Chapter 6
Embracing Psychotherapy The Emmanuel Movement and the American Medical Profession
In November 1906 James Jackson Putnam penned a brief letter to his good friend and colleague, Richard C. Cabot. "The Neurasthenic Class, which your suggestion first put into my mind," Putnam wrote, "is going to be provisionally launched tomorrow evening in the Vestry of the Emmanuel Church, where Dr. Worcester and I are to explain the plan and I am to make a brief address. ... May we not hope at least to excite an interest, making practical some of the fundamental principles of psychology and philosophy and mental hygiene? I feel sure that many persons would be much interested to be told in simple language and in reference to practical learning, what the scientific people are doing."[1] Within two years Putnam's hopes were dashed. In a public letter to the Boston Sunday Herald the Harvard Medical School professor renounced his ties to what had become a full-blown national movement and conceded that his early support had been seriously misplaced: "I have spent many sleepless nights the last year worrying over injury I may have done in allowing my name to stand sponsor for a state of affairs that I deeply feel is of harm to the public."[2]
Although not unprecedented, the willingness of a prominent American physician to air his views in public was by no means common. The decision of Putnam and other critics of what came to be known as the Emmanuel movement to express their concerns in such a glaringly visible manner was fueled in large measure by the realization that they were losing their capacity to direct the course of psychotherapy in the United States. Putnam's changing sentiments were just one small gust
in a much larger storm that had swept the topic of psychotherapy into the homes of virtually every literate American.[3]
Whereas more than thirty years of vigorous internal professional debates had failed to generate a consensus among American neurologists and psychiatrists regarding the scientific legitimacy and clinical efficacy of mental therapeutics, in two short years the Emmanuel movement had forced the American medical community to confront squarely and publicly a subject that it had long avoided.[4] More than any other single factor the Emmanuel movement not only raised the American public's awareness of psychotherapy but also compelled the American medical profession to enter a field that it had long neglected.
What came to be known as the Emmanuel movement was initially conceived as a local cooperative venture between Boston physicians and Episcopalian ministers. It began as an experiment in public health that aimed to provide impoverished victims of neurasthenia and other functional nervous disorders with a "fusion of religious faith and scientific knowledge."[5] The movement's name stemmed from its affiliation with one of Boston's most venerated institutions, the Emmanuel Church, which was located on Newbury Street near the Public Garden. By 1909 a host of similar ventures had been launched across the nation, in Brooklyn, Buffalo, Detroit, Philadelphia, Baltimore, Seattle, and elsewhere. No longer confined to the Episcopalian church, the psychotherapy movement's appeal transcended denominational boundaries. Baptists, Presbyterians, Congregationalists, Unitarians, and Universalists all enlisted in the cause.
Although the program's medical and clerical champions had realized early on that this unprecedented medical-pastoral venture might arouse the ire of their more intransigent colleagues, they failed to anticipate not only the popular allure of their program but also the almost ubiquitous professional opposition that their efforts would soon elicit. Shortly after the program's inauguration Canadian-born journalist H. Addington Bruce declared, "Signs are multiplying that the medical profession, which has hitherto been conspicuous for its opposition to the mental healers, is beginning to show a serious interest in their claims."[6] In a telling statement, journalist Ray Stannard Baker added, "Though there is a union of ministers and doctors in the work of the Emmanuel Movement, yet back of it all lies a real struggle of the two professions to attain a greater influence over the lives of men."[7]
Whereas the frequently overlapping Euro-American medical-cultural discourses regarding neurasthenia, railway spine, hysteria, and mind cure were all vital prerequisites for the establishment of so-called scientific
psychotherapy in the United States, neither alone nor taken together were they capable of generating widespread American medical interest in the topic. Like the mind cure movement, the Emmanuel movement both tapped into and stimulated an already existing demand for mental therapeutics. Where it distinguished itself from its less respectable rivals was in its capacity to exert a profound impact on the American medical profession.
Both the popular coverage of and public enthusiasm for the Emmanuel movement triggered an almost instinctual prudence from more conservative members of the medical and clerical establishments. Such nonsense, they claimed, bore a stark resemblance to the ideas and methods espoused by the more ordinary mind cure quacks. Attacking psychotherapy as being no different from Christian Science, New Thought, or any of the other healing cults, the movement's professional critics waged a vigorous campaign against what they deemed an equally insidious cult arising from within their own ranks.[8] In response to this rising tide of professional opposition, several physicians who initially supported the movement withdrew their backing. Others, who under more ordinary circumstances might not have given the psychotherapeutic efforts of a few Boston ministers and physicians a second thought, began a vigorous professional and popular campaign to discredit the movement and to usurp its function. The movement's defenders responded in kind. As a result what had formerly been an endogenous, if not actually an esoteric, neurological, psychiatric, and religious discourse became grist for the public mill.
The Emmanuel movement distinguished itself from prior American efforts to legitimate mental healing by the social standing of its promoters and by the coverage it received. In many respects the former fueled the latter. Prior to 1910 the Readers' Guide to Periodical Literature does not cite a single article on either Freud or psychoanalysis; it does, however, list thirty-one articles on the Emmanuel movement.[9] In contrast to both Christian Science and New Thought, each of which had been painted in relatively unflattering colors, the Emmanuel program's fusion of "science" and established religion was initially depicted in highly favorable terms. One article boasted that "this union of religion with sound science ... is the most tremendous alliance yet made for the benefit of suffering humanity."[10]
This positive assessment derived from the eminence of the program's founders. Both were pillars of the cultural establishment. Protestant, male, and educated in the finest European universities, Elwood Worcester and Samuel McComb faced few, if any, of the obstacles that impeded
the efforts of their less respectable rivals. These facts alone distinguished the Emmanuel movement from virtually all other contemporary religious healing movements. Worcester, chief rector of the Emmanuel Church, possessed credentials that rivaled, if not surpassed, those of virtually all American academic psychologists: in addition to holding degrees from Columbia University and the General Theological Seminary, he had also earned a Ph.D. in philosophy at Leipzig, where he had studied with Max Heinz and Wilhelm Wundt.[11] Worcester's recently arrived assistant, Samuel McComb, could boast of virtually identical qualifications.[12]
Before coming to Boston in 1904 Worcester had spent several years in Pennsylvania, where he taught classes in psychology at Lehigh University and later served as minister to the St. Stephen's Episcopalian Church in Philadelphia. At St. Stephen's Worcester came in contact with Philadelphia's famed neurologist and writer, S. Weir Mitchell.[13] Worcester and Mitchell were more than mere acquaintances. Later in life Worcester recounted that Mitchell had been his "most interesting parishioner and ... most intimate friend."[14] Indeed, despite Mitchell's later condemnation of the program, Worcester credited him with having first suggested the idea of establishing a clerical-medical alliance to promote psychotherapy.[15]
One day, as we were walking up Walnut Street, Dr. Mitchell stopped and said: "Rector, if you and I should get together and establish a work on the basis of sound religion and sound science, we could put [mentioning a person he detested] out of business." I left Philadelphia soon after this occasion, and I do not know if Dr. Mitchell ever thought of these words again. They remained in my mind, however, and they were destined to play an important part in my subsequent life.[16]
Several years passed before Worcester had the chance to put Mitchell's suggestion into practice.
