American Psychiatry Research Articles

The transformation of American psychiatric nosology at the dawn of the twentieth century.

Between 1896, when Kraepelin published his first formulation of dementia praecox (DP), and 1917, when the American Medico-Psychological Association issued the first official American psychiatric nosology that contained DP and manic-depressive insanity (MDI)--Kraepelin's key categories--psychiatric nosology in the United States underwent a transformation. I describe and contextualize historically this process using Thomas Clouston, a Scottish Psychiatrist and widely-read textbook author, as a representative pre-Kraepelinian diagnostician. Clouston used three major diagnostic categories based on symptomatic presentation--mania, melancholia and paranoia--all derived from the beginnings of modern psychiatry in the early nineteenth century. He observed that these categories contained good-outcome cases and those progressing to 'secondary dementia'. Kraepelin designed his categories of DP and MDI to reflect putative distinct disease processes reflected in their course and outcome. Although Clouston and Kraepelin each saw similar patients, their nosologies started from different first principles: symptomatic presentation versus presumed etiology. Driven largely by social forces with American psychiatry, Kraepelin's system spread throughout the United States in the succeeding decades replacing older diagnostic approaches typified by Clouston's. In 1896, American psychiatry was demoralized as the idyllic asylums had become overcrowded, isolated scientific backwaters. Kraepelin's nosology was derived from and was championed by individuals working in high-status research-based university psychiatric clinics. It brought excitement, the promise of subsequent research breakthroughs and the high prestige then associated with German biomedicine. Scientific research comparing the older and Kraepelinian diagnostic systems played little role in this transition. Using empirical methods to guide changes in our diagnostic system is a recent development in the history of psychiatry.

Book review: Pathologist of the Mind: Adolf Meyer and the Origins of American Psychiatry

Book review: Pathologist of the Mind: Adolf Meyer and the Origins of American Psychiatry

S. D. Lamb.Pathologist of the Mind: Adolf Meyer and the Origins of American Psychiatry

Pathologist of the Mind recounts the life and times of psychiatrist Adolf Meyer, one of the most influential psychiatrists of the first half of the twentieth century, although he is not frequently mentioned today. Part intellectual biography, part institutional history, Lamb's monograph covers the period from 1892 to 1917, beginning with Meyer's intellectual training, and moving in later chapters to the Henry Phipps Psychiatric Clinic at Johns Hopkins University. Meyer oversaw this clinic, founded in 1913, where, as Lamb argues, a scientifically based, clinical practice of psychiatry in the United States was inaugurated. One of the aims of this monograph is to highlight Meyer's importance in creating links between the study of pathological anatomy and the clinical case—a central foundation for American psychiatry. A Swiss-German, Meyer trained in medicine at the University of Zurich. He was skeptical of the brain localization schemes proliferating in Theodor Meynert's German school, a materialism that August Forel, Meyer's mentor, called “brain mythology.” Meyer emigrated to Chicago in 1892, leaving his mother behind, whose mental illness had influenced Meyer's choice of career, and who was later institutionalized at Meyer's training hospital—the Burghölzli. Working in asylums near Chicago and in Worcester, Massachusetts, Meyer exhorted his colleagues to develop a rigorous approach to clinical assessment, and interwove pathological, experimental, and clinical data into his scientific approach to clinical psychiatry.

Book Review: Susan Lamb, Pathologist of the Mind: Adolf Meyer and the Origins of American Psychiatry

Book Review: Susan Lamb, <i>Pathologist of the Mind: Adolf Meyer and the Origins of American Psychiatry</i>

