Psychologist and physician collaborations: 1800s through 1940s — Early beginnings

Collaborations between psychology and health care have begotten a long-standing and rich history.

 
The collaborations between psychologists and pediatricians are often viewed as fairly recent developments. However, these relationships are more than a century in the making. Pediatrics as a specialty was founded in the mid-1800s, with evidence of psychology’s involvement since the 1890s. Lightner Witmer (1867-1956) of the University of Pennsylvania, often credited with first defining clinical psychology (McReynolds, 1997; Witmer, 1907), wrote of the opportunities for collaboration, stating that pediatricians have the opportunity to learn “what normal, mental, and physical conditions manifest themselves in and out of the school-room” from psychologists, while psychologists are to learn from the pediatrician “the morbid and abnormal conditions that are frequently met with in childhood, and to acquire some knowledge…towards their amelioration” (Witmer, 1896, p. 391).
 
In 1911, APA established a Committee on the Relations between Psychology and Medical Education (Franz, 1913). The committee began discussions about psychology’s involvement in medical education. In 1921, psychology and pediatrics were both provided with support for their work with the passage of the Sheppard-Towner Act, which increased funding for maternal and child health centers across the country, dramatically increasing the availability of pediatric care and decreasing the rates of infant mortality (Lemons, 1969; U.S. Congress, 1921).
 
Around this time, child-focused research began to expand, with pediatricians focusing on the etiologies of and treatments for childhood illness (Golden, 2011). The Society for Research in Child Development (SRCD), a multi-disciplinary organization involving psychologists, was founded in 1933 (Hagen, 2008). Behavioral psychology was also on the rise, resulting in the founding of behavioral clinics, including the Massachusetts Habit Clinics, within hospitals that focused on habit training, parenting skills, and developmental assessment (Thom, 1938).
 
John Edward Anderson, (1893-1966) of the University of Minnesota and president of SCRD (1942-1944) and APA (1942-1943; Ohles, Ohles, & Ramsay, 1997; Templin, 1968), addressed the American Medical Association and articulated both the strengths and weakness of psychology at the time: “Unfortunately, [psychologists], who are slowly, but surely building a science, seldom secure the ear of the public and to their regret must see their field constantly misrepresented and exploited by the charlatan and the quack in a manner not unlike that which works to the harm of scientific medicine (Anderson, 1930, p. 1016).” In his address, Anderson focused on opportunities for psychologists to utilize their unique skills within pediatrics, including their strong training in child development and conceptualization of children as more than “adults in miniature.” He believed that psychology could contribute to the practice of pediatrics though intelligence testing, developmental assessments, and child behavior training, areas in which pediatricians and nurses were often undertrained.
 
While views that pediatric medicine and psychology could benefit from working and training together were shared by some, a schism existed between those who thought psychologists stood poised to contribute to well-being of children and those who believed it was a “menace.” Joseph Brennemann (1872-1944), a prominent pediatrician (Gibson, 1944), was the latter. His views reflected prominent issues at the time, including the proprietary role of pediatricians in dispensing information to parents and the underdeveloped status of psychiatry. He believed that pediatricians would meet the psychological needs of children. He stated, “It hardly seems feasible [for a mother] to consult a psychiatrist periodically as she did a pediatrician, although one psychiatric group has maintained that one out of every three children should have psychiatric care. God help the race if it is true” (Brennemann, 1933, p. 16).
 
Throughout the 1940’s, progress in pediatric medicine continued to create opportunities for the involvement of psychologists. For example, the shift to preventative medicine, including immunizations, nutrition, and the use of antibiotics (Connolly, 2011) that resulted in dramatic declines in infant and child mortality, provided more opportunities for addressing behavioral concerns in children. Public interest in child rearing increased, with the publication of popular books on psychology, including Benjamin Spock’s The Common Sense Book of Baby and Child Care (Spock, 1946).  
 
