Shrinks (10 page)

These psychiatric refugees would soon change the fundamental nature of mental health care in the United States, but not necessarily for the better. They brought with them the dogmatic and faith-based approach to psychiatry that Freud had espoused, discouraging inquiry and experimentation. Eventually, just as Freud predicted, psychoanalysis would become a plague upon American medicine, infecting every institution of psychiatry with its dogmatic and antiscientific mind-set. But this resistance to research and empirical verification was only part of the problem.

All of the immigrant psychoanalytic luminaries were displaced Jews, fleeing persecution. They had been trained by Jews, had mostly Jewish patients, and had undergone harrowing experiences as refugees from a brutally anti-Semitic regime. By 1940, American psychoanalysis had become a unique phenomenon in the annals of medicine: a scientifically ungrounded theory, adapted for the specific psychic needs of a minority ethnic group. It would be hard to imagine a therapy less suited to the treatment of people with severe mental illness.

The Rise of the Shrink

The American Psychiatric Association (APA) is the premier professional organization for psychiatrists in the United States and is best known to the public as the publisher of the
Diagnostic and Statistical Manual of Mental Illness
. The APA is also the oldest active medical organization in America, founded in 1844 as the Association of Medical Superintendents of American Institutions for the Insane. (By comparison, the American Medical Association was founded in 1847.)

For the first century of its existence, the APA was almost exclusively a society of alienists. In 1890, the APA adopted the image of Benjamin Rush for its seal, and Rush’s face remains on the official APA emblem to this day. By the time Freud visited the States in 1909, the APA had changed its name to the American Medico-Psychological Association (reflecting the emphasis on psychology that Freud had orchestrated and Wundt and James had embraced) even though its members still mostly worked in institutions for the insane, and they remained alienists in 1921 when they adopted the organization’s present appellation.

In the first couple of decades after Freud’s visit to the United States, the members of the APA weren’t particularly interested in his unsubstantiated theories about unconscious conflicts, which appeared to have little relevance for the screaming and suicidal inmates of overcrowded asylums. On the other hand, American psychoanalysts most certainly cared about the APA. Beginning in 1924, the American Psychoanalytic Association held their meetings at the same time and in the same city as the much larger American Psychiatric Association. In the early 1930s, the APsaA began pushing hard for the APA to officially recognize the psychoanalytic approach to psychiatry, igniting a portentous conflict within the executive board of the APA.

At first, the leading alienists of the APA resisted endorsing Freud’s theories, which they termed unscientific and unproven. Eventually, though, the mood began to shift, as the alienists came to realize that, science aside, psychoanalysis offered a distinct benefit for their profession: a way out of the asylum. For almost a century, the most prominent role a psychiatrist could hope to obtain in the medical field was to be a director of an asylum, an alienist in a country madhouse overseeing a horde of incurables, working apart from one’s medical colleagues, separated from mainstream society. In contrast, neurologists had by this time developed pleasant and lucrative office practices outside of hospitals, where they could obtain generous fees from well-heeled patients for tending to headaches, muscle paralysis, and fainting, among other maladies. Neurologists looked down their noses at their country bumpkin psychiatric cousins, and even the most eminent of alienists resented their lowly status. The psychiatrist Frank Braceland, who often presided over meetings of psychiatrists and neurologists when he served as the director of the American Board of Psychiatry and Neurology from 1946 to 1952, described the relations of the sibling professions in the 1940s to me when I interviewed him for a historical documentary film in 1979:

It was impossible to get neurologists and psychiatrists to sit down together, because neither side liked one another much. The neurologists thought that neurology was the “Queen of Medicine” and psychiatry was the jester. The psychiatrists, meanwhile, insisted the neurologists preached neurology but practiced psychiatry.

Now, for the first time in psychiatry’s inglorious history, Freud’s remarkable new therapy of psychoanalysis granted alienists the opportunity to establish office-based practices of their own. Whether a devotee of Freud, Adler, Jung, or Rank, the psychoanalyst could treat wealthy patients with minor mental maladies in the civil environs of a comfortably appointed drawing room.

Of course, embracing psychoanalysis meant embracing a radical redefinition of mental illness. Previously, the boundary between sick and healthy was drawn between those who
needed
to be institutionalized and those who
did not
need to be institutionalized. To be mentally ill meant one was
seriously
mentally ill—suffering from unhinged psychosis, debilitating depression, heedless mania, or a sizable diminution of intellect. But Freud blurred the boundary between mental illness and mental health, since psychoanalytic theory suggested that almost everyone had some kind of neurotic conflict that could be resolved with proper (psychoanalytic) treatment. Psychoanalysis introduced a new type of psychiatric patient, a person who could function effectively in society but who wanted to function even better. Today, these types of patients are known as the
worried well
.

The worried well became the primary market for psychoanalysis in both Europe and the United States, fueling its ascent. In 1917, only about 8 percent of American psychiatrists were in private practice. By 1941, this figure had increased to 38 percent, largely because of the adoption of psychoanalysis. By the 1960s, more than 66 percent of all American psychiatrists were in private practice. Instead of wearing white coats and shouldering through a daily grind of raving and catatonic inmates, psychiatrists could chat with well-heeled businessmen about their childhood memories and gently guide well-coiffed matrons through their free-associations.

