Abstract
Of all the health care specialties, the field of mental health is among the most interdisciplinary, both in intellectual and professional terms. The complex nature of mental disease, encompassing as it does biological, psychological, and social factors, necessarily invites a variety of etiological and therapeutic approaches. Moreover, the range of mental disorders now believed to benefit by treatment is extremely broad, ranging from the most severe psychoses to the less debilitating “problems of living.” To meet these diverse mental health needs, there has grown up a complex system of treatment, ranging from private practice to acute care hospitals, staffed by professional workers from varied disciplines. By the mid-1980s, there were almost 170,000 mental health professionals in the United States, 22% of whom were psychiatrists, 20% psychologists, 22% were psychiatric nurses, and 36% clinical social workers. By the late 1990s, available statistics suggest that of an estimated 245,000 professionals, 16% were psychiatrists, 32% were clinical psychologists, 13% were mental health nurses, and 39% were clinical social workers.1
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Notes and References
The 1980 statistics on psychiatrists, psychologists, and social workers come from Daniel Goleman, “Social Workers Vault into a Leading Role in Psychotherapy,” New York Times 30 April 1985, Section III, p. 1. Data on nurses come from National Data Book 1980, Publication No. ADM 80-938 (Washington, DC: Government Printing Office, 1980), pp. 71–72. The 1999 data on psychiatry, clinical psychology, and psychiatric social work come from R.M. Scheffler and P.B. Kirby, “The Occupational Transformation of the Mental health System.” Health Affairs 22:5 (2003): 177–188. SAMHSA, Mental Health 2000 Appendix D gives an estimate of 32,648 mental health nurse specialists.
Bertram S. Brown, “The Federal Government and Psychiatric Education.” New Dimensions in Mental Health, Publication No. ADM 77-511 (Washington, DC: Government Printing Office, 1977), p. 6.
In order to keep this chapter to a manageable size, I have chosen to focus only on the four core disciplines recognized by the N.I.M.H. when it began aggressively funding professional training programs in the late 1940s. Yet I recognize that there are other important providers of mental health care today. Recent studies document that primary care physicians treat many more people suffering from mental disorders than do specialists in mental health care. In addition, since World War II, the pastoral care movement has greatly increased the clergy’s involvement in counseling and therapy. In mental hospitals, occupational therapists play an important role in treatment. Last but not least, nonprofessionals now hold a majority of staff positions in mental health clinics and hospitals. See Darrel A. Regier, et al., “The De Facto U.S. Mental Health Services System,” Archives of General Psychiatry 35(1978): 685–693; John C. Burnham, “Psychology and Counseling: Convergence into a Profession,” in The Professions in American History, ed. Nathan O. Hatch (Notre Dame, Indiana: Notre Dame Press, 1988), 181–198, esp. pp. 184–185; and Michael Gershon and Henry B. Biller, The Other Helpers: Paraprofessional and Nonprofessionals in Mental Health (Lexington, MA: D.C. Heath and Co., 1977).
My approach in this chapter is heavily indebted to the work of sociologist Andrew Abbott, especially his book, The System of Professions: An Essay on the Division of Expert Labor (Chicago: University of Chicago Press, 1988). When I first wrote this chapter ten years ago, there were surprisingly few historical accounts of the mental health team concept. Since then, a number of articles and books have addressed various aspects of the interprofessional relations between psychiatry and social work and psychiatry and psychology, which I have used to revise my argument, and acknowledge in the notes that follow.
For an overview of nineteenth-century psychiatry, see Gerald Grob’, Mental Institutions In America (New York: The Free Press, 1973). The phrase “one man rule” is explained in Nancy Tomes. A Generous Confidence: Thomas Story Kirkbride and the Art of Asylum-Keeping. 1840–1883 (New York: Cambridge University Press, 1984), esp. pp. 146–148.
For overviews of dynamic psychiatry and its interdisciplinary tendencies, see Gerald Grob, Mental Illness and American Society 1875–1940 (Princeton: Princeton University Press, 1983); John Burnham, “Psychiatry, Psychology, and the Progressive Movement,” American Quarterly 12 (1960): 457–465; Norman Dain, Clifford Beers (Pittsburgh, PA; University of Pittsburgh Press, 1980); Jacques Quen, “Asylum Psychiatry, Neurology, Social Work, and Mental Hygiene,” Journal of the History of Behavioral Sciences 13 (1977): 3–11; and Barbara Sicherman, “The Quest for Mental Health in America, 1880–1917,” unpublished Ph.D. dissertation, Columbia University, 1967. For three excellent studies of the institutions born of the “new” psychiatry, see Lawrence Friedman, Menninger: The Family and the Clinic (New York: Knopf, 1990); Margo Horn, Before It’s Too Late: The Child Guidance Movement in the United States, 1922–1945 (Philadelphia: Temple University Press, 1989); Elizabeth Lunbeck, The Psychiatric Persuasion: Knowledge, Gender and Power in Modern America (Princeton, NJ: Princeton University Press, 1994): and Kathleen W. Jones, Taming the Troublesome Child: American Families. Child Guidance, and the Limits of Psychiatric Authority (Cambridge, MA: Harvard University Press, 1999).
