Psychotherapeutics and the Problematic Origins of Clinical Psychology in America

Eugene Taylor Saybrook Institute, Harvard University, and the Massachusetts General Hospital

The problematic place of psychotherapy within the larger history of scientific psychology is reviewed, especially in the absence of any definitive history of clinical psychology yet written. Although standard histories of psychology imply that psychotherapy was somehow derived from the tradition of German laboratory science, modern historiography reveals a dramatically different story. Personality, abnormal social and clinical psychology have their roots in an international psychotherapeutic alliance related more to French neurophysiology, and this alliance flourished for several decades before psychoanalysis. Reconstruction of the American contribution to this alliance, the so-called Boston school of abnormal psychology, suggests an era of medical psychology in advance of today. Note is also made of the possible misattribution of Lightner Witmer as the father of clinical psychology.
n the minds of psychologists today, the term clinical psychology most often refers to a broad subfield in which qualified professionals trained in some aspect of mental health deliver therapeutic services to patients or clients, usually in a school, office, or hospital setting. However, this simple definition poses a problem for the professional historian in psychology because of the sometimes close overlap of a clinical psychologist's activities, both today and in the past, with aspects of psychiatry, social work, nursing, pastoral counseling, school guidance, and other professions in the mental health field. Where, in other words, does the actual history of clinical psychology as a subject area in the graduate field called psychology begin? One convenient place that has received noticeable attention within the history of American academic psychology has been Lightner Witmer's founding of a psychological clinic at the University of Pennsylvania in 1896. A lineage of Witmer's disciples, as well as a group of contemporary psychologists, generally maintain that Witmer was the founder of modern day clinical psychology (McReynolds, 1997). Here again, however, this claim is problematic for the professional historian in psychology. Witmer did make important contributions to the development of psychology in the schools, and he was an advocate for psychologists and physicians working together in the clinic, but his primary focus was on mentally defective children, and the subfield of clinical psychology has always been much wider than this. Here, I come to the biggest September 2000 American Psychologist

impediment to naming Witmer the father of clinical psychology: Psychotherapy or, as it was originally called around the turn of the past century, psychotherapeutics, was an endeavor that Witmer clearly detested and actually knew very little about. From the standpoint of the history of psychology as an academic science, which is Witmer's tradition, psychotherapy remains the great enigma because much of what it encompasses has always defied quantification. Yet, next to administering tests and conducting research, in the minds of the general public psychotherapy is, rightly or wrongly, believed to be the primary activity of most psychologists. In addition, although there have been gestures in that direction (Reisman, 1991; Routh, 1994), a definitive history of clinical psychology comparable with Boring's A History of Experimental Psychology (1950) has yet to be written. This may be partly due to the murcurial place of psychotherapy in the larger history of the clinical tradition. Thus, whenever the attempt has been made to write the history of psychology, clinical psychology has erroneously been cast most often as a derivative or applied form of experimental psychology in the tradition of German psychophysics and English mental testing, whereas psychotherapy within clinical psychology has generally not been considered at all or has been relegated to the subhistory of psychoanalysis. Here, the history of psychotherapy is usually thought to begin with Jean-Martin Charcot and his use of hypnosis at the Salp~tri~re in Paris beginning in the early 1880s. However, it then jumps to Freud's Interpretation of Dreams (1900) and the Clark University conference of 1909 as if nothing else went on in the interim of more than a quarter of a century except a few isolated events (Bromberg, 1963; Freedheim, 1992; Walker, 1959; Zilboorg, 1951).

Editor's note. Almosttwo dozen of the leading historians of psychology agreed to write "snapshots" of various aspects of psychologycirca 1900. The articles appear in serial form throughout Volume 55. The series was edited by Donald A. Dewsbury. Author's note. EugeneTaylor, SaybrookInstitute; Departmentof Psychiatry, Harvard University; and the Psychological Service, Massachusetts General Hospital. Correspondence concerning this article should be addressed to Eugene Taylor, PsychologicalTesting Center, Massachusetts General Hospital, 5 EmersonPlace, Boston, MA 02114. Electronic mail may be sent to etaylor@igc.org.
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Copyright 2000 by the American Psychological Association, Inc. 0003-066X/00/$5.00 Vol. 55, No. 9, 1029-1033 DOI: 10.1037//0003-066X.55.9.1029

