The psychodynamic wave

An important factor in the spread of the doctrine of psychoanalysis was the emigration of a relatively large number of German and Austrian psychoanalysts to the United States from 1933 onwards. They had been compelled to leave their home countries for racial reasons—psychoanalysis had been condemned by the National

Socialist regime as Jewish and Freud's books had been publicly burned. Many of the young psychiatrists trained in large numbers to answer the demands of the armed forces adopted psychoanalysis under the influence of some of those in charge of the programmes. For a generation, until the end of the 1960s, psychoanalysis became the dominant ideology in American psychiatry.

The American form of psychodynamism often deviated from Freudian orthodoxy, but it emphasized the role of psychogenetic factors, the value of the study of intrapsychic mechanisms, and the basic importance of psychotherapy, while giving little consideration to the traditional clinical approach and to nosology. The domination of this essentially psychological orientation, sometimes compared with the success of the German mentalist school during the first half of the nineteenth century, had important consequences. Although the disorders of hospitalized psychotics were eventually interpreted according to psychoanalytic theory, psychotherapy was mostly used, as it has been since its beginnings, on ambulatory neurotic patients. As early as 1951-1952, 3000 of the 7500 American psychiatrists identified private practice as their main activity, and in 1954 the number of private psychiatrists exceeded that of their salaried colleagues for the first time, with a quarter of the former devoted exclusively to psychotherapy. However, with the initial encouragement of official institutions such as the Veterans Administration, the clinical psychologists began to engage in psychotherapeutic activities. The number of members of the Clinical Psychology Section of the American Psychological Association reached 20000 in 1980 at a time when they were 26000 psychiatrists in the United States. In public opinion, and to a certain extent in general medical opinion also, psychiatry was assumed to consist only of psychotherapy and psychology.

In most other countries the developments that occurred in the United States were not as intense, generally appeared later, and were modified by local traditions and influences. In the German-speaking countries they were delayed by the still powerful neuropsychiatric perspective and the temporary vogue for existential phenomenology. In the United Kingdom, the eclectic current fostered by the influential London Institute of Psychiatry during the decades following the war restricted the advance of psychodynamism; in 1956 Time Magazine could affirm, as a conclusion of a survey, that 'all of Great Britain [had] half as many analysts as New York City'. In France, the psychoanalyst Jacques Lacan gave the doctrine a special colouring. On the whole, however, the rise of psychodynamism was a general phenomenon, except in the communist countries where Freud's doctrine had been condemned on ideological grounds.

A reaction began in the 1960s with the successes of the new pharmacotherapies. Clinical psychologists had developed alternative radically different psychotherapeutic methods based on learning theories, especially the behaviour therapy introduced in 1958 by Wolpe, supported in the United Kingdom by Eysenck, and the cognitive therapy often associated with it. These methods competed successfully with the psychodynamic techniques and conquered a large part of the field. Psychodynamism did not disappear; many of its concepts retained their place in psychiatry and psychotherapeutic methods continued to be practised, but it lost its predominant ideological position. In addition to its theoretical contributions, when its influence on the professional aspect of psychiatry is considered from a historical perspective, it has been an important factor in the further expansion of the activity of psychiatrists in the treatment of relatively minor disorders and has also encouraged clinical psychologists to play an active and independent role in this field.

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