© ROY SCOTT/IKON IMAGES/CORBISDuring the early 20th century American psychiatry fell under the influence of psychoanalysis. At mid-century, psychiatry broke with psychoanalysis to align more closely with scientific medicine. As psychiatry turned toward the biological sciences, state hospitals discharged thousands of severely mentally ill patients with prescriptions in hand, and federally funded mental-health initiatives, ill-prepared to cope with the deluge, sprang up in communities across the nation. This led to a split in the practice of psychiatry. For psychiatrists concerned with the brain as an entry point into a new scientific era, neurochemistry and neuropharmacology filled the void left by psychoanalysis. For psychiatrists working in the emerging community-health programs, a wide range of additional activities and their supporting sciences—sociology, psychology, and economics, as well as vocational, transcultural, and other studies—became relevant to providing improved patient care. During the ensuing years, the brain sciences flourished, while services in communities, affected by social policies, withered. Today, psychiatrists debate whether psychiatry should become an applied neuroscience focused on brain functions or a research enterprise driven by the clinical needs of patients and communities.
Clinician psychiatrists find current academic priorities and the policies that shape them unbalanced regarding which sciences and practices best serve psychiatric patients. By abruptly terminating federal funding of community services, the Reagan Administration precipitated a continuing decline in vital corollary adjuncts to psychiatric treatment. The use of drugs to manage mental disorders and the managed-care practices of insurance companies encouraged psychiatrists to abandon working in community health clinics in favor of practicing in offices. Federal policies that leave clinical drug development to industry, and the dependence on pharmaceutical companies for funding, constrained academic research. Academics and universities began to profit by selling their discoveries to such companies. Each of these developments has favored the tilt toward neuroscience and undermined psychiatry’s integration of other disciplines.
Psychiatry’s ...
