Story of Psychology - Morton Hunt [374]
American medicine was equally slow to adopt psychoanalytic methods. Early in the century, American psychiatrists mainly treated hospitalized psychotics and almost entirely by physical methods: constraint, tub soaks, exercise, and physical work. But World War I produced a bumper crop of veterans with traumatic neuroses, and in consequence a number of psychiatrists, aware that psychoanalytic therapy was said to have considerable success with severe neurotics, began to take an interest in it.20
A few went to Europe for training, and when several psychoanalytic institutes opened in American cities, a trickle of psychiatrists and others began analytic training. Some better mental hospitals, such as the Institute of Pennsylvania Hospital in Philadelphia, invited European psychoanalysts to come train their staffs. Eventually, organized psychiatry made psychoanalysis one of its specialties and, through its psychoanalytic societies, limited training to physicians, although only a minority of psychiatrists ever took training in it and practiced it. Psychologists and others who were not physicians but wanted training had to get it in Europe. Later a few institutes were founded in the United States for “lay analysts” (nonmedical analysts).
During the 1920s psychoanalysis became a favorite topic among the avant-garde, and psychodynamic concepts were taken up by the psychological establishment. As we saw, they were a major influence on Henry Murray, creator of the Thematic Apperception Test, and his research group at Harvard. By the 1930s, when a number of European psychoanalysts fleeing Nazism arrived here and the number of training institutes grew, psychoanalysis attained the status of a movement.
Like the earlier movement in Europe, however, it underwent frequent fissions. In the 1930s, some psychoanalysts in America altered and significantly added to Freudian doctrine, often distancing themselves from the main psychoanalytic body. Most notable were various “neo-Freudians” who worked out systems of their own and set up institutes to teach them. Although they did not reject Freudian dynamics, they gave social and cultural factors equal or even greater importance in character development and mental disorders. The gentle philosophic Erik Erikson, whose developmental theory we have already seen, was one of them; the fiercely independent protofeminist Karen Horney, another; and the poetic social-reformist refugee from Nazism, Erich Fromm, a third.
Another neo-Freudian of note was the psychiatrist Harry Stack Sullivan. He was an only child and the only Catholic child in his upstate New York farming community. Perhaps because of his loneliness, he became interested in the relationship between the growing child and the caretaking adult and how it affected character and behavior. The dynamic treatment he devised, “interpersonal therapy,” was based in part on Freud, but rather than relying on free association, it called for the therapist and patient to engage in face-to-face discussion, with the former behaving as a real person, not as a shadowy figure on whom the patient projects transference images.
Since, in the 1930s, the usual regimen of therapy by Freudians and neo-Freudians consisted of four or five sessions per week—Freud preferred six—for at least several years, the number of patients in treatment remained limited to the few who were both well-to-do and able to spare the time. But World War II produced far more psychologically damaged veterans than had World War I—in 1946, Veterans Administration hospitals alone had forty-four thousand of them as in-patients21—and an urgent need for a larger corps of psychotherapists and for briefer forms of treatment. The result was a sharp growth in the numbers of psychiatrists and clinical psychologists, who were increasingly beginning to use psychodynamic concepts and methods.
At the same time, psychoanalytic notions about the human psyche, popularized