The opportunity to debate publicly one of the leaders of psychiatric epidemiology about its history and future directions is a privilege. With regard to its history, it makes little difference whether the post-World War II investigators avoided psychiatric diagnoses because of ideology or practical considerations about reliability and feasibility; the consequences were the same. The major community surveys relied heavily on overall impairment scales independent of specific diagnoses as the dependent measures.
While some investigators, including Dr Srole and his associates, may not have intentionally adopted the view that mental health and illness were on a continuum, this theoretical position was in fact expressed in their research. In the mid 1950s, it was a viewpoint expressed by several prestigious scientific groups, including the National Advisory Mental Health Council, and by a series of conferences on psychiatric epidemiology sponsored by the Milbank Memorial Fund and the World Health Organization.1-3