Legislative warriors: American psychiatrists, psychologists, and competing claims over psychotherapy in the 1950s

Abstract

American psychiatrists and psychologists have long been close colleagues and fierce rivals. There is no better illustration of this polarized relationship than the chronic tug-of-war over psychotherapy. Both groups laid claim to psychotherapy-whatever it was and however it was practiced. Psychiatrists attempted to monopolize psychotherapy despite its ambiguous status as an essential component of the healing arts. After the war, psychologists pressed for a share on the basis of their qualifications and competence, but struggled to overcome the limitations imposed by medical envy. This story lays bare the crucial function of tools and techniques for defining the identity and the boundaries of a science-based profession.

DSM-III and the revolution in the classification of mental illness

“…Prior to the DSM-III, psychiatrists primarily targeted the underlying psychological causes of mental illness and disorder with psychotherapy. Alternative approaches, such as behavioral therapy, were subordinated to the dominance of psychodynamic theory and practice (Buchanan, 2003). With the DSM-III, they gradually shifted to primarily targeting the symptoms of mental illness and disorder with psychopharmacology, the use of drugs to treat mental ills.…”

“…But they also spawned their own professional competition. Since the 1950s, psychologists in particular had contested psychiatric authority over the practice of psychotherapy (Buchanan, 2003). Medical training seemed irrelevant for the understanding of the central dynamic processes of repression, childhood sexuality, and symbolic interpretation of symptoms.…”

Where do classifications come from? The DSM-III, the transformation of American psychiatry, and the problem of origins in the sociology of knowledge

“…As a corollary of these changes, the rise of clinical psychologists and their growing control over psychotherapy might suggest that they took control of the field, assuming the necessary symbolic capital and reordering all of mental health treatment on the basis of their practice (Buchanan 2003). Clinical psychology had become a significant force in mental health by mid-1970s, with "behavior" and, in particular, "cognitive-learning" theories of therapeutic treatment exercising growing control over a splintered "psychotherapeutic jungle" (Mahoney 1977;Healy 2004, pp.…”

“…As many suggest (Wilson 1993;Buchanan 2003;Healy 1997Healy , 2004, the development of psychotropic medication for treatment of less serious disorders was a crucial step in the transformation of psychiatry. Eventually, it became tightly coupled to the diagnostic approach.…”

¿Pluralismo o monoteoría en psicología clínica? Análisis empírico de problemas epistemológicos y formativos en carreras de psicología en Argentina (2015)

“…Por la otra, es cuestionable la idea de que los autores que deban formar psicólogos en el ámbito clínico sean autores sin formación en psicología y con intereses potenciales creados respecto de la incidencia de los psicólogos en el campo de la psicoterapia. Debe recordarse que en países como Estados Unidos y en contextos de problemas profesionales como el ejercicio de la psicoterapia (Buchanan, 2003) y la formación científico-practicante (Albee, 2000), el hecho de que fueran psiquiatras quienes formaran y tutelaran a los psicólogos provocó distorsiones grávidas en la autopercepción del grupo profesional, que en cualquier caso no se coinciden con las diferencias abstractas (básicas, tecnológicas y praxiológicas) y concretas (disciplinares, institucionales y pragmáticas) entre la comunidad de los psiquiatras y la de los psicólogos. La Figura 1 expone comparativamente, en términos de porcentajes, la presencia de textos psicoanalíticos y no psicoanalíticos de cada universidad y las principales pertenencias profesionales halladas.…”