American Psychiatry after World War II (1944-1994) (review)

Roy W. Menninger and John C. Nemiah, eds. American Psychiatry after World War II (1944-1994). Washington, D.C.: American Psychiatric Press, 2000. xxv + 651 pp. $49.00 (0-88048-866-2).

Over the last fifty years, American psychiatry has undergone enormous changes. To name the most obvious, these transformations have included the precipitous decline of state hospital patients (from more than 550,000 patients in the mid-1950s to fewer than 70,000 by the mid-1990s), the rise and fall of psychoanalysis, the meteoric ascendancy of psychopharmacology and neuroscience in general, and a fundamental transformation of who could be considered a psychiatric patient and how our culture understands the nature of psychological distress. Indeed, the very way in which we understand the mind and what it means to be human has been implicated in these shifts over the last half-century. It is this history that American Psychiatry after World War II attempts to tackle.

This book is a sequel to one that charted the first hundred years of American psychiatry from 1844 to 1944, and, like its predecessor, the present text is largely a work of practicing psychiatrists. Of the thirty-seven contributors, thirty-two are physicians and only three are professional historians (Gerald Grob, Nathan Hale, and Norman Dain). In fact, many of the contributors themselves--such as Ross Baldessarini, Robert Cancro, Jerome Frank, Glen Gabbard, Lawrence Kolb, Richard Lamb, Roy Menninger, and John Nemiah--shaped, in major ways (and, in some instances, continue to do so), the history that this book traces. As the range of the twenty-five chapters attests, the editors have endeavored to be as comprehensive as possible, structuring the book around what they see to be the major themes in American psychiatry, such as public policy, clinical psychiatry, clinical science, and specialization.

However, given the extent to which American psychiatry has changed over the last fifty years as well as the degree to which it has seeped into so many aspects of our cultural and social life, this is a difficult history to summarize in a single volume. The large number of contributors makes matters worse in this respect, and one of the book's greatest weaknesses resides in its lack of unity. Also, since many of the writers are (or were) practitioners, some have difficulty disentangling themselves from the history that they portray. For example, describing the antipsychiatry movement and its beliefs, one contributor writes: "It is difficult to believe that any reasonably rational individual could believe such nonsense, but it was not only broadly accepted at the time but also had a powerful effect on the field" (pp. 425-26). As an insider history, the work also largely ignores the cultural and social world that shaped, as well as being shaped by, the science and practice of psychiatry--though, as Menninger points out in the introduction, "[t]o a degree unmatched in any other branch of medicine, psychiatry and its fundamental parameters are altered and redefined by cultural values and events" (p. xxii).

Despite these caveats, Menninger and Nemiah have put together an important and, in many respects, impressive volume. There are a number of first-rate essays, such as Grob's penetrating chapter on mental health policy or Hale's on the rise and decline of psychoanalysis. Further, Menninger's introduction provides an extremely thoughtful meditation on the central issues that have bedeviled American psychiatry over the last half-century, especially the often seemingly irresolvable split between biological and psychological approaches to psychological distress. I even would argue that one of the book's major weaknesses--the fact that most of the authors are highly partisan participants in this history--is also one of its important strengths: the editors have done a tremendous service to historians curious about the self-reflections of a significant group of American psychiatrists as they look at what they have wrought over the second half...