The Role of Psychologists in the Treatment of Mental Illness:

1. The Role of Psychologists in the Treatment of Mental Illness: Historical Perspectives

2. Psychology’s Public Image “The public has always had its own version of psychology whether it be phrenology, or physiognomy, or characterology, or spiritism, or amateur psychoanalysis, and it isn’t going to give up its psychology to satisfy the so-called real psychologists, or real psychologists-in-training… Psychologists have no right to expect the public to understand our psychology because psychologists have never been able to define it for themselves.” (Benjamin 2001)

3. The Public’s Psychology • The public’s psychology has little to do with experimental psychology and more to do with psychology as a helping profession. • Experimental psychologists make up a small minority of our profession; the majority of psychologists work in applied settings. • Not surprisingly, then, the public’s psychology has always more closely resembled applied psychology, and is equated more with the psychological practice (the treatment of the mentally ill) of clinical psychologists and counselors than with experimental psychology.

4. Whose psychology is really psychology?and… What is psychology, really?

5. Beyond Leipzig… • The practice of psychology has existed as long as (arguably longer than) a science of psychology • The helping of persons in psychological distress has likely existed from the beginnings of human existence in some form • Yet, the history of psychology is designated as the history of “philosophy meets physiology” and not the history of treatment of individuals in psychological distress

6. Beyond Leipzig… • In the 18th and 19th centuries, “psychological” practice took place under the labels of phrenology, physiognomy, graphology, mesmerism, spiritualism, and mental healing. • However, no certification or licensure laws existed to define the training or practice of these individuals or to protect the public. • The assessment, diagnosis, and treatment of mental illness were “officially” the responsibility of psychiatrists. • Throughout the 19th century, psychiatrists (not psychologists) provided treatment at “lunatic asylums.”

7. So how did psychologists come to be involved in the care of the mentally ill?

8. French Experimental Psychology of the Subconscious • Throughout the 19th century, the French emphasized “la clinique,” or bedside teaching. • All experimental applications had to prove themselves before being considered psychologically legitimate. • Jean Martin Charcot, through the study and use of hypnosis, became convinced that hysteria was of psychological origins. • Pierre Janet, influenced by Charcot, used hypnosis to treat hysterical patients and developed a system of psychology similar to Freud’s psychoanalysis. • Alfred Binet also studied under Charcot; his interests included hypnotism and psychopathology, and later individual differences and mental testing

9. Freud and Psychoanalysis • Freud was a psychiatrist! • After studying with Charcot, Freud’s interests shifted from neurology to psychopathology. • Freud named his son after Charcot (Jean Martin). • Upon returning to Vienna, began work with Josef Brauer, whose patient Anna O. was cured by the cathartic method (the talking cure). • Combined influences of Charcot and Breuer to develop the free association method. • Contemporary psychotherapy is often cited to have developed out of Freud’s work • Freud is considered a founder of psychotherapy • Championed the right of non-medically trained individuals to practice psychoanalysis

10. Meanwhile, across the Atlantic… • The Boston School of Abnormal Psychology, consisting of Americans such as William James, Morton Prince, and James Mark Baldwin, is considered the center of development in scientific psychotherapy between 1880-1920. • James and Baldwin reviewed French materials on diseases of personality and translated them into English. • In 1885, the American Society for Psychical Research was founded for the purpose of investigating clairvoyance, telepathy, and hypnosis. • Results of these investigations led to concrete empirical evidence for the existence of altered states of consciousness and a scientific understanding of dreams, visions, hallucinations, and normal imagery.

11. From the 1870s-1890s, the laboratories of experimental physiology, neuropathology, and experimental psychology investigated functional disorders of nervous and mental disease and replicated hypnotic research from abroad • The results of these investigations justified the introduction of psychotherapeutic techniques based on dissociation, and patients were seen at Massachusetts General and the Boston City Hospital. • By the mid 1890s, a new graduate specialty known as Experimental Psychopathology had resulted from the fusion of physiological psychology with psychical research. • This contributed to the explosion of applied therapeutics just after 1900 and to the emergence of personality, abnormal and social psychology as distinct areas of academic specialization • In 1905, Morton Prince published The Dissociation of a Personality and in 1906 founded the Journal of Abnormal Psychology

12. The Emmanuel Movement • While serving as rector of the Emmanuel Church in Boston, Elwood Worcester (one of Wundt’s students) invited members who had moral or psychological problems to a meeting. • Almost 200 people appeared, convincing him of the need for a therapeutic program involving hypnosis and relaxation training. • In 1908, Worcester published Religion and Medicine: The Moral Control of Nervous Disorders • Both psychiatrists and psychologists criticized the Emmanuel Movement because it was not based in sound medicine or psychology • By 1910, medicine (psychiatrists) took control of psychotherapy.

13. The Mental Hygiene Movement • In 1908, Clifford Beers published A Mind That Found Itself, which was an expose of the horrible treatment he had received as a patient in a mental asylum. • Psychiatrist Adolf Meyer worked with Beers to establish the Committee for Mental Hygeine. • Meyer and Beers wanted to bring about societal changes that would lead to psychologically healthier lives and an improvement of conditions and treatment in mental hospitals. • Though ineffective in achieving its goals, their movement brought public attention to issues of mental health when psychiatrists and psychologists were re-evaluating their roles regarding the mentally ill.

