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.

Community Protection versus Individual Healing: Two Traditions in Community Mental Health

This article identifies two major traditions that drive the mandate for a community mental health care system-community protection and individual healing. It discusses the historical antecedents of these two traditions and how these traditions relate to different visions of what the "common good" means. It then discusses how they both operate in the current US-based system, creating inherent conflicts and tensions, and gives specific examples from the personal and professional experiences of the authors. The article proposes ways to reduce the tension and discusses what sacrifices and compromises this resolution would entail for the US community mental health system. Copyright © 2017 John Wiley & Sons, Ltd.

Distinguishing distress from disorder as psychological outcomes of stressful social arrangements

Some studies in the sociology of stress conceptualize their outcome variables as distress, while others treat the same outcomes as mental disorder. This article focuses on the importance of distinguishing between the two. It argues that there are fundamental differences between distress that arises in non-disordered persons and genuine mental disorder but that studies of stress typically fail to distinguish between these conditions. The article outlines the historical developments that led the field to conflate distress and disorder. Finally, it indicates some advantages for research, treatment and policy that can accrue when distress that is initiated and maintained by social conditions is distinguished from mental disorders that are dysfunctions of internal psychological mechanisms.

[(Community) psychiatry, a parenthesis?]

Beyond an a priori antagonism between these two notions, alienism and mental health cultivate analogies as to the place to which they assign mental health. Is community psychiatry not therefore simply a parenthesis in the history of psychiatry? The question is raised therefore regarding the place given to subjectivity and complexity. What must be done to ensure that this parenthesis of community psychiatry does not close? It is perhaps a case of making use of the tools which institutional psychotherapy has developed to keep the community psychiatry spirit alive.

World citizenship and the emergence of the social psychiatry project of the World Health Organization, 1948-c.1965

This paper examines the relationship between 'world citizenship' and the new psychiatric research paradigm established by the World Health Organization in the early post-World War II period. Endorsing the humanitarian ideological concept of 'world citizenship', health professionals called for global rehabilitation initiatives to address the devastation after the war. The charm of world citizenship had not only provided theoretical grounds of international collaborative research into the psychopathology of psychiatric diseases, but also gave birth to the international psychiatric epidemiologic studies conducted by the World Health Organization. Themes explored in this paper include the global awareness of mental rehabilitation, the application of public health methods in psychiatry to improve mental health globally, the attempt by the WHO to conduct large-scale, cross-cultural studies relevant to mental health and the initial problems it faced.

Forgotten paths: culture and ethnicity in Catalan mental health policies (1900-39)

Between 1900 and 1939 the regional government in Catalonia discussed a complete reform of the psychiatric institutions inherited from the nineteenth century. The debate was centred on the Spanish government's lack of interest in mental health policies and the growing demand for services. The projects developed between 1900 and 1939 opened a wide-ranging discussion on the role of ethnic and cultural factors in shaping mental illness, and the need to adapt the new facilities to the ethnic features of Catalonia. This study explores the production of Catalan psychiatric discourses and their ideological roots, and the development of public policies up to the end of the Spanish Civil War (1936-39). The paper concludes with a discussion of the influence of pre-war Catalan mental health policies on the wartime practice of psychiatry and, later, on the development of the French psychothérapie institutionnelle after World War II.

"A fine new child": the Lafargue Mental Hygiene Clinic and Harlem's African American communities, 1946-1958

In 1946, the Lafargue Mental Hygiene Clinic, a small outpatient facility run by volunteers, opened in Central Harlem. Lafargue lasted for almost thirteen years, providing the underserved black Harlemites with what might be later termed community mental health care. This article explores what the clinic meant to the African Americans who created, supported, and made use of its community-based services. While white humanitarianism often played a large role in creating such institutions, this clinic would not have existed without the help and support of both Harlem's black left and the increasingly activist African American church of the "long civil rights era." Not only did St. Philip's Church provide a physical home for the clinic, it also helped to integrate it into black Harlem, creating a patient community. The article concludes with a lengthy examination of these patients' clinical experiences. Relying upon patient case files, the article provides a unique snapshot of the psychologization of postwar American culture. Not only does the author detail the ways in which the largely working class patient community used this facility clinic, he also explores how the patients engaged with modern psychodynamic concepts in forming their own complex understandings of selfhood and mental health.