For overviews of the emergence of the professional social sciences, see Mary O. Furner, Advocacy and Objectivity (Lexington, KY: University of Kentucky Press, 1975); Thomas Haskell, Emergence of Professional Social Science (Chicago: University of Illinois Press, 1977); and Dorothy Ross, The Origins of American Social Science (New York: Cambridge University Press, 1991).
For overviews of the nature/nurture debate, see Hamilton Cravens, The Triumph of Evolution (Univ. of PA Press, 1978) and Carl N. Degler, In Search of Human Nature (New York: Oxford University Press, 1991). See also the works on eugenics cited in the previous footnote.
For a general overview of the early history of social work, the best single volume remains Roy Lubove, The Professional Altruist (New York: Athaneum, 1973 [reprint of 1965 ed.]).
Lois French, Psychiatric Social Work (New York: The Commonwealth Fund/Oxford University Press, 1940), pp. 32–45.
Mary Jarrett, “Psychiatric Social Work,” Mental Hygiene 2 (1918): 289.
Mary Jarrett and Elmer E. Southard, The Kingdom of Evils (New York: Macmillan, 1922); French, Psychiatric Social Work, pp. 246–247. For two recent historical assessments of Jarrett’s career, see Penina Glazer and Miriam Slater. Unequal Colleagues: The Entrance of Women into the Professions, 1890–1940 (New Brunswick, NJ: Rutgers University Press, 1987), esp. chapter five; and Lunbeck, The Psychiatric Persuasion, esp. pp. 39–42.
The literature on the early history of psychology is immense. In preparing this chapter, I found the following books most useful: Edwin G. Boring, A History of Experimental Psychology, second ed. (New York: Appleton-Century Crofts, 1950), esp. pp. 505–583; Hamilton Cravens, The Triumph of Evolution (Philadelphia: University of Pennsylvania Press, 1978); Dorothy Ross, G. Stanley Hall: The Psychologist as Prophet (Chicago: University of Chicago Press, 1972): John M. Reisman, A History of Clinical Psychology second ed. (New York: Hemisphere Publishing Corp., 1991). On the history of mental testing, see Michael M. Sokol, ed. Psychological Testing and American Society, 1880–1930 (New Brunswick, NJ: Rutgers University Press, 1987). On the eugenics movement, see Mark Haller, Eugenics: Hereditarian Attitudes in American Thought (New Brunswick, NJ: Rutgers University Press, 1984); and Daniel Kevles, In the Name of Eugenics (Berkeley, CA: University of California Press, 1985).
On Yerkes’s work at the Boston psychopathic, see Lunbeck, The Psychiatric Persuasion, esp. pp. 33–34; James Reed, “Robert Yerkes and the Mental Testing Movement,” in Sokol, Psychological Testing and American Society, pp. 75–94; and Richard T. Von Mayrhauser, “Manager, Medic, and Mediator,” ibid, pp. 128–157.
Herbert H. Lou, Juvenile Courts in the United States (New York: Arno Press, 1972 reprint of 1927 ed.).
William Healy and Augusta Bronner, “The Child Guidance Center: Birth and Growth of an Idea,” in Orthopsychiatry 1923–1948, ed. Lawson Lowrey and Victoria Sloan (Menasha WI: The American Orthopsychiatry Association, 1948), pp. 14–49; George Gardner, “William Healy, 1869–1963,” Journal of the American Academy of Child Psychiatry 11 (1972), 1–20; John Burnham, “Augusta Bronner,” in Notable American Women, ed. Barbara Sicherman and Carol H. Green (Cambridge, MA: Harvard University Press, 1980), pp. 108–110.
For a sense of how the team’s protocol worked, see the Judge Baker Foundation, Case Studies 1–15 (Boston: The Judge Baker Foundation, 1922–1923.) Other clinics developed similar working styles, but the Judge Baker reports were probably the most widely known exemplar of the team method in the 1910s and 1920s. See Jones, Taming the Troublesome Child, for an excellent history of the Judge Baker clinic.
See Lunbeck, The Psychiatric Persuasion, for an insightful discussion of the new “metric” approach to diagnosis.
John Burnham, “The Struggle Between Physicians and Paramedical Personnel in American Psychiatry, 1917–1941,” Journal of the History of Medicine 29 (1974): 93–106, esp. pp. 100–101; Grob, Mental Illness and American Society, p. 250.
French, Psychiatric Social Work. pp. 51–56. 246–340; Daniel O’Keefe, “Psychiatric Social Work,” The Social Work Yearbook 14 (1960): 451–452.
Recent work on the World War I testing experiments has revised the traditional view that it represented a great triumph of a newly united profession. As Richard T. Von Mayrhauser has shown, the group of psychologists led by Robert Yerkes preferred working more closely with medicine and psychiatry, and devising tests to eliminate the mentally unfit. Another group, led by Walter Dill Scott, an academic psychologist with strong ties to business and advertising, wanted to focus more on leadership and aptitude testing. Von Mayrhauser shows that the military actually used both kinds of tests, and found those developed by Scott to be more useful. However, from the standpoint of the future development of clinical psychology, Yerkes’s conception of the psychologist/psychiatrist collaboration was the more prescient. See Richard T. Von Mayrhauser, “Manager, Medic, and Mediator,” in Sokol, Psychological Testing and American Society, pp. 128–157. See also Reed’s chapter in the same volume, esp. pp.75–76. 83–85. Reisman, A History of Clinical Psychology, pp. 96–98, discusses Woodworth’s Psychoneurotic Inventory.
Thomas Camfield, “Psychologists at War: The History of American Psychology and the First World War,” Ph.D. dissertation, University of Texas at Austin, 1969; Daniel Kevles, “Testing the Army’s Intelligence,” Journal of American History 55 (1968), 565–581. See also articles cited in the previous note.
Grob, Mental Illness and American Society, pp. 251–258; Alice Bryan and E.G. Boring. “Women in American Psychology: Prolegomenon,” Psychological Bulletin 41 (1944), 447–454.
For a particularly insightful discussion of the gender issue as it concerned psychiatry and social work, see Lunbeck, The Psychiatric Persuasion, esp. pp. 25–45.
On the general history of nursing, see Susan Reverby, Ordered to Care (New York: Cambridge University Press, 1987). On the early history of psychiatric nursing, see Olga M. Church, “Emergence of Training Programs for Asylum Nursing at the Turn of the Century,” in Nursing History, ed. Peggy Chin [Advances in Nursing science 7:2 (January 1985), 35–46.] To my knowledge, the only full-length study of the history of psychiatric nursing is Olga Church, “That Noble Reform: The Emergence of Psychiatric Nursing in the United States, 1882–1963,” unpublished doctoral dissertation, University of Illinois — Chicago, 1982. Statistics on the number of nursing schools come from Hildegard E. Peplau, “Some Reflections on Earlier Days in Psychiatric Nursing,” Journal of Psychosocial Nursing and Mental Health Services (August 1982), 20 (8): 17. See also her paper, “Historical Development of Psychiatric Nursing: A Preliminary Statement of Some Facts and Trends,” in A Collection of Classics in Psychiatric Nursing Literature, ed. Shirley A. Smoyak and Sheila Rouslin, (Thorofare, NJ: Charles B. Slack, Inc., 1982), pp. 10–46. This is a useful compilation of papers illustrating the evolution of the field.
Leonard V. Stevens and Doyle O. Henrie, “A History of Psychiatric Nursing,” Bulletin of the Menninger Clinic 30 (1966), 32–38; Nancy Tomes, “The Silent Battle: Nurse Registration in New York State, 1903–1920,” in Nursing History: New Perspectives, New Possibilities, ed. Ellen Condliffe Lagemann (New York: Teachers College Press, 1983), pp. 114–115.
V._May McDonald, “Psychiatry for Nurses,” American Journal of Nursing 20 (1920): 827. On Taylor’s career, see Kathleen C. Buckwalter and Olga M. Church, “Euphemia Jane Taylor: An Uncommon Psychiatric Nurse,” Perspectives in Psychiatric Care 17 (3) (1979): 125–131. On the superintendents’ reservations about trained nurses, see also Samuel Hamilton, “The History of American Mental Hospitals,” in One Hundred Years of American Psychiatry, ed. J.K. Hall (New York: Columbia University Press, 1944), p. 130. For a good example of the social workers’ prejudices toward nurses, see Jessie Taft, “Qualifications of the Psychiatric Social Worker,” National Conference of Social Work Proceedings 46 (1919): 594–599. The fact that several of the most prominent exponents of dynamic psychiatry, including Adolf Meyer and Harry Solomon, were married to psychiatric social workers surely contributed to the preference of social worker over nurse. See Dain, Clifford Beers, p. 112; and Lunbeck, The Psychiatric Persuasion, p. 44. An exchange of letters between Effie Taylor and Adolf Meyer in April and May of 1920 makes clear the constraints nurses experienced in the psychopathic hospital; among other problems, Taylor complained bitterly about the physicians’ refusal to allow nurses to look at the patient’s records, a privilege evidently extended more freely to social workers. The letters are preserved in the Adolf Meyer Papers, Series 1, Johns Hopkins University. See also Grob, Mental Illness and American Society, pp. 244–245.
Andrew Abbott estimates that by 1930, at least 31% of all American psychiatrists were in private practice. See “The Evolution of American Psychiatry, 1880–1930,” unpublished Ph.D. dissertation, University of Chicago, 1982, p. 148. In a private correspondence with the author, Abbott also points out that the 48% in hospital practice included many young physicians there to acquire a few years of experience before setting up a private practice. Burnham, “The Struggle Between Physicians and Paramedical Personnel,” p. 94, states that by 1930 almost half of all psychiatrists were in private practice. For an interesting discussion of early eclectic psychotherapy in private practice, see George Gifford, “George Arthur Waterman, 1872–1960, and Office Psychiatry.” in Psychoanalysis, Psychotherapy, and the New England Medical Scene, 1894–1944, pp. 227–241.