The triumph of American psychiatry: How it created the modern therapeutic state

Over the past 170 years, American psychiatry has progressively asserted its authority over a larger segment of the American population. From the mid-1800s to the end of World War II, psychiatry had authority over the asylum population, which markedly increased in the first half of the twentieth century due to the influence of eugenics, an ideology that argued the ‘mentally ill’ had to be segregated from society. After the war, American psychiatry adopted Freudian conceptions of mental disorders, which enabled it to begin treating people in the community who were ‘neurotic’ in some way, which dramatically expanded its influence in society. Then, in the 1970s, when many in American society were questioning psychiatry’s legitimacy as a branch of medicine, the American Psychiatric Association (APA) responded by adopting a disease model for diagnosing mental disorders, which it set forth in the third edition of its Diagnostic and Statistical Manual. There were no scientific discoveries that led to this new model, but soon the APA was informing the American public that mental disorders were diseases of the brain, and that psychiatric drugs helped fix those diseases, ‘like insulin for diabetes.’ The APA, in concert with pharmaceutical companies, has successfully exported this belief system to much of the developed world. In order to break free of this ‘therapeutic state,’ the public needs to understand the history of how it came to be, and see the social injury it has caused.

American Psychiatry Called on the Carpet

American Psychiatry Called on the Carpet

Pathologist of the Mind: Adolf Meyer and the Origins of American Psychiatry by S. D. Lamb (review)

Pathologist of the Mind: Adolf Meyer and the Origins of American Psychiatry by S. D. Lamb (review)

The Transcultural Psychiatry Reading Group: a Learner-Led Approach to Cultural Psychiatry.

A number of North American psychiatry residency training programs have developed cross-cultural curricula with the hope of producing psychiatrists who are self-reflective, sensitive to cross-cultural issues, and respectful of divergent perspectives. Many programs have introduced this challenging subject matter either as part of the mandatory curriculum [1] or as electives [2]. Some curricula have focused on a particular aspect of culture, such as religion or spirituality [3]. Other curricula have adopted a broad definition of culture in attempts to examine psychiatry’s own professional culture with the view to better understand how we as psychiatrists interact with diverse populations [4]. This article will examine one particular approach to fostering cross-cultural competency, sensitivity, and critical mindedness: an extracurricular residents’ transcultural psychiatry reading group. In 2008, psychiatry residents from the University of Toronto established the Transcultural Psychiatry Reading Group with the aim of fulfilling a need for interdisciplinary discourse on psychiatry and culture. The residency already had a largely didactic, longitudinal cultural psychiatry curriculum. Our group was formed to offer a more discussion-based opportunity for cultural learning. The residents shared a desire to reflect on the assumptions, philosophy, and practice of psychiatry. By creating a group that was also open to clinicians and scholars outside of psychiatry and medicine, members hoped to create a dedicated time and space to engage fully, freely, and collaboratively in critical readings and discussions. In this context, current diagnostic classification systems and treatment approaches could be openly discussed as culturally informed practices that reflect societal ideals, values, and norms within a specific historical time and place. The analysis here, drawing on our insights as members, as well as information from participant surveys, will describe the group process and provide an illustrative case in order to demonstrate one model of a learner-led initiative that may be adapted by psychiatry residents in other locations.

