Changing American Psychiatry
A Personal Perspective
Psychiatrists, psychoanalysts, other mental health workers, behavioral scientists, and university medical and neuroscience professionals will benefit from this articulate insider’s view of post-World War II psychiatry in Changing American Psychiatry: A Personal Perspective by Melvin Sabshin, M.D. Dr. Sabshin served as Medical Director of the American Psychiatric Association (APA) for 23 years, from 1974 to 1997, during a period of perhaps the greatest change in psychiatry since the World War II produced a dramatic modification of practice.
The author describes in detail two extraordinary periods of change, the first stimulated by laudatory efforts to understand the high rate of psychiatric casualties among World War II veterans and to provide treatment for them. Psychiatry grew quickly during the postwar years, considerably influenced by the immigration of many Central European psychoanalysts. Gradually, however, psychiatry began to weaken its ties to medicine and lost much of its public respect. By the 1970s, postwar optimism had been replaced by widespread concern that psychiatric practice was being dominated by unsubstantiated formulations rather than reliable evidence. Psychiatry was dramatically impacted by enormous pressure for therapeutic accountability exerted by a managed care reimbursement system. The profession recognized the need for a new direction and resolved to change.
In the foreword to the book, current APA Medical Director James H. Scully Jr., M.D., notes that Dr. Sabshin has woven a personal journey of the history of the intellectual conflicts and changes in the field of psychiatry in the post-war era, culminating in the remedicalization of psychiatry and the development of the DSM-III.
Dr. Sabshin encourages psychiatric professionals to change the field so it can employ an empirically based “bio-psycho-social” model that has the potential to revitalize the next phase of American psychiatry. He details how the potential for the future of psychiatry can be enhanced by today’s practicing professionals, stressing the:
- Need to incorporate the rapid developments of neuroscience into a professional practice that is increasingly integrated with empirically demonstrated psychological and social influences upon mental illness.
- Importance on continued research that is fed back into practice and keeps the professional evidence-based.
- Need of psychoanalysis to make its beliefs explicit, formulating hypotheses that can be tested scientifically in order to be employed reliably in evidence-based practice.
This well-crafted historical account describes how the profession has become a more respected and accountable part of medicine and how it scientific credentials have risen as a result. Dr. Sabshin concludes that the use of psychological understanding and psychotherapies must play a major role combined with psychopharmacology in the treatment of psychiatric patients.
- List of Plates
- About the Author
- Chapter 1. Post–World War II Scene in American Psychiatry
- Chapter 2. A Pathway to Psychiatry
- Chapter 3. Implicit Preparations for a Leadership Role in Psychiatry
- Chapter 4. Reflections During the Search
- Chapter 5. Clarifying the Mission
- Chapter 6. En Route to Equity
- Chapter 7. International Affairs
- Chapter 8. Psychoanalysis
- Chapter 9. Forensic Psychiatry
- Chapter 10. Evidence-Based Diagnosis and Treatment
- Chapter 11. Psychiatric Research
- Chapter 12. Psychiatric Education
- Chapter 13. A Changing Membership
- Chapter 14. Annual Meetings
- Chapter 15. Publications
- Chapter 16. Governance and Leadership
- Chapter 17. Management of External Relationships
- Chapter 18. Social and Community Psychiatry
- Chapter 19. Conclusions
- Appendix 1: Selected Papers
- Appendix 1A: Turning Points in Twentieth-Century American Psychiatry
- Appendix 1B: The Future of Psychiatry
- Appendix 2: American Psychiatric Association Speakers of Assembly of District Branches
- Appendix 3: Presidential Themes for American Psychiatric Association Annual Meetings, 1984–2008
- Appendix 4: Officers of the American Psychiatric Association
- Appendix 5: American Psychiatric Association Membership Figures, 1873–2007
- Appendix 6: Presidents of the American Psychiatric Association
- Appendix 7: American Psychiatric Association Organizational Chart, 2008 and 1986
- Appendix 8: American Psychiatric Association Joint Commission on Government Relations
- Appendix 9: Psychiatry Organizations of Interest
- Appendix 10: American Psychiatric Association Assembly Area Councils by Region
- Appendix 11: Comparison of American Psychiatric
- Association Area and District Branch Membership, 2002–2007
- Appendix 12: DSM Task Forces and Working Groups
- Appendix 13: American Psychiatric Association Medical Directors
- Appendix 14: American Psychiatric Association Governance System
About the Authors
Melvin Sabshin, M.D., was Medical Director of the American Psychiatric Association from 1974 to 1997. Dr. Sabshin studied medicine at Tulane University. After postgraduate training and a research post at Tulane’s Department of Psychiatry, he received an appointment at the Michael Reese Hospital in Chicago, a center of psychiatric research and psychodynamically oriented practice, where he completed psychoanalytic training. In 1961 he was appointed Professor and Head of the Department of Psychiatry at the University of Illinois College of Medicine. Dr. Sabshin is an Honorary Fellow of the Royal College of Psychiatrists.