Statistics on the number of clinics are taken from French, Psychiatric Social Work, pp. 60, 111. On the role of foundations in the interwar period, see Margo Horn, Before It’s Too Late.
In 1927, Maida Solomon stated that roughly half of all social workers were in hospital work, including private, public, and V.A. institutions. That percentage declined rapidly over the next decade as clinic facilities expanded. Among A.A.P.S.W. members, who represented the most elite psychiatric social workers. Lois French found a decline of numbers engaged in hospital work from 76% in 1920 to 21% in 1937. Maida Solomon. “Annual Address.” Journal of Abnormal and Social Psychology 21 (1927): 422. French. Psychiatric Social Work, p. 81. I have found no comparable data for psychologists in the interwar period, but as of 1949, the Group of the Advancement of Psychiatry, reported that only 3% of the American Psychological Association’s membership worked in city or state mental hospitals. Prior to the 1950s, psychologists employed by mental hospitals appear to have worked primarily as diagnosticians and researchers. See G.A.P., “Statistics Pertinent to Psychiatry in the United States,” Report No. 7 (March 1949), p. 6.
This characterization of private practice and clinic work as more “desirable” does not represent my own judgment, but rather how they were viewed by professional groups at the time. Social workers’ preferences for nonpsychotic, noninstitutionalized patients are clearly spelled out in Margaret Hagan, “Psychiatric Social Work in Mental Hospitals.” Education for Social Work [Proceedings of the Dartmouth Conference of the AAPSW] (New York: A.A.P.S.W., 1950). pp. 29–30. Gerald Grob makes a similar observation about both psychiatry and social work in Mental Illness and American Society, pp. 143, 257.
Burnham, “The Struggle Between Physicians and Paramedical Personnel,” p. 102; Grob. Mental Illness and American Society, pp. 266–316; Jack Pressman, Last Resort: Psychosurgery and the Problem of Mental Disorder. 1935–1955, forthcoming, Cambridge University Press.
Burnham, “The Struggle Between Physicians and Paramedical Personnel,” esp. pp. 104–105; Grob, Mental Illness and American Society, esp. pp. 266–287.
John C. Burnham, “The Influence of Psychoanalysis on American Culture,” in American Psychoanalysis: Origins and Development, ed. Jacques Quen and Eric T. Carlson (New York: Brunner/Mazel, 1973), pp. 52–72.
On the controversy over lay analysts, see Clarence Obendorf, A History of Psychoanalysis in America (New York: Grune and Stratton, 1953), pp. 174–176, 182.
On the Rockefeller Foundation’s early relations with the N.C.M.H., see Grob, esp. pp. 146–147, 158–159. For a good discussion of the Commonwealth Fund’s influence, see Margo Horn, Before It’s Too Late.
French, Psychiatric Social Work, pp. 45–46. As of 1933, 50% of the A.A.P.S.W membership had advanced degrees, mostly the M.A.; only 7% of psychiatric social workers had no college training at all. See French, p. 99. On the general history of social work in this period, see John Ehrenreich, The Altruistic Imagination: A History of Social Work and Social Policy in the United States (Ithaca: Cornell University Press, 1985), and Daniel Walkowitz, Working With Class: Social Workers and the Politics of Middle-Class Identity (Chapel Hill: University of North Carolina Press, 1999).
Ibid., p. 210. For a good summary of trends in psychiatric social work, see Horn, Before It’s Too Late, esp. pp. 100–104.
Ibid. pp. 202–241, provides a good overview of the changing conception of case work. For a more detailed discussion of the new techniques, see “A Symposium on Attitude Therapy,” Newsletter of the A.A.P.S.W 5(1935), 1–14. For an insightful discussion of the mother/social worker identification, see Jones, Taming the Troublesome Child.
Lubove, The Professional Altruist, pp. 113–117; Ehrenreich. The Altruistic Imagination, pp. 123–138.
Grob, Mental Illness and American Society, pp. 254–256. As Gob points out, the psychiatric social workers longed for a closer relationship with psychiatrists, but the latter showed little interest in collaboration.
Lois French observed that so long as they held the supervisory role, psychiatrists essentially controlled how far the social workers could expand their therapeutic responsibilities. See French, Psychiatric Social Workers, pp. 132–134. On psychiatry’s overall attitude toward interwar social work, see Grob, Mental Illness and American Society, pp. 254–256. On the frictions between social workers and psychiatrists, see Lunbeck. The Psychiatric Persuasion, esp. pp. 39, 158–159: Burnham. “The Influence of Psychoanalysis,” p. 202. One major source of conflict was the mental hospital superintendents’ refusal to support higher educational standards for psychiatric social workers in hospital practice. A small number of psychiatric social workers did go into private practice, but only in conjunction with a psychiatrist, for whom they performed the traditional services. See Solomon, “Annual Address,” p. 422; French, Psychiatric Social Work, pp. 73–74.
