Ever since Sigmund Freud
introduced the world to daddy issues and penis envy, Americans have struggled
with the role mental health plays in their lives. The pursuit of happiness has
been a cultural touchstone since the founding fathers, but "happiness" has
never been a clear, specific term; that vagueness becomes particularly
difficult for psychiatrists trying to define the long-term goals of analysis.
Is it their job to simply fix a patient's most obvious neurosis, or is there
something more at stake—a deeper connection, requiring long hours of
intensive discussion and interpretation pointing toward an uncertain goal? In American
Therapy: The Rise Of Psychotherapy In The United States, Jonathan Engel follows
the history of psychiatry and its offshoots, showing how the science has been
as much about refining terms as it is about establishing them.
Beginning with
Freud—his ideas on the id, superego, and unconscious, his system of
psychoanalysis involving hundreds of hours between a patient and an aloof
interpreter/observer— Engel charts the expansion of psychotherapy on
American soil. Initially seen largely as a tool for the indolent wealthy,
psychiatry gained legitimacy in the trenches of World War II; returning
soldiers were unable to readjust to civilian life, and mental-health
specialists were the only ones capable of recognizing and dealing with the
problem. In the decades since, psychiatry has splintered into sub-groups, some
positive (social workers, AA), some less so. In recent years, the refinement of
therapeutic drugs like lithium and Prozac has forced doctors to adjust their
conception of "treatment" once again.
Psychotherapy is even-handed and
comprehensive, providing an invaluable overview of the past century's struggles
with the most internal of all medicines. If anything, Engel is a little too level-headed; his clarity
is laudable, but too often his depictions of internal squabbling and theory
reduce potential drama to its driest essentials. Which may be part of the
point; one of psychotherapy's biggest problems has been in establishing
clinical standards, and by describing developments in textbook prose, Engel
gives the profession a sense of quantifiable growth. More passion would've been
appreciated, as would a more in-depth examination of therapy's cultural
influence. But for anyone interested in how head-shrinkers moved from couches
to pharmacies, Psychotherapy is essential reading.