The last few months have seen the passing of Frank Ayd and Charles Brenner, two huge figures in American psychiatry. Their obituaries in The New York Times reflect the ideological divide between psychoanalysis and pharmacotherapy that defined stateside psychiatry during the 20th century.
Ayd, pictured top, was one of the pioneers of antipsychotic drug therapy in the states. Although it was already popular among European psychiatrists, Ayd was one of the first to try chlorpromazine (more commonly known as Thorazine) with some of his outpatients.
As well as noticing the huge potential for the drug, virtually the first ever effective treatment for severe psychosis, he was also persistent in publicising the disabling side-effects when many others were dismissing them as part of the illness or ‘hysterical’ in nature.
In contrast, Brenner was a mainstay of mainstream Freudian psychiatry for most of his life.
Interestingly, both Brenner and Ayd came from similar backgrounds. In their early years, both published on drug treatments and lobotomy (then at the height of its popularity), although Brenner later trained as a psychoanalyst and began to focus almost entirely on a Freudian approach.
Brenner is perhaps best known for his ‘conflict theory’, first presented in an influential paper entitled The Mind as Conflict and Compromise Formation.
This overturned the distinction between the Id, Ego and Superego and the Freud’s idea of the unconscious as being nothing more than metaphors, and proposed a model of the mind which we would now recognise as a constraint satisfaction approach – where the mind attempts the best compromise between the satisfaction of drives while accounting for emotions and defences.
While Anglo-European psychiatry tended to lean toward the biological approach, in the mid-20th century American psychiatry was largely Freudian. This is partly to do with the differing practice traditions, European psychiatry was largely hospital based and focused on psychosis while American psychiatry was largely concerned with office practice and neurosis.
The shift to a more scientific approach to psychiatry in the 1970s was led by several US psychiatry departments who were more Anglo-European influenced (Washington University, Johns Hopkins, Iowa Psychiatric Hospital, New York Psychiatric Institute).
This hit psychoanalytic psychiatry hard. One of the major blows was the 1980 publication of the DSM-III diagnostic manual that threw out almost all Freudian-influenced diagnoses after studies found them unreliable.