THE LAST ten years have been witness to some remarkable changes in psychiatry. The consulting room has edged its way into the community; patients never before seen by psychiatrists are becoming the ones to whom the most energetic efforts are being directed; programs that have no obvious relationship to the 1:1 conventional format of the patient-clinician relationship are being called psychiatric. The general aim of curing mental illness is being replaced by a more modest, but perhaps a more realistic aim of adaptation to circumstances, and amelioration of illness and suffering.
This massive redirection of effort has been catapulted by the recognition that mental disease is the third most severe public health problem in the United States. This rank rests on figures showing that one out of every 12 persons is likely to enter a mental hospital during adulthood, that onehalf of all beds at general hospitals