Beginning with the pioneering work of the existential psychiatrist and historiographer Henri Ellenberger (1970), developments in the history and philosophy of psychology over the past 30 years suggest a completely different story; namely, rather than a hiatus, between the time of Charcot but before Freud, the field of psychotherapeutics was born (Taylor, 1982a, 1982b, 1996, 1999). Although psychologists believe that modem scientific psychology began with the founding of Wundt's laboratory in Leipzig in 1879, this event relates only to the evolution of the experimental laboratory tradition in the university environment. The thesis I develop here is that, like experimental psychology, clinical psychology in the United States began within the tradition of academic psychology in the early 1880s, but it began when physiological psychology fused with psychical research, the scientific study of the paranormal. A major consequence of this was the development of the new subfield of experimental psychopathology. These developments, especially in the United States, then contributed to the explosion of applied psychotherapeutics just after 1900 and to the emergence of personality, abnormal, and social psychology as distinct areas of academic specialization (Taylor, 1982b, 1988, 1996). Granted, the emergence of psychology as a science was predicated on the German experimental laboratory ideal, which demanded that pure science generated under tightly controlled conditions be the gold standard that defined all subsequent practical applications. Throughout the 19th century, however, the French had emphasized the tradition of la clinique--bedside teaching, in which all experimental applications had to prove themselves in vivo before being conceived as scientifically legitimate. In the United States, these ethnocentric differences became somewhat homogenized and then additionally reshaped by the unique direction of American science. The German laboratory ideal dominated the development of newly formed doctoral programs in psychology at universities such as Johns Hopkins, Clark University, the University of Chicago, The University of Pennsylvania, and elsewhere, while the clinical ideal diffused throughout a variety of different disciplines, ranging from medicine and psychiatry to philosophy and psychology, and extended even into sociology, anthropology, and religion, particularly at Harvard and Yale. Whereas the laboratory ideal was dominated by concepts of reflex action, introspection, and association, the clinical ideal was based on the theory of dissociation. A term first coined in psychology by William James, dissociation was developed to explain various phenomena of altered consciousness, such as somnambulism, fugue states, and conditions of double consciousness. Personality was considered a plurality of states ranging from pathological to transcendent, with waking consciousness being only one possible state among many. Cases such as Louis V. and Felida X., reported first in the French and then in the American medical literature in the late 1870s, soon led to the new diagnosis beyond hysteria and double consciousness, namely, that of multiple personality. Subsequently, dissociation theory was also extended to an understanding of the social psychology of the crowd. Dissociation was the 1030

reigning model for the explanation of all abnormal phenomena, just as associationism, according to the British theorists, defined the patterns of normal rational thought. Although today dissociative identity disorder is but one category in the Diagnostic and Statistical Manual of Mental Disorders, 100 years ago it was applied to all forms of subconsious phenomena. The first American notices of these French materials included reviews of works such as Ambrose Liebeault's Sleep and Analagous States (James, 1868), as well as translations of Alfred Binet and Charles Frrr's Animal Magnetism (1887), Hippolyte Bernheim's Suggestive Therapeutics: A Treatise on the Nature and Uses of Hypnotism (1889), and Pierre Janet's Mental State of Hystericals (1901). Binet's monograph On Double Consciousness: Experimental Psychological Studies (1890) and Theodule Ribot's various essays (Ribot, 1882, 1884, 1887, 1889) on diseases of the will and diseases of personality were translated by the end of the 1880s, while William James, Morton Prince, and James Mark Baldwin became the most ardent American expositors of what Binet had called the "French Experimental Psychology of the Subconscious" (Binet, 1890, p. xii), After 1894, James and Baldwin became the two most frequent reviewers of the French literature in Psychological Review, the journal where James also gave the first notice of Josef Breuer and Sigmund Freud's work to the American psychological public (Taylor, 1982b). Moreover, recent historical scholarship suggests that contrary to the prevailing assumption that psychotherapeutics originated within psychiatry, in America it had its origins in a confluence of such seemingly disparate sources as physiological psychology, neurology, and psychical research (Taylor, 1982a, 1982b, 1988, 1996). Beginning in 1885 with the formal launching of the American Society for Psychical Research, committees of this society, dominated by a small cadre of Harvard professors, undertook an extensive investigation of clairvoyance, telepathy, mediumship, thought transference, ghosts and apparitions, as well as hypnosis and related techniques. (The Committee on Experimental Psychology, beginning in 1885 and led by distinguished astronomers and physicians, even made a survey of the prevalence of thought transference in the population at large; Taylor, 1996.) Results of the committees' investigations produced no proof of life after death but did lead to concrete empirical evidence for the existence of trance states different from normal waking consciousness. Out of the welter of spiritualist techniques presented to them, investigators were able to confirm the effectiveness of crystal gazing, automatic writing, and light hypnosis as techniques for inducing, under controlled conditions, not only all the phenomena of mediumship, but also most of the major symptoms of hysteria and neurasthenia, the most prevalent illnesses of the day associated with the ambulatory psychoneuroses. Meanwhile, their study of ghosts and apparitions also led to major psychotherapeutic developments in the scientific understanding of dreams, visions, hallucinations, and normal mental imagery. September 2000 * American Psychologist

