Historical influences and modern descriptions
K W W S G [ G R L R U J / L J K W Q H U : L W P H U + L V / L I H D Q G 7 L P H V E 3 0 F 5 H Q R O G V & R S U L J K W k $ P H U L F D Q 3 V F K R O R J L F D O $ V V R F L D W L R Q $ O O U L J K W V U H V H U Y H G & R S U L J K W $ P H U L F D Q 3 V F K R O R J L F D O $ V V R F L D W L R Q 1 R W I R U I X U W K H U G L V W U L E X W L R Q The First Psychological Clinic D uring the early years of his tenure at the University of Pennsyl- vania, Witmer had structured his career strictly in the mainstream of the new experimental psychology. His articles and presentations had been frequent and well received. He was a charter member of APA, and al- though still quite young (he was only 28 in 1895), he had been ap- pointed to an important APA committee. Further, he held one of the more prestigious chairs in American psychology and was in line for even- tual promotion to full professor. Certainly, it would have been predicted at this time that Witmer would continue working from an experimental, laboratory-oriented per- spective and probably would become one of the leaders in the new scientific psychology. Indeed, such a prediction would not have been altogether amiss. He did continue with laboratory work, and as late as 1904, he presented a paper on psychophysics at the 13th Annual Meet- ing of the American Psychological Association.’ Further, as is evident in the chapters to follow, Witmer always maintained, in his own mind at least, a strong identification with laboratory-based research. Nevertheless, there also existed in Witmer this other, this more prac- & R S U L J K W $ P H U L F D Q 3 V F K R O R J L F D O $ V V R F L D W L R Q 1 R W I R U I X U W K H U G L V W U L E X W L R Q 70 LIGHTNER WITMER tical, more person-oriented interest that has been noted earlier in pre- vious chapters. Here, briefly, is a summary of the earlier indications of Witmer’s interest in working directly with people in some kind of help- ing relationship. First, there was his inclination toward a career in the law, a motivation so strong that he remembered it vividly in his latter years. Even his passing undergraduate flirtation with business and polit- ical science bespeaks an orientation toward an applied career. Next, there was his interest, when he was teaching at the Rugby Academy, in work- ing with a boy who had learning problems. Later, when he had had this same boy in a class at the University of Pennsylvania in 1894- 1895, he was again intrigued and challenged by the young man’s limitations. Then, according to his later testimony, Witmer, while in Germany, was thinking of what was later to become clinical psychology. These early clues to his future course, based as they were on his recollection some years later, may have been somewhat altered in the process of recall; however, they were not at all implausible. Indeed, the implausible thing would be for Witmer’s interest in an applied, helping vocation to have appeared suddenly, without a prior period of incubation. Although this applied perspective in Witmer’s thinking had lain dor- mant since 1890, when he became assistant in psychology under Cattell, it now began to reassert itself. One manifestation of this interest was a focus on child psychology. As already noted, Witmer began offering a seminar in this area in the 1894-1895 school year.‘ Interest in the psychology of children was not unique with Witmer, as it was an emerg- ing field in the early to mid 1890s, stimulated largely by the broader child study movement. While Witmer himself had never taken a course in child psychology as such, his courses in educational psychology at Leipzig undoubtedly included extensive material on developmental psy- chology. These courses should be given considerable weight in tracing the process of Witmer’s professional development. Before he went to Germany, he had no training whatsoever in practical, applied psychol- ogy; at Leipzig, however, he took four courses in education, and edu- cational psychology is preeminently an applied discipline. Further, Ger- many was then probably the leading center for the study of pedagogical principles. Although specific information on the content of the four courses that Witmer took in education is not available, it can be assumed that they included material on the views of such preeminent educational reformers as Johann Heinrich Pestalozzi and Friedrich Froebel and of & R S U L J K W $ P H U L F D Q 3 V F K R O R J L F D O $ V V R F L D W L R Q 1 R W I R U I X U W K H U G L V W U L E X W L R Q THE FIRST PSYCHOLOGICAL CLINIC 71 the influential pedagogical psychologist Johann Friedrich Herbart.3 One of Witmer’s instructors, Ludwig Strumpell, was a well-known pedagogist and a follower of Herbart. Most important, the courses differed strikingly from those of Cattell and Wundt in that they focused on the whole person rather than on psychological processes as such. This earlier aca- demic history, then, can be seen as presaging the shift in Witmer’s central interests that was to occur in 1896. This shift was from an exclusive commitment to psychology as a pure science-experimental psychology- to a parallel, and eventually stronger, commitment to psy- chology as a practical, helping profession. This chapter focuses on the year 1896, in particular on Witmer’s founding, during that year, of a psychological clinic at the University of Pennsylvania. The establishment of the Clinic (as it was called), the worlds first, was a major event in the history of psychology, especially in the history of clinical psychology. Thus, it ranks as one of those symbolic points, like Wundt’s establishment of the first psychological laboratory 17 years earlier, that will always stand as an important marker in the history of the discipline. This chapter reviews and reconstructs the various events and circumstances involved in the Clinic’s beginning. First, however, it will be helpful to briefly consider the overall cultural milieu in which Witmer worked, which provided the intellectual climate in which his innovative ideas could take root and prosper. COMPLEX EVENTS, SUCH