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Psychotherapy and the Pursuit of Happiness Ronald W Psychotherapy and the Pursuit of Happiness Ronald W. Dworkin Freudianism sits alongside Marxism and Darwinism in the pantheon of modern theories held to be so revelatory that they not only gained the adherence of Western intelligentsia but shaped the broader cul- ture. During the first half of the twentieth century, an air of intrigue and mystery hovered around Freud’s newly anointed practitioners. Psychotherapists occupied a strange universe, speaking in a language so incomprehensible but seemingly authoritative that it alternately awed and scared the average man on the street. Psychotherapy is no longer an intellectual movement today as it once was. But in the form of modern professional “caring,” it has assumed a new role, which is to provide a peculiar sort of substitute friendship — what we might call “artificial friendship” — for lonely people in a lonely age. To understand why this occurred and what it means for American culture, we must study the fractious history of the mental health field over the last six decades. It is a complicated story, with a staggering variety of terms, schools, leaders, and techniques, so any overview must neces- sarily leave out many important details. But from even just a synopsis of the conflicts that gave rise to today’s culture of psychotherapy — battles over who would hold the truest title to physician of the mind, tensions between scientists and clinicians, academics and professionals, elites and the public — we can see more clearly how psychotherapy has profoundly shaped the American conception of what happiness is and how we can achieve it. Disciplines in Conflict A mental health crisis erupted in the United States after the Second World War, touching not just returning soldiers but people from all walks of life. Alcoholism and juvenile delinquency became rampant. The number of patients admitted to hospitals and outpatient psychiatric Ronald W. Dworkin, M.D., Ph.D. is a senior fellow at the Hudson Institute and teaches in the George Washington University Honors Program. Spring 2012 ~ 69 Copyright 2012. All rights reserved. See www.TheNewAtlantis.com for more information. Ronald W. Dworkin clinics for mental health problems began to climb rapidly. There were not enough trained mental health personnel — the nation then had only a few thousand clinical psychologists — to deal with the problem. So the federal government responded by passing the National Mental Health Act (NMHA) in 1946, leading to the establishment a few years later of the National Institute of Mental Health and the provision of funding to train more psychotherapists. The new policy represented a genuine attempt to handle the crisis, yet it also brought to the surface important subcurrents and divisions within the mental health community, including skepticism among both academic psychologists and medically trained psychiatrists toward an elevated role for less-trained psychotherapists. Before proceeding, let us clarify some terminology. It is easy today to conflate psychologists and psychiatrists, psychoanalysis and psychothera- py, and the many other related words used by those who study the mind or seek to treat mental health problems. The vast multiplicity of terms can be daunting and, as we shall see, some definitions and distinctions have grown blurry with time. But if we use the words with care, the contours of our story will be clearer. Psychotherapy — the therapeutic treatment of individual mental and emotional problems — had fascinated the American people ever since Freud had visited the United States in 1909. Although as late as 1940 no more than four percent of the American population had actually under- gone some form of psychotherapy, the public held a generally fixed set of ideas about it, including the belief that psychoanalysis — the term used for Freudian psychotherapy, which most people did not distinguish from psychotherapy in general — was a true science. Psychiatrists are medical doctors; they are trained in biology and anato- my, and like other medical doctors can prescribe drugs. At the start of the twentieth century, most American psychiatrists had worked as superinten- dents in state mental hospitals and held a biological view of mental illness. Only a third of all psychiatrists offered psychoanalysis in private practice by the 1940s. Nevertheless, the great majority of psychoanalysts at the time were psychiatrists. The medical establishment had made a concerted effort to cleanse America of non-M.D. psychoanalysts, with the result that by 1953, 82 percent of the country’s psychoanalysts were psychiatrists. The government’s plan to boost rapidly the number of psychotherapists threat- ened both biology-minded psychiatrists and psychiatrists practicing