In an insightful article on social work in the 1920s, Daniel Walkowitz concluded, “female social workers created a variant of the male professional: the Professional Woman, a practitioner who adopted the ‘male’ ethos of the professional worker, even while continuing, with evident discomfort, to defer to her male colleagues and bosses.” See Daniel J. Walkowitz, “The Making of a Professional Identity: Social Workers in the 1920s.” American Historical Review 95(4) (October 1990): 1051–1075. Quote is on p. 1075. On the gender issue, see also Grob, Mental Illness and American Society, pp. 254–256; and Lunbeck, The Psychiatric Persuasion, esp. pp. 35–45.
Katharine M. Wickman. “Psychiatric Social Work and Clinical Psychiatry,” Newsletter of the A.A.P.S.W. 9(1939), On the diffusion of casework treatment, see French, Psychiatric Social Work, pp. 80, 82. On the growing popularity of psychiatric perspectives in social work generally, see Lubove, The Professional Altruist, pp. 85–117; Ehrenreich. The Altruistic Imagination, pp. 71–77, 123–138.
Simon H. Tulchin. “Behavior and Personality Problems in Children: The Psychologist,” American Journal of Orthopsychiatry 1 (1930): 46. On clinical psychologists in child guidance clinics, see Horn, Before It’s Too Late, esp. pp. 104–105.
Reisman, History of Clinical Psychology, pp. 178–180; Helen D. Sargent and Martin Mayman. “Clinical Psychology,” in American Handbook of Psychiatry, ed. Silvano Arieti, 3 vols. (New York: Basic Books, 1959), II: 1714. Psychologists working in mental hospitals, chief among them Harriet Babcock at Bellevue, Frederick Lyman Wells at the Boston Psychopathic, and Grace Kent at Worcester, pioneered the adaptation of traditional mental tests for the clinical evaluation of psychotic adult patients.
Reisman, History of Clinical Psychology, pp. 139–142, 183–186; Julian Rotter, “A Historical and Theoretical Analysis of Some Broad Trends in Clinical Psychology,” in The Clinical Psychologist, ed. Bernard Lubin and Eugene E. Leavitt (Chicago: Aldine Publishing Co., 1967), pp. 23–52; Robert Watson, “A Brief History of Clinical Psychology,” Psychological Bulletin 50 (1953): 334–335.
William C. Menninger, “The Relationship of Clinical Psychology and Psychiatry,” American Psychologist 5 (1950): 7.
Frederick Lyman Wells, Mental Tests in Clinical Practice (New York: World Book Co., 1927), p. 300.
Horn, Before It’s Too Late, pp. 136–139. For a good account of Watson’s career and the origins of behaviorism, see John O’Donnell, The Origins of Behaviorism: American Psychology 1870–1920 (New York: New York University Press, 1985). The interest in habit formation came from many directions, (including adds meyer); and not solely experimental psychology; my point here is that the new psychology invoked laboratory research, in addition to clinical experience, as a guide to treatment strategies. Since psychiatrists rarely did laboratory research during this period; the authority of the experimental tradition belonged solely to psychologists then.
Reisman, History of Clinical Psychology, pp. 202–207; Rotter, “A Historical and Theoretical Analysis,” pp. 39–40. In her study of the Commonwealth Fund clinics, Horn suggests that the tester to therapist transition remained more a potential than actual threat to child psychiatry in the 1930s. See Horn, Before It’s Too Late, pp. 104–105.
For an excellent discussion of psychology in the 1920s, see John C. Burnham, “The New Psychology,” in Change and Continuity in Twentieth Century America: the 1920s, ed. John Braeman, Robert Bremner, and David Brody (Columbus, Ohio: Ohio State University Press, 1968), pp. 351–398.
T.N. Weisenberg to Adolf Meyer, May 12, 1931, reprinted in The Inner World of American Psychiatry: Selected Correspondence, ed. Gerald Grob (New Brunswick, NJ: Rutgers University Press, 1985), p. 243. The same year Louis Casamajor made a similar complaint to Meyer about the “vigorous propaganda” of clinical psychologists; see Ibid, p. 241. On the role of the Great Depression in eroding psychiatry’s tolerance for psychology, see Burnham, “The Struggle Between Physicians and Paramedical Personnel,” pp. 102–103.
Psychologist H. Meltzer noted that when he went into private practice in 1934, after six years in a child guidance clinic, he knew of only one other Ph.D. in psychology who was in private ate practice. Of course,, many individuals with little or nor formal training called themselves psychologists in this period and cultivated a paying clientele. H. Meltzer, “The Place of Private Practice in Professional Psychology,” in The Clinical Psychologist, ed. Lubin and Leavitt, p. 214. The statistics on women in clinical work are given in Donald S. Napoli, Architects of Adjustment (Port Washington, NY: Kennikat Press, 1981), p. 56.
James G. Miller, “Clinical Psychology in the Veterans Administration,” American Psychologist 1 (1946): 181. For an overview of clinical psychology’s struggles with the larger profession, see Robert Watson, “A Brief History of Clinical Psychology,” Psychological Bulletin 50 (1953): 334–335; and Reisman, History of Clinical Psychology, pp. 116, 160–161.