New APA Logo Unifies Image of Psychiatry

Back to table of contents Next article Association NewsFull AccessNew APA Logo Unifies Image of PsychiatryMark MoranMark MoranSearch for more papers by this authorPublished Online:28 May 2015https://doi.org/10.1176/appi.pn.2015.6a14AbstractThe new design symbolizes contemporary psychiatry as a science of mind, brain, and body and will help to unify the image of APA and the profession for patients, families, and the wider public.A new APA logo signifying the leadership of the modern psychiatrist as a physician of mind, brain, and body was unveiled last month during the Opening Session of APA’s 2015 annual meeting in Toronto. The logo depicts the ancient serpent entwined–Rod of Asclepius—wielded in Greek mythology by the god Asclepius and associated with medicine and healing—superimposed over the image of two hemispheres of a human brain. The trademarked logo appears next to the words “American Psychiatric Association,” with the word “Psychiatric” in bold type; the tagline “Medical leadership for mind, brain and body” appears below the logo. The new logo graphically updates the image of psychiatry to express its expertise in biopsychosocial and integrated care in treating mind, brain, and body and provides a unifying “brand” to the Association by appearing on all of APA’s products.The logo and rebranding were approved by APA’s Board of Trustees at its March meeting at the recommendation of APA CEO and Medical Director Saul Levin, M.D., M.P.A., and APA Chief Communications Officer Jason Young. At that meeting, Young told Trustees that many of APA’s departments, programs, and publications were using their own logos rather than the Benjamin Rush seal, which has served as APA’s de facto logo since 1921. The result has been a jumble of unrelated graphics that have led to confusion among members and the public about the identity of APA products and its advocacy achievements, he said. The seal features the profile of Benjamin Rush, M.D., who is considered the father of American psychiatry and was a signer of the Declaration of Independence. The seal will continue to be used for ceremonial purposes and some internal documents. To help the APA administration, district branches, and state associations adopt the new logo and the related material that support it (such as a color palette and type fonts), APA’s Office of Corporate Communications and Public Affairs has produced the document “APA Brand Guidelines.” The preface outlines the purpose of the new branding: “It’s an exciting time for our organization as we shape the future of mental health treatment. This means a change in our priorities as well as our visual brand. The American Psychiatric Association is leading the charge for better treatments, more acceptance, and stronger policies to improve the lives of those with mental illness.”“This guide contains everything you need to understand and use our brand system. By consistently adhering to our brand architecture, you will strengthen our collective presence and thus the cause.”Levin said the new branding will help to present a cohesive, consistent image of APA and psychiatry to members and the public. “I am confident the logo and rebranding will be a valuable service to our district branches and individual members by providing a unifying image for all of APA’s products,” Levin told Psychiatric News. “The APA Board of Trustees and leadership deliberated carefully with our consultants to come up with an image and tagline that convey to patients, families, and the wider public the expertise of the contemporary psychiatrist as a physician and healer of mind, brain, and body.” ■To view a video that reflects the values of modern psychiatry and their translation into the new logo, click here. ISSUES NewArchived

True parity in North American psychiatry

True parity in North American psychiatry

2015 Match Finds Big Jump in Students Choosing Psychiatry

Back to table of contents Previous article Next article Education and TrainingFull Access2015 Match Finds Big Jump in Students Choosing PsychiatryMark MoranMark MoranSearch for more papers by this authorPublished Online:9 Apr 2015https://doi.org/10.1176/appi.pn.2015.4b15AbstractNeuroscience advances and the increasing perception of psychiatry as integral to the “house of medicine” may be attracting more graduating medical students to the specialty.The number of U.S. senior allopathic medical school students entering psychiatry through the National Resident Matching Program (NRMP) increased by 13 percent this year, compared with 2014, with 774 U.S. graduating seniors choosing to enter psychiatry training.Anita Everett, M.D., chair of the APA Board of Trustees Work Group on Health Care Reform, summarizes the work group’s report at the Board’s meeting last month in Arlington, Va. The work group made a series of recommendations to strategically position APA and American psychiatry to promote and influence U.S. health care reforms.David HathcoxThe outcome for psychiatry in this year’s match is unusually good: the percentage of seniors selecting psychiatry rose from 4.2 percent in 2014 to 4.6 percent in 2015—a larger percentage increase than any other specialty in the match.The increase of 89 students selecting psychiatry this year compared with last year (see chart on page 10) exceeds that of family medicine, emergency medicine, and general surgery—all of which have many more residency positions than psychiatry. (Only internal medicine—which experienced an increase of 150 students over 2014—had a larger jump in numbers than psychiatry.)“This is great news,” said Tristan Gorrindo, M.D., APA’s director of education, in comments to Psychiatric News. “In my own experience of working with medical students, I see two potential contributors. First, as we include more neuroscience in medical student education, students see the promise of new and exciting treatments. There is a general sense that we are on the verge of a number of breakthroughs and that the treatments we will have in 10 years will be much more advanced than what we have now. And it’s exciting to be part of this revolution in medicine. “Additionally, as psychiatry begins to work in closer collaboration with primary care through new models like the patient-centered medical home, I think students like the idea of seeing themselves remaining within the ‘house of medicine,’ ” Gorrindo said. “The ability to be part of a primary care team but to offer specialized expertise on some of the problems that so vex our primary care colleagues allows students to feel as though they are making a valuable contribution to the overall care of patients.“My hunch is that we’ll see this trend continue with more students going into psychiatry each year,” he said.The annual match, in which the choices of graduating medical students are paired with those of residency programs seeking trainees, is typically watched as an indicator of workforce size and makeup of the various medical specialties for the coming years.Sidney Weissman, M.D., a former APA trustee who has long held an interest in workforce issues, said he believes that increasing competition for slots has led many medical students to seek out positions in more than one specialty. “Psychiatry did well in this year’s match, as senior medical students aware of the limited number of residency positions in the most sought-after specialties are considering more options as they plan their medical careers,” he said. “This is why many of us have interviewed applicants matching in more than one specialty. This response from an expanding pool of U.S. graduates is likely to continue into the foreseeable future.”Weissman noted that in 2018, unless the present cap on Medicare funding for new positions is lifted, U.S. medical schools will graduate 21,000 allopathic and 8,000 osteopathic students. “This number will approximate the number of available PGY-1 positions,” he said. “As the decade progresses, I would predict for these reasons that we will have 1,000 U.S. graduates entering psychiatry, by combining allopathic and osteopathic graduates by 2018.” ■This year’s match results can be accessed here. ISSUES NewArchived