[Erlenmeyer hospitals in Bendorf, Germany. Pioneers in social psychiatry and education for the mentally retarded]

Social psychiatry and education for mentally retarded people is by no means an achievement of the last 50 years. Influenced by the Enlightenment, some physicians thought and acted 150 years ago consistently with today's insight. The mental hospitals of Erlenmeyer senior and junior in Bendorf near Koblenz, Germany, serve as an example. In contrast to large and mostly governmentally led or supported institutions, smaller private institutions treated mentally retarded people more personally, lovingly, and attentively.

"Where the need is greatest": social psychiatry and race-blind universalism in Harlem's Lafargue Clinic, 1946-1958

Between 1946 and 1958, Harlem was home to a small psychiatric facility, the Lafargue Clinic. An interracial institution run entirely by volunteers, the clinic helped expand mental health care into underserved African American communities. Relying upon extant case files, this article examines how the Lafargue staff handled clinical situations with African Americans. In its attempt to forge a new antiracist approach, the staff struck a balance between viewing Harlem patients as psychological products of their unique social context (social psychiatry) and applying modern psychiatric principles to African Americans without adjusting for racial or sociological difference (race-blind universalism).

Raymond Prince and the R. M. Bucke memorial society for the study of religious experience

The study of the relationship between psychiatry and religion has become an issue of increasing importance for both research and clinical practice. This article presents the history of the R. M. Bucke Memorial Society for the Study of Religious Experience, established by Raymond Prince in Montréal in 1964 as one of the first scientific societies whose aim was to investigate those characteristics of religious experience of interest to psychiatry. It also describes some of Prince's own studies on religious experience.

Between institutional psychiatry and mental health care: social psychiatry in The Netherlands, 1916-2000

The term “social psychiatry” became current in the Netherlands from the late 1920s. Its meaning was imprecise. In a general way, the term referred to psychiatric approaches of mental illness that focused on its social origins and backgrounds. In this broad interpretation social psychiatry was connected to the psycho-hygienic goal of preventing mental disorders, but also to epidemiological research on the distribution of mental illness among the population at large. The treatment called “active therapy”, introduced in Dutch mental asylums in the 1920s and geared towards the social rehabilitation of the mentally ill (especially through work), was also linked with social psychiatry. In a more narrow sense social psychiatry indicated what before the 1960s was usually called “after-care” and “pre-care”: forms of medical and social assistance for patients who had been discharged from the mental asylum or who had not yet been institutionalized. This article focuses on the twentieth-century development of Dutch social psychiatry in this more narrow sense, without, however, losing sight of its wider context: on the one hand institutional psychiatry for the insane and on the other the mental hygiene movement and several outpatient mental health facilities, which targeted a variety of groups with psychosocial and behavioural problems. In fact, the vacillating position of pre- and after-care services was again and again determined by developments in these adjacent psychiatric and mental health care domains. This overview is chronologically divided into three periods: the period between and during the two world wars, when psychiatric pre- and aftercare came into being; the post-Second World War era until 1982, when the Social-Psychiatric Services expanded and professionalized; and the 1980s and 1990s, when they became integrated in community mental health centres.

Social psychiatry in Germany in the twentieth century: ideas and models

In the first decades of the twentieth century, German-language papers were published which included the term “soziale Psychiatrie” in their titles. At the same time modern concepts of extramural psychiatric care were being developed. Yet, the meaning of “sozial” (“social” in English) varied widely. This was partly due to its ambiguity. “Social” can be used in the sense of small communities or the wider public; it refers to interpersonal relationships, or to relationships between individuals and social groups or other communities. According to this latter meaning, “social” can emphasize the interests of social groups rather than those of the individual. This is how the term was used at the end of the 1920s and during the National Socialist era. On the other hand, “social” may indicate a friendly and humane intention, a philanthropic approach. It was in this sense that the term was widely used in the 1970s when philanthropic psychiatrists and others called for psychiatric reform and the closure or downsizing of asylums for the mentally ill. Moreover, in association with psychiatry, it can mean both the social dimension of mental illness (including the aetiology) that is assumed to lie in human relationships and in social circumstances, and the social and economic effects of mental illness. In parallel with these shifting meanings of the term “social”, the established models of twentieth-century ambulant psychiatric care also showed a variety of structural characteristics.

