Ever since Sigmund Freud introduced the world to daddy issues and penis envy, Americans have struggled with the role mental health plays in their lives. The pursuit of happiness has been a cultural touchstone since the founding fathers, but "happiness" has never been a clear, specific term; that vagueness becomes particularly difficult for psychiatrists trying to define the long-term goals of analysis. Is it their job to simply fix a patient's most obvious neurosis, or is there something more at stake—a deeper connection, requiring long hours of intensive discussion and interpretation pointing toward an uncertain goal? In American Therapy: The Rise Of Psychotherapy In The United States, Jonathan Engel follows the history of psychiatry and its offshoots, showing how the science has been as much about refining terms as it is about establishing them.

Beginning with Freud—his ideas on the id, superego, and unconscious, his system of psychoanalysis involving hundreds of hours between a patient and an aloof interpreter/observer— Engel charts the expansion of psychotherapy on American soil. Initially seen largely as a tool for the indolent wealthy, psychiatry gained legitimacy in the trenches of World War II; returning soldiers were unable to readjust to civilian life, and mental-health specialists were the only ones capable of recognizing and dealing with the problem. In the decades since, psychiatry has splintered into sub-groups, some positive (social workers, AA), some less so. In recent years, the refinement of therapeutic drugs like lithium and Prozac has forced doctors to adjust their conception of "treatment" once again.


Psychotherapy is even-handed and comprehensive, providing an invaluable overview of the past century's struggles with the most internal of all medicines. If anything, Engel is a little too level-headed; his clarity is laudable, but too often his depictions of internal squabbling and theory reduce potential drama to its driest essentials. Which may be part of the point; one of psychotherapy's biggest problems has been in establishing clinical standards, and by describing developments in textbook prose, Engel gives the profession a sense of quantifiable growth. More passion would've been appreciated, as would a more in-depth examination of therapy's cultural influence. But for anyone interested in how head-shrinkers moved from couches to pharmacies, Psychotherapy is essential reading.