AS the establishment of the first psy- chological clinic, are invariably multidetermined. Frequently, the critical precursors are the confluence of favorable circumstances in the prevailing cultural currents and the presence of a dynamic, catalytic individual with the insight and verve to make things happen. From this perspective, the characteristics of the larger American society in the 1890s are now re- viewed, to point out the factors that made the times propitious for the beginning of a psychological clinic, a facility that had not existed before but that a half-century later would be commonplace. Benjamin Harrison was president when the decade began. He was succeeded by Grover Cleveland (his second term) in 1893, and William McKinley served from 1897 to 1901, when he was assassinated and succeeded in office by Theodore Roosevelt. Not only chronologically and symbolically, but in actuality as well, the 1890s represented a transitional & R S U L J K W $ P H U L F D Q 3 V F K R O R J L F D O $ V V R F L D W L R Q 1 R W I R U I X U W K H U G L V W U L E X W L R Q 72 LIGHTNER WITMER period in American history. Thus, the historian Henry Steele Commager referred to “the decade of the nineties as the watershed of American history,”* before which the nation was primarily agricultural and con- cerned with domestic problems and after which the primary focus was urban and industrial and on the nation’s place in the international com- munity. Similarly, H. Wayne Morgan observed that the 1890s brought a sense of change, along with a feeling of national unity. “Many Amer- icans,” he wrote, “sought a larger ‘civilizing mission beyond material success to sustain national vitality.” As the new century approached, the political, economic, and psycho- logical traumas of the Civil War were fading into the past. “Already,” wrote Commager, “the war was becoming a romantic memory: its grand figures were writing their stately memoirs, and novelists were celebrating its heroic virtues.”6 Although the nation was not without certain eco- nomic stresses, the overall mood of the decade was one of optimism, spiritedness, and vigor. Excitement in the “new psychology’’ matched the ferment in other fields, and the discipline of psychology was rapidly becoming established as a major area of study in American universities.’ The production of PhDs in the top American departments was increas- ing rapidly, with a consequent drastic decrease in the number of Amer- icans going to German universities. At the same time, American uni- versities, including the University of Pennsylvania, were expanding rapidly, especially at the graduate level, and tended to be receptive to new programs and directions. It would seem, then, that the peculiar cultural qualities of the 1890s, particularly in academic circles, provided a welcoming atmosphere for professional innovations, such as Witmer’s Clinic was to be. Another cultural verity, this one particularly endemic to the American ethos, that facilitated Witmer’s inception of his Clinic was a pervasive concern with the practical value of actions. It is instructive to note that in 1896, Witmer published an article titled “Practical Work in Psychology”’ and later in the same year presented a paper on “The Organization of Practical Work in Psychology”9 at the Fifth Annual Meeting of the American Psychological Association (these two papers are reviewed in the next section). The theme of looking to the practical value of knowledge, of fostering the useful, the utilitarian, was-and is-deeply ingrained in the American psyche, possibly having descended in part from the struggles of the early pioneers in converting a wilderness & R S U L J K W $ P H U L F D Q 3 V F K R O R J L F D O $ V V R F L D W L R Q 1 R W I R U I X U W K H U G L V W U L E X W L R Q THE FIRST PSYCHOLOGICAL CLINIC 73 to a nation. As examples of this national spirit in Witmer’s day, there was the practical work of Thomas Edison in nearby New Jersey and the development of pragmatic philosophy in the hands of Charles Pierce and William James.” This interpretation can help explain not only the ori- gins of the Psychological Clinic but also the positive reception received by the Clinic and other, similar facilities early in the twentieth century. A PARTICULARLY IMPORTANT TREND in the wider society that helped set the stage for the emergence of a psychological clinic was the rise, in the 1880s and 1890s, of what came to be known as the child study movement. Alhough interest in the systematic study of children can be traced back to Pestalozzi, in the late eighteenth century, and to Froe- be1 and Herbart, in the early nineteenth century, the more immediate antecedents of the child study movement were Charles Darwin’s record of his infant son’s development” and Wilhelm Preyer’s influential Die Seele des Kindes. In this latter work, translated as The Mind of the Child,’’ Preyer reported detailed observations on the early development of his own child. His book led to a number of biographical, diary-like studies of infant and child development by other investigators. One of the earliest of these observational studies was conducted by Kathleen Carter Moore, a doctoral student in psychology at the Uni- versity of Pennsylvania. For her dissertation, “The Mental Development of a Child,” Moore carried out systematic observations on her infant son throughout the first 24 months of his life.” Although her study was patterned after that of Preyer, it contained considerable original material and can still be read with interest and profit. Moore received her PhD in 1896, the same year in which Witmer founded the first psychological clinic.’4 Witmer’s role, if any, in suggesting, advising, or directing Moore in her study is not known. She was married in 1892 to John Percy Moore, an instructor in geology, and was conducting her research during Wit- mer’s early period on the faculty. He had recently returned from Ger- many and was doubtless more familiar with child psychology and with Preyer’s work than anyone else on the faculty. It is plausible, then, to assume, at the very least, that Moore discussed her