Anxiety: A Short History

Chapter 6. Psychology’s Ascendance

CHAPTER SIX Psychology’s Ascendance F F F AN ALTERNATIVE PARADIGM OF ANXIETY During the first six decades of the twentieth century, psychoanalytic approaches dominated the study of anxiety within psychiatry . Outside of medicine, however, psychologists developed a behavioral view that contrasted with the biological and intrapsychic conceptions that psychiatrists had favored since the middle of the nineteenth century. The behavioral model diverged in almost every possible way from the psychodynamic approach. For one thing, behaviorists used thoroughly positivistic methods , concentrating on observable and measurable phenomena. They scorned nonquantifiable processes and exclusively focused on objective, empirical, and calculable measures. This starkly contrasted with the psychodynamic focus on unobservable processes such as the unconscious or the Oedipal complex. For another thing, the behaviorists took a strictly environmental approach to human action. For them, people acted in response to external rewards and punishments, not to interior biological or psychological forces. Behavior was learned through exposure to these stimuli, which differed for each individual, so all people displayed unique reactions. The behaviorists’ “blank slate” conception of human 98 Psychology’s Ascendance 99 nature thoroughly contrasted with psychodynamically oriented views.1 Finally, behavioral treatments were intensely practical. Behaviorists were less interested in explaining behavior than in transforming it; they sought behavioral change, not intellectual enlightenment . Their therapies ignored attempts to gain insight but instead sought to adjust patients to their environments. They believed that all trained practitioners could apply their techniques in uniform and standardized ways. Moreover, they claimed to change unwanted fears quickly, efficiently, and cheaply. Behaviorism thus confronted psychiatry in the therapeutic marketplace as well as in a clash of distinct worldviews. The behavioral emphasis on quantification , environmental regulation of human action, and useful results had a particular appeal to those twentieth-century Americans who felt they had no time to waste on lengthy explorations of their inner selves. Despite vast theoretical and practical differences between behavioral and analytic approaches, one factor united them: the centrality of anxiety. In each view, anxiety was both the major reason neurotic symptoms developed and the major target of therapy. For most of the twentieth century, behaviorism was the dominant approach within psychology. Over the course of the century, the behavioral study and treatment of fear and anxiety helped propel this profession to a prominent role in American society. From John Watson’s creation of a phobia in Little Albert, to the regulation of natural fears among soldiers in World War II, to the development of behavioral and cognitive treatments for anxiety disorders, psychology’s ascendance was in large part due to its success in managing anxiety. THE INSTITUTIONAL CONTEXT OF PSYCHOLOGY The psychological study of anxiety in the United States developed in very different institutional contexts than had psychiatry. For the first half of the twentieth century, psychologists faced a major professional limitation: psychiatrists monopolized the provision of psychotherapy. In clinical settings, psychiatrists typically super- 100 Anxiety vised psychologists, creating a strong source of structural tension; the former steadfastly protected their prerogatives and opposed the latter’s efforts to gain clinical licensing privileges. Psychologists were generally limited to administering psychological tests and providing diagnoses. Attempting to gain some clinical independence , psychologists tended to practice in settings such as child guidance clinics, industry, and, especially, schools, locations where they did not threaten medical dominance.2 Psychologists played critical roles during World War I, especially in developing and applying intelligence and psychological tests. Between 1919 and 1939 the size of the profession increased tenfold, from just 300 to about 3,000 members. By 1929, the United States was home to more psychologists than the rest of the world combined; most of them were employed in applied psychology positions in education, business, courts, and clinics where they tested and evaluated children, employees, or delinquents. From its inception psychology also had a far higher percentage of female practitioners than psychiatry had, although few of them assumed leadership positions in the profession.3 World War II marked a decisive turning point for psychology . Until then, few psychologists had delivered psychotherapy. During the war, psychologists constructed psychological screening tests and administered them to millions of draftees. They also became involved in efforts to sustain troop morale, engage in psychological warfare, foster leadership within the military, and assign personnel to their optimal positions based on aptitude. An especially important role of wartime psychologists was to teach soldiers how to deal with their fears. Military institutions obviously placed great importance on...