Social Science & Medicine 53 (2001) 349–356 British psychiatry in the 20th century } observations from a psychiatric journal Joanna Moncrieff a , M.J. Crawford b, * a Department of Psychiatry, Charing Cross Hospital, London, UK b Department of Public Mental Health, Imperial College School of Medicine, St Mary’s Campus, Paterson Centre, 20, South Wharf Road, London W2 1PD, UK Abstract In order to investigate change and continuity in the concerns and practices of psychiatry in Britain during the 20th century we examined contents of the British Journal of Psychiatry. Specifically we sought to examine the paradigms used by psychiatry to conceptualise mental illness during this time. Back issues of the journal for 1 year at the mid-point of each decade were examined. We undertook a quantitative analysis categorising each article in terms of its form and content and a qualitative analysis in order to summarise the subjects that were covered. The results show that there has been continuous interest in biological aspects and treatments of mental illness with relatively little coverage of psychoanalysis or social psychiatry. Little support was found for the suggestion that major shifts have occurred in the explanatory paradigms used by psychiatry over the century. Modern interest in biological psychiatry is therefore not a new departure, but appears rather as the continuation of a long-standing inclination. The decline of the asylum-based system of care has been accompanied by a broadening in the scope of psychiatric concerns with a greater emphasis on milder mental disorders such as neurosis and depression. # 2001 Elsevier Science Ltd. All rights reserved. Keywords: Psychiatry; History; Mental illness; Research Introduction It has been suggested that radical shifts in the systems of explanation, or paradigms (Kuhn, 1970) used by psychiatry to conceptualise mental illness have taken place over the 20th century. A prevalent view is that in both Britain and North America social and psycho- analytical models of mental illness, pre-eminent in the mid part of the century, have been replaced by an increasingly biological orientation over the last few decades (Healy, 1996; Warner, 1994; Sabshin, 1990; Shorter, 1997). Some commentators describe this as a new era in psychiatry which has been a ‘‘smashing success’’ and has achieved a ‘‘more solid scientific footing’’ than ever before (Shorter, 1997). An examina- tion of the contents of two American psychiatric journals between 1969 and 1990 claimed to find some evidence that an increasing proportion of articles were concerned with biological research (Pincus, Hederson, Blackwood & Dial, 1993). However, others have described a continuous interest in the use of physical therapies (Grob, 1983) and argued that there has been a fundamental continuity of psychiatric thought centred around biological explanations of mental illness (Scull, 1989). What is certain is that there were dramatic changes in the way in which psychiatric care has been provided over the 20th century. The decline of the asylum and the development of community-based treatment have been extensively documented (Jones, 1972; Crammer, 1990; Bennett, 1991). In this study we set out to examine contents of psychiatric journals in order to investigate change and continuity in the concerns and practices of psychiatry in Britain during the 20th century. A single journal, now called the British Journal of Psychiatry, has been published throughout this period. It is the only journal *Corresponding author. Tel.: 020-7-886-1648; fax: 020-7-886- 1995. E-mail address: m.crawford@ic.ac.uk (M.J. Crawford). 0277-9536/01/$-see front matter # 2001 Elsevier Science Ltd. All rights reserved. PII:S0277-9536(00)00338-5