psycho- analysis. It was unlikely that the number of medically trained psychiatrists could be raised sufficiently to meet the demand for psychotherapists — in the 1950s there were only 10,000 psychiatrists in the United States, with 70 ~ The New Atlantis Copyright 2012. All rights reserved. See www.TheNewAtlantis.com for more information. Psychotherapy and the Pursuit of Happiness just 450 new graduates each year — so government support for psycho- therapy necessarily meant more non-M.D. therapists. Psychologists are not medical doctors; they pursue graduate training in psychology, generally obtaining an advanced non-medical degree. In the 1950s, the majority of psychologists were academics working in college labs. Indeed, the public idea of a psychologist was a man in a white coat testing rats in a maze. Treating unhappy people with psychotherapy was as foreign and threatening to these scientists as it was to the biologically oriented psychiatrists. Academic psychologists had spent decades cultivating the aura of the research scientist while deprecating the role of clinical psychologists — that is, those psychologists who actually worked with patients. A minority within psychology, consisting mostly of women and handicapped by a “nursing image,” clinical psychologists had spent forty years working under psychiatrists, performing tests on patients, but deferring to psy- chiatrists on diagnosis and treatment. Many of them were idealists who dreamed of a new social order with psychotherapy at its core, dreams inspired by Freud and his followers. Although academic psychologists didn’t begrudge the masses their therapists, they looked down on clinical psychologists, believing that the title of “psychologist” should be reserved for people who had been taught the scientific method in the finest schools. The notion that psychotherapists might be granted parity in the pub- lic mind with real professors of psychology was worrisome to these academics. Indeed, no group of mental health workers stood to benefit more from the federal government’s new mental-health policy than the clinical psychologists. Hoping to practice psychotherapy on their own, without restrictions or physician supervision, clinical psychologists saw oppor- tunity in the new push by the government to increase the numbers of psychotherapists. Inevitably, the NMHA brought psychiatrists and clinical psycholo- gists into conflict. No state laws forbade psychologists from practicing psychotherapy on their own, but the courts tended to interpret medical licensing statutes broadly, so a clinical psychologist practiced psychother- apy at some risk. Yet the increasing demand for mental health clinicians changed the dynamic. Clinical psychologists decided to test the limits of the law, and by the early 1950s, nine percent of clinical psychologists were practicing on their own. Psychiatrists fought back, arguing that psychologists lacked the train- ing to detect severe mental illness, while academic psychologists, who Spring 2012 ~ 71 Copyright 2012. All rights reserved. See www.TheNewAtlantis.com for more information. Ronald W. Dworkin resented the popularity of psychoanalysis, attacked the field by arguing that it was unscientific compared to the then-reigning paradigm of behav- iorism. Clinical psychologists, however, began working to popularize psychotherapy among the general public. During the 1950s, many major American newspapers began carrying regular columns on psychological lore, typically written by a psychologist. In popular women’s magazines like McCall’s and Cosmopolitan, psychologists demystified the therapeutic process. In 1958, a young Joyce Brothers, who held a Ph.D. in psychology from Cornell, hosted the first television show devoted to people’s emo- tional and psychological problems. The popular rise of psychotherapy was intertwined with the popular rise of psychoanalysis. Freudian ideas had been popular with intellectu- als and artists in the 1920s, but it was not until the 1950s, with the crisis in mental health, that they widely penetrated the public consciousness. Although few clinical psychologists of this era practiced Freudian psy- choanalysis, they distilled Freud’s ideas into buzzwords, which appeared frequently in their conversations, writings, and speeches, thereby tapping into the public consciousness and identifying with people’s concerns. Journalists of the time wrote about infatuation and subliminal influences. A social worker visiting a family would look for unhealthy parent-child relationships and refer to the Oedipus complex. A probation officer, even a truant officer, would discuss a juvenile delinquent’s family background in the context of aggression and compensation. Freudian concepts satu- rated popular movies, such as Marnie and The Three Faces of Eve.
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