A View of American Psychiatry

To the Editor: On Dec. 18, 1831, a decade before the founding of the Association of Medical Superintendents of American Institutions for the Insane (now APA), Samuel Coleridge remarked, “If men could learn from history, what lessons it might teach us! But passion and party blind our eyes, and that light which experience gives is a lantern on the stern, which shines only on the waves behind us!” (1). Coleridge might equally have remarked on man’s failure to learn from histories of history. This latter misstep is one made in an article by Laura D. Hirshbein, M.D., Ph.D. (2). Although she dissected the APA presidential addresses themselves and cited works by historians, she ignored psychiatrists who, in APA-sponsored works, have provided insight into the very subject she ventured to explicate.

Perhaps most notable of Dr. Hirshbein’s omissions is the work of Walter Barton, the only psychiatrist to serve as both APA president at one point and its medical director at another (3). Barton established a basis for looking at the history of APA: perspective (ideas must be appreciated in the context of their time), pace (psychiatry moves forward in jerky motions, lead by pioneers who bring forward the main body), and cycles (old ideas are repeatedly revisited in the guise of novel thoughts). Dr. Hirshbein made substantial use of the first two principles; she ignored the third.

A second omission is the failure to cite the October 1994 issue of Hospital and Community Psychiatry (now Psychiatric Services). This edition had nine articles published in celebration of APA’s sesquicentennial, six by psychiatrists and one by a historian. Most relevant is an article titled “Issues in American Psychiatry Reflected in Remarks of APA Presidents, 1844–1994” (4). Taking the perspective of Barton’s third principle, this article demonstrates repeated themes throughout the presidents’ addresses as opposed to setting these addresses into historical theme periods. Neither approach is more or less legitimate, but the second one should surely acknowledge the first.

That APA itself revisits its own history is well illustrated by Callender’s final statement in his APA president’s address (5), the first official such address: