The Joint Commission on the Mental Health of Children, 1965-1970: Emotional disturbance, race and paths not taken in child psychiatry.

The Joint Commission on the Mental Health of Children (JCMHC) was a sprawling, multidisciplinary project that took shape in the years immediately after the assassination of President John F. Kennedy. Participants included child psychiatrists, educators, psychologists, social workers, philanthropists and other laypeople and professionals interested in the plight of children. While the original inspiration for the JCMHC was to address the potential for violence from disturbed children and adolescents, its findings and recommendations were an indictment of American society itself in which poor children went hungry, minority children were oppressed and there were not sufficient resources dedicated to the mental health of the nation's population of young people. The task forces and committees of the JCMHC spent significantly more time addressing prevention and mental health rather than mental illness. Two years into the work of the JCMHC, the leadership formed a committee to specifically examine issues related to race. The final report, published in popular book form as Crisis in Child Mental Health, arrived after the unraveling of the liberal consensus that had fueled President Lyndon Johnson's Great Society programs. Most of the proposed solutions for government intervention were ignored by the Nixon administration. The focus on mental health and the willingness to take a critical look at the detrimental effects of racism had represented child psychiatry at that time. In the decades that followed, however, child psychiatrists turned away from issues about prevention, race and environment and instead focused on the problems of mental illness in individual children.

Mind the Gap-Increasing Awareness of the Patient Experience.

This Viewpoint discusses the author's experience as a physician-patient.

Foreign medical graduates and American psychiatry.

Graduates from foreign medical schools (FMGs) began to staff US state psychiatric hospitals after World War II, and became increasingly associated with the poor quality of those institutions. Public and professional commentary on FMGs criticized their skills and suitability for the US healthcare system in the 1970s, at the same time that state hospitals were under increasing attack. By the 1980s and 1990s, the association between international medical graduates (as they became known) and underserved populations became an argument in favour of easing restrictions on these graduates. The role of foreign-trained psychiatrists in the US public sector became a way for American psychiatry leaders to manage the problems of the seriously mentally ill, first with blame and then with neglect.

Leaning into Perplexity: A Case of a Patient Who Did Not Want Treatment But Also Did Not Want to Leave.

This article presents the case of a young, second generation American Muslim man who was admitted involuntarily to an adult psychiatric inpatient unit. The patient's clinical picture was unclear-the treatment team was unsure if he demonstrated signs and symptoms of bipolar disorder or if a personality disorder (antisocial or narcissistic) better explained his presentation. His clinical picture after a couple of weeks of hospitalization was not sufficiently acute that he needed to remain in the hospital, but he refused to leave because he wanted documentation that he had no mental illness. This article considers the patient's history, the nuances of psychiatric diagnosis, the issues involving psychiatry and the law that arose in this case, and the collaboration of the psychiatric providers with the Chaplain Imam at the hospital. The case illustrates a collision between the limitations of science and the expectations of the patient and his family within our broader social, cultural, and professional contexts.

Why psychiatry might cooperate with religion: The Michigan Society of Pastoral Care, 1945-1968.

The early decades of the pastoral care movement were characterized by a remarkable collaboration with psychiatry. While historians of the religious aspects of this movement have noted the reliance of pastoral care on psychiatry and psychology, it has been less clear how and why mental health professionals elected to work with clergy. This paper uses the Michigan Society of Pastoral Care (MSPC), one of the early training programs for hospital chaplains on the model of the Boston-based Institute for Pastoral Care, as a window to explore the interactions between psychiatry and religion at mid century. Raymond Waggoner, the nationally recognized and well-connected chair of the psychiatry department at the University of Michigan, was instrumental in expanding the influential pastoral care program at his hospital and in his state as part of his bigger mission of emphasizing the fundamental role of psychiatry in American life. Waggoner played a key role within the MSPC, in conjunction with leaders within the medical departments of the major hospitals in the state. All of the members of the MSPC viewed psychiatry's insights as essential for pastoral care, with the caveat that chaplains should remain pupils, not practitioners of psychotherapy.

Religion and Spirituality, Meaning, and Faith in American Psychiatry From the 19th to the 21st Century.

Since the beginning of American psychiatry, we have discovered and rediscovered connections among religion, spirituality, meaning, and mental health. In the 19th century, religion was an embedded attribute of moral therapy, the framework for treatment in mental institutions. During the decades in the 20th century when psychoanalysis was ascendant in the profession, some psychiatrists collaborated with the emerging field of pastoral care. As biological psychiatry has come to dominate the profession, though, pastoral care providers and some psychiatric researchers have identified gaps in the human interactions that characterize ideal and meaningful encounters with patients. This article examines how religion has been mobilized in American psychiatry over the centuries within institutional settings, but also looks at a broad consideration of faith in psychiatrists' clinical interventions, how that has affected their interactions with religious ideas and people, and where they have found meaning and purpose in mental health care.

