Different Places, Different Ideas: Reimagining Practice in American Psychiatric Nursing After World War II.

In 1952, Hildegard Peplau published her textbook Interpersonal Relations in Nursing: A Conceptual Frame of Reference for Psychodynamic Nursing. This was the same year the American Psychiatric Association (APA) published the first edition of the Diagnostic and Statistical Manual of Mental Disorders (1st ed.; DSM-I; APA). These events occurred in the context of a rapidly changing policy and practice environment in the United States after World War II, where the passing of the National Mental Health Act in 1946 released vast amounts of funding for the establishment of the National Institute of Mental Health and the development of advanced educational programs for the mental health professions including nursing. This article explores the work of two nurse leaders, Hildegard Peplau and Dorothy Mereness, as they developed their respective graduate psychiatric nursing programs and sought to create new knowledge for psychiatric nursing that would facilitate the development of advanced nursing practice. Both nurses had strong ideas about what they felt this practice should look like and developed distinct and particular approaches to their respective programs. This reflected a common belief that it was only through nurse-led education that psychiatric nursing could shape its own practice and control its own future. At the same time, there are similarities in the thinking of Peplau and Mereness that demonstrate the link between the specific social context of mental health immediately after World War II and the development of modern psychiatric nursing. Psychiatric nurses were able to gain significant control of their own education and practice after the war, but this was not without a struggle and some limitations, which continue to impact on the profession today.

Creating a science of homelessness during the Reagan era.

UNLABELLED: POLICY POINTS: A retrospective analysis of federally funded homeless research in the 1980s serves as a case study of how politics can influence social and behavioral science research agendas today in the United States. These studies of homeless populations, the first funded by the National Institute of Mental Health, demonstrated that only about a third of the homeless population was mentally ill and that a diverse group of people experienced homelessness. This groundbreaking research program set the mold for a generation of research and policy characterizing homelessness as primarily an individual-level problem rather than a problem with the social safety net. CONTEXT: A decade after the nation's Skid Rows were razed, homelessness reemerged in the early 1980s as a health policy issue in the United States. While activists advocated for government-funded programs to address homelessness, officials of the Reagan administration questioned the need for a federal response to the problem. In this climate, the National Institute of Mental Health (NIMH) launched a seminal program to investigate mental illness and substance abuse among homeless individuals. This program serves as a key case study of the social and behavioral sciences' role in the policy response to homelessness and how politics has shaped the federal research agenda. METHODS: Drawing on interviews with former government officials, researchers, social activists, and others, along with archival material, news reports, scientific literature, and government publications, this article examines the emergence and impact of social and behavioral science research on homelessness. FINDINGS: Research sponsored by the NIMH and other federal research bodies during the 1980s produced a rough picture of mental illness and substance abuse prevalence among the US homeless population, and private foundations supported projects that looked at this group's health care needs. The Reagan administration's opposition to funding "social research," together with the lack of private-sector support for such research, meant that few studies examined the relationship between homelessness and structural factors such as housing, employment, and social services. CONCLUSIONS: The NIMH's homelessness research program led to improved understanding of substance abuse and mental illness in homeless populations. Its primary research focus on behavioral disorders nevertheless unwittingly reinforced the erroneous notion that homelessness was rooted solely in individual pathology. These distortions, shaped by the Reagan administration's policies and reflecting social and behavioral scientists' long-standing tendencies to emphasize individual and cultural rather than structural aspects of poverty, fragmented homelessness research and policy in enduring ways.

The "Splendid Isolation" of Aaron T. Beck.

Aaron T. Beck's Cognitive Therapy (CT) is a school of psychotherapy, conceived in the 1960s, that is celebrated by many clinicians for having provided the scientific antidote to all that was wrong with psychoanalysis. This essay situates the origins of CT in the crisis of legitimacy in psychiatry in the 1960s and 1970s, when, among many charges, psycho- analysts had to face the accusation that analysis was not adequately scientific. Beck actually began his career as both a psychoanalyst and an experimentalist. Contrary to common triumphalist accounts, Beck created CT to be a neutral space, not a partisan one, in turbulent times. Other notable psychoanalysts also sought compromise, rather than partisanship, to bridge the transition to biomedical science. The biographical approach of this essay to the origins of Beck's CT both situates him historiographically and articulates the complex experiences of a generation of psychoanalysts otherwise opaque to standard narratives.

Twenty-five years of progress: the view from NIMH and NINDS.

As directors of two NIH institutes supporting neuroscience research, we explore the gap between 25 years of stunning progress in fundamental neuroscience and the persistent needs of those with brain disorders. We conclude that closing this gap will require a more detailed comprehension of brain function, a rethinking of how we approach translational science, a focus on human neurobiology, and a continuing commitment to build a diverse, innovative neuroscience workforce. In contrast to many other areas of medicine, we lack basic knowledge about our organ of interest. The next phase of progress on brain disorders will require a significantly deeper understanding of fundamental neurobiology.

