When did Asylum Directors and Alienists Become Psychiatrists?

 

I am very interested in the answer to this question.  Readers of this blog will recognize the timeline (click to expand) at the top of this post as one I originally did to disprove any connection between psychiatry and drapetomania.  Several books and about 20 papers later, I am very interested in knowing more about this transition.  When the Association of Medical Superintendents of American Institutions of the Insane (AMSAII) was founded in 1844, there were only 13 Asylum Directors at that time. There was no formal education.  After completing medical school, physicians either spent some time working in an asylum or announced their interest and were appointed to these positions. In some cases, sons followed fathers into these positions after they attended medical school.  There was no residency training at that time.  Over time, additional physicians were employed at asylums but there was still no formal psychiatric education and none in medical school.

The American Medico-Psychological Association (AM-PA) was founded in 1892 primarily to accommodate the increasing number of asylum physicians who were not directors.  This organization began publishing the American Journal of Insanity in July 1844 and it was continued until May 1943 when it became the American Journal of Psychiatry.  The AM-PA transitioned to the American Psychiatric Association in 1921.  Between 1880 and 1920 there was a journal Alienist and Neurologist that I am using as a proxy for alienists in the US.  The literature at the time reflects the use of both terms (alienist and psychiatrist) in the same literature – even though the term psychiatrist was coined by Reil in 1808.

So the questions remain.  How did this transition between asylum directors, alienists, and psychiatrists occur?  When did modern psychiatric training start? Another indicator is the early establishment of psychiatric hospitals and clinics.  I recently added the New York State Psychiatric Institute (NYSPI) and Johns Hopkins to the timelines for establishing education and research program in 1895 and 1913 respectively. Johns Hopkins is considered to have established the first residency programs in Internal Medicine, Surgery, and Gynecology in 1889.  The Phipps Clinic opened at Johns Hopkins in 1913 under the leadership of Adolph Meyer.  It was described by Shorter as a German-style psychiatric clinic. I was having some difficulty getting adequate documentation on the first residency programs in psychiatry until today.    

Today I got the first solid information on psychiatric residents from NYSPI.  In July of 1930, there was an initial reference to 3 psychiatric “internes” being appointed. I was very grateful to receive that information from a colleague on Twitter who was kind enough to ask an archivist at this institution about this information.  The American Board of Psychiatry and Neurology was formed in 1934 so there were probably several residency programs at that time.

If you are a residency director, archivist or historian for a large medical school program and have similar information on the first residency program at your institution – I am very interested in hearing about it and will place your program on the timeline.

I am also very interested in the actual numbers of asylum directors, alienists, and psychiatrists at all points in time across the span of this timeline.  I have very accurate information for the past several decades.  I am very interested in any historical information on how the numbers of these subgroups varied in the late 1880s to mid 1900s.  I appreciate any data that can add to this timeline.

 

George Dawson, MD, DFAPA  

Shorter E.  A History of Psychiatry.  John Wiley & Sons; New York; 1997: p 111.