Soon after his arrival in Boston Worcester met Joseph Hersey Pratt, a young internist at Boston's Massachusetts General Hospital who had recently devised a home treatment program for the city's impoverished victims of tuberculosis.[17] Lacking the financial resources to institute his plan, Pratt turned to Worcester's Emmanuel Church for financial support. Worcester graciously acceded to the request. The inspiration for Pratt's program derived from a December 1904 encounter in Asheville, North Carolina, with Dr. Charles L. Minor. An expert on tuberculosis, Minor had developed a home treatment program not for the poor but
for the wealthy, who despite their means refused to avail themselves of expensive sanitariums. Pratt's program, although similar, was not an exact replica of Minor's. In contrast to Minor's personally directed home treatment program, Pratt's plan centered on a weekly meeting of the Emmanuel Church Tuberculosis Class, during which Pratt "focused on bolstering his patients' faith, and encouraging their adherence to the arduous regimen of enforced bed-rest considered so essential to the cure."[18]
To Worcester, Pratt's project demonstrated "what faith and devotion, through the employment of the best methods of science, could accomplish."[19] Pratt "was like a father surrounded by his children. Kind, merry, highly skillful and optimistic, he inspired all his patients by his confidence and hope."[20] Worcester declared in a widely read article, "The success of Pratt's program showed me that the physician and the clergyman can work together with excellent results."[21] Later in life he wrote, "[The] success of our Tuberculosis Class moved me to undertake another service to a larger group of unhappy, unstable men and women, to persons suffering from physical and nervous affections ... and to the victims of injurious habits such as alcoholism and other drug addictions."[22]
Worcester's inspiration to begin a psychotherapy class was not based exclusively on Pratt's program, however. His earlier experiences with both the "higher criticism" and the "new psychology," he claimed, were equally significant. Worcester cited with equal frequency the biblical scholarship of Ernest Renan, Adolf von Harnack, and Theodore Keim and the psychological investigations of Gustav Theodor Fechner, Wilhelm Wundt, and William James. From the former, Worcester concluded that "something valuable had been lost from the Christian religion, and that Christianity had not always been so unsuccessful in its appeal to human nature as it [now was]."[23] From the latter, Worcester became aware of the subconscious mind, the law of suggestion, and the scientific method. "Above all," Worcester added, "I learned from psychology the advantage of a scientific method in dealing with myself and with other men."[24]
From the start Worcester and McComb had little trouble enlisting the aid of prominent neurologists and psychiatrists. Two pillars of the Harvard medical community, Putnam and Cabot, provided much needed backing at a critical stage in the program's development. They were joined by Drs. Isador Coriat, James G. Mumford, Joseph H. Pratt, and Joel E. Goldthwait. Perhaps even more significant was the attitude of Bishop William Lawrence. Lawrence had the authority to squelch
Worcester's program if he feared that it might impair the church's prestige.[25] Never alluding to the movement in public and referring all requests for information directly to the ministers, the bishop maintained an attitude of "benevolent neutrality."[26] Despite the later opposition of several prominent physicians, ministers, and psychologists, the historian John Gardner Greene notes that at no time were Worcester or McComb "opposed by the one man whose opposition could have done decisive harm to their cause."[27]
The Program Begins
The Emmanuel program commenced with a series of public lectures in November 1906. Putnam, Cabot, Worcester, and McComb spoke on a host of topics ranging from recent psychological investigations to Jesus' healing ministry. Worcester concluded the lectures with the announcement that he and McComb, accompanied by two psychiatrists, would set aside some time the following morning to meet with anyone who desired to discuss their "moral problems or psychical disorders." Worcester expected a modest turnout but was confronted with an entirely different situation, which he later described in vivid detail:
I found one hundred and ninety-eight men and women, suffering from some of the worst diseases known to man, old chronic maladies, rheumatism, paralysis, indigestion, conditions which lay totally outside of our province. Thus, from the very beginning, our carefully prepared scheme was taken out of our hands and committed to the people. Our physicians were in despair, but they stuck to their guns and manfully distinguished some cases which seemed promising and furnished us with a number of diagnoses.[28]
In a few short weeks Worcester and McComb had more than two hundred patients on their hands.[29] Over the next several months the two ministers and the program's medical consultants formalized the process by which patients were selected to participate in the program. Candidates for psychological treatment were required to bring a letter from their physicians. Those lacking such letters were referred for examination to one of the physicians of the parish who agreed to examine, free of charge, all who applied for admission to the health class.[30]
In its final form Worcester's program consisted of three mutually reinforcing elements: a medical clinic where physicians provided free
weekly examinations; a weekly health class at which eminent physicians, clergymen, and psychologists lectured on a variety of issues relating to physical, mental, and spiritual health; and private sessions during which the minister employed psychotherapy. The health class was modeled after Pratt's "successful" tuberculosis class. "The idea," Putnam said, "is to have a series of conferences where questions will be asked and answered, and talks given by suitable persons."[31] Meeting each Wednesday evening from November through May, the class typically attracted between 250 and 500 individuals. Its aim was to promote physical, mental, and spiritual health. All segments of the population were represented, but the overwhelming number were women.[32] Each class began with a prayer, after which Worcester, McComb, or a guest speaker would deliver a lecture on some relevant spiritual, medical, or psychological issue. At the close of the lecture the congregation was invited to an upper room for a social hour and refreshments.[33]
Although the Emmanuel class received considerable coverage in the press, it aroused little controversy. The same could not be said for the private psychotherapy sessions with the minister. An early proponent of the movement described the sessions as "a sermonette preached to a congregation of one at the moment of extreme suggestibility."[34] One of Worcester's early disciples explained, "After the discussion and the prescription of good books the patient is seated in the comfortable morris chair before the fire, which I take care by this time to have burning low—is taught by rhythmic breathing and by visual imagery to relax the muscles, and is led into the silence of the mind by tranquilizing suggestion. Then in terms of the spirit, the power of the mind over the body is impressed upon the patient's consciousness, and soothing suggestions are given for the relief of specific ills."[35] This therapy derived its force from the minister's spiritual and moral authority. Treatment usually lasted from fifteen minutes to an hour depending on the difficulties encountered.[36]
The Movement Spreads
Not long after the program was established a number of prominent clergymen began visiting the Boston church to learn first-hand of the medical-clerical venture. By the autumn of 1908 Good Housekeeping reported the initiation of church-sponsored clinics throughout the East Coast and Midwest.[37] Among the most prominent were those
of Bishop Samuel Fallows of Chicago and the Reverends Robert MacDonald of Brooklyn, Loring W. Batten of New York, and Albert Shields of San Francisco.[38] Fallows's reputation prompted others throughout the region to take the movement seriously and helped to inspire what soon became a vibrant national debate concerning both the nature and the control of psychotherapy in the United States. Longtime foes of Christian Science, Fallows and his wife had coauthored Science of Health from the Viewpoint of the Newest Christian Thought (1903) shortly after the turn of the century. This work stressed the compatibility of orthodox Christianity with "the belief in the supremacy of the inner and immortal self over the entire external world."[39]
Although more harmonious with mainstream Protestant denominations than Christian Science, "Christian Metaphysics" suffered from the same shortcomings as its less respectable rivals. Each neglected to consider the most recent "advances" in neurology, psychiatry, and academic psychology. It took Fallows little time to see the virtue of Worcester's more inclusive program. Soon after he learned of the work being done in Boston he commenced with plans to institute a similar venture in his home city of Chicago.[40] By the spring of 1908 the Brooklyn Eagle reported that "the parlors of St. Paul's Church have been crowded with people seeking help and light upon the movement. Remarkable results have already followed the efforts put forth."[41] Fallows proved to be one the movement's most prominent supporters. He devoted virtually all of his time and energy to the work. He lectured throughout the region, published a number of articles espousing not Christian Metaphysics but "Christian Psychology," and wrote a book-length work on the subject, Health and Happiness; or Religious Therapeutics (1908).[42]
Whereas the first ministers to embrace Worcester's program were fellow Episcopalians, not all of his clerical supporters came from the ranks of his denomination. Indeed, one of Worcester's earliest and most vocal champions was the Reverend Dr. Robert MacDonald of the Washington Avenue Baptist Church in Brooklyn, New York. The author of Mind, Religion, and Health (1908), MacDonald proved to be one of Worcester's most able lieutenants.[43] On February 16, 1908, the Baptist minister delivered the first of what would be several published sermons devoted to the Emmanuel movement to an overflowing audience at the Washington Avenue Baptist Church. The reception to MacDonald's sermons was for the most part overwhelmingly positive. Robert E. Peele of Ebenezer, South Carolina, wrote to say that he was "in thorough sympathy with the Emmanuel Movement." W.E.J. Gratz of Elizabeth,
New Jersey, reported that "for a great many years, [he had] been looking for just what this Emmanuel movement is giving us—a clear rational, scientific basis for the presentation of a sadly neglected truth." Not everyone was convinced by MacDonald's lectures, however. I. D. Grover of Brooklyn, New York, charged that "all this talk of 'hypnotic touch,' 'subconsciousness,' 'thought producing diseases as readily as germs,' etc., smacks too much of Christian Science and Spiritualism and their ilk."[44]
In the Public Eye
From its inception the Emmanuel program operated in the public light and under considerable professional scrutiny. Such attention was a mixed blessing. On the one hand, it extolled Worcester's many achievements and inspired others to become familiar with his efforts; on the other, it frequently exaggerated and in several instances grossly distorted the true nature of the program.[45] To combat scores of distortions and misconceptions concerning their program, Worcester and McComb commenced what would become a multiyear effort not only to explain but also to promote the work being done at the Emmanuel Church. The two men provided the nation's booming periodical press with scores of articles discussing various aspects of their work, distributed a brief series of pamphlets that offered a more detailed description of their efforts, and published the best-selling book, Religion and Medicine . In addition to these literary ventures, Worcester and McComb embarked on an extensive lecture tour that took them to several American and European cities.
