James Jackson Putnam and the Legacy of Liberal Protestantism in Early American Psychotherapy
Department of the History of Science
My work in the last year has centered on the questions: How and why did psychotherapy become a fixture of 20th century American life? How can we understand its broad and consistent appeal throughout the century? How can we understand this persistence despite frequent shifts in its practitioners, its theories, its patients, its targeted disorders -- indeed, when virtually everything about it is in a state of flux? At the moment I'm playing with the idea that we might be able to get deeper into these questions by examining the intersection of religious and medical impulses in American therapy. They seem to be ubiquitous. This paper represents one of my efforts towards that end.
There is a conundrum in the history of American psychotherapy with respect to the presence (and apparent absence) of religion, spirituality and the ministry. According to a 1980 government report, psychotherapists defined their practice as representing a "wide variety of treatments employed to ameliorate mental distress, mental illness, and problems of coping with daily life. Its practitioners, they report, are primarily psychiatrists, clinical psychologists, and social workers" (US Office of Technology, 1980). Earlier in the century, however, indeed in the earliest years of American psychotherapy, Richard C. Cabot, instructor in Clinical Medicine at Harvard Medical School and one of the founders of American psychotherapy, defined psychotherapy as such:
I (define) psychotherapy as the attempt to help the sick by mental, moral, or spiritual methods… This fact has, I believe, been realized more fully in America than elsewhere, and it is for this reason that the American type of psychotherapy seems to me to be something distinguishable -- and in many respects superior to any other type now existing… It is becoming increasingly clear that for the best results in psychotherapy we must have the cooperation not only of minister and doctor, but of minister, doctor, and social worker. It is this, I think, which, more than anything else, characterizes the type of psychotherapy which has sprung up on American soil (Cabot, 1908, pp. 7-8).
Ministers, morality and spirituality are central to Cabot's definition of psychotherapy, but they are noticably absent from the U.S. Technology Office's definition, a definition that is representative of the beliefs of American psychotherapists in 1980. Where did the ministers go? Did they just disappear? Did religion and spirituality and morality just disappear?
Cultural critics in the 1960s, such as Philip Rieff and David Reisman, recognized that some of the sociological features of religion have been at the heart of the American psychotherapeutic experience; others, like Thomas Szasz invoked the religious dimensions of psychotherapy as a way of challenging its medical authority. But the history of the persistence of the sociological features of psychotherapy reminiscent of the sociology of religion, and the history of relationship (or lack thereof) between ministers, social workers, psychologists and psychiatrists as practitioners of psychotherapy are virtually ignored. The historiographies of American psychotherapy and American pastoral counseling tend to remain delimited within their own spheres; histories of psychotherapy emphasize its medical and psychological origins, and histories of pastoral counseling emphasize its origin and development within the traditions of the Council for Clinical Training in Theology (CCTT) and Clinical Pastoral Education (CPE). Indeed, historians have given surprisingly little attention to the task of mapping out the particulars of this conundrum -- the questions of how and why religious features in American psychotherapy have persisted or not, and from where they might derive.
One of the more recent developments in the historiography of psychotherapy, however, has been the publication of Eric Caplan's Mind Games: American Culture and the Birth of Psychotherapy (Caplan 1998). Caplan is perhaps the first American historian to recognize the central influences of both medicine and the traditions of faith healing, Christian Science, and liberal protestantism in shaping American psychotherapy in the early 20th century.1 Caplan's book offers an excellent first chapter of the more comprehensive story of the origins of American psychotherapy in both medicine and religion. While some prominent American physicians, he argues, notably Morton Prince and James Jackson Putnam, had "flirted" with psychotherapeutic techniques around the turn of the century, it remained a rather marginal practice. Most physicians practiced a materialistic approach to nervous and mental illnesses, preferring to treat them either with hydrotherapy or electrotherapy, or with physically-based cures such as the rest cure (Weir Mitchell). Psychotherapy as a recognizable medical entity did not explode into the American consciousness until 1906 with the Emmanuel Movement. The Emmanuel Movement, a church-based interdisciplinary initiative at the Emmanuel Church on Newbury St. in Boston offered in the progressive spirit of the social gospel and supported by leaders of the Boston medical community, provided medico-spiritual treatment (free of charge) to psychoneurotic patients. While medical doctors such as Putnam and Isidor Coriat provided neurological evaluations to patients coming to the Emmanuel church, it was the ministers who provided most of the spiritual and psychotherapeutic counseling.
