Mind Games: American Culture and the Birth of Psychotherapy (review)

Eric Caplan.Mind Games: American Culture and the Birth of Psychotherapy. Berkeley: University of California Press, 1998. 242 pp. $35.00 cloth.

Eric Caplan's Mind Games (an unfortunate title evidently dictated by a sales-minded publisher) is a useful addition to the literature on the origin of psychotherapy in the United States. Previous work on the creation of institutionalized psychotherapy in the United States has emphasized the dominant role of psychoanalysis, beginning with Freud's famous Clark University lectures in 1909. Caplan, however, shows how in a brief time period that immediately preceded Freud's visit, psychotherapy became firmly implanted into American medicine and American culture. The central theme of his book is how the jurisdictional conflict between clergy and physicians over the ownership of psychological problems led the medical profession to dominate the practice of a type of healing that it had fervently resisted only a few years previously.

Caplan begins his engaging book with an exploration of "railway spine," a controversial ailment marked by paralysis, headaches, and various aches and pains with no demonstrable physical basis, which appeared after railway accidents. In the latter part of the nineteenth century, physicians treated nervous and mental disorders through almost exclusively somatic means and resisted any sort of psychological therapy. The apparent psychosomatic nature of railway spine, however, forced the medical profession to reexamine its assumption that physical symptoms must have somatic causes and to begin to treat some ailments psychotherapeutically. Although the chapter on railway spine is a fascinating case study, it is not well integrated into the story of the interprofessional conflicts that are at the heart of the book.

Caplan locates the historical origins of American psychotherapy in the highly popular writings of the founder of Christian Science, Mary Baker Eddy, especially Science and Health, first published in 1875. While the physicians at the time felt that both physical and mental dysfunctions had somatic causes, Eddy believed that all forms of disease were solely products of the mind. By the early 1900s, Christian Science had nearly 50,000 adherents. The psychotherapeutic emphasis of Christian Science posed a clear threat to the professional livelihoods of physicians. Although most physicians responded to this threat with renewed insistence about the primacy of somatic treatments, a minority--led by neurologist Morton Prince and psychiatrist Adolf Meyer--began to confront the possibility that psychological, rather than somatic, therapies could usefully treat a range of mental problems.

Caplan traces the more immediate origins of psychotherapy in the United States to the Emmanuel movement that emerged in 1906. This movement joined religious with scientific principles to treat a wide variety of everyday troubles such as "housekeeper's anxiety," "fear of failure," "sleeplessness," and to provide advice about ordinary concerns including child rearing practices and vocational problems. Medical critics fiercely attacked the proponents of the Emmanuel movement for practicing psychotherapy without having appropriate medical licensure and for failing to understand the brain-based nature of mental problems. Although the medical profession had previously displayed little inclination to treat functional mental disorders, the need to confront the Emmanuel group forced physicians into attempts to gain jurisdiction over the treatment of mental disorders. Their success led them to become the legitimate practitioners of psychotherapeutic healing techniques. By 1909, when Freud visited Clark, physicians accepted both the necessity and the efficacy of psychotherapy. The appearance of a professional competitor had forced American medicine to enthusiastically adapt a technique that they had previously either disparaged or ignored. With the imprimateur of medicine, psychotherapy was ready to enter the mainstream of American culture, where it remains until the present day.

Like all good history, Caplan's discussion of the origins of psychotherapy serves to illuminate current debates. The reshaping of psychiatry as a medical subspecialty in the DSM-III in 1980 that enabled psychiatry to distinguish itself from its professional competitors echoes the medical takeover of psychotherapy from...