Pathologist of the mind: Adolf Meyer and the origins of American psychiatry

Pathologist of the mind: Adolf Meyer and the origins of American psychiatry

Is American Psychiatry Drug Dependent?Is American Psychiatry Drug Dependent?

Is American Psychiatry Drug Dependent?Is American Psychiatry Drug Dependent?

Creating an American PsychiatryCreating an American Psychiatry

Creating an American PsychiatryCreating an American Psychiatry

Book Review

Psychiatry and the Business of Madness: An Ethical and Epistemological Accounting. Bonnie Burstow. London, United Kingdom: Palgrave Macmillan, 2015, 316 pp., $40.00 (paperback) $95.00 (hardcover).This book is arguably the most comprehensive and brilliant critique of psychiatry that I've ever read; it's a devastating expose of psychiatry's discredited medical model and institutional psychiatry, "a regime of ruling." Bonnie Burstow's book is absolutely awesome in its numerous, thoroughly researched facts and original insights and scholarship frequently voiced with passion. Burstow uses the research analytic tool of institutional ethnography-"ruling happens through texts, particularly through the activation of texts" (p. 18). With this powerful intellectual probe, she deconstructs "boss texts" and takes us on an incredible journey into psychiatry, its alarming methods of social control, its intrusive brain-damaging drugs and electroshock. Burstow ends this awesome work in the spirit of hope and humanity she calls "Eutopia," a vision of a better world of compassion, empathy, mutual caring, respect for freedom and human rights.She begins with a short and concise history of psychiatry featuring mad doctors and "alienists" (an apt word) during the 18th century, including Philippe Pinel who unchained poor people with mental illness in a Paris asylum but instituted a reign of terror of close surveillance and control. In the 19th century, there's Benjamin Rush, the notorious "father of American psychiatry" whose face appears on the American Psychiatric Association's logo; he invented the traumatic "tranquilizer chair" and advocated fear as therapeutic; he also labeled black slaves with the disease of "drapetomania," running away to be free; he also committed his son to an insane asylum. The gentler "moral treatment/moral management" of country retreats in the late 18th and early 19th centuries soon died; by the late 19th and early 20th century, it was replaced with eugenics/genetics-based, physically intrusive biological psychiatry, which unfortunately dominates today. This is a small but telling fragment of psychiatry's dark history of social control, medical fraud, coercion, and violence.Burstow asserts that two fundamental principles underlie psychiatry and the book: parens patriae and police powers. Parens patriae (literally "father of the country") refers to power of the state to control, imprison, and forcibly treat citizens; police powers are mainly expressed as coercion, arrest, and use of force. Psychiatry, Burstow asserts, is essentially a regime of ruling; however, given psychiatry's hegemonic social control, the terms psychiatric dictatorship and psychiatric police state seem more appropriate.In Chapter 4 ("Probing the Boss Text: DSM-What? Whither? How? Which?"), Burstow brilliantly analyzes the Diagnostic and Statistical Manual of Mental Disorders (DSM), psychiatry's bible of fraudulent diseases. Unlike medical diagnoses, the approximately 350 diagnostic labels in DSM-5 (the current edition) are not only subjective and unscientific but also frequently lead to serious life-changing consequences such as loss of freedom (involuntary commitment), psychiatric drugging, and/or electroshock (electroconvulsive therapy [ECT]). DSM labels, Burstow asserts, serve no medical or scientific purpose, instead they routinely marginalize and stigmatize. Burstow succinctly summarizes major problems of the DSM, "subjectivity . . . masquerading as objectivity . . . nothing less than the essence of who the person is . . . constitutes a disorder" (pp. 94-95). She calls this activating text a "patient-processing system," denounces it as having absolutely no scientific validity or reliability; like the late psychiatrist Thomas Szasz and other dissident health professionals, Burstow correctly states there is "no mental illness" because there is no biological or medical evidence of cellular disease in anybody labeled mentally ill. …