Both men denied that these highly visible endeavors stemmed from any aim to launch a national movement. The decision to publicize their work, Worcester later insisted, derived from little more than a desire to set the record straight; it had, he said, been thrust upon them by "the sensational press [which] saw in our doings an unending source of weird stories and caricature. They were determined to find something wild and fanatical in our work and meetings and, when they could not discover it, they would invent it."[46] Although there is some merit to Worcester's claim, the actions of the two ministers suggest that their motives were not nearly so humble as they would later maintain. Evidence exists suggesting that from the start both Worcester and McComb had high hopes for their program. In a personal letter to Putnam,
Cabot expressed "dismay ... over hearing Dr. McComb, that first evening, prophesy a vast extension of the church healing movement."[47]
As early as March 1907, when the program was not yet four months old, McComb declared, "I propose to set forth as clearly as I can the fundamental principles on which the Emmanuel Church movement is based."[48] More notable than the minister's words was the medium in which they appeared. They were featured in the "Happiness and Health" department of the popular women's monthly magazine, Good Housekeeping .[49] The following month, the magazine's editors proudly boasted that "Good Housekeeping [had] been chosen by Rev. Drs. Worcester and McComb as the periodical through which the good news shall be spread, accordingly it will assist clergymen, physicians and others in establishing centers and introducing the work in their churches or districts."[50] The Good Housekeeping series continued for almost two years.
A plethora of articles detailed all phases of the "movement." Readers received biographical information regarding the movement's founders and details concerning many of the formal aspects of the program. In addition to these informational pieces, the magazine offered its readers an opportunity to express their concerns. The editors received and responded to scores of letters from their almost exclusively female audience. Advice was offered for a vast range of problems such as "housekeeper's anxiety," "fear of failure," "business after business hours," "sleeplessness," and "artistic temperament." Perhaps most significantly, child-rearing practices were discussed in considerable detail. In addition to articles written by Worcester, McComb, and other clergymen, the magazine included pieces by the movement's medical champions: Coriat, Cabot, Barker, and Putnam.
The Good Housekeeping articles typically relied on anecdotal information rather than statistical and factual analysis that might lend further credence to the claims of the author. This perspective was especially common when discussing the actual results of the movement. Good Housekeeping 's readers learned of the case of Mrs. A. who, after a few short weeks of treatment, testified that she had "journeyed homeward feeling that [she] had never been nearer heaven ever before in [her] life." Readers also received news of the formerly reckless Miss B. who, as a result of her encounter with Dr. Worcester, had been transformed into a "bright, clever, and entertaining" young woman. And it was not just women who benefited from the program. The magazine reported that after a few short weeks of treatment, Mr. Packard, who had
come "to Dr. McComb the embodiment of utter hopelessness and despair ... might have posed as a 'happiness advertisement.'"[51]
Good Housekeeping 's literary franchise on the Emmanuel movement lasted throughout most of 1907.[52] Excepting a brief piece that McComb had prepared for Harper's Bazaar , the only other national magazine to discuss the "movement" prior to 1908 was World's Work . In its December 1907 issue Rollin Lynde Hart featured the Emmanuel program in an article provocatively entitled "'Christian Science' Without Mystery." Hart's piece was notable in two respects. Whereas the Good Housekeeping series had been conducted under the aegis of the program's medical and clerical champions, Hart had no personal affiliation with the plan. Moreover, in contrast to Good housekeeping, World's Work appealed to a predominantly male audience. Hart proved to be the first of several lay commentators who would seek to distinguish Worcester's program from Christian Science. "Unlike Christian Science," Hart declared, the Emmanuel plan was "both Christian and scientific; Christian in that it affirms the reality of sin, scientific in that it heals by methods endorsed by the leading neurologists and psychologists of our epoch." After discussing the movement's underlying philosophy and plan of action, Hart asked, "Doesn't all this sound reasonable?"[53] He then chronicled the experiences of five patients—a clergyman, a businessman, an elderly man, a young woman, and a female schoolteacher—who as a result of their treatment by Worcester and McComb had overcome a wide array of nervous afflictions.
Soon after the publication of Hart's article, a number of other national magazines published articles on the "movement." Within a span of several months articles concerning the movement appeared in Century, North American Review, Current Literature, Popular Science Monthly, Outlook, American Magazine, Independent, Review of Reviews, and a host of other national periodicals. Like the articles that appeared in Good Housekeeping, those who appreciated these magazines made great use of anecdotal information. But in contrast to the Good Housekeeping series, the articles in the more masculine periodicals were often supplemented with a variety of facts and statistics. In a piece that he prepared for Outlook, Cabot, a pioneer in the statistical analysis of treatment outcomes, provided a cursory statistical assessment of the program's first year.[54] From a sample of 178 men and women who had been diagnosed at the Emmanuel clinic, Cabot reported that 82 were suffering from neurasthenia, 24 from insanity, 22 from alcoholism, 18 from fears or fixed ideas, 10 from sexual neuroses, 5 from hysteria, and
17 from a number of other miscellaneous disorders. From this sample Cabot reported that there were 123 known results, 61 percent of which were positive. Moreover, he detected no evidence that their course of treatment by the ministers had any detrimental effects on the patients. "The seventy-five cases in which undoubted benefit has resulted," Cabot therefore concluded, "should be put down with clear gain, and nothing to offset it."[55]
Cabot's Outlook piece seemed to provide compelling statistical justification for the program. The following month McComb supplemented Cabot's findings in an article that he prepared for Century . McComb boasted that the Emmanuel program's brand of psychotherapy had been applied to a wide array of functional disorders. The list of ailments that had been cured was extensive. It included
all functional disturbances of the digestive apparatus; congestive, neuralgic, and anemic headaches, certain forms of paralysis, simulated epilepsy, neurasthenia, hypochondria, psychasthenia, hysterical pains, functional insomnia, melancholia, nervous irritability, hallucinations, morbid fears, fixed ideas (including a long list of troubles dignified with Greek names, such as monophobia, claustrophobia, agoraphobia, and so forth), incipient insanities, stage fright, worry, stammering, abuse of tobacco, alcoholism, morphinism, cocainism, kleptomania, suicidal tendencies—in a word, the vast and complicated field of what is technically called the functional neuroses and the psycho neuroses.[56]
More impressive than the contents of McComb's list was the impression it created. Psychotherapy was depicted as being something that bordered on the miraculous.