Outside of medicine, World War II dominated society during the early 1940’s and the focus of medicine and psychology shifted necessarily to treating the physical and mental health of returning soldiers. However, after demonstrating the merits of psychology during the war (Hoffman, 1992), governmental funding for clinical psychology programs increased and the scientist-practitioner focused Boulder Model was established in 1949. Having a standardized focus and requirements for graduate training bolstered the perception that psychology was developing as a profession, gaining the respect of other professionals (Baker & Benjamin, 2000). By the late 1940’s, psychologists were still primarily practicing in psychiatric hospitals and with adults (Mensh, 1953). There is evidence though that progress within child psychology was continuing. For example, the first version of the Wechsler Intelligence Scales for Children was published in 1949 (Wechsler, 1949).
 
In conclusion, collaborations between psychologists and pediatricians have deep roots dating back to the late 1890’s. Individuals on both sides foresaw the benefits of interdisciplinary treatment of children, although growth in these collaborations was slow during the first part of the 20th century. The roots of these collaborations are seen in current models of pediatric psychology practice and integrated care in pediatrics.

References

  • Anderson, J. E. (1930). Pediatrics and child psychology. Journal of the American Medical Association, 95(14), 1015-1018.
  • Baker, D. B., & Benjamin, L. T. (2000). The affirmation of the scientist-practitioner: A look back at Boulder. The American Psychologist, 55(2), 241-247.
  • Brennemann, J. (1933). Pediatric psychology and the child guidance movement. The Journal of Pediatrics, 11(1), 1-26.
  • Connolly, C. A. (2011). Pneumococcic meningitis: Complete recovery of a 6-month-old infant treated with penicillin. Archives of Pediatric and Adolescent Medicine, 165(5), 385-387.
  • Franz, S. I. (1913). On psychology and medical education. Science, 38(981), 555-566.
  • Gibson, S. (1944) Obituary: Joseph Brennemann 1872-1944. American Journal of Diseases of Childhood, 68, 200-202.
  • Golden, J. (2011). Pediatrics, public health, and infant mortality in the early 20th century. Archives of Pediatric and Adolescent Medicine, 165(2), 102-103.
  • Hoffman, L. E. (1992). American psychologists and wartime research on Germany, 1941-1945. American Psychologist, 47(2), 264-273.
  • Lemons, J. S. (1969). The Sheppard-Towner Act: Progressivism in the 1920s. The Journal of American History, 55(4), 776-786.
  • McReynolds, P. (1997). Lightner Witmer: His Life and Times. Washington, DC: American Psychological Association.
  • Mensh, I. N. (1953). Psychology in medical education. American Psychologist, 8(2), 83-85.
  • Ohles, F., Ohles, S., & Ramsay, J. (1997). Biographical dictionary of modern American educators. Westport, CT: Greenwood Press.
  • Templin, M. C. (1968). John E. Anderson: 1893-1966. Child Development, 39(3), 657-670.
  • Thom, D. A. (1938). Habit clinics for child guidance. (United States Department of Labor Publication No. 135). Washington, DC: U.S. Government Printing Office.
  • Spock, B. (1946). The common sense book of baby and child care. New York: Duell, Sloan, and Pearce.
  • U.S. Congress. (1921). Sheppard-Towner Act. United States Statutes at Large, 67th Cong., Sess. I, Chp. 135, p. 224-226. American History Online. Facts On File, Inc.
  • Wechsler, D. (1949). Wechsler Intelligence Scale for Children. New York: The Psychological Corporation.
  • Witmer, L. (1907). Clinical psychology. Psychological Clinic, 1, 1-9.
  • Witmer, L. (1896). The common interests of child psychology and pediatrics. Pediatrics, 2, 390-395.

About the Authors

Jennifer L. Lee is a graduate student in the Department of Psychology at the University of Georgia and the SPP Student Representative. This article is based on a presentation prepared initially for a History of Psychology class.
 
Anne E. Kazak, PhD, ABPP, is co-director of the Nemours Center for Healthcare Delivery Science and professor in the Department of Pediatrics at Thomas Jefferson University. She is the SPP historian.