The ministers at Emmanuel Church were so successful in their treatments, and demand across the country exploded so rapidly for similar Emmanuel-type centers, that physicians feared they had committed professional suicide. They turned-coat and, with much effort, harnassed the rhetorical authority of science and medicine to argue successfully that doctors, not ministers, should practice psychotherapy. James Jackson Putnam was the most visible and vocal of these physicians both in his initial support for the movement and in his later repudiation of it. Caplan argues that the significance of the Emmanuel Movement for the history of American psychotherapy was the fact that it galvanized the medical community not only into an official acknowledgement of the medical legitimacy of psychotherapy but also into a full-scale colonization of its practice.
I would like to pick up where Caplan left off. Historians typically recognize the mental hygiene movement (Pols, 1997) or the reception of psychoanalysis in America (Hale, Burnham) as the next mileposts in the story of American therapy. But I think there was a crucial intermediary step, an overlooked "chapter two", that witnessed an integration of religious and even theological mandates into the calculus of medical psychotherapy. Despite the rapid dissolution of Emmanuel-type centers after 1908, the cultural press continued for psychotherapists to provide integrated medical and religious systems -- to offer moral and empathic consolation in lieu of materialistic cures, to provide a sympathetic ear and gentle guidance with respect to some of the most personal issues. All of the medical psychotherapists post-1908 had to address these popular demands. The years immediately following the demise of the Emmanuel Movement (1908-1917), then, are most notable for the broad-based efforts of medical psychotherapists to offer theological and moral imperatives along with their otherwise entirely materalistic systems. Many of them published, for the first time, ethical and even theological programs representing personal religious beliefs as part of medical treatises on psychotherapy. Pastoral Counseling, also an outgrowth of the Emmanuel Movement, emerged in these same years and in the same spirit: Ministers forged alliances with hospitals in order to fashion an interdisciplinary program that treated the spiritual suffering of the mentally and physically ill in hospitals and in parishes. But in this paper I will examine closely the work in the post-Emmanuel Movement years of James Jackson Putnam and Richard C. Cabot, perhaps the most religiously-inclined as well as most celebrated members of the Boston school of psychotherapy.
Putnam, when he rejected the prospect of ministers turning into physicians, nonetheless remained sanguine about physicians annexing some of the duties of the minister. He alluded to this belief in an oft-cited letter to the Rev. Elwood Worcester of the Emmanuel Movement, where Putnam tried tactfully but forcefully to urge Worcester to cease encroaching on Putnam's professional jurisdiction:
I have, for my part, already taken steps to express publicly my views as to the rational basis of religion in a way to make them appeal a little to physicians… I regard it as the physician's duty to see that his patients are not suffering for lack of moral and religious teaching...2
But Putnam was more explicit about the depth and breadth of this venture into ministry in his correspondence with Sigmund Freud. He confessed to Freud several years later that he experienced a certain kind of religious turning around the time of the Emmanuel Movement (1908):
Until recently I have had no religion at all, properly speaking, and was ready to let ‘natural science' be the arbiter of everything. Within the past few years I have changed in this respect… Psychologic observation of ourselves teaches us much, but it teaches us nothing with regard to the essential nature of the universe or of ourselves… Our psychopathic patients need, I think, something more than simply to learn to know themselves. If there are reasons why they should adopt higher views of their obligations (as based on the belief that this is a morally conceived universe, and that ‘free-will' has a real meaning, then these reasons ought to be made known to us.3
In their lengthy correspondence, published by Nathan Hale in 1971, Putnam asserted repeatedly the increasing influence of religious ideals in his work: "I believe that no patient is really cured unless he becomes better and broader morally, and, conversely, I believe that a moral regeneration helps towards a removal of the symptoms."4 He believed that sublimation alone was insufficient to cure his patients; they needed to understand the higher and greater purpose of the universe and of God, and in so doing of sublimating their energies in morally "right" directions.
