The year 1968 has been described as one that ‘rocked the world’, ‘changed everything’ and ‘made us who we are’. It was certainly a momentous year for psychiatry. On the semicentennial anniversary, a snapshot of the era helps us understand the present.
If change was afoot, Raymond Waggoner, the new head of the American Psychiatric Association, was in touch with the moment. He asserted in 1968 that his aim was to oversee ‘healthy and wisely determined progress …’. He suggested that psychiatrists take a more active role in social problems outside the field of psychiatry. Waggoner also promoted new thinking. With Beyond the Therapeutic Community (1968) and Social Psychiatry in Practice (1968), Maxwell Jones did just that. He advocated user-led treatment in Britain and the United States that necessitated more equality in the therapeutic milieu.
Maxwell was operating in a professional environment shaped by such psychiatrists as R.D. Laing, David Cooper, Joseph Berke and Leon Redler, who produced early critiques of psychiatry. Franz Fanon, the French psychiatrist and philosopher, also published the eighth edition of The Wretched of the Earth in 1968, while Thomas Szasz, another critic, published Law, Liberty, and Psychiatry. Erving Goffman added to the list with the second printing of his influential book Stigma.
Socially conscious psychiatrists in the American Psychiatric Association coalesced during the annual convention in Boston and underlined issues of war, race, class and gender. They voiced concern about how breakthroughs in military hardware, advancements in human rights activism and the rising automation of Western civilisation affected the theory and practice of psychiatry. A year later, the organization's liberal caucus rebranded itself a ‘radical caucus’.
Drugs were an important part of the era. In 1968, a series of articles in mainstream psychiatry debated the dangers of cannabis, linking it to psychosis. The American Journal of Psychiatry and Psychiatric News disapproved of its use. The era of psychedelic medicine drew to a close as well. Authorities in the UK moved against LSD and in 1966 it was made illegal. Medical use also stopped and was prohibited by the Misuse of Drugs Act when it came into force in 1973. LSD was banned in the USA in 1968.
The Diagnostic and Statistical Manual of Mental Disorders II was also published in 1968, and it continued to conceptualise psychopathology from a psychodynamic perspective. Additionally, psychiatrists that year hotly debated the aetiology of schizophrenia. Numerous causes were advanced: a pathological lesion on the brain; a biochemical origin, such as Emile Kraepelin's notion of a metabolic imbalance; a congenital cause; a psychogenic approach, based on psychoanalytic thought; a sociogenic cause; and, finally, a biopsychosocial (holistic) conceptualisation that had been endorsed by Adolf Meyer.
The British Journal of Psychiatry, for its part, was engaging with the major debates of the time. The October 1968 issue evaluated LSD and leucotomy. The August issue devoted several articles to the efficacy and effects of electroconvulsive therapy. The British Journal of Psychiatry's focus on these issues, among others, represented not only evolution in psychiatry but also a free marketplace of ideas.