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As Medical Director of the American Psychiatric Association from 1974 to 1997, Melvin Sabshin, M.D., brings a unique perspective on the history of post World War II psychiatry to Changing American Psychiatry: A Personal Perspective. He describes in detail two extraordinary periods of change, the first stimulated by laudatory efforts to understand the high rate of psychiatric casualties among World War II veterans and to provide treatment for them. Psychiatry grew quickly during the postwar years, considerably influenced by the immigration of many Central European psychoanalysts. Gradually, however, psychiatry began to weaken its ties to medicine and lost much of its public respect. By the 1970s postwar optimism had been replaced by widespread concern that psychiatric practice was being dominated by unsubstantiated formulations rather than reliable evidence. Psychiatry was dramatically impacted by enormous pressure for therapeutic accountability exerted by a managed care reimbursement system. The profession recognized the need for a new direction and resolved to change. In this well-crafted account, Dr. Sabshin describes how the profession has become a more respected part of medicine. The combined use of evidence-based psychotherapy and psychopharmacology will become a central part of future psychiatric practice. Dr. Sabshin encourages psychiatric professionals to continue changing the field so that it can emphasize an empirically based, carefully enunciated, biopsychosocial model that has the potential to revitalize American psychiatry.
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Changing American Psychiatry A Personal Perspective This page intentionally left blank Changing American Psychiatry A Personal Perspective Melvin Sabshin, M.D. Washington, DC London, England Books published by American Psychiatric Publishing, Inc., represent the views and opinions of the individual authors and do not necessarily represent the policies and opinions of APPI or the American Psychiatric Association. Copyright © 2008 American Psychiatric Publishing, Inc. ALL RIGHTS RESERVED Manufactured in the United States of America on acid-free paper 12 11 10 09 08 5 4 3 2 1 First Edition Typeset in Georgia. American Psychiatric Publishing, Inc. 1000 Wilson Boulevard Arlington, VA 22209-3901 www.appi.org Library of Congress Cataloging-in-Publication Data Sabshin, Melvin, 1925– Changing American psychiatry : a personal perspective / Melvin Sabshin. — 1st ed. p. ; cm. Includes bibliographical references and index. ISBN 978-1-58562-307-5 (alk. paper) 1. Psychiatry—United States—History—20th century. 2. American Psychiatric Association—History—20th century. 3. Sabshin, Melvin, 1925– 4. Psychiatrists—United States—Biography. I. Title. [DNLM: 1. Psychiatry—history—United States—Personal Narratives. 2. History, 20th Century—United States—Personal Narratives. 3. Psychiatry—trends—United States—Personal Narratives. WM 11 AA1 S118c 2008] RC443.S23 2008 616.89—dc22 2008004460 British Library Cataloguing in Publication Data A CIP record is available from the British Library. Contents List of Plates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii About the Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi James H. Scully Jr., M.D. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxi 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Post–World War II Scene in American Psychiatry . . . . . . . 1 A Pathway to Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Implicit Preparations for a Leadership Role in Psychiatry. . . . . . . . . . . . . . . . .