American Psychiatric Association (APA)

• DATE: Founded in 1844

• TYPE OF PSYCHOLOGY: Origin and definition of psychology; psychotherapy

The Association of Medical Superintendents of American Institutions for the Insane, established in 1844, changed its name to the American Medico-Psychological Association in 1893 and to the American Psychiatric Association in 1921. It oversaw the transformation of psychiatry into a professionalized occupation during the nineteenth and early twentieth centuries.

Introduction

The Association of Medical Superintendents of American Institutions for the Insane (also known as the Superintendents’ Association), grandparent of the American Psychiatric Association (APA), was established in 1844. At the time, there were twenty-four mental hospitals in the United States and two in Canada. The first of these was founded in Philadelphia, where Benjamin Rush, the acknowledged father of psychiatry in the United States, was instrumental in its establishment. Rush wrote the first psychiatric textbook, Medical Inquiries and Observations upon Diseases of the Mind (1812), which was the dominant textbook in the field for the next seven decades. He explored such methods of treating mental health conditions as bloodletting, control of diet, exercise, hydrotherapy, chemical intervention, diversion, and travel. He called for the humane treatment of patients with mental health conditions.

Two other mental hospitals existed in the United States before 1800, the Eastern State Hospital in Williamsburg, Virginia, and Spring Grove Hospital in Catonsville, Maryland. During the nation’s colonial period and long afterward, the care of individuals with mental health conditions fell largely to their families. In extreme cases that threatened community safety, however, public officials ordered people considered dangerous to be confined, often holding them in prisons, sometimes chained to the walls or floor. Disturbed people who did not have relatives to look after them were expelled from communities. If they stayed on, they might be put in the stocks and publicly whipped, after which they were forced to leave.

As mental hospitals were established, they received many more applications than they could accommodate. Horace Mann, who conducted a legislative survey in 1829, identified 289 individuals with cognitive impairments in Massachusetts, of whom 138 were in almshouses (charitable homes for low-income individuals), 141 were confined in jails or treated at home, and a mere ten were cared for in mental hospitals. Mann’s survey provided the impetus for constructing the Worcester State Hospital in 1833. This institution became a model for other such institutions elsewhere in the country.

Early Medical Schools and Societies

In eighteenth-century America, men could practice medicine simply by declaring themselves to be physicians. Many medical doctors received their training through apprenticeships provided by other doctors. Of thirty-five hundred physicians in the country during the 1700s, about four hundred had received formal training, usually gained by study in European medical schools. By 1840, about 35 percent of the physicians in New England had formal training.

Small medical schools existed in the United States during the eighteenth century, notably those established at the College of Philadelphia in 1756, King’s College—now Columbia University—in New York City in 1767, Harvard University in 1782, and Dartmouth Medical School in 1797. These, however, were limited operations with meager faculties and few students.

In the 1820s, laws were passed permitting medical societies to establish standards for licensing physicians and to grant licenses. Such documents, however, were not required for those who wished to practice medicine, although unlicensed physicians were banned from suing in court to collect unpaid medical bills. At this time, no organization existed for physicians who specialized in treating mental health conditions.

In 1844, John M. Galt, a physician and grandnephew of James Galt—the first administrator of Eastern State Hospital in Williamsburg, Virginia—helped establish what would become the American Psychiatric Association (APA). Twenty-five years old at the time, Galt met in Philadelphia with twelve other superintendents of mental hospitals. The impetus for this meeting came partially from the establishment, in 1841, of the British Association of Medical Officers of Lunatic Asylums (later the Royal Society of Psychiatrists), which emphasized the need for superintendents of mental hospitals to share ideas about the management, treatment, and care of individuals with mental health conditions.

Superintendents of mental hospitals from Maine to Virginia were present at the Philadelphia meeting, which began on October 16, 1844, and continued for four days. Thomas Story Kirkbride, superintendent of the Philadelphia Hospital for the Insane, organized the conference and entertained the delegates in his residence on the grounds of the Philadelphia Hospital. As a result of this meeting, the Association of Medical Superintendents of American Institutions for the Insane was established. Samuel B. Woodward was elected president, and Samuel White, the oldest of the thirteen delegates, was vice president.

Early Objectives of the Association

A widely distributed circular stated the objectives of the Superintendents’ Association, urging administrators of mental hospitals to communicate to share the results of their administrative experiences. This circular suggested that administrators should gather statistical information about individuals with mental health conditions and assist one another in finding ways to improve the treatment of individuals in this population.