A commentary on the history of social psychiatry and psychotherapy in twentieth-century Germany, Holland and Great Britain

The detailed essays in this special issue of Medical History provide an opportunity for reflection on common themes as well as on differing medical and historical contexts, specifically examining the organization and practice of European social psychiatry, its various definitions, as well as the history of psychotherapy, in twentieth-century Germany, Holland and Great Britain. The chance has also arisen for one of the two guest editors to comment briefly on various other points that seem pertinent, by way of brief introduction. His fellow guest editor, Harry Oosterhuis, is the author of one essay and co-author of another.

[On the cultural history of psychiatry]

About 1800, psychiatry was established as a medical discipline with special institutions (madhouses). Therefore, historiography of psychiatry focuses generally on the last 200 years. This contribution will also illustrate aspects of medical and cultural history, which nowadays are mostly supposed to be less important: the premodern concept of melancholy and hypochondria between humoral pathology, demonology, and psychology; the assessment of psychiatric illness as a "creative malady," even complementary to genius; the dialectics of psychiatric therapies between suppression and emancipation, which is especially prominent in the early nineteenth century in regard to "moral treatment" ( psychische Kur in German), a topic stressed vigorously by the "antipsychiatry" movement around 1970; the denunciation of patients and sections of the population by eugenics ( Rassenhygiene in German) and racism (especially toward the Jews) by psychiatrists. Finally, the miraculous mechanisms of mass hysteria of "normal" individuals are questioned.

The Social, Genetic and Developmental Psychiatry Centre: its origins, conception and initial accomplishments

BACKGROUND

The Social, Genetic and Developmental Psychiatry Centre was established by the Medical Research Council, in partnership with the Institute of Psychiatry, King's College London, in 1994.

METHOD AND RESULTS

The paper describes the origins of the Centre; the reasons why a new initiative was needed in the early 1990s; the thinking that led to the proposal for a major interdisciplinary research centre that integrated social, genetic and developmental research perspectives; the approach to international recruitment of world leaders; and the initial research accomplishments with respect to the basic goal of understanding nature-nurture interplay.

CONCLUSIONS

The structure and interdisciplinary approach of the Centre have proved a success and the initial accomplishments have begun to meet the objectives of showing how nature-nurture interplay is involved in the development of psychiatric disorders.

[The prelude to psychiatric reform in Brazil: the contradictions of the 1970s]

The article provides a historical reconstruction of the period leading up to what has become known as Brazil's Movement for Psychiatric Reform, which runs from the 1967 creation of the national social welfare system (INPS) to 1978, when the Mental Health Workers Movement gained prominence. Focusing on technical criteria influenced by the U.S. prevention model, our discussion examines the contradictions in Brazil's official mental health policy and also looks at the practice of financing and strengthening private psychiatric institutions, to the detriment of community action. Although most official documents from the 1970s contain proposals clearly aimed at community actions, what we observe is the crystallization of a model under which the government purchases psychiatric beds in private hospitals.

Chasing rainbow notions: enacting community psychology in the classroom and beyond in post-1994 South Africa

This paper discusses tensions and contradictions experienced by a group of psychologists in post-1994 South Africa as we struggled to develop an MA program in community psychology. Situating our work within the history of the subdiscipline and the historical context confronting South Africans in the "wake of apartheid," we explore models of community psychology that informed praxis under apartheid and contemporary challenges confronting a country in transition. We discuss three tensions that inform the ongoing program development. These include (1) the construction and deconstruction of Western and indigenous knowledge systems; (2) assessment and intervention at multiple levels and from differing value perspectives; and (3) paradoxes experienced by a team of university-educated, primarily White academic staff committed to challenging oppression. We conclude our discussion by suggesting that, within these shifting sands of economic, political, cultural, and institutional change community psychology must, of necessity, resist rigid self-definition and seek to position itself as a "work-in-progress." We suggest that this seemingly anomalous self-description may be suggestive for other community psychologists-in-the-making facing similar challenges within the majority world.