By 1915 Putnam had published his emergent theology in a book entitled Human Motives, a book manifestly designed to introduce Freud's psychoanalytic ideas to an American audience. But Putnam's additional agenda was to add a series of moral imperatives to psychoanalysis: "I … heard a distinguished and clear-thinking professor of philosophy… assert that if God exists, it must be as an influence or energy penetrating the universe as an essential feature of it and as present in every detail and part of it, and that in fact he believed this to be the case. This is my own opinion." (p. 44 Putnam, Human Motives). The striving towards one's best potentials, in the spirit of his unitarian and transcendentalist roots, was at the base of Putnam's psychotherapeutic program after 1908. Putnam's response to the impact of the Emmanuel Movement, in other words, was to build both a theology and a moral system for the physician to use, one rooted in Putnam's private religious experience but one that expressed the values of the larger, protestant and social community in which he lived and worked. In Putnam's eyes the physician could easily serve as both doctor and minister; he offered (what Susan Lanzoni calls) an intradisciplinary model.
Richard C. Cabot, in contrast, was less optimistic than Putnam that physicians had the right "stuff" for the ministry -- even though he agreed with Putnam entirely that it was now incumbent on physicians to take into account these religious imperatives. Cabot confessed to Putnam a lack of confidence in his own fitness, and in the fitness of most of his medical colleagues, for the tasks that psychotherapy now demanded of them:
… I have for some time maintained that the training of physicians does not fit them for the treatment of psychoneuroses, and the recent discussions in relation to psychoanalysis makes me even more emphatically of this opinion
… So long as our doctors are so fundamentally uneducated, that is, so long as they perversely insist on regarding medical science as a branch of natural history, I shall continue to fear that some strong, sensible journal like Collier's weekly will get up and expose the lot of us, showing how we practice pseudo-science instead of the real article, and bunglingly interfere in provinces better understood by laymen.5
He proposed instead a system where ministers and secular equivalents of the ministry --social workers and educators -- would help physicians do psychotherapeutic work:
If an alliance is desirable, I believe myself that the fittest people to be allied with the physicians in this movement to-day are the social workers. I think the social workers, -- what we used to call the ‘charity' workers -- are the best, the wisest, the most spiritual people in the community -- more spiritual in my opinion, more religious, even, than the clergy. Therefore I believe that they should be allied with the physician in carrying out his work.
So a patient may be treated by ordinary physical methods alone; but if, without giving up anything that medicine has taught us so far, we work upon the social, moral and spiritual side of each patient's nature, I think we shall see in the future, through the alliance of medicine with the minister, the social worker or the educator, or by such a reform of medical men as will make them include and treat all sides of human suffering, a far greater help for the diseases with which our bodies are burdened.6
Cabot was finely-tuned to social gospel and progressivist trends. He had published an analysis of several cases from Emmanuel church in Outlook, a social gospel and progressivist journal, and he founded the department of social work at Mass. General Hospital. Cabot's interests in team-work and social service are evidence of his commitment to the central tenets of the social gospel and certainly to a kind of "social christianity", an extension of the social gospel that did not rely to as great an extent on any kind of immanent theology (Dorn, 1995). Cabot redefined religion to downplay its theological dimensions: "I mean by religion the deepest that there is in any human being. When you reach the core of any man, you reach, it seems to me, the divine spark in him, that is, you reach his religion. That center, that core as I have called it, lies behind and issues in all that he does… The point of view of religion is one of hope and confidence in the fundamental rightness of things" (p. 47). Still, Cabot was deeply committed to the view that ministers should have a share in psychotherapeutic healing, albeit so long as they did not attempt to engage in medical healing. In that vein he was also instrumental in founding the Council for the Clinical Training in Theology, an early incarnation of the Pastoral Counseling movement. In the end he had successfully established institutional support for the practice of psychotherapy by physicians, on the one hand, by social workers on the other hand, and by ministers on yet another.