In addition to the ongoing magazine campaign, the distant travels of Worcester and McComb proved to be of particular importance in spreading the Emmanuel idea.[57] After a year of practical experience the two ministers became convinced that the time had come to reach out and share their findings with other congregations throughout the United States and abroad.[58] "Doctor McComb and I," Worcester recounted, "were constantly called on to preach and lecture on weekdays in distant cities and to carry on public debates with physicians, psychologists, clergymen and laymen in the Church Congress, colleges, medical meetings, and other places where questions were freely asked and criticism freely administered."[59] The 1908 edition of the Emmanuel Year Book states, "From all parts of the country came invitations to address medical societies, ministerial meetings, clubs, and popular gathering of various kinds."[60]
Early in 1908 the Archbishop of Canterbury invited Worcester to discuss his work before a committee composed of members of the Pan-Anglican assembly. Unable to accept the invitation, Worcester requested that McComb attend in his place. The assistant minister proved to be a more than adequate substitute. Although he did not win the committee's formal endorsement for the Boston program, he succeeded in having the members acknowledge the potential virtues of a clericalmedical alliance.[61] The New York Times reporter Allan L. Benson recounted McComb's speech before the full assembly of the London conference. He wrote that on hearing a bell that singaled McComb's allotted thirty minutes had come to an end, McComb attempted to stop talking, but "the audience wouldn't let him. The whole assembly rose to its feet and from every quarter there were cries of 'Go On! Go On!'"[62] McComb also spoke in various London churches and addressed several meetings of the city's physicians and ministers. As was the case in the United States, these lectures and meetings received considerable coverage in the city's press and shortly before McComb departed for Boston a similar movement, known as the Church and Medical Union, began in London.[63]
In the summer of 1908 Worcester and McComb supplemented their magazine campaign and lecture tours with an intensive three-week course of lectures on religious therapeutics that attracted considerable attention. More than 140 people enrolled, including the Reverend Samuel S. Marquis, dean of St. Paul's Episcopal Church in Detroit. Students received intensive instruction in the most recent psychological studies and psychotherapeutic knowledge from Worcester, Coriat, and other practitioners of church-sponsored psychotherapy. Many returned to their home parishes eager to put to use their newly acquired knowledge to institute their own church-sponsored psychotherapy programs. Moreover, to facilitate the growth of their movement Worcester and McComb arranged for the publication of a series of pamphlets detailing the many different aspects of the movement. Although the proposed series was to include nine separate articles, the completed version contained only seven. The cost of each was set at twenty-five cents, though many were distributed free of charge. The Emmanuel Church published the initial pieces in-house. The remaining ones were published by Moffat, Yard and Company of New York.[64]
As significant as they were in promoting the Emmanuel message, the pamphlets were quickly superseded by the publication of Religion and Medicine in August 1908. Written jointly by Worcester, McComb,
and Coriat, this work was one of only five books listed under the subject heading "Psychotherapy" in the Index Catalogue of the Library of the Surgeon-General's Office .[65] Promoted by its publisher as a book "which sets forth in clear and non-technical language the principles, and the methods by which these principles have been applied, that underlie the notable experiment in practical Christianity known as the Emmanuel Movement, Religion and Medicine was heralded by the editors of Current Literature as "some of the most illuminating pages yet written on the subconscious mind."[66] The book was reviewed in virtually every major newspaper and medical and religious periodical and soon became the single most important text of so-called scientific psychotherapy in the United States. A reviewer for the New York Times declared, "The book is marked throughout with admirable modesty and moderation."[67] In his review H. Addington Bruce wrote, "No more needed book on the general subject of psychotherapy has lately come forth, and none more likely to exert beneficent influence wherever read."[68] In addition to receiving laudatory reviews, Religion and Medicine sold almost two hundred thousand copies.[69]
Religion and Medicine provided a more detailed discussion of the movement than had ever appeared previously; it allowed Worcester, McComb, and Coriat to speak in their own voices. Unlike the numerous newspaper and magazine articles that had discussed the movement during the prior eighteen months, it offered an unsullied expression of the work being done in Boston. Moreover, it served as a text for others seeking to imitate the Boston venture. What its coauthors failed to realize was that their four-hundred-plus page book would also provide a highly visible target for those seeking to derail the psychotherapy movement. Although the book's title was bound to evoke Eddy's earlier work Science and Health, the authors insisted, "Our movement bears no relation to Christian Science, either by way of protest or of imitation, but it would be what it is had the latter never existed."[70] Anticipating those who might question their motives, they stressed the lack of adequate treatment for functional nervous disorders—especially for the poor—in the United States.
Echoing the views of the mind curists, Worcester readily acknowledged his views on the limits of medical materialism: "One reason why American physicians are slow to avail themselves of psychical influence in combating disease is that they have been educated in a too narrowly materialistic school of science which assumes that only material objects possess reality and which thinks that the mind can be safely ignored."[71] This assertion was by no means radical, however. Similar statements had
been made by Putnam, Prince, Sidis, Meyer, and several prominent American physicians who frequently chastised their professional brethren for their ignorance of scientific psychology. Indeed, the most provocative feature of Religion and Medicine had little to do with its critique of medical materialism or its discussion of the unconscious. Rather, it pertained to the authors' statements concerning the ultimate effects of the movement. "What we have done," Worcester maintained, "other men and other churches can do as well or better, and it is with the earnest hope that other qualified persons may be induced to help us and to relieve us of the pressure of patients from distant cities that we issue this tentative and imperfect statement."[72]
Medical Opposition: The Quest for Control
Even before the publication of Religion and Medicine a number of prominent physicians had begun to express reservations about Worcester's movement. Medical opposition reflected a combination of ideological concerns and professional self-interest. Frequently the latter took precedence over the former. Physicians who attacked the movement typically expressed great concern for their roles as medical professionals. Willing to acknowledge the efficacy of certain types of mental healing, the movement's medical critics sought to restrict the practice of psychotherapy to licensed physicians.
In a January 1908 address before the New York Neurological Society, Charles Dana spoke directly to the issue of control. He urged his more intransigent, somatically inclined colleagues to take seriously the growing public interest in religious psychotherapeutics: "There is already a wave of public interest in the matter, which we at least must watch if we take no definite attitude toward it. It seems as if a certain large group of minor psychoses are to be taken in hand by the clergy, cooperating with medical men, and it is seriously proposed to have psychotherapeutics as part of the religious work of our churches. Already centers of this work exist in Boston, Chicago, and this city."[73] Rejecting the claims of those who argued that the "best attitude to take towards the [Emmanuel] movement was one of aloofness, believing that it will die out," Dana argued instead that a decided position should be taken against it. "We can reasonably assert that the care of the sick is safest in the hands of those trained for the purpose. But if we say this," Dana asked, "will we not have to assert also that medical men are using
the forces of therapeutics, and using them more skillfully and effectively than clergymen, or nonmedical therapeutics can do?"[74]
The first direct medical assault on the Emmanuel movement took place on February 28, 1908. Addressing the section in Neurology and Psychiatry of the Medico-Chirurgical Faculty of Maryland, Clarence B. Farrar, an associate in psychiatry at Johns Hopkins University and future editor of the American Journal of Psychiatry, delivered a vitriolic critique of Worcester's program.[75] It was no surprise, Farrar claimed, that the Emmanuel movement arose in Boston, "the land of witchcraft and transcendentalism."[76] Farrar argued that the Emmanuel movement represented a retreat to the benighted past during which the priest-physician administered to sick and suffering souls.[77] Worcester and his followers, he declared, failed to recognize the long-known fact that "perturbations of the soul (mental diseases) are, in reality, diseases of the nervous system, and more particularly of the brain, and that, therefore, their treatment was the proper work of the physician and not of the priest."[78] Farrar's criticism of the movement was not merely an expression of his somatic bias. It likewise reflected his desire to secure for the medical profession the exclusive right to administer psychotherapy. The ministers' motives, he claimed, were anything but disinterested. On the contrary, the Emmanuel movement was a deliberate effort to restore the church's diminishing authority. "Knowing, however, that an intelligent public would no longer unquestionably bow to theologic authority in these matters, and realizing that the old theocracy was inevitably crumbling," Farrar charged, "the brilliant maneuver with which we are now familiar was executed. It was nothing else but a bold and triumphant gasconade. A truce was sounded and science was bidden to parley."[79]
