The Department of Psychiatry at the University of Maryland has one of the largest psychiatric training programs in the country-with, at any given time, about eighty psychiatric trainees, not all of them full time. The department currently has a full-time, steady-state faculty of about one hundred, with another hundred volunteer faculty. Maryland's chief local rival is Johns Hopkins, across town. Most of the people who come to Maryland come to train to become practitioners.
What started early in the twentieth century as a decentralized apprenticeship model of training in community-based clinics evolved into a formal system of training as part of mainstream American medical education. Psychiatric training, which had initially been community-based (especially in child psychiatry), moved to academic medical centers-except for psychoanalytical training, which maintained an arm's-length relationship with, and a steady distrust of, the academy. There was a shift from psychodynamic and psychoanalytic preeminence in the 1950s and 1960s to evidence-based medicine in the 1980s; from almost exclusively psychotherapeutic interventions to a major emphasis on psychopharmacology combined with psychosocial approaches; from psychotherapy provided chiefly by psychiatrists to a multidisciplinary approach, including psychosocial and vocational rehabilitation, provided by various kinds of health care workers; from a hospital-based system, emphasizing maintenance and containment of individuals with chronic and persistent mental illness, to a patient-centered model for mental health, with an emphasis on hope and recovery. Patients for whom even professionals early in the twentieth century had used such terms as idiot, feeble-minded, lunatic, and insane, had by the end of the century become patients, clients, and consumers of mental health care - individuals who were dealing with a mental illness or disorder, but were not defined by it.
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