The Community Mental Health Movement in the United States - Circa 1970: Part I

Just as most medical specialities have been making tremendous advances in recent years, as seen for example in the developments in medical genetics, organ transplant surgery, artificial organ machines, reproduction control, and space-environment technology, so too has psychiatry been rapidly changing. Indeed, as Braceland¹ has recently pointed out, all of these advances in medicine are likely to produce corresponding situations and conditions for new psychiatric involvements.

It might even be said that we are witnessing the third great revolution in psychiatry of this century. The first was the emergence of psychoanalysis, both as a means of understanding mental functioning and as a treatment of neuroses. Since then, the psychoanalytic movement has undergone many vicissitudes. The apogee of this movement occurred just after World War II, when large numbers of returning physicians, having dealt with emotionally disturbed men during their military service, entered analytic training. Psychoanalysis then dominated not only the field of psychiatry but the other social disciplines, the humanities and the arts as well. During the past few years, however, a reaction seems to have been setting in, and psychiatric interest in psychoanalysis appears to be waning. But, this is variable and spotty and some reports indicate that interest is still quite high in some areas of the country, at least as indicated by membership in psychoanalytic societies.² At the present time, at least in the Eastern regions of the country where analytic centers are concentrated, perhaps three or four out of ten psychiatric residents enter formal analytic training, although another three undertake personal psychoanalysis. Nevertheless, while the curve of enthusiasm for it may have levelled off, it has retained a permanent place in our therapeutic armamentarium. Indications for the use of psychoanalysis in its original classical form have remained relatively limited. So