Descriptive Psychopathology: The Signs and Symptoms of ...

41 Chapter 2: A history of psychiatric classificationtextbook (1969). Slater became the influential editor of the British Journal ofPsychiatry. Psychiatrists in the USA turned to it for scientific discussions ofpsychopathology. In contrast, several well-known psychoanalysts (e.g. FranzAlexander, Sandor Rado, Otto Fenichel) fled to North America, buttressing thepsychoanalytic grip on psychiatric thinking in the USA. 113 European psychiatristsexperienced in convulsive therapy also immigrated to the USA (e.g. WilliamKarliner, Lothar Kalinowsky), but while electroconvulsive therapy has becomethe longest continuously used somatic psychiatric treatment, its early championshad little influence on classification. 114The psychiatric establishment in the USA, typically practicing from a leisurelypsychoanalytic model, was ill-prepared for the numbers and severity of the war’spsychiatric military casualties. The War Department responded by quicklytraining several hundred general physicians, so-called “ninety-day wonders”,to provide the needed care. Following the war, many of these physicians becamethe leaders of academic psychiatry in the USA. Their “on-the-job” training ledto a practical clinical approach to treatment and the acceptance of a stressinducedmodel of psychiatric illness. The understanding of the underlyingpathology of psychiatric syndromes, however, remained psychodynamic. 115 Untilthe late 1960s all chairs of academic departments of psychiatry in the USA weretrained analysts, and psychiatric housestaff were encouraged to obtain analytictraining and undergo a training analysis. 116 Almost all psychiatric teachingprograms, the field’s most prestigious organizations, and agencies accreditingpsychiatric training and treatment facilities were controlled by psychoanalyticleaders intolerant of dissent. 117After the war, interest in psychopathology in the USA was limited to large,under-funded state-run facilities. These were discredited by their poor treatmentof patients and through films such as The Snake Pit that purported to showthe “true” experiences of sufferers. The image of electroconvulsive therapy beingadministered in a dungeon-like setting to a tormented Olivia De Havilland becamethe poster for anti-psychiatry movements to the present. 118 The psychoanalystand his couch was the image of legitimate psychiatric practice. 119The lack of interest and instruction in classification and psychopathology inthe USA at that time is dramatically illustrated by Joseph Zinkin’s experience intranslating Bleuler’s monograph, Dementia Praecox or the Group of Schizophrenias.In his preface, Zinkin writes:It is one of the curiosities of psychiatric work in our time that one of the most valuablemonographs in psychiatric literature [it was referred to in almost biblical terms as the definitivework on the clinical presentation of schizophrenia] has remained, for thirty years, untranslatedfrom the original German. Although during this period practically every psychiatric bibliographymade reference to Bleuler’s monograph, often praising it as an outstanding work, very