Voices From the Past: Lightner Witmer’s “Clinical Psychology”

While there has been a robust interest for decades among scholars in the history of psychiatry, comparatively little has been shown the history of clinical psychology, despite its marked impact on mental health care.

The following excerpt is from Lightner Witmer’s article, “Clinical Psychology,” first published in Psychological Clinic in 1907. Witmer (1867 – 1956) is credited with first coining the term “clinical psychology” and developing its early agenda.

As the text below shows, on the basis of his experience testing cognitively disabled children, Witmer sought to establish clinical psychology as a fully professionalized, “helping” science. From: http://psychclassics.asu.edu/Witmer/clinical.htm.

During the last ten years the laboratory of psychology at the University of Pennsylvania has conducted, under my direction, what I have called “a psychological clinic.” Children from the public schools of Philadelphia and adjacent cities have been brought to the laboratory by parents or teachers; these children had made themselves conspicuous because of an inability to progress in school work as rapidly as other children, or because of moral defects which rendered them difficult to manage under ordinary discipline.

When brought to the psychological clinic, such children are given a physical and mental examination; if the result of this examination shows it to be desirable, they are then sent to specialists for the eye or ear, for the nose and throat, and for nervous diseases, one or all, as each case may require. The result of this conjoint medical and psychological examination is a diagnosis of the child's mental and physical condition and the recommendation of appropriate medical and pedagogical treatment. The progress of some of these children has been followed for a term of years . . .

My attention was first drawn to the phenomena of retardation in the year 1889. At that time, while a student of psychology at the University of Pennsylvania, I had charge of the English branches in a college preparatory school of Philadelphia. In my classes at this academy I was called upon to give instruction in English to a boy preparing for entrance to college, who showed a remarkable deficiency in the English language. His compositions seldom contained a single sentence that had been correctly formed. For example, there was little or no distinction between the present and the past tenses of verbs; the endings of many words were clipped off, and this was especially noticeable in those words in which a final ending distinguished the plural from the singular, or an adverb from an adjective. As it seemed doubtful whether he would ever be able to enter college without special instruction in English, I was engaged to tutor him in the English branches.

I had no sooner undertaken this work than I saw the necessity of beginning with the elements of language and teaching him as one would teach a boy, say, in the third grade. Before long I discovered that I must start still further back. I had found it impossible, through oral and written exercises, to fix in his mind the elementary forms of words as parts of speech in a sentence. This seemed to be owing to the fact that he had verbal deafness. He was quite able to hear even a faint sound, like the ticking of a watch, but he could not hear the difference in the sound of such words as grasp and grasped. This verbal deafness was associated with, and I now believe was probably caused by, a defect of articulation. Thus the boy's written language was a fairly exact replica of his spoken language; and he probably heard the words that others spoke as he himself spoke them. I therefore undertook to give him an elementary training in articulation to remedy the defects which are ordinarily corrected, through imitation, by the time a child is three or four years old. I gave practically no attention to the subjects required in English for college entrance, spending all my time on the drill in articulation and in perfecting his verbal audition and teaching him the simplest elements of written language. The result was a great improvement in all his written work, and he succeeded in entering the college department of the University of Pennsylvania in the following year.

In 1894-95, I found him as a college student in my classes at the University of Pennsylvania. His articulation, his written discourse and his verbal audition were very deficient for a boy of his years. In consequence he was unable to acquire the technical terminology of my branch, and I have no doubt that he passed very few examinations excepting through the sympathy of his instructors who overlooked the serious imperfections of his written work, owing to the fact that he was in other respects a fair student. When it came to the final examinations for the bachelor's degree, however, he failed and was compelled to repeat much of the work of his senior year. He subsequently entered and graduated from one of the professional departments of the University. His deficiencies in language, I believe, have never been entirely overcome.

I felt very keenly how much this boy was losing through his speech defect. His school work, his college course, and doubtless his professional career were all seriously hampered. I was confident at the time, and this confidence has been justified by subsequent experience with similar cases, that if he had been given adequate instruction in articulation in the early years of childhood, he could have overcome his defect. With the improvement in articulation there would have come an improved power of apprehending spoken and written language. That nothing was done for him in the early years, nor indeed at any time, excepting for the brief period of private instruction in English and some lessons in elocution, is remarkable, for the speech defect was primarily owing to an injury to the head in the second year of life, and his father was a physician who might have been expected to appreciate the necessity of special training in a case of retardation caused by a brain injury . . .

"The final test of the value of what is called science is its applicability" are words quoted from the recent address of the President of the American Association for the Advancement of Science. With Huxley and President Woodward, I believe that there is no valid distinction between a pure science and an applied science. The practical needs of the astronomer to eliminate the personal equation from his observations led to the invention of the chronograph and the chronoscope. Without these two instruments, modern psychology and physiology could not possibly have achieved the results of the last fifty years. If Helmholtz had not made the chronograph an instrument of precision in physiology and psychology; if Fechner had not lifted a weight to determine the threshold of sensory discrimination, the field of scientific work represented to-day by clinical psychology could never have been developed. The pure and the applied sciences advance in a single front. What retards the progress of one, retards the progress of the other; what fosters one, fosters the other. But in the final analysis the progress of psychology, as of every other science, will be determined by the value and amount of its contributions to the advancement of the human race.

The absence of any principles to guide me made it necessary to apply myself directly to the study of these children, working out my methods as I went along. In the spring of 1896 I saw several other cases of children suffering from the retardation of some special function, like that of spelling, or from general retardation, and I undertook the training of these children for a certain number of hours each week. Since that time the psychological clinic has been regularly conducted in connection with the laboratory of psychology at the University of Pennsylvania. The study of these cases has also formed a regular part of the instruction offered to students in child psychology.

In December, 1896, I outlined in an address delivered before the American Psychological Association a scheme of practical work in psychology. The proposed plan of organization comprised:

• The investigation of the phenomena of mental development in school children, as manifested more particularly in mental and moral retardation, by means of the statistical and clinical methods.
• A psychological clinic, supplemented by a training school in the nature of a hospital school, for the treatment of all classes of children suffering from retardation or physical defects interfering with school progress.
• The offering of practical work to those engaged in the professions of teaching and medicine, and to those interested in social work, in the observation and training of normal and retarded children.
• The training of students for a new profession-that of the psychological expert, who should find his career in connection with the school system, through the examination and treatment of mentally and morally retarded children, or in connection with the practice of medicine . . .

Read more at http://psychclassics.asu.edu/Witmer/clinical.htm.