Do regulated resident working hours affect medical graduate education? Trends in the American psychiatry board pass rates pre- and post-2003 duty hours regulations.

Aims and method To assess trends of the American Board of Psychiatry and Neurology examination pass rates before and after the 2003 duty hours regulations (DHR). We obtained the pass rates for part I and II for years 2000–2010. Data were divided pre-DHR (2000–2003) and post-DHR (2007–2010).Results During the pre-DHR period, first- and multiple-attempt group pass rates were 80.7% and 39.0% which changed in the post-DHR period to 89.7% and 39.1% respectively. Similarly for the part II exam, the pre-DHR first- and multiple-attempt group pass rates were 60.2% and 43.5% respectively, which increased to 78.7% and 53.8%, among the post-DHR group. Overall, there was a significant increase in the first-attempt candidates pass rates for parts I and II, whereas multiple-attempt candidates did not benefit as strongly.Clinical implications The results suggest that the 2003 DHR may have had a positive impact on examination-based medical knowledge in psychiatry.

Some ECPs Predict Future of American Psychiatry

Some ECPs Predict Future of American Psychiatry

IMGs Called Good-Will Ambassadors to U.S., World Health

Back to table of contents Previous article Next article Professional NewsFull AccessIMGs Called Good-Will Ambassadors to U.S., World HealthMark MoranMark MoranSearch for more papers by this authorPublished Online:2 Jun 2014https://doi.org/10.1176/appi.pn.2014.5b10Every year APA and the American Psychiatric Foundation recognize a physician who has made significant contributions to the enhancement of the integration of international medical graduates (IMGs) into American psychiatry with the George Tarjan Award. Named after APA’s first IMG president, the award recipient receives a plaque and a $500 honorarium and presents an award lecture at the APA annual meeting or Institute on Psychiatric Services.Jagannathan Srinivasaraghavan, M.D.Last year’s recipient, psychiatrist Jagannathan Srinivasaraghavan, M.D. (“Dr. Van”), pictured at right, delivered the Tarjan Award lecture “International Medical Graduates: Enriching American Psychiatry and Good-Will Ambassadors Enhancing World Mental Health,” at the 2013 annual meeting. In his lecture, he recounted the growth of the IMG community in American medicine and recalled that Tarjan—whose 1984 presidential address was titled “American Psychiatry: A Dynamic Mosaic”—urged IMGs to maintain their own identity and forge a new identity as APA members. And Dr. Van drew upon his experience coming from India to forge a multifaceted career in American psychiatry as a clinician, educator, researcher, and administrator. Today he is a professor emeritus of psychiatry at Southern Illinois University School of Medicine and a forensic psychiatrist in Carbondale, Ill.He also described his extensive travels around the world; he was featured in an August 17, 2012, Psychiatric News article, “Most Travelled Psychiatrist Completes Epic Quest,” detailing his travels to all of the 195 “officially designated nations on the planet.”Drawing on the example of IMGs from countries around the world, he said that IMGs are “good-will ambassadors” to American and world health. “American medicine has evolved to include nearly 25 percent IMGs,” he said. “IMGs come from nearly every part of the world and have enriched American psychiatry, while at the same time many IMGs are giving back to their countries and regions and enhancing world mental health.”The 2014 George Tarjan Award lecture was delivered at the annual meeting last month by Jose Canive, M.D. Recent award winners have included Milton Kramer, M.D. (2012), Renato Alarcon, M.D. (2011), Mantosh Dewan, M.D. (2010), Nyapati Rao, M.D., M.S., (2009), Albert Gaw, M.D. (2008), Nalini Juthani, M.D. (2007), and past APA President Dilip Jeste, M.D. (2006). ■ ISSUES NewArchived

