The Development of Clinical Psychology, Social Work, and Psychiatric Nursing: 1900–1980s

  • Nancy Tomes


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


Mental Health Mental Health Care Mental Health Profession Private Practice Clinical Psychologist 
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Notes and References

  1. 1.
    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.Google Scholar
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    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.Google Scholar
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    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).PubMedGoogle Scholar
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    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.Google Scholar
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    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.Google Scholar
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    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).Google Scholar
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    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.Google Scholar
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    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.Google Scholar
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    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.Google Scholar
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    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.PubMedGoogle Scholar
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    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.Google Scholar
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    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.Google Scholar
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    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.CrossRefGoogle Scholar
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    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.Google Scholar
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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Nancy Tomes
    • 1
  1. 1.History at the State University of New York (Stony Brook)USA

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