As a clinician who has practiced for nearly thirty five years, I have seen some remarkable changes in the field of mental health during the past four decades.
The Sixties were the beginning of the publics' awareness and acceptance of mental illness. The Community Mental Health Centers Act of 1964, which was initiated by the Kennedy administration, instituted the idea of affordable psychiatric care and services to the general population. Mental health centers were created all across the country. Patients commonly kept in large state institutions could now be treated within or closer to their home communities.
The stigma and shame associated with mental health problems began to lessen. The print and electronic media can be credited for at least some of these changes. More and more people began to realize their own need for such services. Increasingly, public awareness began to break down the barriers between the need for such services and the embarrassment and fear of seeking such services.
The Seventies was a time of growth and development of new therapies and treatments and a departure from the strictly medical approach to the problem. The fields of psychology and social work became more and more involved in the acute care of patients and clients (as they began to be called). Psychotropic medications were finding acceptance and wider use. A shift occurred from seeing all problems as mental illness to a more appropriate recognition that most people in need of help were actually suffering from emotional problems and were not in fact "mentally ill”
The Eighties saw the emergence of more and more social, interpersonal and systemic explanations for many of these emotional problems that previously were thought to be only in the persons mind. Family, group and couples therapies were very much in vogue and efforts shifted away from only looking at people in a vacuum to seeing them as a product of their interpersonal networks, Family therapy institutes and clinics were common. An influx of women and men into graduate schools of social work and psychology and psychiatry were noted during these years.
The Nineties has seen a mixture of steps both forward and backward in the field of mental health. Managed care has taken its toll on all areas of health care including mental health. Community mental health centers are finding it increasingly more difficult to find funding. Their critical role is now being threatened. Yet the need for services keeps climbing under the increasing stresses and pressures people of all ages are facing.
The new focus is now on biological explanations for emotional problems. Drugs are seen as the first line of response to depression and anxiety and many other conditions. Prozac has become a household word along with Zoloft and Ritalin. They seem like quick and efficient ways of dealing with problems. But Susan Vaughn, M.D., psychiatrist and researcher at Columbia University speaks to this problem in her book THE TALKING CURE. She refers to the idealization of psychiatric medication as "cure-alls for all the nation's ills. She persuasively demonstrates how psychotherapy, like medications, works by changing neuronal connections in the brain. Unlike medications, the changes brought about by psychotherapy can be lasting.
Colin Ross, M.D. wrote THE TRAUMA MODEL and he lays out a persuasive argument against over stating the brain chemistry/brain structure explanation for emotional problems. He too recognizes the importance of brain chemistry and structure issues, yet appreciates the significance of trauma and its effects on changing brain chemistry and the value of psychotherapy to help people to truly address the real cause of their problems.
The good news is that we do see more and more people coming for help. Men now make up a sizable portion of those seeking help. Thirty five years ago few men sought the help of mental health professionals. More and more people now seek help for their marital problems rather than simply divorcing. Mental health issues are common causes for the breakdown of marriage and of the family.
So as we face the beginning of this new century we can only guess what new directions the field of mental health will take. One thing is certain. Human beings will always struggle with the demands of living, no matter what decade they live in.
-William G. Munro