Psychology and Psychiatry - Psychiatric Diagnosis: From Psychosis To The "psychopathology Of Everyday Life", Therapeutics: From Behavioral Control To Biological Disease
changes understandings practice theoretical
Psychiatry in the United States has undergone a number of sweeping changes since the middle of the twentieth century. The settings in which psychiatrists practice, the range of diseases they seek to treat, their theoretical understandings of these diseases, and the treatments they apply are all radically different from those of their predecessors. These changes have had an impact not only on the psychiatric profession but on cultural understandings of the mind as well, altering how people make sense not only of mental illness but of their everyday feelings and behaviors.
What is remarkable is not that such changes occurred, for radical transformations in medical practice and understandings have come to be expected, but that they occurred in the way they did and for the reasons they did. Despite enormous changes, researchers have not identified the root cause of a single psychiatric disease or developed a single definitive cure. This is not to say that understandings and treatment of psychiatric illness have not improved, but simply to say that psychiatry's revolutions cannot be traced to the kinds of scientific breakthroughs that one might imagine, but rather to the interaction of a number of historical developments within psychiatry, medicine, and American culture as a whole.
This article traces the history of psychiatric theory, therapeutics, and clinical science since the mid-1900s, exploring the ways in which their interaction has shaped the course of psychiatry. This history covers three major transformations in psychiatry: an about-face in its theoretical orientation, characterized by the postwar rise and fall of psychoanalysis and the subsequent rise of biopsychiatry; the redefinition of the practice of psychiatry that followed the discovery of psychotropic drugs; and the changes in the clinical science of medicine as a whole that reinforced psychiatry's biological shift.
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The years following World War II were a time of unprecedented growth in the scope of psychiatry in the United States. In a transformation that reflected an increase in outpatient psychiatry rather than a decrease in state hospital treatment, the percentage of psychiatrists working in outpatient settings, a slim minority before the war, grew to more than half by 1947 and to an astounding 83 percent…
The nature of psychiatric care has changed immensely since the early-twentieth century, shaped not only by prevailing psychiatric theory but also—and often more importantly—by practical realities such as setting, needs, and resources. State hospitalization and outpatient psychotherapy both largely have been replaced by a proliferation of psychotropic drugs, with considerable implicat…
Since the mid-twentieth century, American psychiatry has been characterized by increasing efforts to appear both medical and scientific, in terms of the reliability of its diagnostic criteria, the biological specificity of its treatments, and the methods by which these treatments are legitimated. Such efforts suggest the image of a laggard field attempting to play catch-up with its more scientific…
Since the mid-twentieth century, psychiatry has undergone revolutionary changes in how psychiatrists diagnose patients, how they treat them, and how they evaluate whether a treatment works. These changes have brought with them major advances, especially in the neurosciences. But this history also suggests that psychiatry has lost something as it has narrowed its focus mainly to the brain and psych…
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 1st ed. Washington, D.C.: American Psychiatric Association, 1952. ——. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Washington, D.C.: American Psychiatric Association, 1980. Braslow, Joel. Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the Twentieth Cent…
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