American Psychiatry: An Ambivalent Specialty

Abstract

American psychiatry, perhaps more so than other medical specialties, has had a troubled and ambivalent past. For much of its history its members were employed in public mental hospitals and thus lacked the autonomy and independence of their colleagues in private practice. More significantly, psychiatry was indissolubly linked with the fate of public institutions, whose image and reputation often left much to be desired.The ambivalent character of psychiatry has given rise to two distinct and polar interpretations of its past. On the one side is a Whiggish scholarship that indentifies the evolution of psychiatry with scientific progress. The barriers to the creation of a psychiatric utopia result from the actions of malevolent or narrow-minded individuals and groups unwilling to provide appropriate resources. Furthermore, there is a presumption that psychiatric scientific and objective knowledge provided the basis for policies capable of resolving many of the troublesome problems associated with mental illness. On the other side are those who maintain that psychiatrists were involved with the social control of deviant and troublesome individuals. Mental hospitals, therefore, were simply institutions that confined and brutalized individuals whose only crime was their inability to conform to traditional behavioral norms. Embedded in this approach is the assumption that mental disease is a social rather than a medical category.