The following month, Philadelphia neurologist Charles K. Mills picked up where Farrar left off. Speaking before the Philadelphia County Medical Society, Mills addressed the rising passion for psychotherapy generated by Worcester's recent visit to the city of brotherly love. "A wave of increasing interest in psychic medicine," he warned, "appears to be passing over our country. An old, old story is being repeated by new raconteurs; an old, old subject is being presented in a garb not entirely new, but with new trimmings and adornments."[80] To safeguard the public interest, Mills insisted "that psychotherapy like medicinal or mechanical or surgical or climatic, or any other sort of therapy belongs to the physicians and not to the clergyman, however sincere the latter may be in his idea that it his duty to invade the province of his medical
brother."[81] Despite his unwitting influence on Worcester, S. Weir Mitchell expressed a similar view. In an address before the American Neurological Association he declared, "The so-called suggestion used in induced hypnotic states is utterly outside the true domain of the clergyman and if needed should be and remain part of the therapeutic agencies in the hands of physicians alone."[82] The practice of psychotherapy, he continued, was not something to be taken lightly: "I have treated a large number of neurasthenics and need hardly assure you that there are many cases which are simple and which intrusive psychotherapy would severely injure."[83]
Mitchell's paper generated a lively discussion.[84] One the one hand, Francis X. Dercum, Bernard Sachs, and Phillip Coombs Knapp defended Mitchell's argument and in so doing affirmed their allegiance to the somatic paradigm and to exclusive medical control. "The word, psychotherapy," Dercum charged, "offers no advantage over the old term of treatment by suggestion." "Dr. Mitchell's conclusions," Bernard Sachs declared, "might stand forth as the sane sentiment of this Association, in opposition to the psychotherapy idea." "In their craze for matters psychical," Philip Coombs Knapp added, many medical proponents of psychotherapy had "neglected fundamental principles of the art of medicine. The whole tendency of this present move in favor of psychoanalysis and psychotherapy has been to neglect, as Dubois cheerfully neglects, the physical basis which is so often at the bottom of the nervous disorders."[85]
On the other hand, James Jackson Putnam, AdolfMeyer, and Charles Dana argued that while the practice of psychotherapy might not be the panacea that many of its proponents claimed it to be, physicians nonetheless had a professional responsibility to take the subject seriously. In perhaps the most provocative commentary on the subject Dana asserted,
We as neurologists are confronted with the fact that an enormous number of mentally sick people are running around and getting their psychotherapeutics from the wrong well. They go to the seven different kinds of cures which Dr. Mitchell has spoken of, and a great many of them are injured by them. We do not believe that this is the best way for these people to be treated. We feel that there ought to be some definite forms of psychotherapeutics. What are we going to do with the large number who won't come to us and will go to anyone else who will raise his psychic standard? We must find out the good behind these false methods and organize it into some wise scientific measure which can prescribe. Until we do this there will be a
continual succession of new cults, Christian Science, Osteopathy, etc., to the discredit of medicine and more especially psychiatrists and neurology.[86]
Dana was certainly not alone in making such a charge. An increasing number of physicians were beginning to embrace his view that American physicians needed to investigate more vigorously the claims of the mind curists and other nonmedical mental healers.
The promotional efforts of Worcester, McComb, and their followers did more than merely hasten the willingness of formerly intransigent physicians to consider seriously the subject of psychotherapy. They also generated a backlash among certain physicians who had originally supported Worcester's venture. Of these, the most notable was James Jackson Putnam. By the summer of 1908 Putnam himself began to express serious reservations about the direction of Worcester's movement. While vacationing in New York he sent Worcester an eighteen-page, handwritten letter in which he expressed his fear that Worcester and McComb might have originally misled him and the other physicians who had endorsed their initial, humble-sounding venture back in the autumn of 1906. This fear was fueled in large measure by the publication earlier that summer of Religion and Medicine .
In discussing that important matter I make at once the assumption that the movement was not ever designed to remain under your personal leadership or that of your church. In everyone's estimation this fact counts much in forming a judgment of its value and significance. If my present opinion seems to you radically different from those which you had good reason to think I entertained two years ago, I can only say that I have thought about the matter since then, to a degree and in a way that I had not, at that time, and furthermore, that I did not then conceive,—could not easily have conceived, what since has taken place.[87]
While still a staunch believer in the efficacy of psychotherapy, Putnam argued that he no longer supported its application by nonmedically trained professionals.
Individual physicians may fail to appreciate their splendid opportunity, individual clergymen may have a certain special moral fitness for doing part of the doctor's work. But these conditions are incidental and local; they constitute an obvious reason physicians should be made to feel the full weight of the clergymen's criticisms and suggestions but not sufficient reason for an attempt to supersede physicians or rather the medical profession, or to lower its standing in the eyes of the community . Yet this is what the Christian Science movement has avowedly tried to do, and what the Church-based healing movement is doing without wishing it.[88]
Despite Putnam's eloquent statement regarding the Emmanuel movement's unwitting effect on the medical profession, Worcester persisted in promoting his venture and thereby soon brought the full wrath of the medical profession on himself. Earlier that summer, Worcester had accepted an extraordinarily lucrative offer—$5,000—from Edward Bok, editor of Ladies Home Journal, to produce a series of articles for the popular women's monthly. Although he initially declined the offer, Worcester soon reconsidered. "I estimated," he later wrote, "that I could write an article a day and I knew that I should never earn that much money again in my natural life. So I accepted."[89] After considerable editing Worcester's first article appeared in November 1908, and the series continued until the following March.[90]
Putnam's growing apprehensions concerning the direction of Worcester's movement generated the first serious blow to Worcester's leadership role in the American psychotherapy movement—his exclusion from W.B. Parker's newly minted journal, Psychotherapy: A Course of Readings in Sound Psychology, Sound Medicine, and Sound Religion .[91] In an effort both to promote psychotherapy and to counteract the growing number of charges against it, leading academic, medical, and clerical figures engaged in a short-lived collaborative project that aimed not only to demystify but also to legitimate the practice by trained professionals.[92] In the fall of 1908 the first issue of Psychotherapy became publicly available. The intention of what ultimately became a three-volume, twelve-issue collection containing close to ninety articles was "to present in attractive and intelligible form and in a conservative manner the results of the best thought [and] the latest investigations, of the scientific and medical world, in this field."[93]
As originally conceived, the articles in Psychotherapy were to focus on one of five overlapping categories: general or descriptive, physiological, psychological, religious, and historical. Contributors included a host of eminent physicians and professors in both Europe and America as well as members of the American religious establishment who advocated the use of psychotherapy.[94] Conspicuously absent, however, were Worcester and McComb. Parker's refusal to include any work from the original clerical sponsors of the Emmanuel movement derived from a conflict with Worcester that had been fueled in large measure by James Jackson Putnam's changing sentiments concerning the rector's ambition. The Harvard neurologist had become increasingly frustrated with Worcester's promotional efforts on behalf of the Emmanuel movement, and during the summer of 1908 he threatened to withdraw his support from Parker's venture if it took the form of an "Emmanuel Church Course."
Realizing that Putnam's support was critical to the legitimacy and hence the success of Psychotherapy, Parker assured him that the course was in no way connected to the Emmanuel movement: "It is in no sense a church undertaking but essentially an educational undertaking. It is comparable most closely, I think, to the course offered to the old Chautauqua Reading Circles and like them aims primarily to inform and instruct."[95] But given the undeniable contribution of the church healing movement to American psychotherapy, Parker continued, he felt obliged to include representatives of the movement in Psychotherapy. The course, he declared, "cannot ignore the large part that has been played by the church movements—it would be not only incomplete but unscientific if it attempted to deal with the subject [of psychotherapy] without giving adequate attention to these aspects."[96]
Although as late as August 1908 Parker expressed his hope that Worcester might contribute to the project, he made it a point to inform Putnam, "I should not consider this a very prominent part" of the course.[97] Worcester refused to accept such a diminished role, however, and he and Parker soon found themselves at odds. In a personal letter to Putnam dated September 19, 1908, Parker spoke explicitly of his conflict with the minister:
You are doubtless aware that I have had a somewhat unwelcome experience owing to Dr. Worcester's attempt to dominate this Course of Readings and to make it subordinate to his Emmanuel movement. This I very naturally refused to do, and have had to sacrifice whatever advantage there may have been in Dr. Worcester's cooperation, but I think he is wholly at fault in his attempt to have it appear that Psychotherapeutics in America is his creation.[98]
The exclusion of Worcester from the course did not signify a refusal on Parker's part to acknowledge the church's importance to American psychotherapy. Articles by the Reverends Loring Batten, Lyman Powell, Samuel Fallows, and Albert B. Shields more than compensated for Worcester's absence.
