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The 70-year-long tug-of-war between psychology and psychiatry

The July issue of the journal Medical History has a short but illuminating article on the history of the seven-decade-long professional power struggle between psychiatry (particularly psychoanalysis) and clinical psychology.

Before World War II, psychologists were “firmly subordinated to medical men [psychiatrists], largely confined to administering psychological instruments such as IQ tests, and mostly women or Jewish or both (and thus doubly marginalized at the time),” writes Andrew Scull, a sociology professor at the University of California, San Diego, and the author of several books on the history of psychiatry.

Andrew Scull
Andrew Scull

In the 1940s and 1950s, the psychiatric profession (which included mostly psychoanalysts at the time) tried to keep psychologists in a subordinate position. The hierarchy broke down, however, once mental institutions began to empty their beds and the delivery of care shifted to less centralized outpatient facilities.

During those years, the psychiatric profession also made a huge strategic mistake, says Scull.

At the time, psychoanalysts were “intellectually and temperamentally disinclined to conduct large-scale experimental clinical research,” he explains. This was not true of clinical psychologists, who soon acquired “the lion’s share of a rapidly expanding federal research pie — in broad terms about 60 per cent of the federal dollars on offer, as opposed to the paltry 5 per cent captured by psychoanalysts,” says Scull.

Then came the psychopharmacological revolution, which began in the mid-1950s with the first so-called anti-psychotic drug, Thorazine (chlorpromazine). Writes Scull:

Psychoanalysis had managed initially to contain the potential threat posed by the drugs revolution, but by the mid-1970s, that resolution was threatening to break down. Antipsychotic drugs had proved to be an enormously lucrative market, and questions were beginning to be raised in many quarters about precisely what therapeutic advantages accrued from adding seemingly interminable and expensive psychoanalytic treatments to the mix.
A decade earlier, virtually every academic department of psychiatry was led by a psychoanalyst or a psychoanalytic fellow-traveler, but increasingly, the sums on offer to conduct laboratory research on potentially therapeutic compounds were exercising a powerful appeal, one bolstered by the critical importance of funded research in establishing pecking orders in large research universities.

The 1980 edition of the Diagnostic and Statistical Manual of the American Psychiatric Association “proved a watershed moment in the evolution of twentieth-century psychiatry,” Scull argues. It also delivered a severely wounding blow to psychoanalysis.

With stunning rapidity, psychoanalysis lost its apparently secure grasp on the higher reaches of the psychiatric profession. Academic departments rapidly embraced neuroscience and research on drugs. Psychoanalytic recruits, and their brand of psychiatry faded away faster than the Cheshire Cat. By 1990, a Presidential proclamation heralded “The decade of the brain,” and the notion that mental disorders were the epiphenomenal manifestation of disordered neurotransmitters, faulty genes, or biochemical imbalances, was being heavily marketed to politicians and public alike.

You can read Scull’s paper in its entirety online.

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Comments (2)

  1. Submitted by Paul Brandon on 08/03/2011 - 09:12 am.

    Of course, it’s a professional guild fight about insurance reimbursements; not really an academic disagreement about effectiveness.

  2. Submitted by Ray Schoch on 08/03/2011 - 03:47 pm.

    I have to agree with Paul (#1) – this tug-of-war is not about effectiveness, which varies all over the map, but about insurance reimbursements and / or out-of-pocket payments.

    As someone who taught introductory psychology in a public high school years ago – few creatures are more self-absorbed than adolescent humans – I’ve been fascinated by the assumption, sometimes explicit, sometimes implicit, that the broad general field of psychology is somehow a “science.” While the field certainly has its scientific aspects, my understanding of “science” includes the notion that experimental results, to be considered of any validity, have to be replicable on a regular and frequent basis, and by other practitioners.

    That’s not what happens in psychology, according to what I’ve experienced and read over the years. Yes, we can measure how long it takes a rat to go from point A to point B when there’s a food reward at the end, and compare that to the time it takes when there’s no reward, but the applicability of that sort of research to actual human behavior is limited, at best. If there’s a constant to human behavior at all, it’s that, in many “normal” situations, human behavior is not consistent, and is sometimes irrational, which makes the sort of predictability we expect from the usual sorts of scientific experiments something akin to wishful thinking.

    Without suggesting that psychoanalysis is a waste of time and money – it quite clearly is not in many, many cases – I nonetheless came to the conclusion some time ago that the practice of psychology, whether on individuals in a therapy session or on groups whose behavior is being shaped in some way – by advertising, for example – is essentially an art, not a science. If it were a science, the same stimuli would produce virtually identical responses, either across populations, or over the long term with the same individual. Neither one of those things happen.

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