Reisman, History of Clinical Psychology pp. 210–212.
Olga M. Church and Kathleen C. Buckwalter, “Harriet Bailey, Psychiatric Nurse Pioneer,” Perspectives in Psychiatric Care 18(2) (1980): 62–66. Bailey’s text, Nursing Mental Diseases, was published in 1920, had four revisions before 1939, and finally went out of print in 1954. On turnover and staffing problems, see Grob, From Asylum to Community, p. 118. For interwar conditions, see also Peplau, “Some Reflections.” esp. p. 19. The Menninger Clinic seems to be the exception to the rule that dynamic psychiatrists favored social workers over nurses in the new psychiatric institutions of the interwar period. Anticipating the 1950s interest in milieu therapy. Will Menninger took a special interest in milieu therapy, and cultivated nurses as important agents in its execution during the 1930s. The fact that he had a lengthy affair with the hospital’s Superintendent of Nursing, Isabel Erickson, may have contributed to his patronage of the discipline. See Friedman, Menninger, pp. 61–62, 70–71, 75–76, 83.
For a good overview of World War II developments, see Gerald Grob, From Asylum to Community: Mental Health Policy in Modern America, (Princeton, NJ: Princeton University Press, 1991), pp. 5–23. Statistics on the percentage of recruits rejected on psychiatric grounds come from Jeanne L. Brand, “The National Mental Health Act of 1946: A Retrospect,” Bulletin of the History of Medicine 39 (1965): 236. On the importance of WW2 to psychology, see James Capshew, Psychologists on the March: Science, Practice and Professional Identity in America, 1929–1969 (New York: Cambridge University Press, 1999.)
Brand, “The National Mental Health Act,” p. 236; Reisman, History of Clinical Psychology, p. 249.
Brand, “The National Mental Health Act of 1946,” p. 236; Reisman, A History of Clinical Psychology, pp. 225–226, 247–249; Napoli, Architects of Adjustment, pp. 86–106; Saul Hofstein, “Differences in Military Psychiatric Case Work Practice,” Newsletter of the A.A.P.S.W 16 (1946/47), 3; Daniel O’Keefe, “Psychiatric Social Work,” Social Work Yearbook 14 (1960): 452.
Miller, “Clinical Psychology in the V.A.,” p. 182. For the larger context of post-W.W. II developments, see Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982), p. 360.
Daniel Blain, “The Psychiatrist and the Psychologist,” Journal of Clinical Psychology 3 (1947): 8–9.
Miller, “Clinical Psychology in the V.A.,” p. 181. For a good overview of the V.A.’s impact on clinical psychology, see E. Lowell Kelly, “Clinical Psychology: The Post-War Decade,” in Current Trends on Psychological Theory, ed. Wayne Dennis et al. (Pittsburgh: University of Pittsburgh Press, 1961).
Samuel Kutash, “The Psychologist’s Role in Clinical Practice,” Journal of Clinical Psychology 3 (1947): 327. See also Urie Bronfenbrenner, “Research Planning in Neuropsychiatry and Clinical Psychology in the Veterans Administration.” Ibid, 33–38.
Kelly, “Clinical Psychology.” pp. 34–35; see also Reisman, History of Clinical Psychology, pp. 249–251.
Miller, “Clinical Psychology,” p. 185.
Dael Wolfe. “The Reorganized American Psychological Association,” American Psychologist 1 (1946): 3–6; Noble H. Kelly et al., “The Meaning of the A.B.E.P.P. Diploma,” in The Clinical Psychologist, ed. Lubin and Leavitt, p. 340; and Reisman, History of Clinical Psychology, pp. 247–253. Note that in drawing up their “Recommended Graduate Training Program in Clinical Psychology,” better known as the Shakow Report, in 1947, the American Psychological Association’s committee on clinical training was careful to insist on maintaining a strong research component.
Brand, “The National Mental Health Act,” 236–244; The informal funding ratio is discussed in Brown. “The Federal Government and Psychiatric Education,” pp. 2–3. Grob provides an insightful account of the early N.I.M.H. and the reasons’s for Felix’s receptivity to interdisciplinary perspectives in From Asylum to Community, pp. 44–69.
Hildegard E. Peplau, “Principles of Psychiatric Nursing,” in American Handbook of Psychiatry 11: 1841–1842; Stevens and Henrie, “History of Psychiatric Nursing,” p. 34. Note that as of 1949, a literature review turned up not a single reference to a nurse as part of the mental health team. See Dorothy McLaughlin, “The Contribution of the Psychiatric Nurse to the Clinical Team,” in Education for Psychiatric Social Work, p. 55.
Brown, “The Federal Government and Psychiatric Education,” p. 2; Burnham, “The Influence of Psychoanalysis,” pp. 57–62. For statistics on residencies, see Grob, From Asylum to Community, p. 98.
This division of labor is clearly articulated in Miller, “Clinical Psychology,” pp. 182, 184. See also Kutash, “THe Psychologist’s Role,” p. 326.
