Managing mental illness: Trends in continuing mental health education for family doctors, 1977-1996

Medical sociologists have documented psychiatry's tendency to define psychological and behavioral problems as mental disorders. But we know little about how other medical specialties view mental disorders and their treatment. We explore trends in mental health CME (continuing medical education) by analyzing twenty years of data on the quantity and content of articles on mental illness in family practice journals (1977-1996). Pooled time series analyses indicate that drug innovations had the strongest influence on the number of mental illness articles published. New drugs sharply increased attention to all types of mental disorders, not just those with pharmaceutical treatment indications. DSM modifications influenced publications in a complex way: The expanding number of medicalized illnesses in the DSM had a positive impact, while the paradigm shift to the medical model with DSM-III actually decreased the number of articles. Similarly, the supply of patients generated by deinstitutionalization increased coverage of mental illness in this literature, while the growth of managed care was associated with a decrease therein. Content analysis of articles on serious mental illnesses (n = 202) shows that drug innovations only increased the number of articles but did not affect drug treatment recommendations. These trends reflect how the medical model and drug treatments have become firmly established in the management of mental illness.