Clinical Psychology

about this time to markedly reduce the population
of mental hospitals: the advent of psychotropic
medications and a more liberal discharge philoso-
phy in mental hospitals. But as more patients were
being discharged, often under heavy medication,
and as patients who formerly would have been hos-
pitalized were no longer admitted, the need for
better community treatment and supportive services
became evident. In some ways a cause but in other
ways an effect of these events, the community phi-
losophy was beginning to gain a foothold.
A problem with many mental hospitals was their
lack of trained therapists. Regarded by laypersons as a
realistic means for solving difficult emotional prob-
lems, hospitalization itself often created nearly as
many problems as it alleviated. Over the years, men-
tal hospitals (particularly those run by the states) too
often became warehouses or custodial bins. Care was
often marginal and sometimes downright inhumane.
Professional staff was severely lacking in numbers and
sometimes in quality. Indeed, many still argue (and
have demonstrated empirically) that hospitalization is
not an especially effective treatment strategy.

Personnel Shortage. Even as more clinical psy-
chologists and psychiatrists were trained, demands for
their services outstripped their increase in numbers.
Manyofthenewcomerswereenteringprivatepractice,
and others were diverted into teaching or research. In
any event, the supply of trainedprofessionals for service
in hospitals and clinics was hardly keeping pace with
the demand. A number of trends (Albee, 1959, 1968;
Arnhoff,1968)allseemedtocoalescetoproducecritical
shortages of hospital and clinic personnel. To grapple
with these shortages, it became imperative that new
sources of personnel be sought, that more effective
usebemadeofprofessionaltime,andthatnewmodels
of coping with human problems be developed. Albee
(1959, 1968) predicted that it would be literally impos-
sibletotrainenoughmentalhealthprofessionalsto
meet existing and future needs and recommended
that prevention be pursued as a strategy.

Questions About Psychotherapy. In the 1950s,
people began to question not only the efficiency of
psychotherapy but also its efficacy. Some began to
wonder if it was not just intrapsychic factors that

created problems, but the interaction between person

and society. At the same time, because psychotherapy

was expensive and more and more clinicians and psy-

chiatrists were going into private practice, economic

factors were pushing therapy beyond the reach of the

poor and disadvantaged. The relationship between

mental illness and social class had been documented

by Hollingshead and Redlich (1958). Now, it seemed,

there was also a relationship between social class and

the availability of psychotherapy.

Medical Models and Roles. Throughout this

book, we have commented on the widespread

role of the medical or disease model and some of

the discontent with it. The 1960s ushered in a cli-

mate in which institutional prerogatives and tradi-

tionalist beliefs came under attack. That climate

produced listeners who were more willing to accept

attacks on traditional views about mental illness. All

of this contributed to an increased tendency to look

for the social-community antecedents of problems

in living rather than internal biological or psycho-

logical etiological agents.

The general activism of the 1960s also catalyzed

the long-standing discontent of many clinicians with

a role that relegated them to waiting passively for

society’s casualties to walk in the door. Would not

an activist role that took mental health services to the

people be more consonant with a social-community

model? If so, such a role would also provide a mea-

sure of autonomy from the dominance of the medi-

cal profession. We must not overstate these

developments, however. After all, a major trend in

clinical psychology over the last few decades has

been a headlong rush into private practice. Such

behavior is hardly a rejection of the medical model

or an acceptance of the social-community approach.

The Environment. Another force that helped

shape the community psychology movement was a

greater awareness of the importance of social and envi-

ronmental factors in determining people’sbehaviorand

problems. Poverty, discrimination, pollution, and

crowding were being recognized as potent factors. Pro-

viding people with choices and enhancing their well-

being required that psychologists pay attention to these

factors—that they go beyond a reflexive consideration

COMMUNITY PSYCHOLOGY 463