The Turning Point: 1961
Ellenberger describes the development of psychiatry from 1920 as explosive. Subspecialties such as child psychiatry and forensic psychiatry arose and became independent. New research territories were explored, such as genetics, biotypology, and psychiatric endocrinology. Social psychology, transcultural psychiatry, psychosomatics, and social psychiatry made their inroads. All sorts of treatments were invented. Psychiatry’s expansion was limitless. Nor was there a limit to the areas of life in which psychiatry became involved. Rome said, “Actually, no less than the entire world is a proper catchment area for present-day psychiatry, and psychiatry need not be appalled by the magnitude of this task.”
Towards the end of the fifties, an atmosphere of hope, optimism, and euphoria pervaded psychiatry. Ridenour notes with satisfaction that in those years – her book was published in 1961 – the public at large had generally accepted the most important Mental Health principles: the idea that all behavior has a cause, and that there are many of those causes; that feelings and unconscious drives are powerfully motivating forces; that the fulfillment of certain physical, psychological, and social needs are essential to health; and that events in early youth are important in determining later adjustment.
There was a flip side: the Mental Hospitals were still enormous warehouses where treatment was the exception rather than the rule. One wondered whether these institutions did not have more disadvantages than advantages. On the other hand, as patients were being released sooner, the total amount of hospitalized patients declined, in spite of the upsurge in admissions. The “Action for Mental Health” from 1961 promised a revolution: care and treatment would be shifted to the patients’ home environment. The enormous amounts of money that would be saved because psychiatric patients would no longer be hospitalized would be redirected to the entire community through Community Psychiatry.
Henri Ey, according to Ellenberger, warned that the endless expansion of psychiatry, which he called panpsychiatry, would not remain without repercussions.
1961 is the year in which the first book critical of psychiatry appeared, The Myth of Mental Illness by Thomas Szasz. 1961 is also the year that Goffman’s Asylums appeared, and in England, Laing’s Self and Others; as well as in France, Foucault’s Folie et déraison, Histoire de la folie à l’âge classique. Szasz says, among other things, about the explosive development of psychiatry, “Indeed, it is no exaggeration to say that life itself is now viewed as an illness that begins with conception and ends with death, requiring at every step along the way, the skillful assistance of physicians and, especially, mental health professionals.” (Ideology and Insanity, pp. 4-5.)
Twenty years later [when this book was originally written], we know what happened afterwards. We know the confusion that reigned because of the contributions of critical psychiatrists, antipsychiatrists, and sociologists. We know it from the profuse supply of new treatment forms, such as marital and family therapy, behavioral therapy, and sex therapy. The theories on which these various treatments are founded are sometimes so contradictory that if the one is true, the other must be false. Social confusion resulted from the democratization movement and great social conflicts, such as the Vietnam war, the dissatisfaction of disaffected citizens which led to riots in the cities, and by rising feminism. We are familiar with the exodus of chronic patients from the State Mental Hospitals which is called deinstitutionalization. It was an exodus into a society in which nobody welcomed them and in which the promised care and treatment mostly never materialized. We are aware of the disappointment in the CMHCs that did not live up to expectations, and of the thousands of chronic patients who live in squalor, albeit not inside but outside the Mental Hospitals. This prompts Mora to conclude that “Psychiatry is now in a state of uncertainty and restlessness, unable to abandon the traditional theoretic models, and unprepared to face the challenge of the great issues at stake.”
Some signs indicate that the pendulum will again swing in the direction of a somatic explanation for the origin of mental illness, this time in the form of biological psychiatry.* That would mean that complex insights into the multiple causes of psychiatric disorders would be avoided on behalf of the primacy of one orientation, and that history will repeat itself.
*This has since been dubbed biopsychiatry. The author’s prediction can now be confirmed. – translator
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