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Changing American Psychiatry: A Personal Perspective
Am J Psychiatry 2008;165:653-653. doi:10.1176/appi.ajp.2008.08020290
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by Melvin Sabshin, M.D. Arlington, Va, American Psychiatric Publishing, 2008, 419 pp., $59.00.

Changing American Psychiatry: A Personal Perspective is both a history of an extraordinary time in psychiatry and a psycho-socio-economic analysis of factors influencing the development of the discipline, enriched by the author’s role as a major participant/observer in the field’s transformation and growth. The title alerts the reader to that dual role—the term “changing” not only refers to changes in psychiatry but also suggests the active role of the author in influencing and effecting as well as reporting change.

As a bit player in that drama, I was particularly interested in how the story would be told, and I was not disappointed. Dr. Sabshin, with his usual intellect and insight, describes his career in the context of the development of 20th-century psychiatry (and a brief foray into the 21st) and intertwines his work and that of APA with the many external developments that affected the field: the trajectories of psychoanalysis, community psychiatry, and biological research; the role of DSM; the development of advocacy groups; and the impact of APA leadership in public policy and public information. The chapters address the field from a linear perspective, beginning with post-World War II and Dr. Sabshin’s own career development and continuing through the present. The chapters also discuss special topics such as evidence-based diagnosis and treatment, psychiatric education, international affairs, and APA governance and leadership. While there has been more to the development of psychiatry in the last half-century than APA, and while there are concepts or conclusions with which one can take exception, there is no doubt that during Mel Sabshin’s quarter-century tenure, and through his understanding and energy, APA became a key leader in the important growth and strength of the profession.

This volume is quite rich and full and can best be absorbed by a chronological reading, with a return to the special topics of the latter chapters. Even though we recognize that the historical report is shaped by the author’s participation in it, the analytic critical assessment of the interplay of the pivotal factors that have shaped our profession is an important base for future planning. The remarkable view and experience of the author and his important role in this change make a compelling and enjoyable “must-read” for current and potential leaders of our profession, as well as those who wish to have a greater understanding of psychiatry’s history.

For me personally, the volume is particularly timely, as it speaks to my presidential theme: Our Voice in Action: Advancing Science, Care, and the Profession. Dr. Sabshin, with consummate skill and advocacy, led psychiatry to a new and important maturity based on science and professionalism in the service of patients worldwide.

+Book review accepted for publication March 2008 (doi:10.1176/appi.ajp.2008.08020290).




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