Hx of Psychiatry

1. The History of Psychiatry
Mark L. Ruffalo, DPsa, LCSW
Instructor of Medical Education (Psychiatry)
University of Central Florida

2. About Me
• Private practice of psychoanalysis and psychotherapy, Tampa, FL
• Psychiatric emergency room evaluator, Brandon Regional Hospital
• B.S., Psychology; M.S.W., Psychiatric Social Work
• Postgraduate training, Chicago Institute for Psychoanalysis
• D.Psa., Doctor of Psychoanalytic Studies
• Interests: psychotherapy and psychoanalysis; schizophrenia; conversion
disorder and psychosomatic illness; the conceptualization of mental
illness; the history of psychiatry, particularly mid-twentieth century
American psychiatry; the classification of mental disorder.

3. Objectives
• Outline the history of psychiatry, with emphasis on 20th century
American psychiatry
• Early psychiatry and the asylum era (Part One)
• The rise of psychoanalysis (Part Two)
• Deinstitutionalization and the biological revolution (Part Three)
• Recent history of psychiatry and future trends (Part Four)
• Review major historical figures in the field of psychiatry
• Discuss changes in the conceptualization of mental illness, diagnosis,
and treatment of patients over time

4. Early Psychiatry and the
Asylum Era
Ancient Greece – 1900

5. Hippocrates and Ancient Psychiatry
• In the 4th century BCE,
Hippocrates theorized
physiological abnormality at
root of mental illness
• The Supernatural Model
• First mental hospitals and
psychiatric texts in ancient
India in 3rd century BCE
• Religion and exorcism

6. The Humoral Theory
• Hippocrates and Roman physician, Galen (ca. 129-198 AD)
• Four bodily fluids or humors: blood from the heart, black bile
from the spleen, yellow bile from the liver, and phlegm from the
brain
• Too much black bile was thought to cause melancholia
• Perhaps the first example of associating psychiatric disturbance
with chemical imbalance
• Bloodletting and vomiting as treatments

7. The Middle Ages
• Mental hospitals built in
Baghdad in 705 AD; Fes,
Morocco, in early 8th century;
and Cairo in 800 AD
• Specialist hospitals in
medieval Europe from 13th
century used solely for
confinement and did not
provide any treatment
• Magic, demons, and sorcery

8. Treatments for Possession
• Exorcism and faith healing
• Snake pits
• “Hydrotherapy” and other
“shock therapies”
• Shaving the pattern of a cross
in the hair of the patient
• Chaining patients to a wall
near the front of church to
hear Mass

9. Paracelsus and Lunacy
• Swiss physician (1493-1541)
• Rejected notions of
possession
• Suggested movements of the
moon and stars had profound
impact on psychology
• “Lunatic” is derived from the
Latin word for moon, luna.
• Astrology and psychiatry

10. Early Modern Period
• Bethlem Royal Hospital,
founded in the 13th century
• In 1621, Oxford scholar
Robert Burton published The
Anatomy of Melancholy and
argued that knowledge of the
mind, not natural science, is
mankind’s greatest need.
• Louis XIV of France created a
system of public hospitals

11. Moral Therapy
• Originated by Philippe Pinel
(1745-1826), French
psychiatrist, at women’s
hospital La Salpêtrière
• Humane, socially facilitative
atmosphere, in contrast to the
barbaric custodial treatment
at Bethlem
• Later adopted by Benjamin
Rush in the United States

12. “I cannot but give enthusiastic witness to their
moral qualities. Never … have I seen spouses more
worthy to be cherished, more tender fathers …
purer or more magnanimous patriots, than I have
seen in hospitals for the insane, in their intervals of
reasonableness and calm; a man of sensibility may
go there any day and take pleasure in scenes of
compassion and tenderness.”
- PHILIPPE PINEL

13. Benjamin Rush, M.D.
• Founding Father of the
United States, signer of the
Declaration of Independence
• Medical Inquiries and
Observations upon the
Diseases of the Mind (1812)
• Moral treatment and the
medical model of addiction
• The “Father of American
Psychiatry”

14. The Mental Hygiene Movement
• Dorothea Dix (1802-1887)
• Champion of humane mental
health treatment for all,
including the poor and
homeless
• An unintended consequence
of her work was substantial
increase in mental patients
• Rapid transition from moral
therapy to custodial care

