Reflections on US Psychiatry: How the Baton Was Passed From European Psychiatry and the Contributions of US Psychiatry.

ABSTRACT: The medical model in psychiatry and descriptive psychopathology were established in Germany by Krapelin's textbook and Jaspers' General Psychopathology. In the United Kingdom, Mayer-Gross' textbook synthesized both books, influencing US psychiatry. US psychiatrists from the World War II generation defeated the US academic psychoanalytic establishment by building three pillars: biological psychiatry (brought by Wortis), the psychopharmacology revolution, and the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition (DSM-III). The psychopharmacology revolution included immigrants (e.g., Gershon), Cole's marketing, and textbooks by Klein and Fink. The "neo-Kraepelinians" introduced the medical model in US psychiatry and defined 15 valid psychiatric disorders. Spitzer supervised DSM-III's development. Its 1980 publication started the world dominance of US psychiatry and the multiplication of diagnoses. Major contributions by US psychiatrists include a) McHugh's update of the Jaspersian approach, b) Fink's inclusion of catatonia as a syndrome in DSM-5 (following Abrams and Taylor's studies), and c) DSM-III's departure from the Jaspersian hierarchy of schizophrenia and affective symptoms.

Stanley Cobb, the Rockefeller Foundation and the evolution of American psychiatry.

Stanley Cobb founded the Harvard Departments of Neurology (1925) and Psychiatry (1934) with Rockefeller Foundation funding. Cobb was an important transitional figure in both neurology and psychiatry. He and his friend Alan Gregg were the most visible parts of the Rockefeller Foundation psychiatry project, which prepared American psychiatry for the rapid growth of psychiatric research after World War II. Edward Shorter called him the founder of American biological psychiatry, but this misunderstands Cobb and the Hegelian evolution of twentieth-century American psychiatry. I review the major role of the Rockefeller Foundation in the evolution of American academic psychiatry and the disappearance of Cobb's teaching and that of his mentor Adolf Meyer, a founding father of American academic psychiatry.

Mass killing under the guise of ECT: the darkest chapter in the history of biological psychiatry.

Following its inception, electroconvulsive therapy (ECT), rapidly spread all over the world, including Nazi Germany. Paradoxically, at the same time, the euthanasia programme was started in Germany: the extermination of people with intellectual disabilities and severe psychiatric disorders. In Lower Austria, Dr Emil Gelny, who had been granted a specialist qualification in psychiatry after three months of clinical training, took control of two psychiatric hospitals, in Gugging and Mauer-Öhling. In 1944, he began systematically killing patients with an ECT machine, something that was not practised anywhere else before or after, and remains unprecedented in the history of convulsive therapy. He modified an ECT machine, adding extra electrodes, which he fastened onto a victim's wrists and ankles to administer lethal electric shocks.

Documento de posicionamiento de la Sociedad Española de Psiquiatría Biológica / Positioning document of the Spanish Biological Psychiatry Society

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Cyclical swings: The bête noire of psychiatry.

Progress in psychiatry in the West has been retarded by the proclivity of the discipline to swing violently between 2 approaches to viewing mental illness; that is, emphasizing-to the exclusion of the other-the material-somatic vs the psychical-experiential avenues to knowledge. Each time a shift occurs, the leaders of the new dominant approach emotionally denounce the principles and ideas that came before. We can examine this phenomenon historically by looking at Romantic psychiatry, mid-/late-19th century empirical psychiatry, psychoanalysis, and modern biological psychiatry. Looking at the 2 approaches in treatment today, the gold standard of patient care involves combining empirical/psychological care in 1 person (the psychiatrist) or shared between 2 clinicians working intimately with each other (psychiatrist with psychologist or social worker.) Yet as regards psychiatrists, they are discouraged from paying full attention to the psychological side by the way managed care and third-party payment have combined to remunerate them. Finally, how do we account for the intense swings and denunciations in psychiatry? The author speculates on possible explanations but leaves the question open for her readers.

Forced Migration as Public Relations Process? Lothar B. Kalinowsky and the Trans-Atlantic Transfer of Electroconvulsive Therapy.

