He describes in detail two extraordinary periods of change, the first stimulated by laudatory efforts to understand the high rate of psychiatric casualties among World War II veterans and to provide treatment for them. Psychiatry grew quickly during the postwar years, considerably influenced by the immigration of many Central European psychoanalysts. Gradually, however, psychiatry began to weaken its ties to medicine and lost much of its public respect. By the 1970s postwar optimism had been replaced by widespread concern that psychiatric practice was being dominated by unsubstantiated formulations rather than reliable evidence. Psychiatry was dramatically impacted by enormous pressure for therapeutic accountability exerted by a managed care reimbursement system. The profession recognized the need for a new direction and resolved to change.
In this well-crafted account, Dr. Sabshin describes how the profession has become a more respected part of medicine. The combined use of evidence-based psychotherapy and psychopharmacology will become a central part of future psychiatric practice. Dr. Sabshin encourages psychiatric professionals to continue changing the field so that it can emphasize an empirically based, carefully enunciated, biopsychosocial model that has the potential to revitalize American psychiatry.