15. Thomas Story Kirkbride, M.D.
• Founder of the Association of
Medical Superintendents of
American Institutions for the
Insane (AMSAII), which later
became the American
Psychiatric Association
• Superintendent, Pennsylvania
Hospital for the Insane
• Originator of the Kirkbride
Plan for mental asylums

16. “There is no reason why an individual
who has the misfortune to become
insane should, on that account, be
deprived of any comfort or even
luxury.”
- THOMAS STORY KIRKBRIDE

17. Trans-Allegheny Lunatic Asylum

18. Emil Kraepelin
• Founder of modern scientific
psychiatry (1856-1926)
• Champion of descriptive
psychiatry, i.e., biological
psychiatry
• The Kraepelinian dichotomy
• Manic-depressive psychosis
(bipolar disorder)
• Dementia praecox
(schizophrenia)

19. “So-called psychic causes—unhappy
love, business failure, overwork—are
the product rather than the cause of
the disease; they are merely the
outward manifestations of a pre-
existing condition.”
- EMIL KRAEPELIN

20. Eugen Bleuler
• Swiss psychiatrist (1847-
1939)
• Originator of the terms
“schizophrenia,” “schizoid,”
and “autism”
• Viewed schizophrenia to be a
fundamentally physical
disease
• Unlike Kraepelin, Bleuler
believed prognosis not
uniformly grim

21. “I call dementia praecox schizophrenia because,
as I hope to show, the splitting of the different
psychic functions is one of its most important
features. In each case there is a more or less
clear splitting of the psychological functions: as
the disease becomes distinct, the personality
loses its unity.”
- EUGEN BLEULER

22. The Rise of Psychoanalysis
1900-1960s

23. Psychoanalytic Psychiatry
• At the same time Kraepelin and Bleuler were espousing their
biological theories of psychiatric disorder in Germany, Austrian
neurologist Sigmund Freud was formulating his own theories.
• Psychiatry—and especially American psychiatry—began to
discard biological theories in favor of Freud’s dynamic model.
• Psychoanalysis allowed psychiatrists for virtually the first time
to establish private practices.
• Until Freud, the vast majority of psychiatrists had been asylum
doctors treating the severely mentally ill.

24. Psychoanalytic Psychiatry, cont.
• Freud opened psychiatry up to treatment of the less severe
conditions, i.e., the neuroses, and, to outpatient treatment.
• Psychoanalytic psychiatry reached its zenith in the 1950s with
the majority of psychiatrists training to become psychoanalysts.
• Psychoanalysis transformed psychiatry from a specialty
struggling to form its identity within medicine to a lucrative,
high prestige discipline which attracted the best and brightest
candidates.
• Psychoanalysis gradually expanded in its scope and was adapted
to the treatment of severe mental conditions.

25. The Father of Psychoanalysis
• Born in Austrian Empire, present-
day Czech Republic, 1856
• M.D., University of Vienna
• Well-trained neurologist
• Influence of Jean-Martin Charcot
and Josef Breuer
• Development of the “talking cure,”
i.e., psychoanalysis
• International fame and popular
influence

26. From Alienists to “Shrinks”
• Freud visits the United States in 1909
• Association of Medical Superintendents of American
Institutions for the Insane changes its name to the American
Medico-Psychological Association
• In 1921, the group becomes the American Psychiatric
Association
• In the early 1930s, the American Psychoanalytic Association
(APsaA) began pushing for the APA to officially recognize the
psychoanalytic approach to psychiatry.

27. Redefining Mental Illness
• Freud blurred the boundary
between mental illness and
mental health, suggesting that
virtually everyone had some
type of neurotic conflict that
could be treated with
psychoanalysis.
• A new type of psychiatric
patient: the worried well

28. “It is now accepted that most
people have some degree of
mental illness at some time.”
- KARL MENNINGER

29. The Birth of Private Practice
• In 1917, only 8 percent of
psychiatrists were in private
practice.
• By 1941, this figure had
increased to 38 percent.
• By the 1960s, the heyday of
American psychoanalysis, 66
percent of all American
psychiatrists were in private
practice. 0
10
20
30
40
50
60
70
1917 1941 1960s
Psychiatrists in Private Practice

30. The Growth of Dynamic Psychiatry
• One by one, Case Western Reserve, the
University of Pittsburgh, the University of
California at San Francisco, Johns Hopkins, the
University of Pennsylvania, Columbia, Stanford,
Yale, and Harvard each saw analysts ascend to
their department chairs.
• Each new conquest was celebrated as a triumph
within American psychoanalysis.
• By 1960, almost every major psychiatry position
in the country was occupied by a psychoanalyst.

