PSYCHIATRY AFTER WORLD WAR II

Psychiatry and the War

Psychiatry came to the attention of the government and the public during World War II, when more than a million men were rejected from military service because of mental or neurological disorders. Of those inducted into the army and later given medical discharges, 40 percent were dismissed for psychiatric reasons. During the war 850,000 soldiers were hospitalized for psychiatric disorders. Many conscientious objectors were assigned to serve in mental hospitals during the war years and brought back with them tales of neglect, overcrowding, and brutal treatment in the public mental hospitals. Psychiatrists and others blamed these problems on a great, unmet need for psychiatric services.

The Scandal of Neglect

At the end of the war the scandal of public mental hospitals became the subject of Mary Jane Ward's best-selling novel in 1946, The Snake Pit. In another widely read book, The Shame of the States (1948), the historian and journalist Albert Deutsch compared scenes in American mental hospitals to the horrors of Nazi concentration camps. Deutsch and many others called for closer medical oversight of mental hospitals.

A Shift in Orientation

Many European refugee psychiatrists contributed to postwar psychiatry. Before the war American psychiatry was centered around ruralbased institutional "retreats," where physicians specialized in a variety of unsystematic treatments for "nervous disorders." European refugees brought a more urban, psychoanalytically oriented profession to America's middle class, specializing in the treatment of neurosis and anxiety.

Government Action

Because of the state-hospital scandal and the unexpected success in the treatment of psychiatric patients by the military's psychiatric services during the war, Congress was persuaded to pass the National Mental Health Act in 1946. With the federal assistance authorized by this act thousands of psychiatrists, psychologists, social workers, and nurses were educated. In 1949 the government created the National Institute of Mental Health (NIMH), a division of the National Institutes of Health (NIH). With government support psychiatry shifted toward proactive prevention of mental illness and away from the after-the-fall institutional warehousing of the mentally disabled that created such a scandal after World War II.

Sources:

James Bordley III and A. McGehee Harvey, Two Centuries of American Medicine (Philadelphia: Saunders, 1976), pp. 740-743;

William Menninger, Psychiatry in a Troubled World: Yesterdays War and Todays Challenge (New York: Macmillan, 1948);

Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982), pp. 344-346.

Mental hospitals

Institutions for the mentally ill, formerly called asylums, and now called psychiatric institutions.

Beginning in the Middle Ages, mental hospitals were basically prisons. By the end of the eighteenth century, the term asylum was used, and some reforms were being implemented when the notion was introduced that psychological disturbances, like physical ailments, could be viewed as diseases requiring treatment rather than crimes calling for imprisonment. By the late 1800s, reactions against conditions in mental hospitals led to a reform movement in the care and treatment of people with mental disorders. The Mental Health Act of 1946 and the Community Mental Health Centers Act of 1963 allotted federal funds for the establishment of community treatment centers, which provide a variety of services—including short-term and partial hospitalization—in an effort toward the deinstitutionalization of mental patients. As of the late 1990s, institutions for the treatment of mental disorders are called psychiatric institutions. These institutions—along with mental health centers and halfway houses—form a system for treatment of mental disorders at all levels of severity.

Further Reading

Wyer, Robert S., Jr., ed. Knowledge and Memory: The Real Story. Hillsdale, NJ: Lawrence Erlbaum, 1995.

Hartmann, Ernest. Boundaries in the Mind: A New Psychology of Personality Difference. New York: Basic Books, 1991.

See also Institutionalization