From the 1870s to the 1890s, the laboratories of experimental physiology, neuropathology, and experimental psychology at Harvard were the sites of extensive investigations of functional rather than organic disorders of nervous and mental disease, as well as the venues where experimenters extensively replicated hypnotic research from abroad. Reports of these investigations in the local and national scientific literature justified the introduction of psychotherapeutic techniques based on dissociation and suggestion into the treatment of patients in the outpatient walk-in clinics at the Massachusetts General Hospital (MGH) and the Boston City Hospital, as well as on the wards at the MGH and in private hospitals nearby, such as the Adams Nervine Asylum in Jamaica Plain. By the mid-1890s, these trends led to the development of a new graduate specialty called experimental psychopathology, taught at Harvard by William James and at Clark University by Adolf Meyer. Other universities, such as Johns Hopkins, soon followed suit. James presented his 1896 Lowell lectures on exceptional mental states (Taylor, 1982b), a summary of advances in abnormal and social psychology at the time, and the first of the important early texts on the psychology of dissociation was published, Boris Sidis's (1898) The Psychology of Suggestion; a Research Into the Subconscious Nature of Man and Society. Contemporary historians, such as Burnham (1968), Hale (1971), and Gifford (1978), have labeled this period the era of the so-called Boston School of Abnormal Psychology (also called the Boston School of Psychotherapy or the Boston School of Psychopathology). Further, they have identified the Boston school (as in a school of thought) as the center of developments in scientific psychotherapy in the English speaking world between 1880 and 1920 (Taylor, 1982a). Several central figures made up this loose-knit school. William James, in addition to his career as an academic psychologist and philosopher, also taught automatic writing and hypnosis and took a few patients into his home for treatment. James Jackson Putnam, a professor of nervous and mental diseases at Harvard Medical School, first introduced psychotherapeutics into neurology at the MGH in the mid-1880s. Henry Picketing Bowditch, a research professor of physiology and a dean at Harvard Medical School, chaired the monthly meetings of the American Society for Psychical Research. Morton Prince, a neurologist at Tufts University and the Boston City Hospital, specialized in multiple personality and founded both the Journal of Abnormal Psychology and later the Harvard Psychological Clinic. Boris Sidis, the first to receive a doctoral degree in experimental psychopathology at Harvard, was also a doctor of medicine. As a world authority on multiple personality and dissociation, he ran his own private sanitarium in New Hampshire. In 1905, Richard Cabot, an internist, ethicist, and cardiologist, founded the Medical Social Service at the MGH, where Ida Cannon pioneered in developing medical social work for women. Numerous others also populated this school. One in particular, a man who was the target of vitriolic attacks by Witmer, was the Reverend Elwood Worcester, PhD, who studied with September 2000 American Psychologist