31. The Growth of Dynamic Psychiatry, cont.
• The American Psychoanalytic
Association grew from 92 members
in 1932 to about 1,500 in 1960.
• In 1924, the first Freud-leaning
psychiatrist was elected president
of the APA, and the next fifty-eight
years witnessed an almost
unbroken series of psychoanalyst
presidents of the American
Psychiatric Association.

32. The Broadening Scope of Psychoanalysis
• Freud focused on the treatment of individuals with less severe
psychiatric conditions, i.e., the neuroses, yet he maintained that
later modifications to psychoanalytic treatment could render the
more seriously ill accessible to analytic treatment.
• Gradually, as psychoanalysis grew in its influence and power,
psychoanalysts began to apply the theory of psychoanalysis to
the treatment of psychotically disturbed individuals.
• A rift developed between the psychoanalytic camp and the
biological/medical camp of American psychiatry.

33. Adolf Meyer
• Swiss-educated psychiatrist who
immigrated to United States in 1892
• In 1902, he became director of the New
York State Pathological Institute.
• In 1913, he became chair of the first
inpatient psychiatry clinic in a general
hospital in the U.S., at Johns Hopkins,
and began to apply psychoanalytic
methods to the treatment of
schizophrenia.

34. Harry Stack Sullivan
• In 1922, psychiatrist Harry Stack
Sullivan arrives at the Sheppard and
Enoch Pratt Hospital near Baltimore.
• Under the mentorship of Meyer, he
develops one of the earliest
psychoanalytic treatments for
schizophrenia.
• Schizophrenia as a Human Process
published in 1962

35. The Psychoanalytic Hospital
• Along with Chestnut Lodge and
Sheppard Pratt, McLean Hospital near
Boston, Austen Riggs in Stockbridge,
MA, and the Bloomingdale Insane
Asylum in New York City became
centers for the psychoanalytic
treatment of severe mental illness.
• The Menninger Clinic in Topeka, KS,
was founded in 1925 by Drs. C.F., Karl,
and William Menninger, and became
the leading American institution for
psychiatric treatment for five decades.

36. NIMH and Social Psychiatry
• In 1949, President Harry Truman established the National
Institute of Mental Health (NIMH).
• Truman appointed Robert Felix, a practicing psychoanalyst, as
its first director.
• Dr. Felix explicitly forbade NIMH expenditures on mental
institutions, insisting that outpatient psychoanalysis could
prevent psychosis, and refused to fund biological research.

37. The Psychoanalytic Revolution
• During the 1950s and 1960s,
psychoanalysis grew
increasingly dogmatic, and
psychoanalysis was viewed as
a panacea for mental illness,
human suffering, and social
ills, such as war and racism.
• At the same time, it started to
face opposition from both
within and without the field.

38. Thomas Szasz, M.D.
• Chicago Institute-trained psychiatrist
and psychoanalyst who grew
disenchanted with psychoanalysis
• The Myth of Mental Illness (1961) and
The Manufacture of Madness (1970)
• Dr. Szasz remained Professor of
Psychiatry at the State University of
New York until his death in 2012.
• Distinguished Lifetime Fellow of the
APA, author of 36 books

39. “If you talk to God, you are
praying. If God talks to you,
you have schizophrenia.”
- THOMAS SZASZ

40. The Antipsychiatry Movement
• 1960s and 1970s, though still around today (Citizens
Commission on Human Rights, Mad in America, etc.)
• Spearheaded by Szasz, Erving Goffman (a sociologist), and R.D.
Laing (a Scottish psychiatrist)
• Attacked psychiatry on multiple fronts:
• Lack of scientific basis
• Coercive treatment and violation of civil rights
• Long-term hospitalization as cruel and unusual punishment
• “On being sane in insane places” study by David Rosenhan

41. The Rosenhan Study
• Conducted by Stanford psychologist David Rosenhan and
colleagues and published in Science in 1973 under the title “On
being sane in insane places”
• Eight healthy men and women (including Rosenhan himself)
gained admission to psychiatric hospitals by feigning auditory
hallucinations. Seven were diagnosed with schizophrenia and
one with manic-depressive psychosis.
• “It is clear that we cannot distinguish the sane from the insane
in psychiatric hospitals.”