The New York and Boston Controversies
What had been largely a private matter between Parker, Putnam, and Worcester soon became a highly visible public controversy. In the autumn of 1908 Loring W. Batten, Episcopal rector of St. Mark's-
in-the-Bouwerie, announced his intention to establish a "Healing Mission" along the lines of Worcester's Emmanuel class.[99] News of Batten's intentions spread quickly. Good Housekeeping reported that "one of the latest and most important accessions to the list of the Emmanuel clinics is that of St. Mark's (Episcopal) church in New York City."[100] Interest in Batten's proposal increased when seven of the city's Episcopal ministers announced that Worcester himself, along with McComb and Coriat, had accepted their invitation to deliver a series of lectures beginning on Thanksgiving morning. The publicity generated by the news of their forthcoming visit not only helped to entrench the movement in New York City but also provoked a backlash from conservative physicians and ministers that would ultimately doom it.
The weeks preceding Worcester's visit to New York were marked with controversy fomented in large measure by a letter from New York neurologist Joseph Collins to the New York Times . On the same day during which a front-page headline proclaimed "Christian Scientist Held," a headline on page six reported, "Dr. Joseph Collins Attacks Prospectus of Rev. Dr. Batten of St. Mark's." "What is there about the ministerial profession," Collins asked, "that gives them a peep into the human mind and its diseases, or the human body and its diseases that is not vouchsafed to the physicians? On their investiture with orders, are they likewise given a divine potency to open the Pandora chest of the pathologist? Is it not possible that the average man or woman may by years of laborious study prepare himself or herself to recognize disease and learn how most expeditiously and safely to overcome it, quite as well as the man who had no experience with disease and therapeusis save his own arrogance?"[101]
Nine months before, in an article in the American Journal of Medical Science, Collins had expressed what can only be considered grudging admiration for his nonmedical rivals: "I am merely emphasizing the fact that no source of knowledge is too mean or contemptible for us to disdain it, and, that it does not detract from the dignity of our calling to admit the instructive value of these sources."[102] More significantly, he had declared, "I am opposed to the claim that it requires special skill to treat nervous disorders successfully [i.e., beyond those belonging to a general practitioner], and I contend that the general practitioner should study the proper manner of treating them, with the same care he studies infant feeding or the treatment of typhoid fever."[103] Why the change of position? The answer to this question, I suspect, concerns the threat of competition from nonmedically trained "psychotherapists." The growing allure of the Emmanuel movement compelled Collins to
reconsider his former views regarding who was best suited to practice psychotherapy. Soon several other prominent physicians and neurologists would join him in publicly condemning Worcester's movement.
Collins's November 7 letter to the New York Times proved to be just the first shot in an extended volley of criticism leveled against the Emmanuel movement. During the next several days the Times reported considerable dissension among the city's neurologists. Both A.W. Catalin and Moses Allan Starr, as well as Dickinson S. Miller, the Columbia University professor of philosophy, enthusiastically endorsed Worcester's burgeoning movement.[104] "I do not believe," Starr declared, "that the admitted miracles of Lourdes and of St. Anne de Beaupre are supernatural. But since the human mind in its weakness demands some supernatural theory to account for these miracles, why is it not legitimate for the Protestant Church as well as the Catholic to adopt means calculated to produce the ends desired; especially as this means cannot be termed in any sense evil?"[105] Collins immediately shot back: "My letter to the New York Times was a protest against the assumption on the part of Elwood Worcester, D.D., Ph.D., and his followers that there is any justification for their engaging in the practice of medicine; against the arrogation to themselves of a power or capacity to deal with disease therapeutically that is beyond the acquisition of a man or woman who devotes his or her life to the study of disease; against the pretense of Worcesterism that its practices are scientific, and against the unseemliness of directing the finger of scorn and the voice of contumely against its parent, Christian Science."[106]
Collins did not have the last word, however. In yet another letter to the Times, Dickinson Miller argued that Worcester's claims were anything but extraordinary and that Collins's critique bordered on the disingenuous. "Dr. Worcester says that suggestion will relieve many functional disorders," Miller wrote. "This is exactly what the medical profession at large would say. He says that he has not yet found a case where it will relieve organic disorders. Here also he is supported by the majority of the medical profession."[107] Miller's public endorsement of the clerical uses of suggestion provoked a scathing indictment from Henry Rutgers Marshall, a former president of the American Psychological Association. Marshall challenged Miller's contention that ministers could safely administer suggestive therapeutics. Comparing psychotherapy to surgery, Marshall argued that "the operation should not be indulged in carelessly, nor without facing the fact that as life may be saved at the expense of bodily mutilation, so freedom from vicious habit
and pain and worry may be gained at the expense of the weakening of personality."[108] Miller responded by asserting that there was little empirical basis to Marshall's argument. He then proceeded to savage Marshall's analysis:
It is a pity that legend should begin to depict Dr. Worcester as a kind of clerical Svengali, tampering through his uncanny arts with the personalities of his trustful patients. This Dr. Worcester is a creature of the imagination quite as much as Svengali himself. Dr. Marshall speaks of "the radical form of suggestion urged on us by the psychotherapist." I do not know to whom he refers. The methods of mental treatment or "psychotherapy" are many: explanation, encouragement, work-cure, psychic education, suggestion, and others. With all of these, ideas of the philosophy of life may be associated. With all of them, therefore, religion may be associated. Into all of them reason may enter. It is the sanest appeal that is best.[109]
In the midst of the highly visible public discussion of psychotherapy two of the city's most prominent medical journals entered the debate. On November 14 both the New York Medical Record and the New York Medical Journal included editorials on the movement. "While it [the medical-clerical venture] was confined to the Emmanuel Church people in Boston," the Medical Record quipped, "it was generally regarded as a sort of Neo-Eddyism, one more of the many queer fads with which the citizens of that town are wont to amuse themselves, and little more was thought of it."[110] Such eccentricities could easily be overlooked. But now that Worcester's program had spread to other cities responsible physicians could no longer remain silent—lest they wish to set a dangerous precedent. The editorial concluded by asserting that "when men speak with the confidence, shown by the authors of Religion and Medicine, of matters concerning which their words show them to have only uncertain knowledge, it is but a step to the rejection of all advice and suggestion from the physician."[111] In direct contrast to the Medical Record editorial, the New York Medical Journal declared, "As regards our own impression, we do not see in the movement anything subversive of the prerogatives of medical men in their daily work; the ecclesiastic, as represented by Dr. Worcester and Dr. Batten, seem to us to stand ready to cooperate with the medical profession, and not in the least disposed to antagonize it."[112]
New York City's highly publicized controversy concerning Worcester's forthcoming visit and Batten's "Healing Mission" soon spread to other cities. A similar episode erupted in Boston later that month when a local reporter asked James Jackson Putnam to respond to the Medical
Record 's editorial. Putnam did so in writing, and the Boston Herald published his letter on the front page beneath the towering headline, "Convinced that the 'Emmanuel Movement' Is a Mistake." "[While] I have a high respect for the characters and purposes of its founders," Putnam wrote, "I am convinced that movement is a clear mistake. It is clear that clergymen, without adequate preparation, are assuming responsibilities of a kind that physicians are not considered qualified to assume until after years of study and of training. The question is whether the best interests of the community are really being served by this movement, and in my opinion this is not the case."[113]
Worcester and McComb did not remain silent. "The men who have taken up the work," they declared, "are able and experienced, and they are working under the direction of equally able and conscientious physicians. The immense response which our movement has met with, not only in this country, but also in others of the civilized world, proves how great is the need of help that we are offering."[114] In the Sunday issue of the Herald Putnam offered a lengthy reply. "When Dr. Worcester originally consulted me, just two years ago," Putnam explained, "I was at first much interested in his plan. I did not then realize what the outcome was to be. When I did realize it I expressed my criticism to Dr. Worcester, as I have done from time to time ever since—on two occasions at considerable length."[115] Of particular concern to Putnam was the direction of the movement. "The only real question," he explained, "seems to be one of future policy."[116] And on this critical point Putnam sided with the medical critics. The movement needed to be checked.