Anomie in the metropolis: the city of American sociology and psychiatry

American sociologists and psychiatrists have often characterized cities as sites of social disintegration conducive to insanity. Small-town rural life, by contrast, has been presented as ideally suited for fostering mental health. Early research in psychiatric epidemiology confirmed these views. After World War II, psychiatrists and sociologists collaborated in influential research projects on mental illness in the community. Although these studies were guided by theories of social stratification, which ignores location, cities remained problematic for psychiatrists because they contained high concentrations of poverty and social problems and, consequently, mental health problems.

[Santa Tereza Windows: a study of the psycho-social rehabilitation process at the Psychiatric Hospital in Ribeirão Preto, São Paulo]

This is a case study of a psycho-social rehabilitation process taking place at Santa Tereza, a psychiatric hospital in Ribeirão Preto, whose objective is to understand possibilities and limitations implied in the rehabilitation process within Pensões Protegidas (Protected Homes) project. The basic strategies for the present study involved participative observation and interviews with individuals living in such homes as well as with the multi-professional staff working in the process. The results reveal a kind of orientation quite distant from the hospital-centered trend, since they reveal remarkable tendency towards deinstitutionalization. Finally, the author emphasizes the contribution of Pensões Protegidas Project at Santa Tereza for the better understanding of the so-called mentally ill.

Public-health psychiatry in today's Europe: scope and limitations

BACKGROUND

Public-health psychiatry is concerned, on the one hand, to ensure access to mental health services for all persons in need and, on the other hand, to advance knowledge of the social and environmental risk factors of mental disorders, and to establish a basis for preventive action. It is unclear how far current European Community (EC) policies will serve to achieve these objectives. This study aimed to review the mental health reform policies adopted in European countries since 1970, and to identify the main factors impeding progress in practice and research.

METHOD

The relevant publications and statistical documentation for EC countries over the period in question were analysed.

RESULTS

Despite a broad consensus on principles and aims, the implementation of mental health reforms in EC countries has been slow. Progress is subject to constraints imposed by service infrastructures, reductions in state responsibility, changing public attitudes, and growth of relative poverty. Much inferential evidence has accumulated on the importance of social risk factors such as unemployment and socio-economic deprivation, but most studies have had to rely on analysis of ecological correlations, based on administrative data, and there is an urgent need for more direct research making use of case- control and cohort study designs.

CONCLUSIONS

EC harmonization will lead to improved mental health care only if the basic principles of public-health psychiatry are adopted and put into practice.

Rudolf Karl Freudenberg - from pioneer of insulin treatment to pioneering social psychiatrist

Rudolf Karl Freudenberg was Physician Superintendent at Netherne Hospital, Couldsdon, Surrey from 1951 to 1973. In his work as superintendent and government adviser he made important contributions to mental hospital reform and to the establishment of community psychiatric services in Britain. Earlier, in Vienna and following emigration to Britain, he was one of the pioneers of insulin coma treatment with a series of publications on this topic. The paper gives an account of published papers of both phases, and it highlights the background to Freudenberg's shift in professional interest from physical to social intervention. It argues that the change of emphasis reflects important general trends, i.e. profound change due to new forms of physical treatment on the one hand and similarly convincing evidence of the impact of social factors on clinical course and outcome on the other hand.