42. The Biological Revolution
1940s – Present

43. Institutionalization
• For the first century and a half of psychiatry’s existence, the only
real treatment for severe mental illness was institutionalization.
• Dorothea Dix’s work convinced state legislatures to build mental
institutions in significant numbers.
• By 1904, there were 150,000 patients in mental hospitals.
• By 1955, there were 550,000.
• The largest institution was Pilgrim State Hospital in Brentwood,
New York, which at its peak housed 19,000 patients.

44. “Psychiatrists can do little more for
patients than make them comfortable,
maintain contact with their families, and,
in the case of a spontaneous remission,
return them to the community.”
- LOTHAR KALINOWSKY, 1947

45. General Paresis of the Insane (GPI)
• In the early decades of the 20th century,
asylums were filled with inmates suffering
from a peculiar form of psychosis known as
“general paresis of the insane,” caused by
advanced syphilis.
• Julius Wagner-Juaregg and “Hilda”
• Pyrotherapy as the first effective biological
treatment for severe mental illness
• Many psychiatrists attempted to use
pyrotherapy in other patients with other
forms of mental illness—without success.

46. Manfred Sakel and Coma Therapy
• Austrian psychiatrist Manfred
Sakel (1900-1957) had been
treating addicts with low doses of
insulin.
• He began to experiment with
artificially induced comas for
schizophrenics, overdosing
patients on insulin.
• Like pyrotherapy, coma therapy
became widely adopted and used at
almost ever major mental hospital
in the 1940s and 50s.

47. António Egas Moniz and Leucotomy
• Portuguese neurologist (1874-1955)
regarded as the father of modern
psychosurgery
• Performed first leucotomy in 1935 with the
help of a young neurosurgeon, Pedro Lima
• Leucotomy celebrated as a miracle cure and
Moniz awarded the Nobel Prize in 1949 “for
his discovery of the therapeutic value of
leucotomy in certain psychoses”
• Leucotomy (known as lobotomy in the U.S.)
spread to hospitals throughout the world.

48. The Transorbital Lobotomy
• In 1946, American neurologist
Walter Freeman performed
the first transoribital “icepick”
lobotomy.
• About 50,000 people received
lobotomies in the United
States, most of them between
1949 and 1952.
• Freeman performed no fewer
than 3,500 lobotomies by the
time of his death in 1972.

49. Meduna and Convulsive Therapy
• In 1934, Hungarian psychiatrist Ladislas
Meduna began experimenting with
inducing seizures as psychiatric therapy.
• He tried camphor and then metrazol, a
stimulant.
• By 1937, the first international meeting on
convulsive therapy was held in
Switzerland.
• Problems with metrazol included a feeling
of impending doom and violent, thrashing
convulsions.

50. Ugo Cerletti: The Father of ECT
• In the mid-1930s, Italian psychiarist Ugo Cerletti
was experimentally inducing seizures in dogs by
delivering electric shocks to their heads.
• In 1938, along with colleague Lucino Bini, Cerletti
built the first device designed for humans.
• By the 1940s, electroconvulsive therapy was
adopted by almost every major psychiatric
institution.
• ECT remains the single most effective procedure
for several forms of treatment-resistant illness.
• An early U.S. practitioner was Lothar Kalinowsky.

51. The Birth of Psychopharmacology
• Morphine, chloral, sodium bromide, and early agents
• Psychoanalysts dismissive of pharmacological research
• The first psychopharmaceutical drug was not born until 1950:
meprobamate, originally marketed as “Miltown.”
• By 1956, 36 million prescriptions had been written for Miltown,
and the drug became known as “Mother’s Little Helper.”
• By the 1960s, Miltown was superseded by Librium and Valium.
• Three drugs that would change psychiatry forever:
chlorpromazine, imipramine, and Lithium

52. Henri Laborit and Chlorpromazine
• In 1949, a French surgeon named Henri Laborit was seeking a way to
reduce surgical shock.
• Working in a French military hospital in Tunisia, he noticed that
when he gave a strong dose of one particular antihistamine,
chlorpromazine, patients’ attitudes changed enormously.
• In 1952, Laborit convinced a skeptical psychiatrist to administer the
drug to a schizophrenic patient for the first time.
• American psychiatrists were initially very resistant.
• Smith, Kline, and French targeted state governments instead of
psychiatrists, referring to “health economics” and citing the “cost-
cutting” effects of chlorpromazine.

53. Roland Kuhn and Imipramine
• In the 1950s, Swiss psychiatrist Roland
Kuhn began experimenting with
“Compound G 22355” after being
approached by Swiss pharmaceutical
company Geigy.
• Without telling Geigy, Kuhn administered
G 22355 to three patients suffering from
severe depression.
• Initially disinterested, Geigy released
imipramine to the public in 1958 as the
first tricyclic antidepressant.