Even better, psychoanalysis bestowed on psychiatrists a meaningful and active role in treatment: Like omen-divining wizards, they interpreted the private emotional experiences of their patients and drew upon their intellect and creativity to formulate elaborate diagnoses and orchestrate complex treatments. Instead of hapless caretakers for the insane, they became
consiglieri
for the wealthy, educated, and influential. They were alienists no longer. They had become
shrinks
.

The term “headshrinker” first originated in the 1940s in the offices and backlots of Hollywood and reflected the emerging new role for psychiatrists. During this era, adventure films were the rage in movie palaces, especially movies set in exotic jungles where cannibal tribes often shrank the heads of enemies. Since the name of the person who first applied the term “headshrinkers” to psychiatrists is lost to history, we don’t know for certain whether he intended to suggest that psychoanalysts were shrinking the big egos of movie stars down to size or was comparing psychoanalysis to the primeval sorcery of the jungle witch doctor. The latter seems more likely. One of the first appearances of “headshrinker” in print was in a 1948 letter to the editor in the
Baltimore Sun
, penned by a psychoanalyst in response to an article by noted Baltimore writer H. L. Mencken that had lambasted Freudian therapy as “hooey.” The psychoanalyst retorted, “Mencken should examine the syllabus of the requirements necessary for certification before damning these gentlemen as witch doctors, head shrinkers, totemists, and voodooists.”

It seems appropriate that Hollywood, with its culture of self-absorption, self-improvement, and pretense, was one of the first communities to embrace a new therapy that involved endless self-examination. A 1949 scholarly study of cartoons in popular magazines documented the transition taking place within psychiatry. “Older cartoons about psychiatry portray only psychotic patients in insane asylums,” concludes the author. “There is no
psychiatrist
portrayed because psychiatry was not a profession then. The number of cartoons about psychiatrists greatly increased in the 1930s and 1940s until they became even more frequent than cartoons about general practitioners and ministers.”

The term “headshrinker” entered broad use after a 1950
Time
magazine article about Western “B” movie actor Hopalong Cassidy, which stated, “Anyone who had predicted that he would end up as the rootin’-tootin’ idol of U.S. children would have been led instantly off to a headshrinker.*” The asterisked footnote read: “Hollywood jargon for a psychiatrist.” By the mid-1950s, the entire country was using the term, which made its way into the lyrics of the 1957 Broadway musical
West Side Story
:

JETS: We’re disturbed, we’re disturbed,

We’re the most disturbed,

Like we’re psychologic’ly disturbed.

DIESEL: In the opinion of this court, this child is depraved on account he ain’t had a normal home.

ACTION: Hey, I’m depraved on account I’m deprived.

DIESEL: So take him to a headshrinker.

Emboldened by their growing influence, American psychoanalysts in the 1940s aspired to even greater prominence and power. Knowing that the path to influence ran through medical schools and teaching hospitals, psychoanalysts began targeting universities. A 1940
Bulletin of the American Psychoanalytic Association
encourages its members to “secure a formal contract from a near-by university,” and later asserts that “it is to the interest of psychiatry, and especially to the development of psychoanalytic psychiatry, that our psychoanalytic training institutes should teach more men who are heading towards academic teaching positions in medical schools and towards positions in hospitals.” One by one, Case Western Reserve, the University of Pittsburgh, the University of California at San Francisco, Johns Hopkins, the University of Pennsylvania, Columbia, Stanford, Yale, and Harvard saw analysts ascend to their department chairs, and each new conquest was celebrated as a triumph within the psychoanalytic movement.

By 1960, almost every major psychiatry position in the country was occupied by a psychoanalyst. There were twenty psychoanalytic training institutes across the United States, many affiliated with psychiatry departments at top universities. The American Psychoanalytic Association swelled from 92 members in 1932 (when the first European émigrés began to arrive) to about 1,500 in 1960. By then, virtually all clinical psychiatrists—whether formally credentialed or not—were psychoanalytically oriented. In 1924, the first Freud-leaning psychiatrist was elected president of the APA, and the next fifty-eight years witnessed an almost unbroken series of psychoanalyst presidents of the American Psychiatric Association.

William Menninger, one of the most famous and respected of American psychoanalysts, became the face of American psychiatry and enthusiastically promoted his profession in the media; in 1948,
Time
magazine featured Menninger on its cover, labeling him “psychiatry’s U.S. sales manager.” He was so influential that he was able to secure a personal meeting with President Harry Truman in 1948 and prevailed upon him to send “a message of greeting” to the joint meeting of the APA and APsaA. Truman wrote: “Never have we had a more pressing need for experts in human engineering. The greatest prerequisite for peace must be sanity, which permits clear thinking on the part of all citizens. We must continue to look to experts in the field of psychiatry and other mental sciences for guidance.” By “psychiatry and mental sciences,” the president meant psychoanalysis. By “experts in human engineering,” he meant shrinks.

William Menninger on the cover of
Time
magazine. (
Time
, October 25, 1948, © Time, Inc. Used under license)