The industrialization of American psychiatry

Physician surpluses and escalating medical care costs have fostered an alliance among government, corporate America, and health insurers that has inspired medicine's industrialization. These same forces will transform psychiatry into an industry where prospective payment, automation, salaried employment, and central control of clinical activities threaten to become the dominant form of medical practice. Emerging trends suggest that both patients and health professionals will gravitate to various forms of alternative provider organizations in an effort to shield themselves from the economic uncertainties of seeking and providing care. The chronically mentally ill and others requiring extensive treatment risk exclusion from this new system, where cost consciousness may supplant compassion.     

Twentieth-century developments in American psychiatry

This article traces the development of psychiatric services from their institutional base at the turn of the century to the enactment of the Community Mental Health Center Act of 1963. Many perceived this legislation, which brought about community based but federally funded psychiatric care, as a radical departure from existing trends; indeed, President John F. Kennedy introduced it as a bold new approach. In fact, it represented the culmination of a slow, gradual evolutionary development. This article identifies the concepts underlying community psychiatric services and their programmatic elements and specifies their time of origin. The author concludes that while the current federal initiative in community psychiatric care (e.g., CHHCs) may be in jeopardy, its evolutionary nature ensures its continuance in one manner or another.     

Turning points in twentieth-century American psychiatry

The author examines four major turning points in twentieth-century American psychiatry, emphasizing the movement during the post-World War II period toward a psychotherapeutic/psychoanalytic approach and the emergence of biological psychiatry, neuroscience, and logical positivism during the 1970s and 1980s. He discusses the impact of Adolf Meyer during the mid-twentieth century and his ongoing influence. The final turning point involves a prediction of a late twentieth-century change, including new directions in nosology, emphasis on combined pharmacotherapeutic/psychotherapeutic treatments, efforts to create alternatives to full inpatient care, better outcome data for psychiatric treatments, and beginning resolution of major boundary problems of current practice.