AMERICAN THERAPY

Thorough yet concise history of the talking cure.

“Of course you have to start with Freud,” writes Engel (Health Care Policy and Management/Seton Hall Univ.; The Epidemic: A Global History of AIDS, 2006, etc.). No matter how modern psychology may attempt to distance itself from its out-of-fashion master, there is no escaping Freud’s work in psychoanalysis. For better or for worse, it indelibly shaped not only the enterprise of psychotherapy but also the ways in which people think about themselves and the workings of their inner lives. Engel quickly moves on with an outline of the extended turf wars over who had the better claim to the promotion of sanity and mental health: The medically trained psychoanalysts with their biological understanding of psychopathology? The research-trained doctorates whose field had its roots in psychological testing? The social workers who brought with them an emphasis on understanding the context in which mental illness occurred? Half a century after these questions were first raised, many of them are still debated. Engel also walks the reader through such subjects as the growing recognition of alcoholism as a disease and the foundation of organizations like Alcoholics Anonymous as extra-therapeutic means of dealing with it; lobotomies and other surgical interventions; the development of vastly different schools of psychological thought, from cognitive-behavioral therapy and humanistic therapy to the current trend in “eclectic” therapies. The book closes with the rise of pharmacotherapy and the decline of traditional psychoanalysis. In the final chapter, Engel describes the frightening impact of managed care, which effectively bars psychoanalysis for all but the wealthiest patients and pushes those suffering from a variety of maladies to try less time-consuming and costly pharmacological remedies first. This despite the fact, he notes, that multiple studies have shown psychotherapy—of many different kinds—to be as effective or more effective than pills alone.

A capable explanation of a complicated field.