The expansion of psychiatry after 1945

The Second World War coincided with a major transformation of the psychiatric specialty. The war had vividly demonstrated the frequency of mental disorders in the United States; they had proved to be the leading cause of medical discharges from the military service and the primary cause of almost 40 per cent of selective service rejections. The previously prevailing view that psychiatry was a minor and often somewhat despised medical discipline, concerned primarily with the custodial care of psychologically deviant and potentially troublesome individuals, was progressively dispelled. The preservation and the restoration of mental health—an expression from now on often used by national and international institutions—began to be considered by governments as an important task. The fundamental changes which took place after 1945 and shaped psychiatry as we know it today were the result of this new atmosphere and of the emergence of new perspectives in the three traditional domains— the psychological, the social, and the biological. Some appeared in slightly different forms at different times, their relative influence was submitted to variations, and eventually they came into conflict. The result has been an impressive expansion and increase of the efficacy of psychiatry, profound institutional transformations, and successive ideological waves which have had a major impact on the professional position of the psychiatrist.

The demographic data reflect the new importance of psychiatry in medicine. In the United States the proportion of psychiatrists in the medical profession was 0.7 per cent in 1920, 1.4 per cent in 1940, and 5.5 per cent in 1970, the rate of growth having doubled after the Second World War. In France at present there are 18 psychiatrists for 100000 habitants; they constitute 6 per cent of all physicians. Similar levels were reached during the postwar decades in the developed countries and remain relatively stable today. Even before this spectacular increase in numbers, psychiatrists had been becoming conscious of the necessity to affirm the identity of their discipline. The First World Congress of Psychiatry, held in Paris in 1950, has been followed by periodic meetings and by the creation of the World Psychiatric Association to which almost every national society of psychiatry belongs. The health authorities of various countries have become conscious of the necessity to provide adequate financial means to support research and training in the discipline. In 1946 the United States government created the National Institutes of Mental Health for such a purpose, and similar efforts were made in many countries although the structures of the organizations formed were different. To promote the same goals at the international level, the World Health Organization, created immediately after the Second World War, had a Section (later Division) of Mental Health which, among other co-ordinating activities, tried to overcome the difficulties of communication between the national schools by establishing a common nosological language.

While the changes affected almost all countries, they were most spectacular in the United States. From the end of the nineteenth century until the 1930s, the concepts developed in the German-speaking countries had been the most influential. This disappeared with the advent of the National Socialist regime which, under cover of racist theories, expelled many of the leading psychiatrists from Germany and Austria, introduced compulsory sterilization for several varieties of mental illnesses, and promoted the voluntary killing in psychiatric hospitals of mentally retarded children and chronic patients. The United States, which had emerged from the Second World War as the most powerful country in the world, began to exert a widespread influence in psychiatry as in the rest of medicine. Because of the prestige of its research and teaching institutions and the worldwide influence of its scientific publications, reinforced by the progressive adoption of English as the language of international scientific communication, American psychiatry became a model in many countries, even though many of the theoretical trends and technical advances it adopted and developed had originated in Europe. However, in the United States, with a local colouring, they took on a special intensity.

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