Thursday, December 15, 2011

What Would Psychiatry Be Without Psychoanalysis?

How might the practice of psychiatry have evolved without the close association with psychoanalysis? I don't know the history of how the two fields became so intimately intertwined, but I might imagine that at the time psychoanalysis gained acceptance it seemed to compare favorably with what little else we could offer those who suffered from mental disorders.

I would attribute several elements of the practice of psychiatry during the past 50 years or more to the influence of psychoanalysis:

  • The term "shrink," short for head shrinker, probably generalized from psychoanalysts to all psychiatrists. 
  • Likewise the practice of referring to psychiatrists as "therapists" probably would not have occurred without the nearly universal incorporation of this modality into psychiatric practice. 
  • Psychoanalytic/psychodynamic theory probably continues to form the basis of psychotherapy training in most residency programs. 
  • Then there is the 50 minute hour. What other medical specialty has fostered an expectation that so much time would be spent with the patient at each encounter? And what other medical specialty refers to these encounters as "sessions?"

What other medical specialty emphasizes "getting to know" or "understanding" the patient? Did this not originate with psychoanalysis?

Had it not been for psychoanalysis would other psychologies or psychotherapy methods have taken hold in psychiatry to the same extent? Keep in mind that many of these evolved out of or in reaction to psychoanalytic theories.

Will psychiatric practice some day return to what it might have been as the impact of psychoanalysis diminishes over time? Will that impact eventually disappear entirely? In the end will we say that psychoanalysis has damaged psychiatric practice or enhanced it?

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