Year of Publication

2025

College

Undergraduate Education

First Advisor

Mark Wurth

Second Advisor

Alexander Elswick

Abstract

Psychiatry is a unique field of medicine. While nearly every other branch of health care can be tied to objective markers, psychiatry works with intangibles. The diagnoses it gives deal with behavior, mood, and thought. Its success, then, deals not only with clinical markers, but more importantly the belief of patients and the greater public in its legitimacy. Because of this, psychiatry’s authority has always been uniquely vulnerable to shifts in cultural moods, media narratives, and public trust. Since the middle of the twentieth century, psychiatry in the United States has undergone a series of reforms that promised to revolutionize care. From the closure of asylums to the updates to the Diagnostic and Statistical Manual of Mental Disorders (DSM) to the pharmaceutical boom led by drugs like Prozac, psychiatry framed each of these as a turning point–corrections to the failures of the past. Yet following each of these moments of hope was a wave of disillusionment. From overcrowded emergency rooms and criminalized mental illness to pharmaceutical lawsuits and media backlash, psychiatry’s promises of reform would give way to unintended consequences and renewal of public skepticism.

It is easy to speak of psychiatry as a single institution making collective decisions. But like any field, it is made up of individuals working within broader systems, for psychiatry the most salient of which being healthcare policy, pharmaceutical industry relations, and cultural expectations. It is within these entangled systems that the reforms of psychiatry have been both made and undermined. It is best to understand the history of psychiatry as a series of cycles rather than straightforward progress. These cycles change and evolve, but each contain a familiar pattern of optimism, controversy, 7 and backlash. To understand the fractured nature of contemporary psychiatric discourse, we must attempt to unravel these historical rhythms and the conditions that made them. By analyzing key moments in psychiatric reform, we can see these ccycles take shape. The deinstitutionalization movement aimed to replace overcrowded and inhumane asylums with community-based care, aided by the advent of the antipsychotic medication Thorazine. It is true that the psychiatric profession by in large supported the closure of these state hospitals, but it was not in control of the political and economic systems that were to provide the infrastructure needed to replace them. Because of these planning failures, patients were discharged into a society that could not support them. The movement, initially a humanitarian advancement, instead led to homelessness and neglect. Later, psychiatry attempted to reprove its credibility with the DSM-III, an updated diagnosis manual that defined mental disorders with observable symptom checklists rather than psychoanalytic theories. With this, the field entered an era of biological psychiatry and entered a closer partnership with the pharmaceutical industry. In the decades that followed, medications like Prozac and Zoloft gained significant popularity, largely aided by a boom in pharmaceutical advertising. The promise of a biochemical explanation for mental suffering caught the attention of the public, but in doing so laid the foundation of future backlash. Lawsuits, black box warnings, and patient accounts of overmedication and misdiagnosis began to build. Psychiatry found itself, once again, celebrated in one moment and critiqued in the very next. This thesis is based in the belief that understanding psychiatry’s present requires one to revisit its past. It explores not only how psychiatry has reformed itself, but how 8 these reforms are continually shaped by, and in turn shape, public sentiment and cultural expectations. Mental health is an increasingly significant part of public discourse, but the conversations around it are often fragmented and polarized. Online, some advocate for greater access to psychiatric care, and others argue the legitimacy of mental diagnoses altogether. This degradation of psychiatric trust has real consequences. Children and adolescents depend on their parents not to be caught between skepticism and over-pathologization; people with severe mental illness may be criminalized rather than treated; and marginalized communities can separate themselves entirely from these systems if they see them as coercive or alienating. Psychiatry’s relationship with pharmaceutical marketing and mass media makes it even more complicated to try to promote informed and ethical care. These challenges to psychiatry all exist within a culture of deep political polarization. Mental health has become a symbolic issue, being used as ammunition in debates from criminal justice to public education. With calls to revive asylums resurfacing in modern political rhetoric, we once again see psychiatry caught in sociopolitical crossfire. Through an analysis of the rise and fall of psychiatry in public sentiment, this thesis offers a historical perspective that can inform contemporary discourse about trust, care, and legitimacy.

Download

Available for download on Friday, May 21, 2027

Share

COinS