The mental health sector and the social sciences in post- World War II USA. Part 2: The impact of federal research funding and the drugs revolution.

The second of two linked papers examining the interactions of psychiatry and the social sciences since World War II examines the role of NIMH on these disciplines. It analyses the effects of the prominence and the decline of psychoanalysis, and the impact of the psychotropic drugs revolution and the associated rise of biological psychiatry on relations between psychiatry and clinical psychology; and it explores the changing relationships between psychiatry and sociology, from collaboration to conflict to mutual disdain.

The mental health sector and the social sciences in post-World War II USA. Part I: total war and its aftermath .

This paper examines the impact ofWorldWar II and its aftermath on the mental health sector, and traces the resulting transformations in US psychiatry and psychology. Focusing on the years between 1940 and 1970, it analyses the growing federal role in funding training and research in the mental health sector, the dominance of psychoanalysis within psychiatry in these years, and the parallel changes that occurred in both academic and clinical psychology.

From rodent utopia to urban hell: population, pathology, and the crowded rats of NIMH.

In a series of experiments at the National Institute of Mental Health, the animal ecologist John B. Calhoun offered rats everything they needed, except space. The resulting population explosion was followed by a series of "social pathologies"--violence, sexual deviance, and withdrawal. This essay examines the influence of Calhoun's experiments among psychologists and sociologists concerned with the effects of the built environment on health and behavior. Some saw evidence of the danger of the crowd in Calhoun's "rat cities" and fastened on a method of analysis that could be transferred to the study of urban man. Others, however, cautioned against drawing analogies between rodents and humans. The ensuing dispute saw social scientists involved in a careful negotiation over the structure and meaning of Calhoun's experimental systems and, with it, over the significance of the crowd in the laboratory, institution, and city.

Identifying unmet therapeutic domains in schizophrenia patients: the early contributions of Wayne Fenton from Chestnut Lodge.

Wayne Fenton, MD, died on September 3, 2006, while giving emergency clinical care. His leadership at National Institute of Mental Health provided a framework for therapeutic discovery. He crafted a new approach to psychosis based on poor functional outcomes and the psychopathology domains underlying long-term morbidity. His research and clinical observations during his career at the Chestnut Lodge clarified the unmet therapeutic needs in schizophrenia and provided the foundation for his vision. The results have radically changed the paradigm for discovery with emphasis on impaired cognition and negative symptom psychopathology.

The relevance of medical sociology to psychiatry: a historical view.

Collaboration between sociology and psychiatry is traced to the 1920s when, stimulated by Harry Stack Sullivan and Adolph Meyer, the relationship was activated by common theoretical and research interests. Immediately after World War II, this became a true partnership, stimulated by the National Institute of Mental Health, the Group for the Advancement of Psychiatry, and the growing influence of psychoanalytic theory. The effects of a sociology that focused on issues of health and illness proceeded to grow in medical education, research, and the treatment of mental illness until 1980, when a distinct shift of emphasis in psychiatry occurred. In its role as educator of future physicians, postwar psychiatry developed a paradigm of biopsychosocial behavior but, after 3 decades, changed to a biopharmacological model. The definition of mental illness as a deviant extreme in developmental and interpersonal characteristics lost favor to nosological diagnoses of discrete or dichotomous models. Under a variety of intellectual, socioeconomic, and political pressures, psychiatry reduced its interest in and relationship with sociology, replacing it in part with bioethics and economics. In this article, the detailed underpinnings of these changes are described and interpreted.

Four decades of community mental health: a symphony in four movements.

The authors present a detailed chronological discussion of the evolution of community mental health care in the United States with emphasis on the period of the 40 years since the passage of the Community Mental Health Centers Construction Act of October 31, 1963.

The contributions of Sam Greenhouse to research on psychiatric diagnosis and psychopharmacology.

Sam Greenhouse began his involvement in mental disorders research in 1954 when appointed chief of the Theoretical Statistics and Mathematics section at the National Institute of Mental Health. He remained with the NIMH until 1966. Despite moving on to several other positions at the NIH and at the university during the ensuing years, he continued as a consultant to NIMH investigators. He also participated actively as an advisor and co-investigator on a number of important collaborative research programmes launched by the Institute in the 1970s and 1980s. His contributions to the design and methodology of the first clinical trials of drugs for the treatment of schizophrenia, to research aimed at revising the national and international classification systems for the mental disorders, and his participation in the planning of the first attempt to use the collaborative research model to test hypotheses about the genesis of a specific mental disorder (depression), are described. Finally, the signal importance of the 'profile analysis of variance' method that he and Seymour Geisser developed, to research on personality and mental disorders, is examined in detail. The authors describe applications of the method in their own research on the classification of the mental disorders, predicting response to drug treatment and the variations in the expression of mental illness across different cultures. Sam worked in mental health during an era of revolutionary changes in the diagnosis and treatment of mental disorders. The field was acutely aware of his many contributions to the progress of research and his colleagues are very grateful to have had the opportunity to work with him.