This is a lucidly written, deeply thoughtful and candid memoir that deciphers psychiatry’s recent vicissitudes and historic transformations. Recounting both early and later life experiences, including over two decades as Medical Director, Mel Sabshin, psychiatry’s venerable leader, intellectual catalyst, and diplomatic facilitator, illuminates his many and diverse roles while shepherding the profession in its transition from an oracular craft to a respected evidence-based science. Every mental health professional, beginner or practiced alike, will find this chronicle to be an enlightening odyssey, one consequential to his or her own biopsychosocial work.—Theodore Millon, Ph.D., D.Sc., Dean and Scientific Director, Institute for Advanced Studies in Personology and Psychopathology
Mel Sabshin skillfully weaves three stories into one: the revolution in American psychiatry in the last half century, the development of the modern American Psychiatric Association, and his personal and professional biography. Sabshin was central to each, and provides an informal insider's perspective that is available nowhere else. A must read for anyone who wants to understand where psychiatry is today and how it got there.—Robert Michels, M.D., Walsh McDermott University Professor of Medicine & Psychiatry, Former Chairman, Dept of Psychiatry, Former Dean & Provost for Medical Affairs, Weill Medical College Cornell
There is no-one better qualified to present the “view from the bridge” of American psychiatry than Mel Sabshin, a towering and influential leader in the process of change. In this unique and invaluable book, Sabshin first invites us into the world of his formative years, and of the family and mentors who helped shape his ambitions and goals. He then shares his personal vision, over many decades, from the helm of academic and organized psychiatry, of the many forces that shaped the changing face of the field. Sabshin tells it like he sees it, and he sees it with wisdom and the authority of center stage.—John M. Oldham, M.D., Senior Vice President & Chief of Staff, The Menninger Clinic, Professor & Executive Vice Chair, Menninger Dept of Psychiatry & Behavioral Sciences, Baylor College of Medicine
Melvin Sabshin’s “persona perspective” is fascinating and brilliant. This is the remarkable history of the transition in psychiatry from ideology to science, written by someone who helped make this transition happen. Dr. Sabshin has “last word” on where we have been and where we are going in psychiatry.—Steve S. Sharfstein,M.D., President & CEO, Sheppard Pratt Health System; Clinical Professor & Vice Chair, Dept of Psychiatry University of Maryland; & Past President, American Psychiatric Association
It is not surprising that Mel Sabshin would bring together the complexity of American psychiatry with enormous texture, substance and sophisticated nuance. Mel Sabshin directed the American Psychiatric Association for several decades in which his unique blend of brilliance and interpersonal skill helped lead the association and the field to increasing levels of accomplishment and through major challenges. This text is a marvelous compilation of those interesting and rich years and will provide interesting reading for any and all interested in American and world psychiatry.—Herbert Pardes, M.D.
In this book, the author takes readers on a journey through psychiatry from the mid to late 1900s by using personal accounts, humor, and historical facts. In doing so, he has created a unique historical perspective on psychiatry.—Doody Enterprises, Inc., 7/1/2009
Changing American Psychiatry is a well-documented insider’s view of the changing face of psychiatry during the past half century. It will interest anyone concerned with the history of psychiatry or who wants to understand the past as a guide to dealing with current challenges in mental health care. Consequently it will be of value to both mental health practitioners and public policy makers.—PsycCRITIQUES, 7/1/2009
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