1. The 1980 statistics on psychiatrists, psychologists, and social workers come from Daniel Goleman, “Social Workers Vault into a Leading Role in Psychotherapy,” New York Times 30 April 1985, Section III, p. 1. Data on nurses come from National Data Book 1980, Publication No. ADM 80-938 (Washington, DC: Government Printing Office, 1980), pp. 71–72. The 1999 data on psychiatry, clinical psychology, and psychiatric social work come from R.M. Scheffler and P.B. Kirby, “The Occupational Transformation of the Mental health System.” Health Affairs 22:5 (2003): 177–188. SAMHSA, Mental Health 2000 Appendix D gives an estimate of 32,648 mental health nurse specialists.
2. Bertram S. Brown, “The Federal Government and Psychiatric Education.” New Dimensions in Mental Health, Publication No. ADM 77-511 (Washington, DC: Government Printing Office, 1977), p. 6.
3. In order to keep this chapter to a manageable size, I have chosen to focus only on the four core disciplines recognized by the N.I.M.H. when it began aggressively funding professional training programs in the late 1940s. Yet I recognize that there are other important providers of mental health care today. Recent studies document that primary care physicians treat many more people suffering from mental disorders than do specialists in mental health care. In addition, since World War II, the pastoral care movement has greatly increased the clergy’s involvement in counseling and therapy. In mental hospitals, occupational therapists play an important role in treatment. Last but not least, nonprofessionals now hold a majority of staff positions in mental health clinics and hospitals. See Darrel A. Regier, et al., “The De Facto U.S. Mental Health Services System,” Archives of General Psychiatry 35(1978): 685–693; John C. Burnham, “Psychology and Counseling: Convergence into a Profession,” in The Professions in American History, ed. Nathan O. Hatch (Notre Dame, Indiana: Notre Dame Press, 1988), 181–198, esp. pp. 184–185; and Michael Gershon and Henry B. Biller, The Other Helpers: Paraprofessional and Nonprofessionals in Mental Health (Lexington, MA: D.C. Heath and Co., 1977).
4. My approach in this chapter is heavily indebted to the work of sociologist Andrew Abbott, especially his book, The System of Professions: An Essay on the Division of Expert Labor (Chicago: University of Chicago Press, 1988). When I first wrote this chapter ten years ago, there were surprisingly few historical accounts of the mental health team concept. Since then, a number of articles and books have addressed various aspects of the interprofessional relations between psychiatry and social work and psychiatry and psychology, which I have used to revise my argument, and acknowledge in the notes that follow.
5. For an overview of nineteenth-century psychiatry, see Gerald Grob’, Mental Institutions In America (New York: The Free Press, 1973). The phrase “one man rule” is explained in Nancy Tomes. A Generous Confidence: Thomas Story Kirkbride and the Art of Asylum-Keeping. 1840–1883 (New York: Cambridge University Press, 1984), esp. pp. 146–148.