Psychiatric Revolutions

The article about Robert Cancro, M.D., in the September 6 issue describes two revolutions in psychiatry: the psychoanalytic in the 1950s and the psychopharmacologic in the 1960s. Each made significant contributions to psychiatry, and each became synonymous with psychiatry itself. While praising their achievements, he acknowledged their limits as treatment: “We are producing more patients than cures.” Dr. Cancro would like to see a reconciliation of the two camps of zealous practitioners. Psychiatric treatment was losing the battle with mental illness.

In the decades before 1950, as psychoanalysis was being introduced throughout the world and offered the possibility of treatment for mental illness, another treatment emerged.

Chemical convulsive treatments were shown to be an effective treatment for mental illness and applauded in the press, while medical authorities called it too horrible to use. ECT soon followed; it was much easier to use and was widely overused. In the 1950s medical modification had made it safe and removed the “shocking” aspects. The real revolution in psychiatry was that psychiatry had an effective treatment for the psychoses (serious mental illness).

Psychopharmacology reintroduced the chemical treatment of mental illness with many significant improvements, but still produced more patients than cures. ECT practitioners had learned that psychoses are chronic recurring conditions and that remissions must be maintained by one or more modalities. Authoritative experts assert that ECT is underused (medication trials are overused), including the Surgeon General; Max Fink, M.D., in his 1999 book Electroshock: Restoring the Mind; and Sally Satel, M.D., in her 2000 book PC, M.D.: How Political Correctnesss Is Corrupting Medicine.

Psychiatry is indebted to psychoanalysis for the impending revolution in medical education.

Some universities have already incorporated the psychosocial model into medical education, and others are adopting it. An understanding and awareness of mental illness, psychodynamics, and emotional factors in illness is imparted to all medical students. This revolution is seen as a step toward Dr. Cancro’s goal of preventing mental illness, by producing better doctors and better care.