The ambivalent role of the institution in the history of child and adolescent psychiatry: a case study of the Hawthorn Centre in Michigan, USA.

Historians have examined the role of psychiatric institutions in the USA and addressed whether this form of care helped or harmed patients (depending on the perspective of the time period, historical actors, and historians). But the story for children's mental institutions was different. At the time when adult institutions were in decline, children's mental hospitals were expanding. Parents and advocates clamoured for more beds and more services. The decrease in facilities for children was more due to economic factors than ideological opposition. This paper explores a case study of a hospital in Michigan as a window into the different characteristics of the discussion of psychiatric care for children.

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.

L Ron Hubbard's science fiction quest against psychiatry.

Layfayette Ronald Hubbard (1911-1986) was a colourful and prolific American writer of science fiction in the 1930s and 1940s. During the time between his two decades of productivity and his return to science fiction in 1980, Hubbard founded the Church of Scientology. In addition to its controversial status as a religion and its troubling pattern of intimidation and litigation directed towards its foes, Scientology is well known as an organised opponent to psychiatry. This paper looks at Hubbard's science fiction work to help understand the evolution of Scientology's antipsychiatry stance, as well as the alternative to psychiatry offered by Hubbard.

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.

The Short-Answer Vignette Examination (SAVE): an assessment tool for the core psychiatry clerkship.

OBJECTIVE: This study aims to develop a vignette-based assessment tool for medical students on the psychiatry clerkship, with the goal of capturing knowledge and clinical reasoning. METHODS: The Short-Answer Vignette Exam (SAVE), four case vignettes with open-ended questions regarding assessment, differential diagnosis, management, and treatment, was developed for and administered to medical students rotating through psychiatry at a university medical school over one academic year (n = 169). The correlation of SAVE scores to resident/faculty evaluations (clinical rating) and Shelf exam scores were analyzed. RESULTS: SAVE scores were significantly correlated with scores on both the Shelf and Clinical Rating. By contrast, Shelf scores were not significantly related to Clinical Rating. CONCLUSION: The SAVE may measure aspects of clinical decision making not measured by the Shelf, without being redundant in what is assessed by the Clinical Rating. The SAVE provides an additional potentially useful assessment tool to evaluate medical students on the psychiatry clerkship.

Looking back to the future of psychopharmacology.

In 1967, select members of the American College of Neuropsychopharmacology (ACNP) met to discuss the future of the field. In their publication from this meeting, Psychotropic Drugs in the Year 2000, in 1971, the group imagined wild possibilities for chemical alteration of human behaviors and experience. These men thought that drugs could be used to solve social problems for all people. Not surprisingly, few of the predictions came true because the ACNP members could not have foreseen changes in American society and politics, a separation between street drugs and prescribed medications, and the increasing power of the pharmaceutical industry.

Historical essay: electroconvulsive therapy, memory, and self in America.

Electroconvulsive Therapy (ECT) practitioners and anti-ECT activists have divergent interpretations of both the treatment and its history. Despite claims by ECT opponents that practitioners do not acknowledge memory side effects, the published literature on the procedure demonstrates psychiatrists' awareness of this issue. And though current ECT practitioners claim that memory side effects were mostly the result of outmoded methods, investigators continue to publish studies that indicate ongoing memory problems. This article explores the conflict between pro- and anti-ECT groups around the issue of memory side effects in the broader context of changes in American psychiatry and society.

Scientific research and corporate influence: smoking, mental illness, and the tobacco industry.

Mentally ill individuals have always smoked at high rates and continue to do so, despite public health efforts to encourage smoking cessation. In the last half century, the tobacco industry became interested in this connection, and conducted and supported psychiatric and basic science research on the mental health implications of smoking, long before most mental health professionals outside the industry investigated this issue. Initially, representatives of tobacco industry research organizations supported genetics and psychosomatic research to try to disprove findings that smoking causes lung cancer. Tobacco industry research leaders engaged with investigators because of shared priorities and interests in the brain effects of nicotine. By the 1980s, collaborative funding programs and individual company research and development teams engaged in intramural and extramural basic science studies on the neuropharmacology of nicotine. When mental health researchers outside the industry became interested in the issue of the mentally ill and smoking in the mid-1990s, they increasingly explained it in terms of a disease of nicotine addiction. Both the idea that smoking/nicotine does something positive for the mentally ill and the conclusion that it is the result of nicotine dependence have the potential to support corporate agendas (tobacco or pharmaceutical).