More on the Impossible Profession

The term "Impossible Profession" was indeed coined to describe the status of the professions of psychiatry and psychoanalysis during the period from 1844 to the mid-1950s. It is not possible to say who coined this term and used it first in the psychiatric, psychoanalytic literature.This term reflects the challenges, complexities, and uncertainties faced by psychiatrists and psychoanalysts in their work with patients and the understanding of mental illnesses.

The exact originator of the term is not attributed to a specific individual, and it has been used by various authors and professionals in psychiatric and psychoanalytic literature. The term "Impossible Profession" gained prominence in the writings of several influential figures in the field, including:

1.?Karl Menninger: The American psychiatrist Karl Menninger used the term "The Impossible Profession" in the title of his book, which was published in 1936. Menninger explored the difficulties and dilemmas faced by psychiatrists in their clinical work, including the challenges of diagnosis, treatment, and the inherent subjectivity of mental health.

2.?Felix Deutsch: Felix Deutsch, an Austrian-American psychoanalyst, also used the term "The Impossible Profession" in the title of his book, published in 1948. Deutsch examined the complexities and uncertainties of psychoanalytic practice and the inherent limitations in understanding and treating mental disorders.

It's worth noting that while the term "Impossible Profession" is associated with these authors and their works, it has been used more broadly in the field of psychiatry and psychoanalysis to capture the inherent difficulties and intricacies involved in these professions.

The work force of trained psychiatrists in the large Institutions for the mentally ill was extremely limited prior to WWII and only gradually increased as more psychiatrists were trained in late 1940's and 1950's. The field of psychiatry was still in its early stages, and formal training programs for psychiatrists were not as widespread as they are today. As a result, there were only a small number of psychiatrists available to work in mental institutions during the 19th and early 20th centuries.

Before World War II, the understanding of mental illnesses was limited, and treatment options were often rudimentary. Large mental institutions, often called asylums, were the primary settings for housing and treating individuals with mental disorders. However, these institutions were often overcrowded, and the quality of care varied widely.

Regarding the number of mentally ill confined individuals in the US and the number of psychiatrists available in mental institutions between 1844 and 1944, specific data on the exact figures for every year during this period is markedly limited. However, one can provide some general information based on historical trends:

• Throughout the 19th and early 20th centuries, the number of mentally ill individuals confined to mental institutions increased steadily. This growth was partly due to social factors, such as changes in societal attitudes towards mental illness, which led to more people being institutionalized for various conditions. These numbers increased until the mid-70's for those who were confined in public mental hospitals and veteran's affairs (administration) hospitals.
• The number of trained psychiatrists during this period was limited, and their availability in mental institutions was inadequate to meet the growing demand for mental health services. As a result, many mental institutions were understaffed, and patients often received suboptimal care.
• It wasn't until after World War II, in the late 1940s and 1950s, that there was a significant increase in the number of psychiatrists being trained, and the field of psychiatry began to expand rapidly. This expansion was influenced by advances in understanding mental illnesses and the development of more effective treatments, including the use of psychotropic medications in the mid-1950's.
• The period after World War II marked a turning point in the field of psychiatry, with more attention being given to research, education, and the establishment of psychiatric residency programs to train new psychiatrists. This led to a gradual improvement in the availability of psychiatrists in mental institutions and other healthcare settings.

It's important to note that the history of mental health care in the United States is complex, and there were significant changes in the approach to treating mental illness over this time period. The movement towards deinstitutionalization and the development of community-based mental health services gained traction later, in the mid-20th century, in late 1960's culminating in mass deinstitutionalization in late 1970's which further impacted the landscape of mental health care in the country.

