The Making of Contemporary American Psychiatry, Part 1: Patients, Treatments, and Therapeutic Rationales Before and After World War II

Health Services Research Center, Neuropsychiatric Institute, University of California, Los Angeles.
History of Psychology (Impact Factor: 0.26). 06/2005; 8(2):176-93. DOI: 10.1037/1093-4510.8.2.176
Source: PubMed


This article, the 1st in a 2-part series, uses patient records from California's Stockton State Hospital to unearth the midcentury roots of contemporary American psychiatry. These patient records allow the authors to examine 2 transformations: the post-World War II expansion of psychiatry to include the diagnosis and treatment not only of psychotic patients but also of nonpsychotic patients suffering from problems of everyday living, and the 1950s introduction of the first psychotropic drugs, which cemented the medical status of these new disorders, thus linking a new therapeutic rationale to biological understandings of disease. These transformations laid the groundwork for a contemporary psychiatry characterized by voluntary outpatient care, pharmacological treatment of a wide range of behaviors and distress, and a doctor-patient relationship and cultural acceptance of disease that allow psychiatric patients to identify themselves as consumers.

Download full-text


Available from: Joel Braslow, Mar 24, 2015
  • Source
    • "Initially diagnosed as a paranoid schizophrenic by the controversial Dr. Landy in 1983, Wilson was heavily medicated with anti-psychotic drugs; so much so that he developed tardive dyskinesia (Carlin, 2006, p. 271). All sources referring to the medication he was taking until 1992 are no more specific than mentioning 'psychotropic drugs', though the development of tardive dykinesia implicates medication with phenothiazines , and it is likely that chlorpromazine would have been used in such an instance (Starks & Braslow, 2005). Psychiatric evaluations between 1992 and 1994, after Wilson had left Landy's care, favoured diagnoses of schizoaffective disorder and mild bipolarity. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The suggestion of a relationship between creativity and mental disorder has existed for centuries, and has been advocated by many psychological researchers. The present analysis offers a consideration of the nature of mental disorder present in Brian Wilson, an individual recognised as one of the most creative figures in 20th century popular music. Using converging biographical evidence, and the diagnostic program Opcrit, Wilson’s diagnosis is concluded to be schizoaffective. Employing details of his drug abuse, various models of schizoaffective spectra are examined, in particular a reconsideration of the LSD model of schizophrenia. The model is shown to be useful for positive schizophrenic symptoms including overinclusion, a potentially key element of creativity. In doing so, this psychobiographical analysis allows examination of potential relationships between mental disorder and creativity, the effects of various narcotics on creativity and various elements of mental disorder, the efficacy of various drug models of psychotic disorders, and the overlap between psychotic and affective disorders.
    Full-text · Article · Jun 2009 · Personality and Individual Differences
  • Source
    • "These records include admission and discharge summaries, continuous (progress) notes, treatment and medication order sheets, and transcripts of clinical case conferences and doctor–patient interviews. In the first article in this series (Starks & Braslow, 2005), we used these records to examine the treatment of two kinds of patients: (a) the psychotic patients that characterized the early state hospital and (b) the nonpsychotic patients who flooded into the hospital following World War II, seeking care for problems of everyday life. These patient cases offered a window into not only the expansion of the scope of psychiatry but also the early use of antipsychotic drugs, both of which laid the foundation for much of contemporary psychiatric theory and practice. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In this article, the 2nd in a 2-part series, the authors use patient records from California's Stockton State Hospital to explore the changing role of gender norms and other cultural values in the care of psychiatric patients. The authors show that cultural values are always imbedded in psychiatric practice and that their role in that practice depends on the patients, treatments, and therapeutic rationales present in a given therapeutic encounter. Because the decade following World War II witnessed dramatic changes in psychiatry's patients, therapeutics, and rationales, Stockton State Hospital's patient records from this time period allow the authors to show not only the extent to which gender norms shape psychiatric practice but also how psychiatry's expansion into the problems of everyday life has led to psychiatry taking a more subtle and yet more active role in enforcing societal norms.
    Full-text · Article · Sep 2005 · History of Psychology
  • Source
    • "State hospitals have changed a great deal over the last century. Although individuals with mental illness were once housed in psychiatric hospitals for most of their lives, care of Americans with severe mental illness has now shifted to the community (Starks & Braslow, 2005). Thus, brief hospitalizations are necessitated by the managed care environment, and interventions must be brief and easy to implement without extensive staff training (Lieberman, "

    Preview · Article ·
Show more