Current status of milieu psychiatry

Appreciation of the role of milieu in psychiatry has waxed and waned in response to various scientific, ideologic, and social pressures. In this review, historical trends in the use of environment in treatment of mental illness are integrated with social science and empirical research studies of milieu. While the insights of social scientists of the prepsychotropic drug era helped sensitize psychiatry to deleterious effects of hospitalization, the 1960s saw development of a schism between an antipsychiatry movement and a defensive medical reaction, now critical of the excesses and claims of proponents of milieu treatment methods. Recent research studies, however, have begun to document significant effects of milieu upon treatment outcomes, suggesting an opportunity for renewed collaboration between social scientists and hospital psychiatrists. The importance of directing future research efforts toward more specific parameters of milieu in interaction with different diagnoses or patient populations is discussed.