Research in biological psychiatry during the first half of the 20th century was based upon a wide range of interrelated disciplines, including neurology, neuroanatomy, neuropathology, and experimental biology. The work of German-American psychiatrist and neurologist Lothar B. Kalinowsky (1899-1992) is taken here as an example of how such fields could be combined to produce a highly innovative and multidimensional research program in clinical neuroscience. Kalinowsky functioned exceptionally well in both scientific and clinical cultures despite the marked contextual differences between the Charité in Berlin and his later workplace in New York's Columbia Medical School. The innovative ideas exemplified by Kalinowsky's efforts, however, sometimes amounted to a dubious advantage for émigré clinical neuroscientists: they easily led to incommensurable scientific views, and sometimes even resulted in the marginalization of the innovator from existing research programs.

Contending professions: sciences of the brain and mind in the United States, 1850-2013.

Argument This paper examines the intersecting histories of psychiatry and psychology (particularly in its clinical guise) in the United States from the second half of the nineteenth century to the present. It suggests that there have been three major shifts in the ideological and intellectual orientation of the "psy complex." The first period sees the dominance of the asylum in the provision of mental health care, with psychology, once it emerges in the early twentieth century, remaining a small enterprise largely operating outside the clinical arena, save for the development of psychometric technology. It is followed, between 1945 and 1980, by the rise of psychoanalytic psychiatry and the emergence of clinical psychology. Finally, the re-emergence of biological psychiatry is closely associated with two major developments: an emphasis that emerges in the late 1970s on rendering the diagnosis of psychiatric illnesses mechanical and predictable; and the long-term effects of the psychopharmacological revolution that began in the early 1950s. This third period has seen a shift the orientation of mainstream psychiatry away from psychotherapy, the end of traditional mental hospitals, and a transformed environment within which clinical psychologists ply their trade.

¿Qué aportan a la Psiquiatría los estudios en cerebro post mórtem? / Do post-mortem brain studies provide useful information for Psychiatry?

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[Maurycy Urstein: forgotten Polish contributor to German psychiatry]. / Maurycy Urstein: zapomniany polski wspóltwórca niemieckiej psychiatrii.

Polish psychiatrist Maurycy Urstein (1872-1940) is nowadays almost forgotten. He is not mentioned in the history of Polish psychiatry which only partially may be explained by the fact that his most essential works were published in German language. His scientific oeuvre contains dozens of publications, including four monographs on catatonia. Urstein was an ardent advocate of the autointoxication theory of psychiatric disorders, fierce opponent of psychoanalysis and enthusiast of the use of biological methods of treatment in psychiatry. Both some eccentric views and specific personality probably equally contributed to his almost complete isolation among psychiatrists in the interwar Poland.

Stanley Cobb (1887-1968): studying the link between the mind and the body.

Stanley Cobb was an eminent neurologist that is regarded as 'the founder of biological psychiatry'. Having studied at Harvard university, Cobb had many varied interests, including ornithology and natural history. Following his undergraduate studies, he travelled widely and incorporated a period of study in Europe. Upon return to America, he was appointed Director of the Harvard Neurological Unit. Following a change of interest from neurology to psychiatry, Cobb was instrumental in establishing psychiatry as a specialty in America. The research laboratory, 'Stanley Cobb Laboratory for Psychiatric Research' at Massachusetts General Hospital was named in his honour and contribution to the service at the hospital.

¿Es científica la psiquiatría? Carta al residente de psiquiatría del siglo XXI / Is psychiatry scientific? A letter to a 21st century psychiatry resident

Durante el desarrollo del DSM-5 incluso la prensa ha cuestionado la validez científica de la psiquiatría. Esta revisión proporciona a los residentes de psiquiatría del s. XXI maneras de responder a estas críticas a través de la definición de los conceptos y la historia de la psiquiatría (una rama de la medicina), la medicina y la ciencia. El lenguaje psiquiátrico tiene 2 niveles: primero, describir los síntomas y signos (la psicopatología descriptiva del s. XIX , desarrollada en Francia y Alemania), y, segundo, describir los trastornos (la nosología psiquiátrica fue desarrollada a principios del s. XX por Kraepelin y resucitada por la revolución americana neo-kraepeliniana, llevando finalmente al DSM- III ). La ciencia es un proceso histórico complejo de ensayo y error que puede verse amenazada por aquellos que creen demasiado en ella e ignoran sus limitaciones. Los avances psiquiátricos más importantes (la terapia electroconvulsiva y los principales agentes psicofarmacológicos) fueron descubiertos por «casualidad», no gracias a la planificación científica. La Psicopatología general, escrita por Jaspers, es un complejo libro de 100 años de antigüedad que describe: 1) los trastornos psiquiátricos como heterogéneos y 2) la psiquiatría como una disciplina científica híbrida que requiere una combinación de comprensión (un método del campo de las ciencias sociales) y explicación (un método del campo de las ciencias naturales). En el s. XXI Berrios nos recuerda los aspectos relacionados con la poco afortunada metodología de la psiquiatría debido a la heterogeneidad de sus síntomas y trastornos, algunos de los cuales resultan más comprensibles si son considerados problemas de comunicación fruto de la interacción entre seres humanos; en estas situaciones, los métodos neurocientíficos como las pruebas de neuroimagen no tienen sentido. Se necesita un nuevo lenguaje en la psiquiatría. Los residentes de psiquiatría del este de Asia, que no están particularmente apegados al lenguaje anticuado utilizado actualmente, pueden resultar especialmente preparados para la tarea de recrear el lenguaje psiquiátrico utilizando el conocimiento del s. XXI (AU)

