Asylum reform and the great comeuppance of 1894--or was it?

The July 1894 issue of Journal of Nervous and Mental Disease published S. Weir Mitchell's address to the 50th meeting of asylum superintendents, the American Medico-Psychological Association, which had convened in Philadelphia in May. A reluctant but unapologetic Mitchell criticized the asylum doctors for their isolationism and backward ways. This article reviews Mitchell's critique of psychiatry and the responses to it during the next 50 years. Analyses of the critique by Adolf Meyer and others show that reform was already underway in 1894. Although Mitchell is often credited with delivering psychiatry a wake-up call, it is equally feasible that he was merely channeling the organic reforms from within the profession.