54. John Cade and Lithium Therapy
• Australian psychiatrist John Cade (1912-
1980) believed that uric acid might cause
mania if accumulated in the brain.
• Cade selected lithium carbonate, a
compound known to dissolve uric acid, for
the treatment of mania.
• Cade abandoned his toxin theory of mania
and later came up with a second incorrect
hypothesis: that mania was caused by a
deficiency of lithium.
• Lithium became FDA approved in 1970.

56. Nathan Kline: Father of Psychopharmacology
• American psychiatrist Nathan S. Kline
(1916-1983) widely regarded as the father
of American psychopharmacology
• Known for his work on reserpine for
schizophrenia and iproniazid, the first
MAOI antidepressant
• Maintained a private practice in New York
City and aggressively prescribed the latest
psychotropics in creative cocktails
• Only two-time winner of Lasker Award

57. Medication and Deinstitutionalization
• With effective treatments for psychiatry’s three flagship
disorders, states began to implement plans for medication-
driven community mental health care.
• President Kennedy’s Community Mental Health Act of 1963
• In 1955, more than a half a million Americans were housed in
mental institutions.
• By 1977, the number of hospitalized patients reduced to
160,000.
• Today, there are roughly 30,000 inpatient psychiatric beds in
the United States—most are in general medical hospitals.

60. The Diagnostic and Statistical Manual
• Pre-DSM and psychoanalytic
conceptualization
• DSM-I (1952)
• DSM-II (1968)
• DSM-III (1980)
• DSM-III-R (1987)
• DSM-IV (1994)
• DSM-IV-TR (2000)
• DSM-5 (2013)

61. Recent History of Psychiatry
1980s – Present

62. Some Recent Trends in Psychiatry
• Increased influence of managed care
• Shorter visits, more patients; shorter and shorter inpatient stays
• Average length of stay in the 1980s was 6-8 weeks
• Resurgence of ECT and the birth of TMS
• Broadening definition of mental illness
• Controversy surrounding DSM-5, particularly criticism by Allen
Frances, chair of DSM-IV Task Force
• Greater emphasis on pharmacotherapy, less interest in
psychotherapy amongst psychiatry trainees, though this may be
changing

63. Resurgence of ECT
• Electroconvulsive therapy became increasingly unpopular in the
1960s and 1970s due to ethical concerns and the anti-psychiatry
movement, spearheaded, in part, by Thomas Szasz, Erving
Goffman, David Rosenhan, Peter Breggin, and R.D Laing, and
perpetuated by the Church of Scientology, etc.
• ECT experienced a resurgence in the early 1980s with good
evidence of its effectiveness for treatment-resistant depression.
• Increasingly, ECT came to be provided with consent, and
modified ECT became standard.
• Current estimates indicate that 100,000 Americans receive ECT.

64. Birth of TMS
• A kinder, gentler ECT?
• The first reliable TMS was developed by
Anthony Barker.
• The physical principles of TMS were
discovered by Michael Faraday, showing that
a pulse of electric current passing through a
wire coil can generate a magnetic field.
• Total out-of-pocket cost for average patient is
about $10,000 with an average session
costing roughly $300 to $400.

65. Listening to Prozac by Peter Kramer, M.D.
• Published in 1993, shortly after
widespread introduction of fluoxetine
• Kramer explores the moral question of
“cosmetic psychopharmacology,” i.e.,
using psychotropics to change
personality in healthy persons.
• Although not opposed to
psychopharmacology by any means, he
questions its overreach and the trend
away from psychotherapy.

66. Listening to Prozac, cont.
• Kramer asks if it is ethically defensible
to treat a healthy individual to, for
instance, help him climb a career, or
on the other hand, if it is ethically
defensible to deny him that possibility.
• Resulted in a number of books and
articles with similar titles, e.g., Talking
Back to Prozac by Peter Breggin, M.D.,
and “Listening to Prozac But Hearing
Placebo” by Irving Kirsch, Ph.D.

67. Unhinged by Daniel Carlat, M.D. (2010)
• Carlat critical of “split treatment” model
that has become commonplace
• Only about 10% of outpatient
psychiatrists offer psychotherapy to all
of their patients, and only about 30%
offer it at all.
• Carlat questions whether psychiatry has
“lost its humanity” by focusing almost
solely on the neurobiological.

