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Psychiatry is now facing the latest of several crises in its relatively brief history. The present one is related to its recent fascination with modern neuroscience findings. This might be a positive development except that it is unfortunately often accompanied by a near exclusion of the psychosocial components of mental disorders. This trend therefore has significant potential for harm to patient welfare. It poses a challenge to psychoanalysis and the entire field of psychodynamic psychotherapy.
Psychiatrists have historically suffered from greater problems with professional identity than other specialties in medicine. Underlying this syndrome has been the resistance they have faced in their striving to be fully integrated, equal, and bona fide members of the medical profession. A necessarily sketchy review of some aspects of the history of psychiatry follows to demonstrate how elusive and unfulfilled this quest has been and help us to understand better the converging forces that have brought psychiatry to its present position.
Through the centuries, philosophers, natural scientists, and later, psychologists and physicians struggled to explain and reduce mental suffering. The approach was originally psychological. Yet, when in the 19th-century psychiatry as a field began to emerge, its scope was narrow and basically limited to the care of the “insane”—deviant or helpless adults as well as those with organic brain disorders. In the United States, in 1844, psychiatrists formed an organization called the Association of Medical Superintendents of American Institutions for the Insane, which published a journal, The American Journal of Insanity. Mental illness and, by association, psychiatry was feared and stigmatized. For example, Pinel, the courageous French physician who in 1793 pioneered humanized care, was called insane because of his intimate involvement