During the development of the DSM-5, even the lay press questioned psychiatry’s scientific validity. This review provides 21st century psychiatry residents with ways of answering these attacks by defining the concepts and history of psychiatry (a branch of medicine), medicine and science. Psychiatric language has two levels: first, describing symptoms and signs (19th century descriptive psychopathology developed in France and Germany), and second, describing disorders (psychiatric nosology was developed in the early 20th century by Kraepelin and resuscitated by the US neo-Kraepelinian revolution leading to the DSM-III I ). Science is a complex trial-and-error historical process that can be threatened by those who believe too much in it and disregard its limitations. The most important Psychiatric advances, electroconvulsive therapy and major psychopharmacological agents, were discovered by « chance » , not by scientific planning. Jaspers’s General Psychopathology is a complex 100-year-old book that describes: 1) psychiatric disorders as heterogeneous and 2) psychiatry as a hybrid scientific discipline requiring a combination of understanding (a social science method) and explanation (a natural science method). In the 21st century Berrios reminds us of psychiatry’s unfortunate methodological issues due to hybrid symptoms and disorders, some of which are better understood as problems in communication between interacting human beings; in those situations neuroscience methods such as brain imaging make no sense. A new language is needed in psychiatry. East Asian psychiatry residents, who are not particularly attached to the antiquated language currently used, may be particularly equipped for the task of recreating psychiatric language using 21st century knowledge (AU)

Visión de un residente español de la psiquiatría del siglo XXI / A Spanish resident's vision of 21 st century psychiatry

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La Revista de Neuro-Psiquiatría y los primeros tratamientos biológicos en la psiquiatría mundial / The Revista de Neuro-Psiquiatría and the first biological treatments in world psychiatry

A lo largo de las primeras décadas de su existencia, la Revista de Neuro-Psiquiatría fue testigo y fuente efectiva de difusión de los trascendentales avances en la terapéutica psiquiátrica que se dieron entre los años de 1930 a 1960, particularmente en el campo de los tratamientos biológicos. Estos avances condujeron a que la psiquiatría, aun cuando no sin tropiezos u obstáculos, fuera considerada, con toda justicia, como una especialidad médica.

During the first decades of its existence, the Revista de Neuro-Psiquiatría became both a witness and an effective source of dissemination of the significant advances in psychiatric treatment that occurred between the 1930s and 1960s, particularly in the area of biological treatments. These advances led psychiatry, even though not without obstacles or setbacks, to being considered, in all fairness, as a medical specialty.

Julius Wagner-Jauregg and the legacy of malarial therapy for the treatment of general paresis of the insane.

Julius Wagner-Jauregg, a preeminent Austrian psychiatrist was awarded the Nobel Prize in Medicine in 1927 for the development of malaria therapy for the treatment of neurosyphilis, or general paresis of the insane. Despite being only one of three psychiatrists to win a Nobel Prize, he has faded from public consciousness and his name recognition pales in comparison to his contemporary and fellow Austrian, Sigmund Freud. This paper explores his contributions to the field of biological psychiatry and also touches upon reasons, such as the growing bioethics movement, his controversial affiliation with the Nazi Party, and the evolution of neurosyphilis, that explain why Wagner-Jauregg is not more widely celebrated for his contributions to the field of psychiatry, even though his malarial treatment could be considered the earliest triumph of biological psychiatry over psychoanalysis.