ABSTRACT
We are concerned with the problem of how best to help psychiatric patients. Individuals that we would now call the psychiatrically ill have been dealt with over the years in a great variety of ways. Before they were brought under the aegis of medicine, they tended to be treated as possessed by supernatural spirits, for better or worse, and handled accordingly. The transformation that occurred as medical care was substituted for other ways of handling the mentally ill was so great as to have been termed the first great ‘revolution’ 1 in the development of psychiatry. The second ‘revolution’ is marked by the development of the psychodynamic approach, in which therapy for the patient was based on a developmental and functional theory of personality. This change, marked by the work of Freud, brought into psychiatry a therapeutic method that was more than simply naturalistic classification and allowed more than simply sporadic, unexplained empirical success. Psychoanalysis introduced a system of thinking that conceived of psychiatric illness as an anomaly in personality development. It also developed a method for influencing or revising personality structure. This method, however, has remained expensive, time-consuming, practicable only by a few specialists whose training is so arduous as to preclude their widespread availability. Thus it has influenced psychiatry more through the ideas it has generated than through the actual numbers of patients it has dealt with.
