Transitions in the Mental Health Field's System of Professions from WWII Until the Present: the Case of Dubville Daniel Noam Warner
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Duquesne University Duquesne Scholarship Collection Electronic Theses and Dissertations Summer 2009 Transitions in the Mental Health Field's System of Professions from WWII until the Present: The Case of Dubville Daniel Noam Warner Follow this and additional works at: https://dsc.duq.edu/etd Recommended Citation Warner, D. (2009). Transitions in the Mental Health Field's System of Professions from WWII until the Present: The asC e of Dubville (Doctoral dissertation, Duquesne University). Retrieved from https://dsc.duq.edu/etd/1341 This Immediate Access is brought to you for free and open access by Duquesne Scholarship Collection. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of Duquesne Scholarship Collection. For more information, please contact [email protected]. TRANSITIONS IN THE MENTAL HEALTH FIELD’S SYSTEM OF PROFESSIONS FROM WWII UNTIL THE PRESENT: THE CASE OF “DUBVILLE” A Dissertation Submitted to the McAnulty Graduate School of Liberal Arts Duquesne University In partial fulfillment of the requirements for the degree of Doctor of Philosophy By Daniel Noam Warner August 2009 i Copyright by Daniel Noam Warner M.A. 2009 ii TRANSITIONS IN THE MENTAL HEALTH FIELD’S SYSTEM OF PROFESSIONS FROM WWII UNTIL THE PRESENT: THE CASE OF “DUBVILLE” By Daniel Noam Warner Approved: April 16, 2009 Daniel Burston Roger Brooke Associate Professor of Psychology Professor of Psychology Dissertation Director Committee Member Psychology Department Chair Constance Fischer Ralph L. Pearson Professor of Psychology Provost /Academic Vice President and Committee Member The McAnulty College and Graduate School of Liberal Arts Professor of History iii ABSTRACT TRANSITIONS IN THE MENTAL HEALTHY FIELD’S SYSTEM OF PROFESSIONS FROM WWII UNTIL THE PRESENT: THE CASE OF “DUBVILLE” By Daniel Noam Warner August 2009 Dissertation supervised by Professor Daniel Burston A case study of one mental health field in a medium-sized, steel-belt city over a 50 year period is presented. Through interviews and archive data, the narrative elucidates the transitions that occurred in regards to which professions are dominant, and which services count as mental health services, in different eras and under different science and governmental regimes. The dissertation focuses on four professional categories in particular: psychoanalytic psychiatrists, neurological psychiatrists, research psychologists, and clinical psychologists. It also focuses, primarily, on three institutions: a large psychiatric research hospital, a university psychology department, and a psychoanalytic institute. Through tracing the dynamics of the professional transitions undergone by these professions and institutions, four major conclusions are reached: (1) The transitions in mental health were not just scientific advancements, but changes in the “object” over which mental health professionals are considered to have expertise. (2) iv Sidestepping the “total person” has resulted in a radical transition in the very hierarchy of the mental health system of professions. (3) The problem of the “total person” continues to complicate efforts in mental health, despite having ostensibly been “sidestepped.” (4) “Totality” has become an area of technocratic expertise for those working in private practice psychotherapy. However, totality is no longer exclusively conceptualized through a psychoanalytic lens, while the ground to make a claim on “totality” is still grounded in “clinical experience.” v ACKNOWLEDGEMENTS First, I must thank my many interviewees, who selflessly donated their time for this project. I thank them for taking time out of their busy schedules to help my edification, and hopefully to help the mental health field grow in self-understanding and maturity. I would also like to thank my dissertation committee, Daniel Burston, Roger Brooke, and Constance Fischer, who shepherded me not only through the complex process of writing a dissertation, but through the entirety of my graduate training in psychology and the human sciences. In particular I would like to note my Committee Chair, Daniel Burston, for showing me the power of historical analysis in addressing theoretical questions. There were also many experts who assisted me out of pure selfless dedication to scholarship. Two sociologists in particular helped me generate an analytic frame for understanding the mental health field that I only knew from “the inside.” First is Matt Schneirov Ph.D., who introduced me to the field of medical sociology, and second is John Marx who helped educated me on many dynamics in the contemporary mental health professions. Sam Knapp was indispensable in his encyclopedic knowledge on the history of professional psychology, Martin Packer pushed me to develop an appropriate method for my project, and Ken Thompson was indispensable in connecting me to sources I could never have found on my own (as well as in allowing me to check out library books on his account!) vi The polish and clarity of the final product was made possible by the tireless editing of Mathew Lorenz and Joshua Gregson, who spent innumerable hours pushing me to make sense. The Duquesne University Psychology Department office managers Norma Coleman and Marilyn Henline assisted me through the many logistical hurdles of proposing and writing the dissertation. Last, I need to thank my wife, Erika Fricke, who not only provided unmatched copyediting help, but has been my foil and debating partner as I worked through the ideas expressed in this dissertation, and which power my commitment to mental health work. vii TABLE OF CONTENTS Page Abstract.................................................................................................................. iv Acknowledgements................................................................................................. v 1 - Introduction ....................................................................................................... 1 Theory................................................................................................................. 5 The System of Professions.................................................................................. 7 Method .............................................................................................................. 18 Notes on Bias .................................................................................................... 27 Notes on Technical Issues............................................................................. 29 Summary........................................................................................................... 30 2 - DIMH 1950 – 1970: The Psychoanalytic Psychiatrists................................... 31 The Total Person............................................................................................... 38 Community Psychiatry...................................................................................... 50 Tensions ............................................................................................................ 54 Relationship to the State ............................................................................... 62 Relationship to the Local Community .......................................................... 65 Analytic Regression...................................................................................... 68 Analytic Maturity.......................................................................................... 74 Analytic Science and Accountability............................................................ 79 Summary: Unheeded Research Findings.......................................................... 84 3 – Clinical Psychology: 1950 – 1970 .................................................................. 89 Psychology – A Disputed Discipline ................................................................ 89 viii Workplace Assimilation.................................................................................. 102 The Emergence of Behavior Therapy............................................................. 110 Tensions .......................................................................................................... 123 Summary......................................................................................................... 131 4 - DIMH in the 1970s: Flattening the “Total Person” ....................................... 133 Research.......................................................................................................... 136 Treatment ........................................................................................................ 142 Training........................................................................................................... 147 The Community .............................................................................................. 150 Extracting Psychiatry from Politics ................................................................ 153 The “New” Community Mental Health .......................................................... 157 Tensions .......................................................................................................... 163 Tensions with Research .............................................................................. 164 Tensions with Treatment............................................................................. 170 Tensions with the System ..........................................................................