Psychiatry is in the grip of radical change, spurred both by dramatic discoveries about the biological basis and treatment of mental illness, and by the increasing difficulties of reimbursement and of competition from other non-medical mental health care workers. In the midst of these changes, there is the danger that the inevitable anxiety that accompanies training will express itself more readily than before in defining an ambiguous field to defend against that anxiety. This may have a negative impact on patient care. This study proposes to employ anthropological techniques of participant observation to study the relationship between training, expert knowledge and professional culture in psychiatry. The immersion method of long-term participant observation fieldwork, combined with formal interviews and comparative exposure to more than one center for psychiatric training, will be the primary means of gathering data; careful observation will also be made of psychiatrists-in-training in initial evaluation interviews of patients. The study hypothesizes that psychiatrists-in-training must master certain developmental tasks in order to integrate what are often perceived to be two diametrically opposed poles of psychiatric expertise, biological psychiatry and psychotherapy. It also hypothesizes that the psychiatrist-in-training's mastery of these tasks may be impeded by anxiety generated in connection with these tasks, and that he or she may respond by in some measure conceptually compartmentalizing different kinds of psychiatric knowledge, creating an overly rigid dichotomy between biological psychiatry and psychotherapy. In sum, the study suggests that the anxiety created by psychiatric training, particularly in psychotherapy, tends to escalate commitment to particular paradigms in psychiatry, and to escalate the emotional investment in the field's intellectual disagreements. The goal of the project is to write an ethnography of psychiatry, focused on the training of young psychiatrists but sensitive to both the external pressures affecting practioners in private practice and in research- insurance policies, the changing structure of medical treatment, competition from other mental health professionals-and to the internal pressures created by the learning process from within the psychiatry residency program.