To facilitate communication, it was decided that the organization should meet regularly. The second meeting was held in Washington, DC, beginning on May 10, 1846. Ten superintendents who had not attended the first meeting were present for the second meeting, along with the thirteen original delegates. It was decided that subsequent meetings should be held in May, a time of year when travel was relatively easy. Membership was open to the medical superintendents of any incorporated or legally constituted institutions for the insane, and where there was no medical superintendent because of different organizational patterns, the regular medical officer of such institutions might attend the scheduled meetings.

Between 1844 and 1860, meetings were held every year except 1845 and 1847. Meeting places were varied and included Philadelphia; Boston; Washington, DC; Baltimore; Cincinnati; Quebec; Utica, New York; New York City; and Lexington, Kentucky. With rare exceptions, annual meetings have been held every May since the 1860s.

Early Initiatives

As the Superintendents’ Association grew in size, it also grew in strength and influence. At its 1851 meeting, it set standards for the construction of mental hospitals, emphasizing ideal size, location, fire safety, and overall design. From its 1866 meeting came guidelines urging every state to provide facilities for the care of individuals with mental health conditions. Large states were to be divided into districts where people with mental health conditions might be housed in residential facilities. The association called for those individuals who were considered to have a treatable psychological condition and those considered incurable to reside together. It called on states to construct hospitals for the insane, following closely the recommendations of its 1851 meeting.

In 1868, the association set forth twenty-one legal constraints relating to people with a mental health condition, emphasizing individual rights and dignity and designed for the protection of those with mental disorders. It had earlier condemned political appointments of superintendents of mental hospitals, demanding instead that the best person be appointed.

Reorganization

Despite its influence, the Superintendents’ Association never had a large membership. Fewer than thirty delegates attended most of its annual meetings, although the fiftieth-anniversary meeting in 1894 drew about one hundred delegates. At this time, the organization lacked a constitution and was run by a president, a vice president, and a secretary-treasurer.

Fourteen years earlier, the association had abolished its committees. In 1892, it established eight new committees that dealt with a broad range of mental disorders and related matters. It adopted its first constitution, which established a governing council and three levels of membership: active, associate, and honorary. The proceedings of the meetings were to be published in a journal called Transactions. The following year, as the organization prepared for its fiftieth anniversary, it was renamed the American Medico-Psychological Association (AMPA), a name it retained until 1920. In 1921, the organization became the American Psychiatric Association.

The Twentieth Century

The twenty-seven years of AMPA’s existence were marked by phenomenal growth in modern psychiatry, impelled by the influence of such leading European theorists as Sigmund Freud, Alfred Adler, and Carl Jung. The association had earlier suggested guidelines for the training of psychiatrists. During this time, the field of child psychiatry came into being, and such fields as psychiatric social work and psychiatric nursing were established.

The American Medical Association (AMA) had long sought to have the associations serving psychiatry join it, but it took until 1930 for the AMA to form a committee on mental health. This committee suggested an increased emphasis on psychiatry in medical schools, as well as on issues relating to individuals with mental health conditions and the legal aspects of their care and treatment.

Psychiatry received a boost during and immediately after World War II when many enlisted men or returning veterans experienced psychiatric conditions caused by the stress of combat. During the late 1940s, two APA leaders, William Menninger and Daniel Blain, helped establish new programs and obtained funding to strengthen the association. More advances in treating individuals with mental health conditions, particularly through drug therapy, occurred in the last half of the twentieth century than had been made in the preceding three centuries.

During the directorship of Blain, from 1948 to 1958, the APA moved into handsome headquarters at 1700 18th Street NW, in Washington, DC, where a permanent staff ran the now-flourishing organization. Under Walter E. Barton’s directorship, from 1963 to 1974, the permanent staff grew from 48 to 116 persons. The APA Museum was constructed, and the headquarters building was renovated and expanded.

Following Barton as medical director was Melvin Sabshin, who assumed office on September 1, 1974. He founded the American Psychiatric Press and set about raising funds for the construction of the twelve-story headquarters building at 1400 K Street NW, in Washington, DC, that was needed to serve an ever-increasing membership, which had spiraled from 5,856 members in 1950 to 18,407 members by 1970 and to around 39,000 members through the first quarter of the twenty-first century. In 2018, the APA moved to 800 Maine Ave in Washington, DC.

The organization continues to grow and contribute significantly to its medical subspecialty as well as the broader spectrum of mental health professions, especially through the publication of its influential Diagnostic and Statistical Manual of Mental Disorders (DSM-V), first published in 1952 and in its fifth edition since 2013, which was revised in 2022 (DSM-V-TR). The APA also has a notable impact on legislation regarding individuals with intellectual and mental disabilities and is influential in directing the course of psychiatric training and licensure throughout the United States and Canada.

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