Psychology and Psychiatry

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.