Lois Jean Brady: Apps for Autism: An Essential Guide to Over 200 Effective Apps for Improving Communication, Behavior, Social Skills, and More!

During the past decade, public autism awareness has increased and rapid changes in technology have occurred in the Western world. These developments have been facilitated by the scientific literature from Leo Kanner’s (1943) original description of early infantile autism to the more recent conceptualizations of autism spectrum disorders by cutting edge researchers such as Lorna Wing, Christopher Gilleberg and Fred R. Volkmar. The prevalence of autism is on the rise and at the same time the recent revision of the American Psychiatry Association’s diagnostic taxonomy (DSM-V) is heavily debated. Today tablet computers and smartphones represent an important part of our live, and shared experiences of the use of available technology in order to help individuals with ASDs should be most welcome. When talking about technology and ASDs we often focus on technology that could help us to diagnose individuals with ASD and to a lesser extent on their assistive implications. Since not all children with ASDs or other special needs embrace technology, it will be crucial to do some serious consideration and planning in advance. You will want the applications to strengthen the individual’s skills that are communication, social skills or just everyday life assistance. But to do just this, you have to use the application in a relevant situation matching the goal of the outcome. Giving a tablet computer to a child with ASD, and hope that it will find ways to use it by its own is wishful thinking at best. Lois Joan Brady presents the reader a nice story, which I assume many parents and educators of children with ASD have experienced and could share a familiar feeling around this part of the book. The author starts the book in an informal writing style, but with a lot of energy. I could almost feel her creativity and energy to help children with disabilities, and that is always a good start for a book called ‘‘Apps for autism’’. At this point I was both interested and skeptical. Interested in the passion she clearly shows throughout her book, skeptical to writing a paperback book on applications for tablets and smartphones. The book is presented in a nice esthetical way, it is easy to read, the layout on the review of applications is smart, reasonably lengthy, including a customers review and images of the actual applications. First of all, the book is easily read, it has a section called ‘‘How to use this book’’, which I find to be a very nice feature in the book. The author states the following ‘‘more than 425.000 apps are released every single day’’ which highlights the pitfall with this book since some important applications of newer date will naturally not be a part of this book. In the part focusing on how to use the book and the technology presented, the author has described some features, which are useful to know when trying to implement technology into the world of a child with ASD for those who are not already tablet and smartphone experts. In this chapter the author also has developed some icons that are used throughout the book’s app reviews to provide important information on their features. Since many of parents and educators meet tablets and smartphones for the first time in a therapeutic use, the ‘‘how to’’ section provides a lot of valuable information on choosing the right device, how to download applications and much of the process of buying a tablet and smartphone for a child with ASD. The book focuses mostly on Apple products, but it could also apply in a similar way to products of other manufacturers. The application reviews are divided into categories such as communication, vocabulary and concept development, pragmatics and social skills, organizers and visual, R. Oien (&) Yale Child Study Center, 230 South Frontage Road, New Haven, CT 06405, USA e-mail: roald.oien@yale.edu

Changing Values in American Society and American Psychiatry

To understand what has happened to our country, our people, and our professionals, we need to recognize the degradation of underlying attitudes and values. Among young people, conventional moral sentiments have given way to radical individualism. In medicine, the emphasis on economics and technology has been pushing out empathetic caring and service to humanity. Inured to violence, the American public has accepted human cruelty as normal. In some political circles, cooperation has become a bad word. Yet, altruism and compassion are not totally dead, as real-life anecdotes illustrate. Physicians in their practices can model concern and kindliness, utilizing voice and presence on behalf of unfortunates such as troubled youth, and fostering benevolence toward those who differ in body or mind.