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Top 10 Changes in Psychiatry

Top 10 Changes in Psychiatry

  • An intriguing investigation, based on a survey of about 200 mental health experts in North America over 3 years.

According to an investigation by Mark Micale, PhD,1 University of Illinois Professor of History and author and editor of a number of influential books on the history of psychiatry,  the events here were cited as the most important changes in psychiatry since 1945.

For more on this topic, see The 10 Most Important Changes in Psychiatry Since 1945: An Invitation to Readers, by Greg Eghigian, PhD, on which this slideshow was based.


Dr Eghigian is the History of Psychiatry Section Editor for Psychiatric Times. His full bio can found here.


1. Micale MS. The ten most important changes in psychiatry since World War II. Hist Psychiatry. 2014;25:485-491.


Reasonable and important tooo


To my opinion Dr. G.Eghigian didn't mention several important changes in psychiatry. One of them is profound methodological shift in diagnosis and classification from phenomenology to operationalization and further - to objectivation and psychometrics. It is much more substantial thing than simple dissemination of DSM. The second change is - informatization of psychiatry including introduction of the Internet psychiatry. Very important item is the development of psychosomatic and integrative medicine. Crutial changes are taking place due to genetic research updating and cognitive approach. It is worth mention also an appearance of new forms of psychotherapy and psychosocial interventions, changes in professional education, international cooperation, political influences, ethics and financing.

Alexey @

Psychiatrists (as well as physicians in general) are no longer professionals. There is no longer a physician-patient relationship. We are Providers and Patients are clients. Also, psychotherapy has been lumped under psychoanalysis and discarded in favor of pharmacologic approaches. Psychologists and social workers have not necessarily benefited but have had to be the ones to provide it. Too bad.

Martin @

I'd like to propose a possible #11. As a psych NP, my prediction is that clinicians will detect more and more chromosomal deletions or mosaics. Behavioral issues may very well be genetic variants, even without the full-blown chromosomal disorder. These are the patients who are incredibly unaware of how their behavior interferes with others. I have started observing for simian creases (bilateral), abnormal fingers and toes, drooping eyelids, etc. These pts may have been diagnosed as BPD for decades. While their presentation met criteria for BPD, it may be likely the client has congenital abnormality of frontal lobe. On to 2016!

eileen @

I predict the major change in the science of psychiatry in the 21st c. will be the "de-pathologization" (can anyone spell that?) of intuition. New technologies for observing, quantifying and experimenting with related phenomena will emerge. AI may be the "way in" as the current resistance to the study of intuition seems both culturally and gender-biased. Our "smart" machines are currently intuitive; they will continue to become more so as they become more self-aware.

willetta @

Although I agree these were important landmarks, these are not necessarily improvements.

Michael @

I am always bemused by the propensity for so many psychiatrists' research articles to indicate prescription of pharmaceutical treatments ahead of any other therapy. It seems that clients suffer changing med's and varying dose rates until sometimes they become lost, then as if it is new therapy and untested, the client is treated with ECT.
Over many years extensive information tells that neurology and so function of the brain occurs electro-chemically; It would extrapolate therefrom that ECT could be a more appropriate early treatment, for more cases than we hear of.
Eghigian's framework is an interesting assessment.
Merry Christmas to all stay safe and well, Garry

Garry-Glendon @

I couldn't agree more. I am not a clinician but the mother of a daughter we nearly lost to suicide. I advocated for ECT for my severely depressed then 18 year old daughter, as a result of extensive research, and I was vilified by Child and Adolescent Mental Health services. She eventually did a partial course of ECT which lifted her mood somewhat. She subsequently underwent a full course of ECT and it is now her treatment of choice. But I don't believe that CAMHS views about ECT have changed at all, despite that its success was clearly demonstrated by the results for my daughter.

When weighing ECT, clinicians seem to ignore the quite profound side effects of many of the medications. My daughter still takes medication, including medication for the side effects from her medication. I am really concerned about the longer term impact of them on her health, and am hoping for a trial of maintenance ECT, as she has become unwell again (while taking tricyclics, anitpsychotics, ect) and will need to do another course of ECT.

Michelle @

We (psychiatrists) do not have yet available any treatment that "cure" mental disorders; only "palliative" approaches. Of all approaches ECT. is the most effective and minimum undesirable side-effects. When applied unilateral there is almost no side effect.
ECT. does not cure depression neither medications. Repeating ECT. when necessary is acceptable.
Emanuel Winocur, MD. (ret.)

Emanuel M. @

The best combination that we have practiced is Lithium(low dose) + Carbamazepine to elevate the mood and to lift up the depression. It is a long term treatment with no significant side effect.

R @

It seems that the psychiatric intervention for your daughter may not be really helping her in any meaningful way. Might I suggest that you and she examine alternatives to physical treatments of medication and ECT. The research re ECT is pretty clear that it is at best a short term option, that the more it is used the greater the risk of permanent cognitive defects, including early onset dementia. See Sackheim 2007, Peter Breggin, Jock McLaren, Bob Johnson, John Friedberg. I don't know what her medication burden is but polypharmacy is a growing problem when long term defects are concerned. The antipsychotics, antidepressants and ECT are now all implicated in permanent brain changes, including frontal lobe neuronal loss. (Gotzsche, Moncrieff, Kirsch, Perrin, Dukart, van Waade, among others.) It may be time to re-think ways to help this young woman. I suggest you think about the psychosocial approaches such as Open Dialogue, Formulation and other psychotherapy programs as presented by non-medical specialists. I wish your daughter all the best. As a professional and a person who has had ECT, I have to say that the permanent brain damage I suffer from (I am in currently receiving neurological rehabilitation) as a result has severely affected my life, career and relationships. However I no longer take medication, or need treatment for any psychiatric condition. Long ago, when I was trained, depression was considered a self limiting state. Now, with all our `modern' treatment it has become an almost hopeless chronic unremitting disaster for far too many...We have to ask, Why?

deirdre @

Biggest change (mistake) was placing brain disorders, such as schizophrenia, under SAMHSA, who's main foundation is the Behavioral Health sciences, and treating schizophrenia with the same policies and procedures used for substance abuse.

Mary @

Well done! He covered therm all.

James @

I think you missed a huge one. The shift in control of psychiatric care from the psychiatrist/psychotherapist to the insurance payor.

Robert @

Make that "control of reimbursement of psychiatric care…"

Robert @

No, I agree with the initial way it was stated. Insurance companies dictate much of psychiatric services. They will only pay for Drug A vs. Drug B. Etc.

eileen @

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