This blog is a shortened form of my BBC Radio 3 ‘Free thinking’ talk.
In the archives of the American Psychiatric Association, is an unfinished manuscript called ‘The Magic Years: The History of Psychiatry, Mental Health and Mental Retardation, 1945-1970’. As its title suggests, The Magic Years cast post-war psychiatry in a warm, rosy glow, describing how psychiatry had moved ahead unprecedentedly during this period.
Its pages describe how the experience of the Second World War had convinced both psychiatrists and politicians that mental illness was much more widespread than previously thought. Psychiatry was now thrust into the forefront of public health and psychiatrists were empowered by the development of the first antipsychotic drugs. Such drugs also gave psychiatrists and politicians confidence that outdated asylums could be replaced with community mental health care centres, allowing patients to reintegrate into society. It was also a time when psychoanalysis was at its zenith in both psychiatry and popular culture.
Crucially, the manuscript suggests increased awareness of mental illness led to federal funding for new initiatives, which promised to elucidate the specific environmental causes of mental illness, resulting in the very prevention of mental illness. These were magic years, indeed.
A time of hope and promise?
Describing these magic years was psychiatrist Daniel Blain, who served as medical director and president of the American Psychiatric Association. Blain embarked upon his writing project in retirement, but never finished it; the manuscript was filed along with his other papers and promptly forgotten.
So why was I so excited to find a mouldering, unfinished manuscript written by some establishment psychiatrist as a doomed retirement project? The first clue is in the title: The Magic Years. Unlike Blain’s characterisation, most historians who have explored the post-war period have described it as anything but magical for mental health.
Some have bemoaned it for being dominated by pseudoscientific psychoanalysis which stunted the onward progress of biological psychiatry. Others, have decried the dominance of psychopharmacology, with drugs to treat every slight aberration in human behaviour, from sad feelings to hyperactivity. In retrospect, the closure of asylums has been described as a disaster, resulting in unprecedented levels of homelessness. Last, but not least, this was also the heyday of radical psychiatry and anti-psychiatry, where psychiatrists questioned the legitimacy of their profession, its approach to mental illness and, the very notion of mental illness itself.
How could these years be called magic?
The best way to answer this question is to turn to the approach to psychiatry that characterised The Magic Years; specifically to: social psychiatry. While psychoanalysis was more culturally relevant and psychopharmacology more scientifically legitimate, social psychiatry, a preventive approach to psychiatry which focussed on the relationship between socioeconomic factors and mental health, was the most politically influential approach to emerge in the post war period. Social psychiatric theory influenced presidents and state governors, prompted mental health legislation and dominated the thinking of leading psychiatrists. However, today it has been largely forgotten, especially in the US, where it had the most political traction.
Rather bluntly, The Magic Years provides me, a historian interested in rejuvenating social psychiatry, the opportunity to reassess and shift the prevailing idea that post-war American psychiatry was a complete disaster. It supports my claim that, though the implementation of social psychiatry might have been flawed, this was more to do with the broader political, economic, and social context, rather than the basic principle of social psychiatry itself: that socioeconomic factors have an enormous bearing on mental health.
So, why did Daniel Blain choose to write The Magic Years?
Fortunately, I have had help in answering this question. Blain did not attempt to write the definitive history of post-war American psychiatry on his own. He was assisted by Michael Barton, a PhD student, who went on to become a Professor of American History and recently retired. I tracked him down to ask him about the project.
Barton described how Blain felt duty-bound to write his history of psychiatry because of his position at the heart of the American psychiatric establishment. Blain was ‘on the top of the mountain, watching everything happen’. He wanted to write a definitive account, an official history that would be taken seriously. Blain’s history was to be a contextualised political, social and economic history, encompassing not only medical advancements and legislation, but also themes such as architecture and voluntary organisations.
Blain saw psychiatry progressing in parallel with other rapidly advancing sciences, from atomic sciences and space science to antibiotic research and surgery. No doubt there were challenges afoot, but the unfinished history Blain wrote was essentially an optimistic story of progress, advancement, opportunity and success.
Unfinished and unblemished
Sadly, The Magic Years was never completed, nor published. Grant funding ran out and Barton got another job. Blain had hoped to carry on, but his wife fell ill and died. He would die himself soon after, his definitive history confined to the archives.
It is a sad story in many ways, but perhaps a fortunate one for historians. Had Blain continued working on the project, it is possible that his opinions would have changed with the benefit of hindsight, and become jaded. Had Blain lived longer, he might have seen the fruitful developments he witnessed wilt on the vine, as psychiatry became increasingly biological, psychopharmacological and uninterested in the social context.
Thankfully, in Blain’s unfinished account, we have a valuable perspective, unblemished by what we know now. We can revisit the period and learn lessons about the social determinants of mental health, community mental health, adopting a pluralistic approach to psychiatry and tackling mental illness through prevention. The lessons are about genuine and full-throttled interdisciplinary academic research and open-mindedness when it comes to mental health. There was plenty of magic in The Magic Years – Blain’s account helps us to remember that.