The collective mind: trauma and shell-shock in twentieth-century Russia

This article deals with the treatment and wider understanding of shell-shock and trauma in modern Russia. At the beginning of the twentieth century, when psychiatrists in many European countries were beginning to think about the issue of shell-shock, Russian psychiatrists took part in the general debate. After the Bolshevik revolution, however, the Russian psychiatric profession became isolated and heavily ideologized, and the treatment of all forms of trauma within the Soviet Union developed along specific lines. At the social level, trauma disappeared as an issue. The idea of a damaged ego was not a central consideration in Soviet psychological thinking. People survived by working, and by reference to the collective, rather than to individual consciousness. Trauma, in its modern form of PTSD, only re-emerged in Soviet psychological discourse as a result of contact between veterans of the Soviet Union's war in Afghanistan and American veterans of Vietnam. Despite the Soviet Union's anguished history, the concept of trauma is still largely ignored by the population as a whole.

[Social psychiatry and social aspects of psychiatry--on the historical applications of the concepts]

In German language the two terms "Soziale Psychiatrie" and "Sozialpsychiatrie" are used without any clear distinction. In this paper a historical analysis of the connotations of the two terms is made while underlying concepts are not considered. In the 19th century the words social and medicine were connected. At the beginning of the 20th century the terms "Soziale Psychiatrie" and "Sozialpsychiatrie" appeared in German as synonyma. In Germany-unlike, for instance, in the USA-ideas of segregation of the mentally ill and of eugenics were also regarded as "Soziale Psychiatrie". In difference to this connotation "Soziale Psychiatrie" described intentedly ideological positions in the 70's, while a certain of area of research was rather associated with "Sozialpsychiatrie". Finally, a more precise use of the terms is suggested for current discussions.

[Socialpsychiatry, social psychiatry 1911. On the origins of the concept in the writings of Max Fischer of Wiesloch]

The term "Social Psychiatry" was first used in English in 1917 by E. E. Southard. Six years before, in 1911 Max Fischer, director of Wiesloch Mental Hospital near Heidelberg employed the terms "Sozialpsychiatrie" and "Soziale Psychiatrie" in German.

Four decades of mental health trends: an empirical analysis of Hospital and Community Psychiatry

OBJECTIVE

The authors examined important trends and developments within the mental health field since the 1960s as reflected in articles published in Hospital and Community Psychiatry.

METHODS

A total of 798 articles were reviewed, representing all contributions to the journal in 1962, 1967, 1972, 1977, 1982, 1987, and 1992. Articles were classified into one of six categories, and empirical research articles were further classified by primary topic. In addition, all articles were indexed by primary setting (hospital, community, or both); academic credentials and gender of first author, and economic or public policy focus.

RESULTS

The number and percentage of empirical research articles increased over time, while articles describing programs and professional roles declined. Some changes were observed in the primary topics of empirical research. Other findings reflect a shift in the setting of articles from hospitals to the community and a growth in the percentage of women who were first authors and of authors with a Ph.D. degree.

CONCLUSIONS

The documented growth of empirical research in psychiatry suggests a greater emphasis on methodological rigor in the design and implementation of mental health services. Moreover, increases noted in scholarly contributions by women and nonmedical professionals indicate a broadening of disciplinary perspective over time that is likely to strengthen psychiatric research and services.

Psychiatric treatment and services in Australia, 1914-1994

Eighty years ago, psychiatrists believed that mental illnesses were caused by, among other things, excessive devotion to sport, the introduction of phones and motor cars, ill-sorted marriages and perverted sexual intercourse. Psychiatric theories and institutions in Australia have come a long way since then.

Re-inventing progressive community psychiatry: the use of history

Over the last half-century progressives in community psychiatry have challenged the social order while addressing the needs of persons with psychiatric disorders. Recently, however, their vision and energy has faltered. A re-evaluation of the progressive position is essential, beginning with a review of its historical experience. Unfortunately, modern psychiatry has become increasingly ahistorical. Those histories that do exist reveal little about the experiences of progressive practice and tend to attack it from the right or from the left. There is a tremendous need to synthesize new socially-oriented histories of the progressive movement in community psychiatry.

The evolution of Oregon's Public Psychiatry Training Program

Public psychiatry training in Oregon traces its roots to the community mental health movement of the 1960s and now includes a focus on training in the community and in state hospitals.