A history of psychiatric consultation in America

Consultation-liaison psychiatry emerged in a particular socio-historical context, following a major shift of medicine into a more scientific, hospital-based system. Psychiatrists realized that they needed to move outside of the asylum and reintegrate themselves with the new structures of medicine, especially the general hospital and the medical school. Psychosomatic theory and psychoanalytic influence shaped the emergence of consultation-liaison activities in the 1930s through 1950s as they shaped most psychiatric services in the United States at that time, but they were an epiphenomenon to this powerful underlying dynamic that dictated psychiatry's move into the medical hospital. The experience of other countries tends to confirm this hypothesis, though a comparative history is limited by the strong postwar US influence. Pediatric consultation-liaison had a somewhat different evolution, reflecting the later emergence of pediatrics itself as a field and its strong psychosocial and preventive medicine emphasis.