Just as the leading New York medical journals had expressed their concerns during the New York controversy, the Boston Medical and Surgical Journal entered the fray. Conceding that the medical profession could do more to promote the instruction of psychotherapy in the nation's medical schools, a November 26 editorial proclaimed that "it is not for a moment to be conceived that the great field of mental therapeutics is to be turned over to the churches, nor is it conceivable that representative medical men will indefinitely stand between the public and the minister to pass on patients which it is their manifest duty to treat themselves."[117] But the field of mental therapeutics had never "belonged" to physicians. It was not theirs to turn over to the churches, or to anyone else for that matter. If anything, the opposite was true. Lay proponents of mental healing were not stealing patients away from physicians. On the contrary, physicians were seeking to lure potential patients away from the lay mental healers.
By publicly assailing the movement, medical critics of Worcester's program hoped to establish themselves as the only legitimate source of mental healing in America and seize control of a market that they had long neglected. "The only knowledge which is of value in the field of abnormal psychology and mental therapeutics," the Boston Medical and Surgical Journal asserted, "has been gained from the laborious investigations of psychologists and physicians. ... The field is foreign to the ordinary clerical mind and is not a matter which in any large way concerns the churches. It is, however, essentially a medical problem, and one which the profession is quite capable of handling in the future as it has in the past."[118] But saying that psychotherapy was "essentially a medical problem" did not make it so. Moreover, the assertion that physicians had handled the subject in the past was an egregious distortion that contradicted three decades of somatic intransigence and widespread unwillingness to take seriously the complaints of men and women afflicted with functional nervous disorders.
The New York and Boston controversies were more than mere local events. They were portents of what was to come. Newspapers throughout the region covered the dispute. The New Jersey Herald reported, "In the face of the volleys of criticism and denunciation which have been leveled by prominent Boston neurologists at the so-called 'Emmanuel Movement' for the cure of functional nervous diseases, certain of its sponsors now admit that the charge that dangers lurk in 'its spread to other churches' and in the administration of methods by 'untrained and unqualified men' may have a valid foundation."[119] On December 31 an editorial writer for the Boston Medical and Surgical Journal opined, "While we may regret the fact that the medical profession as yet has not completely aroused itself to its privileges and responsibilities, we entirely disagree with the statement that physicians are not concerned with the need which the Emmanuel movement seeks to meet."[120] A growing number of American physicians agreed. "What personally I feel," John Jenks Thomas asserted, "is that all methods of treatment of disease are with greater safety left in the hands of medical men and that by cooperation with clergymen in the future, as in the past, the often perplexing moral and religious questions that may arise in these curious functional nervous disorder can be best met."[121] "By whom should the treatment be carried out?" Robert T. Edes asked. "Obviously by the physicians."[122]
In an attempt to meet this mounting criticism and to defend the Emmanuel movement four Boston physicians, Richard C. Cabot, Joseph H. Pratt, Joel E. Goldthwait, and James G. Mumford, jointly wrote
a letter dated January 15, 1909, in which they argued for reforming rather than destroying Worcester's movement.[123] But their effort proved to be too little and too late. With their defense in tatters, proponents of the Emmanuel movement found themselves increasingly under siege. Physicians, ministers, and academic psychologists all joined arms in the attacks.
Echoing the views expressed by previous medical critics, New York alienist Allan McClane Hamilton charged, "The motif of the Emmanuel movement ... simply consists in the fact that there are a certain number of clergymen who become amateur doctors, their particular religion not forming the basis for any therapeutic plan, and they meddle with things of which they naturally know but little and injure themselves in their own calling at the same time."[124] An editorial in the Old Dominion Journal of Medicine and Surgery agreed: "[Great] masses of our people are now being blindly led by the promises of these movements to dizzy psychic heights, and this has so encouraged the originator and teachers that they have developed expansive delusions of the most ridiculous variety." Just as Christian Science was fading, the editorial continued, "another cult is arising, more insidious, more fascinating, more intellectual, holding out with one hand the apparent sanction of an established church and with the other holding in reserve the caduceus of the medical profession, to be used when necessary."[125]
In early May several prominent neurologists convened in New Haven, Connecticut, for a three-day symposium on psychotherapeutics.[126] The symposium was chaired by the associate editor of Psychotherapy, Frederick H. Gerrish, and included James Jackson Putnam, Morton Prince, Edward W. Taylor, Ernest Jones, and several other neurological exemplars of psychotherapy.[127] Echoing the views expressed by many of Worcester's medical critics, Gerrish opened the conference by declaring, "[Most] physicians and some neurologists have little appreciation of this branch of the healing art."[128] Ernest Jones, whose militant advocacy of psychoanalysis made him a maverick among the participants, agreed that physicians had to meet the challenge posed by both lay and religious mental healers. "The sooner we honestly face the shameful but undeniable fact that unqualified empirics can relieve distressing affections in cases that have defied medical skill, can produce results where we fail," Jones asserted, "the sooner will this flagrant lack in our system of education be remedied, and the better will it be for the dignity and honor of the medical profession." Until physicians learned to exploit the methods of their nonmedical rivals, Jones concluded,
"our profession must submit to being the prey of the charlatan and the mock of the sufferer."[129] Four months later Freud himself offered a similar analysis. In an interview with a Boston reporter the Viennese neurologist declared, "When I think that there are many physicians who have been studying modern techniques of psychotherapy for decades and who yet practice it only with the greatest caution, this undertaking of a few without medical training, or with superficial medical training, seems to me at the very least a questionable good."[130] Freud's views were forcefully reiterated by John K. Mitchell: "Most earnestly should we insist that the treatment of a patient, whether it be surgical, medical, or psychic, should for the safety of the public, be in the hands of the doctor."[131]
Clerical Opposition
Physicians were not alone in condemning the Emmanuel movement. Leading religious figures from the Protestant establishment also assailed Worcester's popular venture. "We can imagine nothing so fatal to real religion ," declared the Episcopal minister J. Edgar Johnson, "as the encouragement of the notion that people are invited to accept our religion for the sake of their health." Acknowledging the impressive credentials of those who founded the Emmanuel movement, Johnson nonetheless feared "the hasty adoption of Christian Therapeutics by those who are ill prepared for the venture."[132] The Boston minister Chauncey Hawkins attacked the movement on other grounds: "I believe that out of this movement there is coming a shallow type of ethics, the same as originated through the multitude of healing movements, among which Christian Science, Mental Healing, and the Emmanuel Movement are classed."[133] Hawkins's views were reiterated by George L. Parker, a minister from Salem, Massachusetts: "I protest against any theory that reduces the Gospel to a mere curing system, anything that makes it a mere religious watering-place, a sort of spiritual Baden-Baden or French Lick Springs. ... Psychotherapy has too much the atmosphere of a drawing-room end-of-the-century fad. It is interesting for nervous dilettantes and those who have not much else to interest or employ them."[134] James Monroe Buckley, Methodist minister and editor of the Christian Advocate , provided an equally critical assessment of the Emmanuel movement: "For Dr. Worcester, his motives, his ardor, his inde-
fatigable labors, I have nothing but admiration. But the foregoing facts and considerations, and others for which there is not room here, compel me to believe that for parishes or congregations to sustain a clinic as a part of their regular work presided over by the pastor, would be detrimental both to the church and the medical profession."[135]
In contrast to the views expressed by Hawkins, Taylor, and Buckley, the Congregational minister George A. Gordon's opposition to the Emmanuel movement derived from a subtle, albeit compelling, analysis of the role of professionalism and expertise. Expressing sentiments similar to those that Putnam had earlier conveyed in his September 1908 letter to Worcester, Gordon argued that the Emmanuel movement led the sick "to underestimate the service of the expert; it turns them away from the true source of hope—knowledge, experience, scientifically qualified men; it raises in them false expectations, feeds superstitious feeling, revives the popular belief in miracle, and blinds the community to the inviolable order of human life."[136] In recognizing the vital role of professionalism itself, Gordon offered not so much an attack of the Emmanuel movement as a defense of expertise. One of the more insightful responses to Gordon's article came from the minister of the Union Church in Haverhill, Massachusetts, George Henry Hubbard. Given the role of specialization among American physicians, Hubbard questioned the very meaning of medical expertise. If we are speaking of medical practice, Hubbard wrote, "the most skillful surgeon may be a layman in medicine and the medical practitioner a layman in surgery. The osteopath is a layman in the use of drugs and the drug doctor a layman in osteopathy. As for psychotherapy, the average physician of any school is as truly a layman as is the average minister or lawyer or tradesman."[137]
Hubbard did not deny the existence of experts. What he questioned, however, was whether all physicians—regardless of their specialty—were entitled to pronounce themselves experts on every single question regarding sickness and health. Moreover, Hubbard asked, "If we agree who are the laymen and who are the experts, are we are ready for the next step? Does it follow that the expert is the only person fit to practice a given art?"[138] But such thoughtful questions were the exception rather than the norm. In the debate to shape the future of American psychotherapy virtually none of the participants ever seriously addressed this critical issue.