It is tempting to think of the reactions of Putnam and Cabot as outliers from, or exceptions to, the sentiments of the general community of Boston medical psychotherapists. Putnam and Cabot were, after all, the most publicly religious and moralistic members of their community. But such was not the case in the years following the decline of the Emmanuel Movement. Virtually all of the prominent members of the Boston school of psychotherapy made their voices heard after 1908 with their own solutions to the religious problem that the Emmanuel Movement urged on them. For instance, Morton Prince and the faculty at Tufts University tried to solve this problem by offering two different courses on psychotherapy, one exclusively for medical students (taught by Prince) and the other exclusively for divinity students, taught by Rev. Shields7, a student of Worcester and McComb. The Boston Evening Record, noting these new developments at Tufts, admitted that the Emmanuel Movement had reshaped the landscape of medical psychotherapy: "Even the critics of the Emmanuel Movement… admit that it is part of a great movement… " The Herald reported that "these two "psycho" courses at one of the most enterprising of our Eastern colleges should help to remove the grounds of such criticism by supplying a better quality of scientific training to such divinity students as are drawn towards the new ideas.. We believe this is the first course of lectures of this kind in any medical college in this country."8
Other prominent members of the Boston School of Psychotherapy proposed different solutions. Hugo Münsterberg, the eminent Harvard psychologist, responded in 1909 with a large treatise on psychotherapy suggesting that psychologists, rather than physicians or ministers, were best suited to bridge the worlds of medicine and religion (Munsterberg 1909). Isador Coriat, a Boston neurologist and son of Moroccan Jewish immigrants who remained a loyal consultant to the Emmanuel Church long after Putnam turned away, continued to conceive of his work as an integration of religion and medicine even after he became a psychoanalyst. He argued that the psychoanalyst was "capable of combining the roles of physician and minister" (Sicherman, p. 172). It is also worth noting that prominent physicians outside of Boston responded similarly; James J. Walsh, for instance, Dean and Professor of Functional Nervous Disorders at Fordham University School of Medicine, published in 1913 a 780-page textbook on psychotherapy dedicated to "the Jesuits… To whom the author owes a happy introduction to the intellectual life and constantly renewed inspiration in his work." Indeed, despite the overwhelming amount of medical information in the book, Walsh ultimately gave religion the last word. The final appendix of the book was dedicated to the subject of "Religion and Psychotherapy;" and Walsh ended the book by reminding his readers that "we are here on trial for another world is the thought that in the past strengthened men to bear all manner of ills, if not with equanimity, at least without exaggerated reaction. It has still the power to do so for all those who accept it simply and sincerely" (p. 780) (Walsh 1913).
Historians have rightly observed that Putnam, Cabot, Prince and the others used a flourish of rhetoric about the greater value of science and medicine over religion in their efforts to buttress the leadership of the medical profession in psychotherapeutic practice in the post-Emmanuel Movement years. But this was not their only, or even most successful, line of defense. In this paper I am arguing that they also tried to outwit the ministers at their own game as spiritual leaders. They shored up their personal religious and spiritual philosophies, certainly philosophies that would have been of little rhetorical or practical value to them in the purely materialistic framework of late 19th century neurology, and integrated these philosophies into their emerging "psychologo-medical" calculus. This new calculus (to borrow a phrase from Caplan) of medical psychotherapy now demanded not only technologies of symptom-reduction, or even knowledge of psychological response-times, but also programs of faith, rooted in the social gospel and other liberal protestant ideals, with which to rectify and build upon the perceived moral lassitude of urban patients. The appearance of Freud and his entourage at Clark University in 1909 could not have been more propitious. The purely psychological framework of psychoanalysis offered a crucial bridge, in secular language, between their materialistic past and their new medico-spiritual undertaking.
