Mind Games: American Culture and the Birth of Psychotherapy. Eric Caplan. 246 pp. University of California Press, 1998. $35.
The psychotherapy industry finds itself in turmoil. The issues are cost containment by managed care and an ever-expanding pharmaceutical cabinet, arguments over the scientific evidence for therapeutic efficacy and turf battles among several professional groups, notably master's-degree practitioners, to be recognized as independent psychotherapy providers. In the midst of what clearly is a crisis state in psychotherapy as profession, Eric Caplan offers us a historical account of its beginnings.
Psychotherapy in America is a 20th-century invention. Standard lore indicates that it emerged at the beginning of this century for two reasons: a change in view of the etiology of mental illness from somatic to psychic factors and the popularity of psychoanalysis following Sigmund Freud's only visit to America in 1909. Caplan argues that this standard history is wrong on both accounts. In this brief book he marshals considerable evidence to support his claim that the place of psychotherapy was established in medical practice before the advent of psychoanalysis, and that acceptance of the validity of somatic causes for mental illness was key to the medical profession's ultimate appropriation of the talking cures.
Caplan begins with an excellent treatment of "railway spine," a late 19th-century hysteria-like syndrome of multiple complaints (for example, mental confusion, sleeplessness, personality changes, loss of sensation) believed to have been caused by excessive jostling or accidents in railroad cars. The syndrome generated both medical and legal specialties that proved profitable for everyone except the railroad owners. Whereas anyone who could afford the price of a rail ticket might acquire railway spine, neurasthenia, whose symptoms were similar, was reserved for people of higher intelligence and social class. This highbrow disorder was believed to be caused by excessive thinking. It was treated by a variety of somatic "cures" that included cold baths, special diets, stimulation with mild electric current, drugs and rest.
The multitude of somatic treatments for railway spine and neurasthenia evidenced the general lack of success in treating the diverse symptoms of what would become recognized as psychoneurotic disorders. Although American physicians acknowledged the prevalence of psychological symptoms in these disorders, they remained convinced of their somatic basis and wedded to the treatments demanded by such etiology. Yet outside medicine the talking cures flourished, especially in the mental-healing approaches that William James collectively called America's "mind cure movement."
Most mental healing was religion-based. Mental healers acknowledged that the mind was capable of curing the body; some argued that all disease was the product of the mind and thus could be cured through mental efforts. Caplan focuses on the healing theories generated by Phineus Parkhurst Quimby and his two most prominent disciples, Warren Felt Evans and Mary Baker Eddy. Eddy's Christian Science is certainly the best-known example of this movement. Medicine's initial response to these healers was to ignore them. As they grew in influence, however, physicians proposed state licensure that would bar mental healers from what physicians viewed as medical practice. Not surprisingly, such efforts failed.
By the beginning of the 20th century, years of experience in treating psychoneurotic disorders, such as neurasthenia, had convinced most physicians of some role for mental factors in cure. That experience, however, had not led them to abandon their insistence on somatic causes or their belief that any successful treatment program must be grounded primarily in somatic treatments. In the chapter "Flirting with Psychotherapy," Caplan describes this change of mind-set that led the medical horses to the trough. What led them to drink was a new program of healing organized by Elwood Worcester and several Boston physicians.
Worcester, pastor of the Emmanuel Church in Boston, had earned a doctor of philosophy degree with Wilhelm Wundt (the founder of scientific psychology) at the University of Leipzig. He proposed a healing program that combined medicine and Christianity. From its beginning, the program was enormously popular, and it spread rapidly to other churches in other cities in what became known as the Emmanuel Movement. Physicians, who had assumed they would be in control of the treatment programs, found themselves relegated to lesser roles by the expansion of ministers as therapists. Consequently, many physicians withdrew their support and launched a sea of criticism in the popular press against Worcester and his followers. Yet the public need for psychotherapy did not diminish.
After years of resistance, and for economic and scientific reasons, medicine took the monumental step of appropriating psychotherapy as a medical treatment. In doing so American medicine did not do away with alternative psychotherapies. In Caplan's words, it did, however, create "a viable cultural space for a new type of psychotherapy," one that reinforced the importance of a meaningful doctor-patient relationship and one whose efficacy would presumably be assured as part of medical science.
Caplan's book is important for its significant reconceptualization of the origins of American psychotherapy. The historical coverage is sketchy at times—for example the chapter on mind cures—but overall this is a well-researched history, grounded in American culture and science. It fills a significant void in the histories of psychiatry and psychology that to date have focused too exclusively on psychoanalysis and mental asylums.—Ludy T. Benjamin, Jr., Psychology, Texas A&M University