Wundt and the aging Fechner in Leipzig. Later, as an Episcopal priest Worcester launched the Emmanuel movement in Boston, which combined techniques of scientific psychotherapy with the Christian teachings of character formation and led to the subsequent development of the clinical pastoral education movement in the United States and Europe. Psychotherapeutics flourished to become an integral part of clinical psychology because of the various contributions of these figures. Reconstruction of this era, then, suggests a reevaluation of such benchmark events in the history of psychology as the Clark University conference of 1909 (Ross, 1972), where the famous photo of conference attendees was taken. The conference is always analyzed in terms of Freud's visit, as if this were the main event of the celebrations (it was not), but little has been said about the figures in the picture other than James, Hall, Freud, Jung and perhaps the other Freudians, Ferenczi, Brill, and Jones (see Figure 1). The great Titchener is there. So is William Stern, the German personalist who first formulated the conception of IQ. James McKeen Cattell, editor of Science and Wundt's first American doctoral recipient, is there, along with Carl Seashore, E. C. Sanford, E. B. Holt, and H. H. Goddard. What has never been pointed out is that nearly one third of the professionals in the picture, if the Freudians are included, were engaged directly in the practice of psychotherapy of some kind: James, Wells, Jung, and Jastrow I have already mentioned. Edwin Katzenellenbogen was a physician at the Danvers Asylum who taught abnormal psychology as a lecturer at Harvard. Soloman Carter Fuller, the only Black psychologist in the picture, was a homeopathic pathologist at the Westboro State Hospital for the Insane who carried on a private psychotherapeutic practice in Boston. His most famous patient was G. Stanley Hall. Adolf Meyer was then the chief pathologist for the New York State Asylum System, and he required all his staff to be conversant in the prevailing forms of psychotherapy. The practicing psychoanalysts in the picture include Freud, Ferenczi, Brill, and after 1909, Jones. Numerous other doctoral psychologists and medical doctors were engaged in psychotherapy, most of whom, aside from Smith Ely Jelliffe in New York City and William Alanson White at St. Elizabeth's Hospital in Washington, DC, were not associated with psychoanalysis. C. MacFie Campbell, a protrg6 of Adolf Meyer, practiced several different forms of psychotherapy, first in New York, then at Johns Hopkins University, and after 1921 at the Boston Psychopathic Hospital. John Duncan Quackenbose was a physician and hypnotherapist in private practice in New York City in the early 1900s. George A. Waterman and E. Wyllys Taylor, both medical doctors, practiced psychotherapy at the MGH under Putnam in the Neurology Department as early as 1903. Much later, Waterman went on to develop his own private practice, which included such famous patients as General George Patton and Robert Frost. Helen Flanders Dunbar and Mary Putnam Jacoby were New York physicians engaged in abnormal psychology. Eleanor Bertine, Esther Harding, Christine Mann, and 1031

Figure 1 1909 Clark UniversityConference

related to Wundt. In total, Sidis, Horton, Wells, Emerson, and Worcester held the doctor of philosophy degree, whereas the rest were all either physicians who also held doctor of philosophy degrees (Sidis, Janet, Mtinsterberg), or simply physicians (James, Prince, etc.). The mix of degrees, however, should not detract from that fact that most of these pioneers understood that they were doing psychotherapy, which they understood as psychology. Although psychotherapy continues to be practiced today, it still remains a widespread enigma. Its history can be understood only by interpreting the meaning of psychology widely and by thinking across boundaries both within and between disciplines. Meanwhile, at the very least, the academic origins of abnormal, social, and personality psychology deserve to be reconstructed in their own right as ways to understand the place of psychotherapy within the larger history of clinical psychology.
REFERENCES

I. Franz Boas 2. E. B. Titchener 3. William James 4. William Stern 5. Leo Burgerstein 6. G. Stanley Hall 7, Sigmund Freud 8. Cad G. Jung 9. Adoff Meyer 10. H. S. Jennings 11. C. E. Seashore 12. Joseph Jastrow 13. J. McK. Ca#ell 14. E. F. Buchner 15. E. Katzene#enbogen 16. ErnestJones 17. A. A. Brill 18. William H. Burnham 19+ A. F+ Chamberlain 20. Albert Schinz 21. J+ A. Magni

22, 23, 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36, 37. 38. 39. 40, 41. 42.