Now, to return to the question: Where did the ministers go? Part of the answer lies in the emergence of pastoral counseling. When ministers retreated from psychotherapy in the wake of the Emmanuel Movement they nonetheless continued its practice in a more limited form and realized it institutionally in the creation of pastoral counseling. Richard Cabot is the one physician from the cohort of Emmanuel Movement physicians to influence directly the creation of pastoral counseling. But many of the ministers involved in Emmanuel-type healing guided the next generation of students of the ministry towards the kind of clinical consciousness that the Emmanuel Movement had awakened. And these ministers, most notably Anton Boisen, crafted the template for pastoral counseling that has endured to this day.
Another, and perhaps more overlooked, part of the answer to the question of the missing ministers suggests that the aim, if not the bodies, of the ministers remained present in the program for medical psychotherapeutics that neurologists and psychiatrists adopted after 1908. American psychotherapy retained its cultural power in part because its early medical practitioners concocted a potent mixture of ethics, spirituality, science and medicine that satisfied a public hungry for Emmanuel-type healing.
I'd like to end by looking more speculatively toward the implications of these ideas. This interdisciplinary moment in the formation of a uniquely American psychotherapy might offer historians a new way of linking the Emmanuel Movement with other later but equally significant psychotherapeutic moments in American history that typically are understood only in secular terms. For instace, the mental hygiene movement of the 1920s. Mental Hygiene psychiatrists, as Hans Pols has shown, preached a philosophy of "positive adjustment", a socialization process whereby they might prevent children and young adults from falling into the pits of mental illness. While this concept of "adjustment" has been linked to Adolf Meyer's philosophy of the organism in its environment, it is equally derivative of social gospel, progressivist and liberal protestant ideals. Social gospelers argued that teamwork and social relations were the path towards salvation in an economy where work was growing increasingly mundane and social roles becoming increasingly diffuse. Suffering, from this standpoint, was redefined as being lonely, isolated, unable to function and work cooperatively with others, being unable to find meaning in one's life's work or in one's social relations. Social adjustment, facilitated by this new moral concoction of early medical psychotherapists, became crucial not only for an industrial and corporate economy but also for the spiritual salvation of individuals here on earth.
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1.Another historian of note is Eugene Taylor, who has written extensively on William James, Swedenborgianism, Transcendentalism and other spiritualist traditions and their relationship to American psychology, psychopathology, psychiatry and psychotherapy.
2. JJP to Worcester, Sept. 12, 1908. James Jackson Putnam Collection Box 6. Rare books and special Collections of the Countway Library, Harvard Medical School
3. Letter from JJP to SF, Feb. 15, 1910, p. 95 in Nathan G. Hale (1971) James Jackson Putnam and Psychoanalysis. Cambridge: Harvard University Press.
4. Ibid., Letter from JJP to SF, Late March, 1911, p. 118.
5. R.C. Cabot to J. J. Putnam, February 17, 1911. James Jackson Putnam Collection Box 6. Rare books and Special Collections of the Countway Library, Harvard Medical School.
6. Richard C. Cabot (1908) Psychotherapy and its Relation to Religion. Religion and Medicine Publication No. 5. New York: Moffat, Yard & Co. pp. 54-55.
7. Shields, I should note, was later brought to Los Angeles to establish the first psychotherapy clinic at a hospital
8. article in the October 14, 1908 edition of Boston Evening Record (?