Menninger, “The Relationship,” p. 13: George Albee, Mental Health Manpower Trends [Joint Commission on Mental Illness and Mental Health, Monograph Series No. 3] (New York: Basic Books, 1959) pp. 57–61, 79–84, 92–99; Brown, “The Federal Government and Psychiatric Education,” pp. 5, 11–12; Henry Davidson, “The Double Life of American Psychiatry,” in New Aspects of the Mental Health Services, ed. Hugh Freeman and James Farndale (New York: Pergamon Press, 1967), pp. 340–341. By 1950, approximately 60% of all psychiatrists had office-based practices; in 1956, a survey found only 17% of the American Psychiatric Association’s membership practiced in V.A. or state mental hospitals. For an excellent overview of psychiatry’s evolution in the post-W.W. II period, see Grob, From Asylum to Community.
See, for example, Virginia Bellsmith. “Social Work,” American Handbook of Psychiatry, II: 1870, 1873. See also G.A.P., “The Psychiatric Social Worker in the Psychiatric Hospital,” Report No. 2 (January, 1948), p. 10. For a fuller account of these trends, see Grob, From Asylum to Community, pp. 115–117.
Editorial, Newsletter of the A.A.P.S.W. 13 (1943/44), 1; Luther Woodward, “Psychiatric Social Work in the National Mental Health Program,” Ibid, 15 (1945/46), 70. Of course, group therapy was not the sole province of social workers. Both psychiatrists and psychologists experimented with group therapy. See Reisman, A History of Clinical Psychology, pp. 203–204, 240.
Helen Perlman, “Social Work in Psychiatric Settings,” American Handbook of Psychiatry, ed. Silvano Arieti, 2nd ed., 6 vols. (New York: Basic Books, 1975), V: 676–677. See also the interesting discussions in Ruth Smalley, “Psychiatric Social Worker or Psychotherapist?” Newsletter of the A.A.P.S.W. 16 (1947), 107–110; and Joseph J. Michaels and Eleanor Gay, “Psychiatric Casework and Its Relationship to Psychotherapy,” Journal of Psychiatric Social Work 17 (1948): 123–129.
Peplau, “Principles,” p. 1847; Stevens and Henrie, “History of Psychiatric Nursing,” p. 37. For contemporary views, see also G.A.P., “The Psychiatric Nurse in the Mental Hospital,” Report No. 22 (May 1952), p.11; and Marguerite H. Holmes, “Psychiatric Mental Health Nursing,” in American Handbook of Psychiatry 2nd ed. V: 654, 657. For a retrospective of developments in education, see Trudy T. Rosenthal, “University Psychiatric Nursing Education in the United States: 1917–1956,” Issues in Mental Health Nursing 6 (1984): 21–33.
Alfred H. Stanton and Morris Schwartz, The Mental Hospital (New York: Basic Books, 1954), pp. 105–106; Albee, Mental Health Manpower Trends, pp. 176–180; and “The Inventory of Psychiatric Nurses,” American Journal of Nursing 51 (5) (May 1951): 309–312. See also Grob, From Asylum to Community, pp. 118–120.
Grob, From Asylum to Society, pp. 106–113.
For a discussion of psychiatric epidemiology, see Grob, From Asylum to Community, pp. 101–102.
For an insightful history of the Menninger Clinic in the 1940s, and Rapaport’s career there, see Friedman, Menninger, pp. 167–176, 224–253. For a good overview of Rapaport’s work, see Robert R. Holt, “Editor’s Preface,” in Diagnostic Psychological Testing David Rapaport, Merton M. Gill, and Roy Schafer, rev. ed., (New York: International Universities Press, Inc., 1968), 1–44. See also Reisman, History of Clinical Psychology, pp. 225–231.
Reisman, History of Clinical Psychology, pp. 251–252, 292–293; Napoli, Architects of Adjustment, p. 148; Group for the Advancement of Psychiatry, Report No. 7, p. 6; Kelly, “Clinical Psychology,” p. 36; Bernard Lubin “Survey of Psychotherapy Training and Activities of Psychologists,” in The Clinical Psychologist, ed. Lubin and Leavitt, p. 133; Meltzer, “The Place of Private Practice,” p. 216.
Group for the Advancement of Psychiatry, “The Relation of Clinical Psychology to Psychiatry,” Report No. 10, (July 1949), p. 3. See also Menninger, “The Relationship,” esp. pp. 9–13.
Kelly, “Clinical Psychology,” pp. 41–42. (Parens in original.)
Ibid, p. 48: Rotter, “A Historical and Theoretical Analysis,” p. 42; Reisman, History of Clinical Psychology, pp. 242–245, 285–286. Lubin, “Survey,” p. 133, gives data on the number of Rogerians in the field.
Jane D. Hildreth, “Psychology’s Relations with Psychiatry: A Summary Report,” in The Clinical Psychologist, ed. Lubin and Leavitt, pp. 253–258.
