Essay:Evolution of Psychiatric Medicine
This essay is an original work by RobS. Please comment only on the talk page.
This is a large subject, but it would be helpful for now to examine how the American Psychiatric Association (APA) arrived at certain position statements and modes or recommended methods of treatment. Psychiatry does not exist in a vacuum, and some of its standard diagnoses are interwoven with America’s sociological development. We shall examine three areas where changes have occurred in the attitude and outlook of these professionals since roughly the 1940s and 50s.
While Psychiatrists are viewed by most of society as experts in the field of human beings ability to carry on relationships with each other, in the field there is much frustration. Most will tell you they do not have all the answers, or for that matter, even understand what the underlying problems are. Yet the whole of society, beginning with Legislators and Courts, view them as the best educated, most knowledgeable, and place unreasonable demands upon them to provide answers, or at a minimum, explanations for the curious phenomena of all sorts of inexplicable mental conditions and behavior. Since the abandonment of things like faith in God or prayer to treat some of these problems, coupled with the worship of science, or more properly, man’s ability to gain knowledge and understanding about his environment, all the societal problems of humanity are dumped upon practitioners in this field, who readily admit their limited capacity to understand let alone make recommendations.
Juvenile delinquency gives us our first insight how the field has evolved. In the 1940s, shortly after WWII ended, a great faith was placed in the field of behavioral sciences to resolve the problems of criminal behavior, beginning with youth who had not reached the stage of incorrigibility yet. Juvenile courts had existed for some decades, routinely a Juvenile Judge would adjudicate a minor law breaker as “delinquent”, and the offender remanded to state-run Reform Schools. It was a brutal and harsh thing to endure for a young person. By the 1950s Juvenile Judges sought outside expertise before rendering their judgment—they first referred the juvenile offender to a psychiatrist for observation and treatment. If the doctor recommended some alternative mode of treatment – perhaps sending an unwanted or unloved minor to live with an aunt or foster home – the judicial label of “juvenile delinquent” could be avoided, hence not stigmatizing the offender for life. IOW, the Psychiatric profession began passing the judgment upon the child as a “juvenile delinquent”, and the Courts just rubber stamped it. While juvenile delinquency was not a recognized “mental condition” by the APA, nonetheless, they were called upon by the Courts to render a diagnosis “yea or nay” for “delinquency”.
This system worked throughout the 1950s and 60s. By the early 1970s, psychiatrists began to review the fruit of their efforts. “Delinquents”, beginning adult life with a criminal record, soon ended up in adult prisons. Having spent most of their lives institutionalize, and being graduates of crime schools, they soon became incorrigibles. The APA felt they were only contributing to the problem.
Once in adult prisons, they often embraced the homosexual lifestyle completely. Psychiatrists soon saw the correlation between their “diagnosis” of a minor delinquent with their later diagnosis of an adult homosexual. It was at this time, a massive reform of the criminal justice system, or prison industrial complex, began taking shape. Deregulation or outsourcing hit the juvenile justice system, (a Thatcherization of sorts). Private “Residential Treatment Centers” took the place of state run Reform Schools, and the field of psychiatry began to shy away from the “diagnosis” of “delinquency”, except in the most extreme criminal circumstances. “Delinquency”, which never was an APA recognized disorder, was replaced with official diagnosis of "Adolescent adjustment reaction”, -- the pains of growing up.
While the prisons were consistently being fed with the fresh fodder of youth shoplifters and thieves from Reform Schools in the 1930s and 40s, only to graduate as full fledged, well schooled criminals and incorrigibles, by the 1950s and 60s adult prisons were the place homosexual activity was regarded as normal. Homosexuality was still a crime in virtually 48 or 49 states as late as 1980. Vice Squads routinely picked up gay “cruisers” much as they do prostitutes today. In the early 1970s, homosexuals suffered the “double whammy”, homosexuality was considered not only a diagnosable mental condition, it was also a crime.
Having established that a diagnosis of "delinquency” set a troubled youth on a path of an incorrigible criminal career and life in prison as an open homosexual, the APA began to reconsider its role in the Criminal Justice System. To their credit, they gave up all that income from a captive audience in the prisons, where virtually the whole population was being referred to them for having mental and behavior disorders – virtually all with the same diagnosis – homosexuality, the Doctors finally admitted they did not have a clue how to treat it. What was apparent, in their eyes, was their diagnosis caused the stigmatization. (As a digression, the prostitute falls into the same trap: she’s a prostitute because nobody loves her, nobody loves her because she’s a prostitute. It’s a vicious circle.)
So the APA, using the “scientific” research on decades of non-voluntary referrals, changed its classification of homosexuality as a mental illness. For probably 40 years up to that point, perhaps as much as 90% of the case studies on diagnosed homosexuals did not seek Psychiatric help willingly. And as any therapist or facilitator will tell you, a person with any kind of mental, emotional, or spiritual problem must be willing to change to obtain any sort of result. There is no magic pill to cure problems. Recognizing personal shortcomings, and a willingness to do something about it, goes without saying any further comment. The point here is, the science that declassified homosexuality in 1973, was an entirely difference science driven by entirely different set of social factors that are not in play today. The homosexual today who seeks treatment for his condition comes forwardly willingly, only to be slapped in the face, and insulted, and told he has no hope of being able to change.
In our final review topic, we’ll expand somewhat to look at a sub-classification common in the practice of all medical fields, and that is the difference between a disease and a disorder. A disease is considered organically based, whereas a disorder can create symptoms, ailments, and compliments, but has no recognized organic basis. “Eating disorders” for example, while not generally recognized as organically based can cause a multitude of physical and mental problems. The treatments generally consist of educating the patient about his problems and habits, and learning what behaviors are consistent with alleviating his complaints.
Since the time of Freud, “Depression” was considered a “mental disorder”, and later on more often referred to as an “emotional disorder”. The theory evolved that the root emotional problem was “repressed anger”, an inward temper tantrum direct against the self. Various forms of treatment evolved, essentially designed to get the patient to recognize the onset of anger, and to deal with it in some way other than trying to forget it. The famous “Cathartic scream” for example, was one such mode of treatment.
Like most modes of treatment descended from Freudian psychoanalysis, after decades of review surveys it was discovered one third of patients responded to treatment, one third did not, and one third deteriorated. By 1985, the Pharmaceutical lobby got into the act. A pill was designed to cure virtually all ailments, so why not invent an organic basis for depression likewise. The profession was ready to try anything, given its record of failure. Depression was upgraded from a disorder to having an organic basis, and “Bi-polar disease” became the latest fad, based upon a theory of “chemical imbalance in the brain”, i.e. scientific rendition of “we haven’t a clue”.
So now all “depressives” are no longer treated as having emotional disorders that can be treated with educational therapy. On the plus, rather than two years therapy to get the patient to understand his problem, the APA and the Pharmaceutical industry now have a patient for life. Kind of like cell phone or cable TV service, write the patient a new prescription every month for the rest of his natural existence, and its income for everybody, without the messy business of dealing with a crazy person on the couch every week for only two years with a one third success rate. Keep them doped up, and their too incapacitated to understand their real problems anyway.