Over the last fifty years, American psychiatrists have embraced psychotropic drugs as their primary treatment intervention. This has especially been the case in their treatment of patients suffering from psychotic disorders such as schizophrenia. This focus has led to an increasing disregard for patients’ subjective lived-experiences, life histories, and social contexts. This transformation of American psychiatry occurred abruptly beginning in the late 1960s and 1970s. My essay looks the ways these major transformations played themselves out in everyday clinical practices of state hospital psychiatrists from 1950 to 1980. Using clinical case records from California state hospitals, I chronicle the ways institutional and ideological forces shaped the clinical care of patients with psychotic disorders. I show there was an abrupt rupture in the late 1960s, where psychiatrists’ concerns about the subjective and social were replaced by a clinical vision focused on a narrow set of drug-responsive signs and symptoms. Major political, economic, and ideological shifts occurred in American life and social policy that provided the context for this increasingly pharmacocentric clinical psychiatry, a clinical perspective that has largely blinded psychiatrists to their patients’ social and psychological suffering.

在过去的五十年里，美国精神病学家已经将精神药物作为他们的主要治疗干预措施。在他们治疗患有精神障碍（例如精神分裂症）的患者时尤其如此。这种关注导致越来越忽视患者的主观生活经历、生活史和社会背景。美国精神病学的这种转变始于 1960 年代末和 1970 年代突然开始。我的文章着眼于这些重大转变在 1950 年至 1980 年期间在州立医院精神科医生的日常临床实践中的表现方式。我使用加利福尼亚州立医院的临床病例记录，记录了制度和意识形态力量塑造精神病患者临床护理的方式. 我展示了 1960 年代后期的突然破裂，精神科医生对主观和社会的担忧被专注于一组狭窄的药物反应体征和症状的临床愿景所取代。美国的生活和社会政策发生了重大的政治、经济和意识形态转变，为这种日益以药物为中心的临床精神病学提供了背景，这种临床观点在很大程度上使精神病学家对患者的社会和心理痛苦视而不见。