The society had a dim view of psychiatry during this period of 1844 to mid-50's because psychiatry had little to offer for majority of the mentally ill who were seen as chronically ill and unfit to be integrated in the society at large. This was an unfair characterization of the image of psychiatrists who knowingly entered this impossible profession with dedication to care for the mentally ill, majority of whom were empathic and caring as also markedly dedicated and devoted. However, instead of appreciating these major positive qualities of psychiatrists the society behaved with a second grade level immature attitude to ridicule and tease psychiatrists making them the butt of jokes. The psychoanalysts who were brave to explore the frontiers of knowledge about the human mind and its aberrations with dedicated work spending 10 to 11 hours a day to help disturbed, emotionally hurting individuals were never seen as heroes, and of course, they were of no use to change plight of the chronically mentally ill masses in the institutions for the mentally ill ("insane"). It does not take a genius to understand why psychiatrists and psychiatry carried a negative image instead of being admired for taking up the challenges presented by this impossible professions. Instead of being viewed as heroes they were seen as the drop-outs from the main stream of medicine. Psychoanalysis instead of taking pride in its unique discoveries providing the only rational explanation with comprehensive (dynamic) psychology for the etiology of many psychiatric symptoms and syndromes, and attaining its independent stellar status, became busy to make psychoanalysis a handmaiden of medicine. This was a strange way of gaining prestige in the society by treating the worried well (wealthy) while being of no real use to the masses of the mentally ill confined in the institutions. Very few came to work in the public institutions to give their insights to other psychiatrists and psychiatric residents even for a few hours a week. The masses of the confined mentally ill were soon to be extruded, while poorly prepared to face the real world. They were poured in the open society with a myth that there were effective pills for them. This was done without any regard as to whether they had proper care or even wherewithal of adhering to the treatment (pill regimen). This further damaged the image of psychiatry. Lack of support systems, lack of knowledge of their disease process and not adhering to treatment led to revolving door hospitals. The fact that the modern psychiatric treatments made thousands of mentally ill capable of marginally functioning in the society and enjoying some semblance of liberty was totally lost sight of, not widely recognized nor emphasized in the media. This was indeed a stupendous victory of psychiatry and psychiatrist, but alas, but perceived as failure, and they never received the appreciation from the society at large. Who is to improve the image of psychiatrists and psychiatry? The mentally ill and their families who had keen memories of their plight prior to 1960's and 70's privately admired their psychiatrists but the public image did not improve much. The old baggage constantly following psychiatrists' image, not only in the general public, but also among their medical peers. The medical peers had an ambivalent attitude towards the psychiatrists. They needed their help usually to instantly get the "monkey off their back" if they had a mentally ill individual under their care, but if the psychiatrist was not equipped to do that whether by virtue of not having time, the resources or cooperation of the patient or his/her relatives their (the real doctors') frustrations further tarred the negative image of the psychiatrists.

Improving the image of psychiatrists and psychiatry necessitates a broader societal appreciation and understanding of the challenges and significant strides made in mental health care. Recognizing the achievements and unwavering dedication of psychiatrists and other mental health professionals can help dispel misconceptions and cultivate a more positive and supportive attitude toward the field. Many satisfied ("consumers") patients and their relatives truly appreciate the help they receive from psychiatrists and their psychotherapists. While progress in this direction is evident, it now requires a concerted effort from healthcare institutions, organized medicine, and professional associations of psychiatrists and other mental health practitioners to focus on public relations and public education. This shift is crucial to meet the needs of the nearly 50% of individuals who require mental health services but lack access or coverage to receive essential care.

Achieving changes in public policies also hinges on educating lawmakers in this domain. Only when they are well-informed about the importance of mental health care and its impact on their constituencies will they be compelled to act. By fostering well-informed constituencies, we can empower these individuals to advocate for the necessary reforms, ensuring that mental health care becomes a priority in legislative discussions and decisions. There needs to be a widespread recognition that there is no health without mental health, and good mental health care is as important as the "other health care."

In summary, a multifaceted approach involving public relations efforts, public education campaigns, and collaboration with policymakers is essential to transform societal attitudes toward psychiatrists and mental health care. By shedding light on the vital role Psychiatrists and mental health professionals play in improving lives and advocating for increased access to mental health services, and coverage, we can create a more compassionate and supportive society for those in need.

Society needs to have the same kind of respect for psychiatrists, and other mental health professionals as it does for the life saving first responders, firefighters, and those who provide security for all. They are the ones who have taken the risk of embracing this "Impossible Profession."