NEW POSSIBILITIES IN PRIVATE PSYCHIATRIC PRACTICE

The private practice of psychiatry is, relatively, a new field in medical service. Previous to about 1840 in this country, as elsewhere, most of the mentally sick got little more than custodial care, usually under unbelievably wretched conditions, in county poor houses or state asylums. This system was developed mainly to protect the community from the annoyances and dangers associated with the insane at large. The American Psychiatric Association was founded in i8 by the superintendents of mental hospitals, mostly state institutions. Several privately endowed hospitals, which are still today among the very best, were represented at this organizational meetingthe McLean, by Dr. Luther V. Bell, the Westchester Division of the New York Hospital, by Dr. Pliny Earle, the Pennsylvania Hospital by Dr. Thomas Kirkbride, and also the Pepperell Private Lunatic Asylum. By the late nineteenth century private sanitaria for the care of the insane, alcoholics, and drug addicts, some of them denominational, had arisen in the vicinity of large cities. When the rest cure of Dr. S. Weir Mitchell was introduced for neurasthenia, this type of home or sanitarium increased greatly in number. The group of physicians, brain specialists, as they were then called, in contradistinction to the nerve specialists, practicing privately in a city as large as New York at the beginning of the present century probably did not exceed a dozen. Then the advent of Freud and the psychoanalytic approach to a great variety of mental disturbances changed the nature and scope of private psychiatric practice and developed an entirely new type of psychiatrist. The demand for these specialists increased steadily for two reasons: First, many patients formerly sent to sanitaria were now being treated while living in their own homes and_continuing with their occupations. This