Reforming Psychiatry

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Reforming Psychiatry

Redefining the Psychiatrist’s Role. A public outcry against the lamentable state of patient care in public and private mental asylums during the 1870s and 1880s led to the formation of a reform movement that eventually changed not only hospitals but the nature of psychiatric practice as well. Psychiatry had been progressively moving away from an environmental theory of mental disease that associated it with a degenerate moral environment toward a new German approach that centered on the pathology of the brain and nervous system. This change brought alienists (as asylum-based psychiatrists were called) within the compass of scientific medicine.

Changing the Asylum. The quality of patient care, however, lagged behind advances in medical theory. The movement to reform asylums was led in part by neurologists, whose discipline rivaled psychiatry. Neurologists charged that asylum superintendents were outside the mainstream of American medicine, unable to engage in scientific research and refusing to turn to medical experts for patient care or to submit to public scrutiny. Part of a larger movement to improve medical education in general, critics of mental-health care charged that asylum superintendents had no special expertise but had just worked their way up through the ranks of physicians attached to a particular institution. Rather than being centers of research into emotional and mental disorders, the asylums did no research at all.

Government Regulation. Criticism of conditions in asylums led to a wave of legislative reform. In New York State, for example, candidates for all medical positions in asylums were required to take competitive examinations. The state asserted its prerogative to control treatment of the mentally ill in the counties where asylums were located. Piecemeal changes were codified in the New York Insanity Law of 1896, which established a complete, supervised system of care for the insane. Treatment of the insane everywhere was improved, with greater emphasis on the individual patient and a renewed interest in innovative treatment and research. Yet therapy remained largely ineffectual until the ideas of Sigmund Freud began to be disseminated in the United States during the early years of the twentieth century. Typical Therapies were usually based on the assumptions that emotional problems were caused by defects of the patient’s physical constitution. They included bed rest, hydrotherapy and, toward the end of the century electro-shock therapy.

SCIENCE, RELIGION, AND COLLEGE

When President Andrew Dickson White of Cornell University instituted the elective system, he enraged traditionalists who favored the single, classical curriculum that had remained essentially the same since the Middle Ages. For White, however, the elective system, which made it possible to introduce the study of natural science at the undergraduate level, would have the desirable effect of defusing the “warfare” between science and theology. He concluded his influential book A History of the Warfare of Science with Theology with a comment on the changing nature of American university education:

Under the old American system the whole body of students at a university were confined to a single course, for which the majority cared little and very many cared nothing, and, as a result, widespread idleness and dissipation were inevitable. Under the new system, presenting various courses, and especially courses in the various sciences, appealing to different tastes and aims, the great majority of students are interested, and consequently indolence and dissipation have steadily diminished. Moreover, in the majority of American institutions of learning down to the middle of the century, the main reliance for the religious culture of students was in the perfunctory presentation of sectarian theology, and the occasional stirring up of what were called “revivals,” which, after a period of unhealthy stimulus, inevitably left the main body of students in a state of religious and moral reaction and collapse. This method is now discredited, and in the more important American universities it has become impossible. ... Religious truth ... is presented, not by “sensation preachers” but by thoughtful, sober minded scholars. Less and less avail sectarian arguments; more and more impressive becomes the presentation of fundamental religious truths.

Source: Andrew Dickson White, A History of the Warfare of Science with Theology in Christendom (New York: Appltton, 1896).