The making of contemporary American psychiatry, Part 2: therapeutics and gender before and after World War II

In this article, the 2nd in a 2-part series, the authors use patient records from California's Stockton State Hospital to explore the changing role of gender norms and other cultural values in the care of psychiatric patients. The authors show that cultural values are always imbedded in psychiatric practice and that their role in that practice depends on the patients, treatments, and therapeutic rationales present in a given therapeutic encounter. Because the decade following World War II witnessed dramatic changes in psychiatry's patients, therapeutics, and rationales, Stockton State Hospital's patient records from this time period allow the authors to show not only the extent to which gender norms shape psychiatric practice but also how psychiatry's expansion into the problems of everyday life has led to psychiatry taking a more subtle and yet more active role in enforcing societal norms.     

Brain imaging: Applications in psychiatry

For more than a century psychiatrists have suspected neuropathology in patients with mental illness. In the last decade there have been developed several technologies that are capable of looking at both neuroanatomy and neurophysiology in the brains of living humans. First, x-ray computerized axial tomography led the way in visualizing the living brain, and now magnetic resonance imaging allows brain structure to be shown with even more clarity. Brain electrical activity mapping allows computerized maps of electrophysiological activity to be visualized in a way never before possible. Nuclear medicine has provided the means of looking at various metabolic and neurochemical parameters in the living brain. These include regional cerebral blood flow studies using xenon¹³³, single photon emission tomography, and positron emission tomography. Psychiatrists are cautiously optimistic that these various brain imaging technologies will be important new tools in continued exploration of the causes of mental illness and ultimately may lead to more effective treatments.     

Divergences in American psychiatry during the Depression: somatic psychiatry, community mental hygiene, and social reconstruction

The differences between somatic psychiatrists and mental hygienists, already apparent earlier, became much more pronounced during the Depression years, partly as a consequence of their different perspectives on this social crisis. Somatic psychiatrists, emboldened by the apparent success of new medical treatment methods, reasserted the central position of the mental hospital within psychiatry, attempted to improve the discipline's position within medicine, and promoted basic research. Mental hygienists, following the ideal of prevention, proposed far-reaching programs of community mental hygiene to alleviate widespread mental distress. A small group of mental hygienists embraced socialism and advocated measures of radical social reconstruction.     

Spirituality and religion in psychiatry: the impact of policy

ABSTRACT

Research and debate on the importance of spirituality and religion in psychiatry has led to a number of national and international policy initiatives, intended to clarify the boundaries of good practice and improve the way in which such matters are managed for the benefit of patients. Significant amongst these is the 2015 position statement of the World Psychiatric Association, the only such policy statement to date which has been internationally agreed. Preliminary evidence available suggests that this is having good effect in generating professional debate and further national policy initiatives in different countries. There is a need for further research on such policy initiatives to confirm whether or not they have the intended impact upon clinical practice and whether or not this in turn is beneficial for patients.     

Saints and psychiatry

Summary The Irish Saint Dympna, a distant and misty figure, with her martyrdom inspired a millenary tradition of family and community care for the mentally ill at Geel, in Belgium. She is the Catholic patron of the mentally afflicted.The French Saint Vincent de Paul, a powerful leader, took care of the insane and the poor in gentle ways; worked for reforms in hospitals, education, delinquency, and penology; founded religious orders dedicated to the sick; and set in motion the hospitals of La Salpêtrière and Le Bicêtre.The portuguese-Spaniard Saint John of God, a humble shepherd, a marginal soldier, an ignorant construction worker, and a modest salesman of books, has had more relevance to psychiatry than has Dympna, the martyr, or Vincent de Paul, the social reformer. No other saint has had more practical and sustained influence on hospital psychiatry than he, and it is a mystery of sorts that his name still awaits the distinguished place of honor it so richly deserves.     

The establishment of the department of psychiatry in the Mount Sinai Hospital: a conflict between neurology and psychiatry

A conflict between neurology and psychiatry and controversies about psychoanalysis played an important role in the establishment of psychiatry in the general hospital. This article reviews the impact of this conflict on the establishment of an independent Department of Psychiatry in the Mount Sinai Hospital in New York during the first half of the twentieth century. A unique opportunity is provided to consider the relationships and personalities of the individuals involved, as well as economic, social, and scientific factors, including the introduction of psychoanalysis as a major psychiatric treatment.     

Training and credentialing in forensic psychiatry

The increase in legal regulation of psychiatric practice, malpractice litigation, number of mentally ill in correctional settings and concerns about the sometimes embarrassing quality of expert witness testimony has led to an heightened focus on training and credentialing of psychiatrists who work in these areas. The past 20 years has witnessed a growth of professional organizations, journals, accredited training programs and board certification. The paper outlines the nature of these programs and some of the dilemmas for the profession in establishing formal subspecialties.     

Functional neuroimaging in neurology and psychiatry

How can functional neuroimaging be applied to clinical neurology and psychiatry? This article reviews selected contributions of functional neuroimaging to the clinical neurosciences. We review selected technical aspects of positron emission tomography, single photon emission tomography, and functional magnetic resonance imaging with a focus on the relative strengths and weaknesses of these techniques. Consumers of functional neuroimaging research are encouraged to consider the limitations of imaging techniques and theoretical pitfalls of cognitive task design when interpreting results of functional imaging studies. Then, we selectively review the contributions of functional neuroimaging to neurology and psychiatry, including the areas of epilepsy, stroke, chronic pain, schizophrenia, depression, and obsessive-compulsive disorder. Future directions of functional neuroimaging research are offered, with the emphasis that the best conclusions are informed by a convergence of research from functional neuroimaging, neurophysiological, and lesion studies.