69. Decreased Lengths of Stays
• Inpatient hospitalizations in the 1980s routinely averaged six to
eight weeks offering the opportunity to discontinue all
psychotropics, examine the pathology, and then add
medications as indicated. This is now a fantasy in most places.
• Psychotherapy was also common in inpatient settings. Today, it
has basically disappeared from the hospital.
• Third-party payees prefer shorter stays, but paradoxically, this
is leading to increased readmissions and increased cost
(National Institute of Psychiatric Health Systems, 2010).

70. The Broadening Scope of Psychiatry
• The DSM-I, from 1952, listed 106
disorders; the DSM-III, from 1980,
listed 265, and DSM-IV listed 297.
• Although DSM-5 added several new
mental disorders, the total number
of disorders technically did not
increase due to changes in the
groupings of mental disorders. For
instance, Asperger’s now falls under
Autism Spectrum Disorder.
• Critics contend that recent changes
to DSM have contributed to the
medicalization and pathologization
of everyday life. 0
50
100
150
200
250
300
350
DSM-I DSM-III DSM-IV
Growth in Number of Mental Disorders

71. Allen Frances and Criticism of DSM-5
• Frances, professor emeritus at Duke,
became very vocal about lack of
transparency and pathologization in DSM -
5, including binge eating disorder, psychosis
risk syndrome, and minor neurocognitive
disorder.
• He had a broad following on the website
Psychology Today, and is credited with
stopping some controversial changes.
• Continues to write about his concerns about
changes in the field (see Frances, 2013,
Saving Normal: An Insider’s Revolt…)

72. Example: The “Grief Exclusion”
• Under DSM-IV-TR classification system, Major Depressive Disorder
could not be diagnosed in a grieving person, with some exceptions,
such as a severe syndrome, e.g., if the person became suicidal.
• DSM-5 removed the “bereavement exclusion” and now permits
diagnosis of depression in grieving persons.
• Is this, as Frances contents, the medicalization of our “mammalian
heritage,” i.e., “The price we pay for love is grief”?
• The grief exclusion was a “hot topic” during DSM revision, evoking
strong opinions on both sides of the debate.
• Frances argues similar expansions to the diagnostic system serve to
psychiatry’s disadvantage and to patients’ detriment.

73. The Future of Psychopharmacology
• The pharmaceutical industry has started to de-invest in
psychiatric medication (a 70% decrease in the past 10 years).
• Recent reports indicate that research on psychopharmacology seems to
be at a standstill.
• There have not been any major advancements in the field for years:
most new drugs are “me-too” drugs: slight variations on existing
medications.
• AstraZeneca and GlaxoSmithKline, two global leaders, have pulled out
of the mental health market entirely.
• Psychiatric drugs had been huge moneymakers for years, but as most of
the commonly prescribed drugs have gone off patent, there seems to be
little effort to reinvest in psychiatry.

74. The Future of Psychopharmacology, cont.
• A 2018 paper published in the British Journal of Psychiatry
asks, “Has psychopharmacology got a future?”
• This sentiment is in stark contrast to the feeling of the 1990s,
the “Decade of the Brain”.
• Will ketamine treatment take off?
• Reports indicate patients can improve within six hours, a clear
advantage over common antidepressant drugs, which take up to six
weeks.
• Cost is an issue: $1,000 per treatment, and many patient require
repeated treatments

77. The Future of Psychiatry
• Where is the field headed?
• Back to the couch or towards a more medicalized psychiatry?
• Have pharmaceutical options been exhausted? There appear to
be no major advancements in the pipeline.
• Has psychiatry overreached its bounds? Is Frances correct?
• Will psychiatry eventually merge with neurology, as the famous
neuroscientist Eric Kandel has suggested?
• Will we have any objective diagnostic tests for mental illness?
Or, does this even matter?

79. References
• Carlat, D. J. (2010). Unhinged: The trouble with psychiatry—a
doctor’s revelations about a profession in crisis. New York:
Free Press.
• Frances, A. J. (2013). Saving normal: An insider’s revolt
against out-of-control psychiatric diagnosis, DSM-5, big
pharma, and the medicalization of ordinary life. New York:
HarperCollins.
• Lieberman, J. A. (2015). Shrinks: The untold story of
psychiatry. New York: Little, Brown and Company.
• Shorter, E. (1997). A history of psychiatry: From the era of the
asylum to the age of Prozac. New York: Wiley.