B. T. Baldwin F. Lyman Wells G. M. Forbes E. A. Kirkpatrick Sandor Ferenczi E. C. Sanford J. P. Porter Sakyo Kanda Hikoso Kakise G. E. Dawson S. P. Hayes E. B. Halt C. S. Berry G. M. Whipple Frank Drew J. W. A. Young L. N. Wilson K. J, Karlson H. H. Goddard H. I, Klopp S. C. Fuller

Note. Photo reprinted with permission from the Archives oF the History oF American Psychology-Universi~/of Akron and the Clark University Archives.

Frances Wickes were all female physicians who formed the first circle of Jungian analysts in New York after World War 1. None of these were orthodox Freudians, and certainly none but Reverend Worcester, Hugo Mtinsterberg, and F. Lyman Wells (a doctoral student of Cattell) were even remotely 1032

Bernheim, H. (1889). Suggestive therapeutics: A treatise on the nature and uses of hypnotism. (Christian A. Herter, Trans.). New York: Putnam. Binet, A. (1890). On double consciousness: Experimental psychological studies. Chicago: Open Court. Binet, A., & Frrr, C. (1887). Animal magnetism. London: Kegan Paul, Trench. Boring, E. G. (1950). A history of experimental psychology (2nd ed.). Appleton, Century, Crofts. Bromberg, W. (1963). The mind of man: A history of psychotherapy and psychoanalysis. New York: Harper & Row. Burnham, J. C. (1968). Psychoanalysis and American medicine, 18941918: Medicine, science, and culture. New York: International Universities Press. Ellenberger, H. F. (1970). The discovery of the unconscious: The history and evolution of dynamic psychiatry. New York: Basic Books. Freedheim, D. K. (Ed.). (1992). History of psychotherapy: A century oJ change. Washington, DC: American Psychological Association. Freud, S. (1900). Die Traumdeutung [The interpretation of dreams]. Leipzig, Germany: Franz Deuticke. Gifford, G. E., Jr. (Ed.). (1978). Psychoanalysis, psychotherapy, and the New England medical scene, 1894-1944. New York: Science/History. Hale, N. G., Jr. (1971). Freud and the Americans. New York: Oxford University Press. James, W. (1868). Review of Liebeault's Sommeil at le reves. The Nation, 7, 50-52. Janet, P. (1901). The mental state of hystericals: A study of mental stigmata and mental accidents (Caroline Rollin Corson, Trans.). New York: Putnam. McReynolds, P. (1997). Lightner Witmer: His life and times. Washington, DC: American Psychological Association. Reisman, J. M. (1991). A history of clinical psychology (2nd ed.). New York: Hemisphere. Ribot, T. (1882). Diseases of memory: An essay in the positive psychology (William Huntington Smith, Trans.). New York: Appleton. Ribot, T. (1884). The diseases of the will (J. Fitzgerald, Trans.). New York: Humboldt. Ribot, T. (1887). The diseases of personality (J. Fitzgerald, Trans.). New York: Humboldt. Ribot, T. (1889). The psychology of attention (J. Fitzgerald, Trans.). New York: Humboldt. Ross, D. (1972). G. Stanley Hall: Psychologist as prophet. Chicago: University of Chicago Press. Routh, D. K. (1994). Clinical psychology since 1917: Science, practice, and organization. New York: Plenum Press. Sidis, B. (1898). The psychology of suggestion; a research into the subconscious nature of man and society. New York: Appleton. Taylor, E. I. (1982a, March-April). The Boston school of psychotherapy: September 2000 American Psychologist

Science, healing, and consciousness in 19th century New England. Eight Lowell Lectures cosponsored by the Massachusetts Medical Society and the Boston Medical Library. Boston, MA. Taylor, E. I. (1982b). William James on exceptional mental states: Reconstruction of the 1896 Lowell lectures. New York: Scribner. Taylor, E. I. (1988). On the first use of "psychoanalysis" at the Massachusetts General Hospital, 1903-1905. Journal of the History of Medicine and Allied Sciences, 43, 447-471.

Taylor, E. I. (1996). William James on consciousness beyond the margin. Princeton, NJ: Princeton University Press. Taylor, E. I. (1999). William James and Sigmund Freud: "The future of psychology belongs to your work." Psychological Science, 10, 465469. Walker, N. (1959). A short history of psychotherapy in theory and practice. New York: Noonday Press. Zilboorg, G. (1951). A history of medical psychology. New York: Norton.

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