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Psychology Loses Academic Clout As Therapists Turn Substitute Friends Psychology loses academic clout as therapists turn substitute friends The Sydney Morning Herald | September 7, 2012 Tanveer Ahmed Sydney Morning Herald columnist The Black Dog Institute published its first index of national happiness recently and Australians scored 77 out of 100, which was interpreted as meaning about three‐quarters of us are happy with our lives. Not bad at all. Economists are also fond of measuring wellbeing. But the very idea that we can rely on a subjective measurement of how we feel at a random point is a new one. And it's the result of a trend over several decades. In the history of happiness as an idea, the main tension has been between thinkers who hold a life must meet some objective standard to be considered happy, and those who hold that happiness is merely the subjective state of being pleased with one's life. In ancient times, happiness was deemed a transcendent, almost godlike state, attainable only by the few. Today, however, the concept has become democratised: anyone can be happy. It is more about feeling good than being good. The catch is, with happiness supposedly in the reach of everyone, it is pursued with a frenzy that, perversely, often gives rise to its opposite: unease, discontent, even guilt. The nature of the psychological sciences and the way they have been sold to the masses in the past 50 years has been critical in this transition ‐ in particular, the central place of the modern clinical psychologist as confidant to patients. Today, counsellors are the new friends. At the end of World War II, the average psychiatrist was administering an asylum and the average respectable psychologist was dressed in a lab coat experimenting with animals, putting together theories about behaviour. Clinical psychologists counselling their clients were looked down upon by their academic peers. The real boom in short‐term psychotherapy came with the growth of community mental health centres in the 1960s. It grew out of a defiance of the experts. Since feelings were much easier to measure in a client than abstract psychological criteria determined by the therapist, from the 1980s they became the standard against which all therapeutic methods were judged. The result was an entirely new literature within psychology called "empirically supported treatments", which enabled therapies to be judged according to whether they made clients feel better. As a result, today we see questionnaires are handed out to patients in psychology rooms and GP surgeries, which entirely lack context but are referred to as if hard science, as well as ubiquitous ''happiness studies'' and a plethora of happiness experts. Meanwhile, psychiatrists and the medical profession have kept viewing the prism of mental illness through biology and chemistry, giving them a well‐differentiated niche ‐ but reducing them over time to mere medication managers. So a new breed of therapist slowly emerged ‐ sympathetic, friendly, light‐hearted, warm, and caring. Gone was the transcendent manifestation, the abracadabra of therapy and the detached psychotherapist using complex Freudian terms to describe everyday problems. Freudianism sits alongside Marxism and Darwinism in the pantheon of modern theories that shaped our broader culture. But psychotherapy is no longer an intellectual movement today as it once was. It has assumed a new role in the form of the modern "caring" professions, which provide a peculiar sort of substitute friendship ‐ what we might call "artificial friendship" ‐ for lonely people in a lonely age. A US sociological study has reported on the proportion of people who said they lacked a confidant. In 1985 the study identified one in 10 people. Twenty‐one years later the figure had jumped to one in four. Is it any surprise, then, that the Medicare bill for psychological services blew out to $1.5 billion this year, twice the budgeted amount, forcing the government to cut the subsidised number of sessions with psychologists? Who dispenses this psychotherapy is growing increasingly irrelevant, as a short‐term therapy or counselling session is the same regardless of whether the therapist is a psychologist, a social worker or a counsellor. In the US, more social workers administer therapy than either psychologists or psychiatrists. Psychologists in Australia are increasingly behaving like the medical profession in demanding extensive training and more onerous barriers to entry now they have access to the rivers of gold that is Medicare. But if a growing part of their work is to administer a sort of privatised friendship, new obstacles to carrying out their work, be they masters degrees or doctorates, are getting harder to justify. Dr Tanveer Ahmed is a psychiatrist. Psychotherapy and the Pursuit of Happiness The New Atlantis | 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 culture. 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 necessarily 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 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 psychotherapy, 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 undergone some form of psychotherapy, the public held a generally fixed set of ideas about it,includingthebelief 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 anatomy, and like other medical doctors can prescribe drugs. At the start of the twentieth century, most American psychiatrists had worked as superintendents 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 threatened both biology‐minded psychiatrists and psychiatrists practicing psychoanalysis. 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 just 450 new graduates each year — so government support for psychotherapy 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.
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