UNCERTAIN PROMISE: PSYCHOSURGERY AND THE DEVELOPMENT OF SCIENTIFIC PSYCHIATRY IN AMERICA, 1935 TO 1955 (NEUROPHYSIOLOGY)

Between the Depression and the mid-1950s the profession of psychiatry in America overcame its historical isolation from mainstream medicine, becoming established as a successful medical specialty. Psychiatrists met challenges such as transforming the state hospitals from custodial shelters into medical environments, attracting funds for large-scale research programs where little had previously existed, gaining adequate representation in university medical schools, and convincing the public as well as the general medical community that psychiatric therapies were legitimate. Central to this program of professional reform was the emergence of a new wave of somatic treatments--insulin coma, metrazol convulsion, electric shock and psychosurgery--which gained a reputation as the first effective measures for mental illness serious enough to require hospitalization. Their success galvanized efforts to realize a new era of scientific psychiatry. Psychosurgery was especially crucial to this story as it both offered a solution to psychiatry\u27s most pressing clinical problems, and occasioned the day\u27s most sophisticated experimental investigations in mental health research. Two distinct though complementing themes structure the thesis. First, it is a case study in the origins, diffusion and subsequent re-evaluation of a medical technology. Psychosurgery\u27s beginnings are traced to the specific goals of John Fulton\u27s program of primate research at Yale. It rose to prominence in the state hospitals, valued as a treatment that was active politically as well as clinically. Lastly, concern for adequate professional control of the procedure led to debates about the proper medical role of the psychiatrist and to self-conscious discussions on the adequacy of psychiatric methodology. Each phase of psychosurgery\u27s development reflected a blend of intellectual, institutional, professional and social factors. Second, the adoption of scientific methods, attitudes and priorities within psychiatry was not unproblematic; distinct barriers existed between the world of the state hospital--still the center of the profession--and that of the laboratory. Psychosurgery programs and investigations led to significant new bridges between the two realms, thus providing a catalyst for the profession\u27s evolution as a medical specialty. Examination of psychosurgery thus provides insights into the process by which psychiatrists came to place their confidence both specifically in a particular addition to their therapeutic armamentarium and generally in the process of science itself