AMERICAN PSYCHIATRY AND THE CRIMINAL: A HISTORICAL REVIEW

The history of American psychiatry and the criminal is the history of individuals who through unselfish motives have committed themselves to helping a portion of society that is ordinarily abused and neglected. In some instances they have been dramatically effective; in others they have failed. The growth of psychiatric criminology has been an uneven one. In the 19th Century physicians led the way in initiating social reform and in urging society to examine the criminal as an individual. For the first 40 years of the 20th Century psychiatrists made progress in explaining criminality in psychological terms and involved themselves deeply in the social treatment of the offender. Following the postwar surge towards private practice models of psychiatry, interest in the offender diminished. It did not begin to show signs of revival until this past decade. The newer psychiatric criminology shows some promise. Reflecting the social conditions of our era it seems to be concerned with organized programs rather than with the efforts of individual psychiatrists. Such programs have made encouraging progress in demonstrating how techniques of dynamic psychotherapy can be applied to correctional problems.

This history can be viewed in a somewhat different perspective. The manner in which medical practice has been modified so as to be applicable to problems of deviant behavior in itself makes for an interesting study. The naive biological models of the 19th Century are no longer useful. Similarly, utilization of medical skills to control social problems has proven to be dangerous and unrewarding. For a time psychiatrists were pessimistic of ever being able to treat the offender in settings dominated by the punitive attitudes of correctional administrators. But more recently, those who despaired of treating the criminal through techniques designed for "free individuals" have begun to take a second look. With careful attention to the biological needs of the individual as balanced against the needs of the community it has been possible to devise socio-psychological techniques of treatment that do help. It is true that these techniques are dependent upon theoretical models that still present many puzzling contradictions. Those individuals who have chosen to work with the criminal have repeatedly experienced the agonizing intellectual and emotional exercise of trying to reconcile the needs of the individual with those of society. More than other psychiatrists, they have come to appreciate the staggering complexities involved in this problem. Arrogance, unreflectiveness, and dogma tend to disappear in the face of this bewildering dilemma.

The younger generation of psychiatrists has been trained with the image of private practice and emphasis on psychotherapy of selected patients as the ideal professional career. The pendulum, however, has recently begun to swing. We now seem to be moving in a new direction. Psychiatrists are being called upon to assist the community in the resolution of its social problems. It is doubtful if we could resist such demands, even if we wanted to. But community involvement will require new models of medical care and will necessitate the development of extremely complicated roles for the psychiatric profession. If psychiatry is to concern itself with the social problems of our time, its practitioners would do well to learn from those who have had the most experience with such problems. The body of knowledge accumulated by those American psychiatrists who have worked with the criminal provides a bountiful source for study. If we can learn from their enthusiasm, from their dedication, from their thoughtfulness and from their mistakes we may yet come to fully honor those psychiatrists who have given so unselfishly to their less fortunate brother men.