What Does the History of Inpatient Psychiatric Unit Design Tell Us About Balancing Safety and Healing for Patients With Suicidal Behaviors?

Since the Joint Commission shifted its focus to suicide mitigation strategy implementation in behavioral health units in 2007, examining modern design trends in historical context is more clinically and ethically important than ever. This article considers architectural evolutions in how health care organizations have used structure and space designs to balance safety and healing when housing patients who are suicidal.

The Rise and Fall of the Diagnosis of Psychoneurosis of Childhood.

American child and adolescent psychiatry was dominated in most of its first century by a psychoanalytic framework. Child psychiatrists, as well as their treatment team partners in social work and psychology, assumed that children developed mood and behavior problems based on unconscious conflicts, which were driven by difficulties in early childhood experiences within their families. Treatment depended on a painstaking untangling of the strands of the conflict in each individual child. Diagnosis per se was not initially a goal for child mental health providers. Instead, a broad concept of psychoneurosis was central to emphasize the depth and complexity of childhood psychiatric problems. Psychoneurosis did not translate into the 1980 nosology of the American Psychiatric Association (Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition [DSM-III]), however, and mostly disappeared from child psychiatry by the 1990s. The loss of the developmental, individual, and contextual perspective embedded in psychoneurosis (and other childhood disorders) has been a loss because the widespread use of the DSM symptom criteria has unintended consequences when applied to children.

Politics, profit, and psychiatric diagnosis: a case study of tobacco use disorder.

The idea of tobacco or nicotine dependence as a specific psychiatric diagnosis appeared in 1980 and has evolved through successive editions of the American Psychiatric Association's Diagnostic and Statistical Manual. Not surprisingly, the tobacco industry attempted to challenge this diagnosis through behind-the-scenes influence. But another entity put corporate muscle into supporting the diagnosis-the pharmaceutical industry. Psychiatry's ongoing professional challenges have left it vulnerable to multiple professional, social, and commercial forces. The example of tobacco use disorder illustrates that mental health concepts used to develop public health goals and policy need to be critically assessed. I review the conflicting commercial, professional, and political aims that helped to construct psychiatric diagnoses relating to smoking. This history suggests that a diagnosis regarding tobacco has as much to do with social and cultural circumstances as it does with science.

Gender, age, and diagnosis: the rise and fall of involutional melancholia in American psychiatry, 1900-1980.

Between 1900 and 1980, American psychiatrists employed a diagnosis of involutional melancholia to characterize older individuals, primarily postmenopausal women, who had constellations of depressive symptoms and specific personality traits. American interest in this diagnosis represented a confluence of social and psychoanalytic assumptions about gender, increased interest in old age, and the development of somatic therapies by the middle of the century. In the decades after the introduction of psychiatric medications, however, involutional melancholia lost its significance as a specific disease and was absorbed into the broader category of major depressive disorder.

Science, gender, and the emergence of depression in American psychiatry, 1952-1980.

Between the first (1952) and the third (1980) editions of psychiatry's Diagnostic and Statistical Manual of Mental Disorders, depression emerged as a specific disease category with concrete criteria. In this article, I analyze this change over time in psychiatric theory and diagnosis through an examination of medication trials and category formation. Throughout, I pay particular attention to the ways in which psychiatrists and researchers invoked science in their clinical trials and disease theories, as well as the ways in which gender played an important but largely unspoken role in the formation of a category of depression.

Case-based independent study for medical students in emergency psychiatry.

OBJECTIVE: Brief cases designed for independent study were developed to allow third-year medical students some exposure to important concepts in emergency psychiatry during their required psychiatry clerkship. METHODS: Five independent study cases were given to University of Michigan third-year medical students during their psychiatry clerkship, and their performance on a pre- and posttest of knowledge of emergency psychiatry management was compared between students who did and did not use the independent study cases. RESULTS: All of the students improved in their knowledge of emergency psychiatric management, but the students who completed the cases had a significantly better performance on the postrotation quiz. CONCLUSIONS: Case-based independent study is an effective method to improve exposure to emergency psychiatry cases during a third-year medical student clerkship.

History, memory, and profession: a view of American psychiatry through APA presidential addresses, 1883-2003.

The address of the retiring president of the American Psychiatric Association has been a traditional part of the annual meeting of the association since 1883. The presidential address, which has explicitly been exempted from general discussion or criticism, has become an opportunity for the elected leader of the association to reflect on the state of the profession. Over the last 120 years, the presidents of the association have themselves engaged with the history of psychiatry in ways that reflect the changes in psychiatry of the time. In the process, memory has served a professionalizing purpose, as some aspects of psychiatry's history have been remembered while others have not. In the presidential addresses, history is not just a story about the past but also a story about psychiatry's self-definition and its future.

Women and teaching in academic psychiatry.

OBJECTIVE: This article explores past, present, and future issues for women and teaching in academic psychiatry. A small study of didactic teaching responsibilities along faculty groups in one academic psychiatry department helps to illustrate challenges and opportunities for women in psychiatric teaching settings. BACKGROUND: Although women have comprised half of all medical school admissions for over a decade, tenure-track positions are still largely dominated by men. In contrast, growing numbers of women have been entering academic medicine through clinical-track positions in which patient care and teaching, rather than research, are the key factors for promotion. Thus, the authors hypothesized better representation of clinical-track women in formal, didactic teaching within the medical school setting. METHODS: The authors compared the numbers of tenure and clinical-track men and women teaching lectures to medical students and residents at the University of Michigan, Department of Psychiatry. RESULTS: Contrary to the hypothesis, the majority of didactic teaching was done by tenure-track men. DISCUSSION: Possible explanations and remedies for the continuing under-representation of women in academic psychiatry, particularly teaching settings, are explored. Suggestions are made for future areas in which female faculty might have opportunities for participation and leadership.

Biology and mental illness: a historical perspective.

A century ago, psychiatrists understood women's susceptibility to mental illness in terms of their unique biology. Although contemporary physicians certainly do not share late 19th-century psychiatrists' biases about women and the social order, the similarities between today's emphasis on women's biology and earlier explanations of the relationship between women's biology and mental illness bear investigation. This paper reviews the history of medical ideas about the connection between women's reproductive organs and their mental health and questions modern assumptions about that connection.