Abstract
Over the last fifty years, American psychiatrists have embraced psychotropic drugs as their primary treatment intervention. This has especially been the case in their treatment of patients suffering from psychotic disorders such as schizophrenia. This focus has led to an increasing disregard for patients’ subjective lived-experiences, life histories, and social contexts. This transformation of American psychiatry occurred abruptly beginning in the late 1960s and 1970s. My essay looks the ways these major transformations played themselves out in everyday clinical practices of state hospital psychiatrists from 1950 to 1980. Using clinical case records from California state hospitals, I chronicle the ways institutional and ideological forces shaped the clinical care of patients with psychotic disorders. I show there was an abrupt rupture in the late 1960s, where psychiatrists’ concerns about the subjective and social were replaced by a clinical vision focused on a narrow set of drug-responsive signs and symptoms. Major political, economic, and ideological shifts occurred in American life and social policy that provided the context for this increasingly pharmacocentric clinical psychiatry, a clinical perspective that has largely blinded psychiatrists to their patients’ social and psychological suffering.
Highlights
Since the late 1960s and 1970s, American psychiatry has undergone dramatic changes
Using clinical case records from California state hospitals, I chronicle the ways institutional and ideological forces shaped the clinical care of patients with psychotic disorders
The National Institute of Mental Health (NIMH) research investment portfolio underwent a drastic transformation in which research funding the social, psychological, and cultural dimensions of mental illness was dramatically curtailed from the late 1970s and early 1980s onward, replaced by increased funding into the biological aspects of mental illness
Summary
Since the late 1960s and 1970s, American psychiatry has undergone dramatic changes. Though psychoanalytic and psychodynamic thought and practice dominated American psychiatry throughout the 1950s, it was a short-lived hegemony, replaced by growing faith in biological explanations of disease and an increasing reliance on psychotropic drugs. Peaking in 1955 with a resident patient population of over 550,000, state psychiatric hospitals had provided the vast majority of psychiatric care for over a century and, though already declining in size, disgorged most of their charges between 1970 and 1980 At first blush, these dramatic changes look like progress fueled by science and effective interventions. ‘‘ harsh the conditions of life in total institutions, harshness alone cannot account for this sense of life wasted.’’ It is the illusion of treatment that adds to the depredations inflicted upon the individual by the hospital: One of the virtues of the doctrine that insane asylums are treatment hospitals for sick people is that inmates who have given up three or four years of their life to this kind of exile can try to convince themselves they have been busily working on their cure and that, once cured, the time spent getting cured will have been a reasonable and profitable investment. If there could be a dark side to the ‘‘total institution,’’ there is another side as well, one that requires a more nuanced vision of psychiatric care and underlines the importance that everyday institutional realities play in the ‘‘mortification’’ of patients as well in providing solace and asylum
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