psychology_Sons_(2003)

332 Abnormal Psychology

somebody was “mentally ill” served to limit that person’s
freedom of action and to prevent his communications from
being taken seriously. His argument went on to point out that
the practice of involuntary hospitalization meant that individ-
uals were being incarcerated against their will when they had
not committed crimes. Taken together, these were charges
that contemporary psychiatry was bad science, unreliable
practice, and an abuse of civil rights.
In this context, civil rights issues of the mentally ill at-
tained the same kind visibility as civil rights issues for mi-
norities and for women. The first redress for discrimination
against the mentally ill was deinstitutionalization. Patients
were discharged from hospitals in large numbers, some to
return to their families, but many to live as welfare recipients
or, in some cases, to live homeless on the streets. The scale of
deinstitutionalization was large, and the results varied from
striking improvements in the functioning of some patients to
tragedies of death from neglect in some of the homeless men-
tally ill. Discharge from the hospitals had become feasible
mainly because of the efficacy of the new medications. The
focus of caring for the mentally ill then shifted to problems of
medication maintenance outside the hospital and provision of
some degree of supervisory care in halfway houses or other
residential arrangements that provided transitional care be-
tween the hospital and the private home. Training in the vo-
cational and social skills necessary to obtain employment and
to get along in society outside the hospital emerged as a more
practical goal for psychological techniques than had been the
case with psychotherapy.

The Third Force and the New Therapies

One component of the antipsychiatry viewpoint was devel-
opment of therapies based upon avowedly nonscientific
principles. A spectrum of therapeutic techniques, known
sometimes as the “Third Force,” and sometimes as “human-
istic” arose. These included transactional analysis (Berne,
1961); rational psychotherapy (Ellis, 1958, 1962), logother-
apy (Frankl, 1953), gestalt psychotherapy (Perls, 1969), and
client-centered therapy (Rogers, 1951).
These approaches in general rejected the concept that
human behavior could be studied scientifically. Many hu-
manistic therapists followed the lead of Carl Rogers in aban-
doning the use of the medical term patientpreferring instead
to use client.He, and they, did however retain the use of the
medical term therapy,and defined themselves as “therapists.”
These methods were not often applied to seriously disturbed
clients. The more usual clientele were primarily persons with
minor neuroses, mild anxieties, self-esteem problems, and
the like.

The Return of Diagnosis

One consequence of the hegemony of psychoanalysis in U.S.

psychiatry was the diminution of interest in formal diagnosis.

Patient evaluations typically oriented to a description of the

hypothesized psychodynamics supposed to underlie the clin-

ically manifest behavior. The decision as to what diagnostic

label to attach to the patient’s case was often considered a bu-

reaucratic requirement for statistical reports but of no great

significance in patient treatment. In 1952, the American Psy-

chiatric Association published the first Diagnostic and Statis-

tical Manual of Mental Disorders (DSM-I). The categories

employed conceived of mental disorders largely as personal-

ity reactions to various factors; biological, psychological, and

social. It was replaced in 1968 by DSM-II,to bring it into line

with the Eighth edition of the International Classification of

Diseases (ICD-8).

In later years, further revisions included DSM-IIIin 1980,

DSM III-R(revised) in 1987, and DSM-IVin 1994, and

DSM IV-TRin 2000. These successive versions included an

increasing number of disorders and increasingly detailed cri-

teria for definition of diagnostic categories. Research into

various forms of psychopathology based upon this classifica-

tion system has permitted more confident comparison of pa-

tient samples from different hospitals and from different

countries, an essential requirement if independent replication

of findings is to be established.

Progress in the Biological Understanding

of Psychopathology

Certainly the most significant advances in the study of psy-

chopathology have occurred in the closing decades of the

twentieth century. Progress has been made in developing tech-

niques for measuring the structure and function of the living

brain and in our understanding of the complexities of genetics.

Brain Measurement

At midcentury observation of the structure and function of

the living brain was confined to measuring the electrophysi-

ology of brain activity with the electroencephalogram (EEG)

and x-ray photography. These were replaced by various kinds

of brain imaging that depended on the availability of high-

powered computers and upon new ways of scanning the

brain’s metabolic activity. The major forms of brain imaging

(brain “scanning”) are positron emission tomography (PET),

computerized tomography (CT), single photon emission

computed tomography (SPECT) and magnetic resonance

imaging (MRI). All of these methods rely on the fact that