(Disclosure: I have worked full time for 20 years and now part time in a clinical psychological practice. As a nurse and patient advocate interfacing with physicians, nurse case managers and attorneys, dealing with insurance reimbursement was once 5% of one day a week; now it is closer to 20% of every day. Personal experience flavors objectivity in all of us.)
Addendum A Little History
Psychology
The inner workings of the brain have captivated mankind for thousands of years, but the formal study of psychology did not emerge until the late 1880s as an academic discipline for experimental research. In 1886, G. Stanley Hall, Ph.D. opened the first experimental psychology lab in the United States at Johns Hopkins University. The American Psychological Association formed in July 1892 with Dr. Hall as its first president. For many years, psychology was studied in the laboratory with research and experimentation.
The influence of such research cannot be overstated. (Every research student documents their sources in APA style but do they know they are following the documentation standards of the Publication Manual of the American Psychological Association?)
In 1896, the University of Pennsylvania was the first institution to establish a psychological clinic[1] and later, the first to shift from experimental to actual patient care. Scientists developed divergent theories of personality and development including Behavioral Theory (Watson and Skinner), Trait Theory (Allport and Cattell), Humanistic Theory (Maslow and Rogers), Cognitive Theory (Kelly and Ellis) and numerous other ideologies. Freuds Psychoanalytic Theory marked the first major split from a biological perspective and although a psychiatrist, he is often called the Father of Modern Psychology.[2]
Psychiatry
Formal psychiatry developed in the early 1800s. A politically active physician, Benjamin Rush M.D. published the first psychiatric textbook in the United States in 1812, and is considered the Father of American Psychiatry.[3] In 1896, Freud and Breuer proposed that deep seated conflict and repressed trauma was the origin of mental illness and hysteria and could be resolved using dream analysis. Prior to this there were two psychiatric diagnoses: idiocy (referring to intelligence) and lunacy (any deviation from normal.[4] Freuds evolving (and titillating for the times) concept of psychosexual theory and arrested sexual development eventually alienated many of his colleagues.
Numerous psychiatric societies formed during the early 1900s, and the first formally organized association was known as the American-Medico Psychological Association. In 1921 the name was changed to the American Psychiatric Association (commonly known as little APA). In 1932, disease classifications (physical and medical) were established in the Standard Nomenclature of Disease.[5]
Soldiers returning from World War II were drowning in the depths of their shell shock and research of mental disorders broadened in scope, as did federal funding. With the pursuit of diagnosis, treatment and prevention of mental health, psychiatry broke into numerous small branches.
Realizing that strong unification would allow them to influence the course of public policy, in 2000, the American Psychiatric Association became the umbrella organization for the American Psychiatric Foundation, the American Psychiatric Institute for Research and Education, American Psychiatric Publishing, Inc., and the American Psychiatric Political Action Committee. This alliance came on the heels of an increasing number of psychologists that became licensed for limited prescribing, a treatment modality formerly the sole turf of psychiatry. Additionally, nearly 80 percent of all prescriptions for antidepressants are written by non-psychiatrist providers, and of those almost three-quarters are not accompanied by any psychiatric diagnosis. [6]
Conclusion
The mind is too complex to be reduced to a series of circuits that are switched on or off with medication or neurostimulation. Neither can every patient benefit from psychotherapy. A medical history includes the health status and diseases of family members; this information is equally important in a psychological evaluation. Genetics does play a strong role in familial disorders like schizophrenia. Comprehensive care will ideally address biologic, chemical and biopsychosocial factors with the same goal: the well-being and proper care of patients.
[1] http://psychology.sas.upenn.edu/graduate/resareas/cppp
[2] http://allpsych.com/personalitysynopsis/learning.html
[3] http://www.psychiatry.org/about-apapsychiatry/more-about-apa/history-of-the-apa
[4] Highmore, Anthony, A treatise of the law of idiocy and lunacy, Exeter, N.H.: G. Lamson, 1822
[5] http://1boringoldman.com/index.php/2011/05/09/depression-1952-dsm
[6] http://psychcentral.com/news/2011/08/08/more-antidepressants-prescribed-by-non-psychiatrists/28423.html
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Email: ama@alicemadams.com
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