bacteriology, the biological camp embraced the idea that microbes in the intestine, the mouth, or the sinuses could release toxins that impaired brain functions. The most notorious mid-century surgical intervention was the lobotomy. Freeman crisscrossed the country—a trip he called Operation Icepick—proselytizing for the technique in state mental hospitals. On the nonbiological, analytic side of the discipline, world events again proved pivotal.
Auden, was clouded by fears about the power of nuclear weapons, the Cold War arms race, and the possibility that communist spies were infiltrating society. Accordingly, American neo-Freudians substituted anxiety for sex as the underlying cause of psychological maladies. They replaced Freudian tropes with a focus on family dynamics, especially the need for emotional security in early childhood.
In every case history of a troubled child. Start looking for the real enemy. Feminism furnished just one of several sweeping attacks on psychiatry that saw the enterprise as a tool of social control. In , three influential critiques appeared. By the early seventies, such critiques had entered the mainstream. Psychiatry, they argued, labelled people disturbed in order to deprive them of freedom. Challenges to the legitimacy of psychiatry forced the profession to examine the fundamental question of what did and did not constitute mental illness.
Homosexuality, for instance, had been considered a psychiatric disorder since the time of Krafft-Ebing. But, in , the annual A. I am a psychiatrist. I, like most of you in this room, am a member of the A.
Homosexuality was still listed as a disorder in the Diagnostic and Statistical Manual of Mental Disorders , even as many psychiatrists clearly held a different view. In December, , the A. Today, around one in six Americans takes a psychotropic drug of some kind. The medication era stretches back more than sixty years and is the most significant legacy of the biological approach to psychiatry. It has its roots in the thirties, when experiments on rodents suggested that paranoid behavior was caused by high dopamine levels in the brain.
The idea that brain chemistry could offer a pathogenesis for mental illness led researchers to hunt for chemical imbalances, and for medications to treat them. In , the F. The pharmaceutical industry vigorously promoted it as a biological solution to a chemical problem. Next came sedatives. An alternative, Valium, introduced in , became the most commonly prescribed drug in the country the next year and remained so until One of the first drugs to target depression was Elavil, introduced in , which boosted available levels of norepinephrine, a neurotransmitter related to adrenaline.
Again there was a marketing blitz. The liner notes included claims about the benefits that patients would experience if the drug was prescribed for them. Focus shifted from norepinephrine to the neurotransmitter serotonin, and, in , Prozac appeared, soon followed by other selective serotonin reuptake inhibitors SSRIs.
Yet, despite the phenomenal success of Prozac, and of other SSRIs, no one has been able to produce definitive experimental proof establishing neurochemical imbalances as the pathogenesis of mental illness.
Indeed, quite a lot of evidence calls the assumption into question. Three years later, the National Institute of Mental Health was born.
Prevention was an important goal and the quality of mothering was considered key. Women's magazines cropped up like mushrooms.
If mothers failed, professionals were needed to be available to intervene. A cadre of experts was building. Increasing numbers of trained psychiatrists spilled over into a greater number of child psychiatrists. At the same time, many pediatricians found that the new antibiotics made their specialty consist largely of well child care. Some found this boring. Federal training funding became available to convert pediatricians into pediatric psychiatrists.
The American Academy of Child Psychiatry was founded in It was preceded by two organizations interested in children's mental health. It was multidisciplinary, and its main focus was prevention. Politically, members often leaned to the left and tended to view diagnoses as hurtful labels.
In , 54 child guidance clinics created an organization of clinics. Before child psychiatry residencies, the gold standard credential for child psychiatry was an AAPCC certificate of training. The movement toward subspecialization picked up speed in when the American Psychiatric Association converted its section on Mental Deficiency to the Section on Child Psychiatry.
The following year, 96 psychiatrists met in Atlantic City, N. There were charter members. Members applying were also required to have made an "outstanding contribution to the field of child psychiatry," as reflected by unanimous approval by the AACP Council and a two-thirds majority of the members. In , Frederick Allen, M. Although some child psychiatrists favored an autonomous specialty, similar to pediatrics' break from internal medicine, this did not seem feasible.
There was some debate as to whether the new specialty would be pediatric psychiatry or child psychiatry, but a vote by AAPCC clinic directors overwhelming favored a link to psychiatry rather than to pediatrics. In , six child psychiatrists met with the ABPN's president and secretary to discuss the possible particulars for a new psychiatric discipline.
There was agreement on a two-year child psychiatry residency, with the option to replace the third year of general psychiatry residency with the first year of child psychiatry training. The subspecialty was approved in February About clinicians were grandfathered into the subspecialty. The first certifying exam was in the form of essay questions. The committee found them impossible to grade, so it announced there would be a follow-up oral examination.
There are those today who are still hot with anger about first missing the cut to be grandfathered, then taking the essay exam, and then being forced to take a not previously announced oral exam.
These original classification standards were revised and organized into the Diagnostic and Statistical Manual of Mental Disorders DSM , first published in Further revisions over the years, most recently in with DSM-5, reflect significant clinical and scientific advances made in understanding and diagnosing mental illness. In , American Psychiatric Publishing, Inc. In , the APA created a foundation, now called the American Psychiatric Association Foundation, to advance mental health through public education programs, investing in the future leaders of psychiatry and supporting research and clinical training.
Additionally, to help preserve some of the rich history of the field of psychiatry, the APA today houses a library, the Melvin Sabshin, M. The library includes an extensive collection of texts, documents, images and oral histories. Media Contacts Erin Connors, econnors psych.
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