The most eloquent clerical critic of the Emmanuel movement proved to be the dean of the Yale Divinity School, the Reverend Charles R. Brown:
Let the young physicians be more fully instructed in the medical schools in the principles of psychology as well as in the facts of physiology. The mood and the need of our age imperatively demand it. By that thorough study the physicians themselves will be made competent to render service along those lines, and they will also be the more inclined to invite the cooperation of the minister of religion. Let the minister of religion forsake any secondary ambitions they may have to become amateur dabblers in medicine; let them strive to be more fully competent in aiding the people "to live in the vision and service of the greatest ideals of the race."[139]
In large measure the mounting clerical antagonism to Worcester's program proved to be even more damaging than the medical opposition, and it would not be long before the two ministers ceased their efforts to promote their work.
Psychological Opposition
American academic psychologists were no less divided on the issues raised by the popular American psychotherapy movement than were physicians or ministers. Whereas Dickinson Miller and James R. Angell were outspoken champions of the movement, others were considerably less supportive. Among the most hostile psychological critics of the Emmanuel movement were Lightner Witmer, Henry Rutgers Marshall, and Hugo Münsterberg. Witmer, the director of the Psychological Clinic at the University of Pennsylvania, had earned a reputation as an expert on mental retardation. On December 15, 1908, he presented the first of three articles that criticized the American psychotherapy movement.[140] "Whatever Dr. Worcester's practice may be in his own church clinic," Witmer declared, "the principles of psychotherapy to which he and his associates adhere, are based upon neither sound medicine, sound psychology, nor to our lay mind, upon sound religion."[141]
More representative of the professional psychological criticism were the views expressed by Henry Rutgers Marshall and Hugo Münsterberg. Marshall argued that religion and medicine, despite their invaluable service to the community, were best kept separate. The skills and temperament required in each realm were frequently ill suited for the other.
The effective physician must be a man of keen insight, sound judgment, unwarped by emotionalism, and wise; yet at times even "worldly wise."
It cannot be maintained that clergy are as a rule recruited from those in whom these characteristics are markedly displayed, nor that their training and occupation tend to emphasize these qualities. We cannot but group together the Christian Science healer and the Emmanuel movement leaders as men who lightly take upon themselves work which the most serious experts in medicine study with the deepest care and handle with the greatest caution.[142]
Although Münsterberg shared Marshall's opposition to the Emmanuel movement, he recognized its important contribution to the medical profession. "The ministers first saw what the physicians ought to have seen before," Münsterberg declared, "but the physicians will see it more fully and more correctly."[143] In the preface to his popular 1909 book, Psychotherapy , Münsterberg wrote, "[The] aim of this book is not to fight the Emmanuel Church movement, or even Christian Science or any other psychotherapeutic tendency outside the field of scientific medicine. I see the element of truth in all of them, but they ought to be symptoms of transition. Scientific medicine should take hold of psychotherapeutics now or a most deplorable disorganization will set in, the symptoms of which no one ought to overlook today."[144]
Final Defense
In an article in the April 1909 issue of the Harvard Theological Review , Putnam declared that the movement was "still on trial." The critical issue was "whether the community should endorse a new form of medical specialty, represented by persons without adequate training for their task."[145] His answer, which he had already made clear during the recent Boston controversy, was that it should not. In the face of such overwhelming medical, clerical, and psychological criticism Worcester and McComb made one final effort to defend their movement. In the spring of 1909 the two men published The Christian Religion as a Healing Power .[146] Conceding that the popularity of their work had placed their movement in jeopardy, Worcester and McComb attempted to respond directly to the criticism leveled against them by their medical, clerical, and lay opponents. They insisted that it was a lack of familiarity with their work that had bred the scorn of the medical community, and they chastised their medical critics for failing to acquire a firsthand education concerning the true nature of their
program. "[When] physicians, professing to speak in the name of science, attack a work that is open to inspection without attempting to acquaint themselves with its aims, limitations, or practice," the rector charged, "they bring scientific method into contempt, and show how slight a part science plays in the training of the average medical practitioner."[147] And McComb wrote, "Physicians, no matter how famous, who have made no use of the moral and religious motive are not in a position to deny its efficacy; and if they were truly scientific, they would not do so."[148]
The ministers' criticism of the movement's clerical opponents was even less charitable. Ministerial opposition to the work, Worcester declared, "has come in every instance from men who have reached a time of life when opinions are crystallized and it is too difficult to accept anything new. Their real quarrel is not with us or our work, but with the new spirit that is passing over the world of thought which they are unable to grasp."[149] "The doctrinaire theologian," McComb added, "objects to the therapeutic use of Christianity on the grounds that such use is a degradation of the lofty purposes which this religion was designed to subserve. ... We contend, on the other hand, that the Christian religion is never more in its element, never shines with a greater glory, than when it is seen entering the dark places of our experience to cast out the demons of fear, worry, passion, despair, remorse, overstrained grief, and disgust of life, and to make the soul and body a fit temple for the holy spirit."[150] In addition to defending the movement against "doctrinaire theologians," McComb responded directly to those who accused the movement of being hedonistic in character and who warned that if widely copied would "cheapen religion by putting the emphasis as to the meaning of life upon personal comfort and absence of pain rather upon character, pain or no pain."[151]
By the end of the first decade of the twentieth century few American physicians were willing to challenge McComb's assertion regarding both the necessity and the efficacy of mental therapeutics. Whereas just a decade before only a tiny minority had even flirted with the possibility of systematically employing mental therapeutics, on the eve of Freud's historic visit to United States in September 1909 a substantial plurality, if not an outright majority, of American physicians were now willing to defend vigorously their exclusive right to employ a method that many in the profession had previously maligned and a substantially greater number had simply ignored.
The failure of The Christian Religion as a Healing Power to silence
their critics convinced Worcester and McComb that any additional efforts on their behalf to salvage their movement would be futile. After publishing a few brief articles on their work in early 1910 the two ministers abandoned efforts to defend their movement. Seeking to avoid any future controversy, Worcester and McComb deliberately chose to suppress a work that was to have been a companion to Religion and Medicine after it had already been set in type.[152] Moreover, by the summer of 1910 magazine references to the Emmanuel movement ceased abruptly.[153] According to the Readers' Guide the last popular reference to the Emmanuel movement was May 1910.[154] No longer in the public spotlight, the movement "disappeared completely from current discussion."[155]
In rare moments of candor certain physicians readily conceded that the Emmanuel movement had acted as a vital catalyst in inspiring the medical profession to take the subjects of psychology, psychopathology, and psychotherapeutics more seriously. "For renewed interest in these subjects," John C. Fisher asserted, "we have to thank the Emmanuel movement."[156] A Massachusetts physician, Homer Gage, agreed. Although not without its shortcomings, the Emmanuel movement, Gage argued, warranted praise for adding clarity to the medical debate on psychotherapy. By inspiring the doctor and psychologist to renew their study of the nature, limitations, and practical application of psychotherapy it had recalled "the practicing physicians from too cold a materialism; and [prevented] the dehumanized scientist from taking the place of the doctor of the old school."[157] As H. Addington Bruce proclaimed, more than any other single factor, the Emmanuel movement had "aroused the medical profession to a belated recognition of the importance of scientific study and utilization of the mental factor in medicine."[158]