14. Clark University Conference • Freud’s only visit to America – in 1909 he was invited to speak at Clark University’s 20th anniversary. • Freud is incorrectly credited with introducing psychotherapy to the United States at this time. • Nearly one-third of the attendees were engaged directly in the practice of psychotherapy of some kind (including William James and Adolf Meyer). • In fact, numerous doctoral psychologists and medical doctors throughout the country were engaged in psychotherapy, most of whom were not associated with psychoanalysis.

15. What about Lightner Witmer? • “Founder” of Clinical Psychology, though he studied and treated mentally defective children and his activities most closely resembled today’s School Psychology. • Established the first Psychological Clinic in 1896, where he treated children referred by parents and school teachers. • Did NOT practice (nor like) psychotherapy. • Founded the first journal in the field, The Psychological Clinic, and established the first training program in Clinical Psychology • Proposed that psychology could be of practical human benefit; his legacy was to define and enact a social role for psychology. • In 1907, formally proposed a new helping profession independent of education and medicine, to be called Clinical Psychology.

16. Struggles with Psychiatry • Psychiatry and Psychology have been adversaries from the beginning, and have competed for rights to the treatment of the mentally ill. • William James opposed MA state legislature that attempted to limit the practice of “mental therapy” to licensed physicians. • In 1917, the Psychiatric Community called for an end to clinical psychologists’ practice of “undertaking to pass judgment upon the mental conditions of the sick, defective or otherwise abnormal persons.” • The practice of (clinical) psychology between the two world wars was essentially about assessment, largely administration and scoring. • Psychiatrists demanded that interpretation, diagnosis, and recommendations following from assessment were their domain.

17. Victory for Psychologists • In 1941, the National Research Council instructed the Emergency Committee on Psychology to explore ways of organizing psychology for the national good. • Robert Yerkes was charged with planning for the development of the science and profession of psychology after the war. • The VA and the United States Public Health Service funded psychology departments to train clinical psychologists and established funded practica and internship experiences. • The modern profession of clinical psychology was arguably organized by the federal government seeking to meet a wartime and post-wartime need. • By the end of WWII, psychotherapy was viewed by the public (and the federal government) as a legitimate part of psychological practice. • In 1953, George Goldman established a postdoctoral program in psychotherapy at Adelphi University. • A lawsuit was brought against him for practicing medicine without a license, but he prevailed because the practice of medicine was not found to be a medical specialty.

18. Defining Psychology… • The next step for psychologists was to establish standards for their education and training, as well as for certification and licensure. • Controversy continues to exist over the proper core curricula and training: “Two very interesting conclusions appeared from the conference discussions. First, there is a common core. Second, we should not specify what that is lest we in any way discourage imaginative innovation in graduate training” (Roe, et al., 1958, p. 44). “The responsibility for specifying core content of graduate education for all psychologists rests with departments and schools of psychology” (Bickmann & Ellis, 1990, p. 121)

19. Blurred Boundaries • Psychologists continue to compete with Psychiatrists, now advocating for prescription privileges. • Psychologists also compete with Master’s level counselors and social workers in providing treatment to the mentally ill.

20. References Abt, L.E. (1992). Clinical psychology and the emergence of psychotherapy. Professional Psychology: Research and Practice, 23, 176-168. Benjamin, L.T. (1986). Why don’t they understand us? A history of psychology’s public image. American Psychologist, 41, 941-946. Benjamin, L.T. (1996). Lightner Witmer’s legacy to American psychology. American Psychologist, 51, 235-236. Benjamin, L.T. (2001). American psychology’s struggles with its curriculum: Should a thousand flowers bloom? American Psychologist, 56: 735-742. Benjamin, L.T. (2003). Why can’t psychology get a stamp? Journal of Applied Psychoanalytic Studies, 5, 443-454. Benjamin, L.T. (2005). A history of clinical psychology as a profession in America (and a glimpse at its future). Annual Review of Clinical Psychology, 1, 1-30.

21. References McReynolds, P. (1987). Lightner Witmer: Little known founder of clinical psychology. American Psychologist, 42, 849-858. McReynolds, P. (1996). Lightner Witmer: A centennial tribute. American Psychologist, 51, 237-240. Resnick, R.J. (1997). A brief history of practice – Expanded. American Psychologist, 52, 463-468. Routh, D.K. (1996). Lighner Witmer and the first 100 years of clinical psychology. American Psychologist, 51, 244-247. Taylor, E. (2000). Psychotherapeutics and the problematic origins or clinical psychology in America. American Psychologist, 55, 1029-1033. Thorne, B.M., & Henley, T.B. (2001). Connections in the History and Systems of Psychology, (2nd ed.). New York: Houghton Mifflin Company. Witmer, L. (1907). Clinical psychology. The Psychological Clinic, 1, 1-9.