Albert Deutsch, The Shame of the States (New York: Harcourt Brace, 1948). Stanton and Schwartz, The Mental Hospital, is a good example of the academic critiques done in the 1950s. On the Joint Commission, see its Final Report, published as Jack Ewart, ed., Action for Mental Health (New York: Basic Books, 1961), and Robert H. Felix, Mental Illness: Progress and Prospects (New York: Columbia University Press, 1967), pp. 54–80.
Ewart, ed., Action for Mental Health, p. 248.
National Institute of Mental Health, Community Mental Health Centers DHEW Pub. No. ADM 78-677 (Washington, DC: Government Printing Office, 1978); Stanley Yolles, “The Role of the Psychologist in Comprehensive Community Mental Health Centers,” in The Clinical Psychologist, ed. Lubin and Leavitt, p. 210. On the growing influence of psychology more generally, see Ellen Herman, The Romance of American Psychology: Political Culture in the Age of Experts, 1940–1970 (Berkeley: University of California Press, 1995) and Capshew, Psychologists on the March.
The Community Mental Health Center, pp. 6–7: Paul Lerhrman, Deinstitutionalization and the Welfare State (New Brunswick, NJ: Rutgers University Press, 1982). On the antipsychiatry movement, see Norman Dain, “Psychiatry and Antipsychiatry,” in Discovering the History of Psychiatry (New York: Oxford University Press, 1994), pp. 415–444; and Dain. “Critics and Dissenters: Reflections on’ Anti-Psychiatry,’” Bulletin of the History of the Behavioral Sciences 25 (1989): 3–25. Two of the key texts of the antipsychiatry movement were Thomas Szasz, The Myth of Mental Illness (New York: Hoeber Harper, 1961) and R.D. Laing, The Divided Self (London: Tavistock Publishing, 1959.)
An important issue insufficiently treated here is the impact of the patient/consumer/survivor movement on professional relations in the mental health field, a topic that deserves more historical work. See Nancy Tomes, “The Patient as A Policy Factor: A Historical Case Study of the Consumer/Survivor Movement in Mental Health,” Health Affairs 25: 3 (May/June 2006), 720–729. One such organization, composed of family members of sufferers from the major mental disorders; has, perhaps understandably, adopted a heavily medical perspective on mental illness—the national alliance for the mentally ill (“NAMI”). Their state legislative and congressional lobbies are quite active; and their alliance with the American Psychiatric Association very close.
Brown, “The Federal Government and Psychiatric Education,” p. 9.
David Mechanic, Mental Health and Social Policy 2nd ed. (Englewood Cliffs, NJ: Prentice-Hall Inc., 1980), pp. 139, 141.
Ibid, p. 5. In explaining the long-term origins of the new psychiatric “crisis” of the late 1970s, Brown pointed to post-World War II funding decisions, which essentially allowed the mental health sector to expand without any regulation or rationalization, thus exacerbating already existing problems of physician maldistribution. Once past their residencies, psychiatrists receiving federal traineeships were not required to do any hospital or clinic work; not surprisingly, the vast majority used the public funds to prepare for lucrative private practices. Note the parallel to the argument in Starr, The Social Transformation of American Medicine.
Brown, “The Federal Government and Psychiatric Education.” pp. 8–9.
Goleman, “Social Workers Vault into Leading Position,” pp. 1, 3. Robert Barker. The Business of Psychotherapy (New York: Columbia University Press, 1982), pp. 10–14. See Gifford’s chapter in this volume for a discussion of the antitrust suit against the American Psychoanalytic Association.
Grob, From Asylum to Community, pp. 298–299.
Reisman, The History of Clinical Psychology, pp. 376–380.
A provocative account of the turn toward clinical social work is Harry Specht and Mark E. Courtney’s Unfaithful Angels: How Social Work Has Abandoned Its Mission (New York: The Free Press, 1994). As the subtitle suggests, they regard social work’s “seduction” by psychotherapy as a betrayal of its “true” professional mission.
E. Jane Martin, “A Specialty in Decline? Psychiatric-Mental Health Nursing, Past, Present, and Future,” Journal of Professional Nursing 1 (1985): 48–53.
Data from 1987 show that non-professional workers account for well over fifty percent of staff in mental health organizations, including hospitals and clinics. See Ronald W. Manderscheid and Sally A. Barrett, Mental Health, United States, 1987 [DHHS Publication No. (ADM)87-1518] (Washington, DC: U.S. Government Printing Office, 1987), pp. 21–22.
For useful surveys of the contemporary mental health field, see Richard G. Frank and Sherry Glied, Better But Not Well: Mental Health Policy in the United States Since 1950 (Baltimore: Johns Hopkins University Press, 2006); Gerald Grob and Howard H. Goldman, The D dilemma of Federal Mental Health Policy: Radical Reform or Incremental Change? (New Brunswick: Rutgers University Press, 2006); and David Mechanic, Mental Health and Social Policy: The Emergence of Managed Care 4th ed. (Boston: Allyn and Bacon, 1999).
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Tomes, N. (2008). The Development of Clinical Psychology, Social Work, and Psychiatric Nursing: 1900–1980s. In: Wallace, E.R., Gach, J. (eds) History of Psychiatry and Medical Psychology. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-34708-0_22
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