Published online by Cambridge University Press: 30 July 2009
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.
Author's note: The research for this paper has been supported by a grant from the National Institute for Mental Health (MH 39030), Public Health Service, U. S. Department of Health and Human Services. Slightly different versions were delivered at the Davis Center Seminar at Princeton University in November 1985 and as the Benjamin Rush Lecture at the convention of the American Psychiatric Association in May 1986.
Part of the material in this essay is drawn from my previous books, Mental Institutions in America: Social Policy to 1875 (New York: Free Press, 1973), Mental Illness and American Society, 1875–1940 (Princeton: Princeton University Press, 1983), and The Inner World of American Psychiatry, 1890–1940: Selected Correspondence (New Brunswick: Rutgers University Press, 1985). For further documentation and greater detail, the reader can consult the text and footnotes in these volumes
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42. The Mary E. Switzer Papers (Schlesinger Library, Radcliffe College, Harvard University, Cambridge, Mass.) and the Lawrence Kolb Papers (National Library of Medicine, Bethesda, Md.) have relevant material on the background and passage of the legislation. The hearings can be followed in 79th Congress, 1st session, National Neuropsychiatric Institute Act. Hearing Before a Subcommittee on Interstate and Foreign Commerce House of Representatives … on H. R. 2550 … 1945 (Washington, D. C: Government Printing Office, 1945)Google Scholar, and 79th Congress, 2d session, National Neuropsychiatric Institute Act. Hearings Before a Subcommittee of the Committee on Education and Labor United States Senate … on S. J. Res. 46 … 1955 (Washington, D. C: Government Printing Office, 1946).Google Scholar See also Kolb, Lawrence C., “Research and its Support Under the National Mental Health Act,” American Journal of Psychiatry 106 (12 1949): 407–12CrossRefGoogle ScholarPubMed, and Brand, Jeanne L., “The National Mental Health Act; A Retrospect,” Bulletin of the History of Medicine 39 (05–06 1965): 231–45.Google ScholarPubMed