research with Witmer and possibly was a student in his seminars on child psychology. Studies such as those by Preyer and Moore, while of interest primarily & R S U L J K W $ P H U L F D Q 3 V F K R O R J L F D O $ V V R F L D W L R Q 1 R W I R U I X U W K H U G L V W U L E X W L R Q 74 L I G H T N E R W I’I’M ER to professionals, had little direct influence on the broader child study movement, which swept across the nation in the 1890s. The leading figure in this movement was G. Stanley Hall. Hall’s special area of in- terest was the psychology of children and adolescents, and in 1891, he established the journal I‘eAgogical Seminary. In 1893, he was instru- mental in founding the National Association for the Study of Childhood. Once under way, the interest in child study spread rapidly, as numerous groups for the advancement of child welfare and for the study of children were formed throughout the nation. The movement was especially prom- inent in educational circles, and elementary and secondary school teach- ers were encouraged to undertake studies of children’s behaviors, atti- tudes, and feelings. Many did so, and although the scientific payoff of these efforts was minimal (for the most part, the studies were marked more by the zeal of the investigators than by the rigor of their method, as indeed was largely true of the research by Hall himself), the effects of the teachers’ involvement were to enhance the quality of elementary education and to accentuate the demands for improved education of teachers. Whether inspired by the peripheral winds of the child study move- ment or by a broader Zeitgeist, the University of Pennsylvania in 1894 established a chair of pedagogy, which was filled by Martin Brumbaugh. Brumbaugh much later became governor of Pennsylvania, and it is he to whom Witmer’s father made the suggestion that railroad tracks be enclosed with fences to protect children. The child study movement can perhaps best be seen as part of a broader movement in Western society for the increased valuation of children and concern for their welfare. Another manifestation of this cultural trend was the establishment, in January 1896, of a new medical journal, Pediatrics, devoted to the dis- eases of infants and children. Witmer was not personally involved in the child study movement as such; indeed, his personality was not such as suited him to be a follower in any movement. Yet the movement was important in several ways to his founding of the Clinic and his subsequent work with children. Thus, it helped create the public atmosphere in which the idea and acceptance of a child clinic could flourish: This had never been true before. More specifically, the rising interest in the psychology of children was probably instrumental in Witmer’s instituting his seminar (as noted earlier) in child psychology in the 1894-1895 academic year. Finally, it was a & R S U L J K W $ P H U L F D Q 3 V F K R O R J L F D O $ V V R F L D W L R Q 1 R W I R U I X U W K H U G L V W U L E X W L R Q THE FIRST PSYCHOLOGICAL CLINIC 75 public school teacher who, imbued with the spirit of the times, first sought Witmer’s help (as will shortly be related) in coping with the unusual learning problem manifested by one of her students and thus inaugurated the specific sequence of events that culminated in Witmer’s Clinic. THIS SECTION EXAMINES IN some detail the founding of the Psychological Clinic in the seminal year 1896. One could perhaps quar- rel slightly with the use of the word founding in this context, if by that term one were to mean a deliberate, carefully planned, formal establish- ment and announcement of a new venture. There is certainly no evi- dence that Witmer inaugurated the Clinic in such a public, official sense; nor, indeed, could he have, since its beginnings were necessarily tentative and gradual. Yet it is clear that by the close of 1896, an ongoing clinic, with plans for its continuance, had been established. It will be recalled that Witmer participated in the special program that his university had set up, to provide special classes for local public school teachers. In the 1895-1896 academic year, he offered an introductory course on psychology for teachers, and six students enrolled.” This num- ber is of more than passing interest, because the catalog description of courses for teachers stated that “should the number of students taking a course fall below six, the course may be discontinued.”” It is intriguing to conjecture that if only five or fewer students had enrolled in Witmer’s class, it might have been canceled, with the beginnings of the Clinic quite different than as described below. The following paragraphs trace, in a month-to-month scenario, insofar as this is possible, the sequence of steps that led to the first psychological clinic. These steps can also be taken to reflect developments in Witmer’s thinking during the year. February I896 At some point during this month Witmer gave a talk before the Educational Club of Philadelphia. Possibly the invitation to give this talk was stimulated by his course for teachers in the 1895- 1896 school year. The contents of this presentation can be inferred from a paper that Witmer published in the following July; this paper, sum- marized below, included a note that a portion of it had been read at the February meeting of the Educational Club.lX More important than the content of the talk was the likelihood that it brought him in contact & R S U L J K W $ P H U L F D Q 3 V F K R O R J L F D O $ V V R F L D W L R Q 1 R W I R U I X U W K H U G L V W U L E X W L R Q 76 LIGHTNER WITMER with a wide range of school personnel and thus may have led indirectly to later referrals to him of problem children. March 1896 Sometime during the month following Witmer’s talk a student in one of his classes, who was also a teacher in a Philadelphia grammar school, described to Witmer a difficult problem presented by one of her students. Here is the way Edward l? Cheyney, the eminent historian of the University of Pennsylvania, reported the occasion: It was in a course on child psychology given in the winter of 1895-96 by Prof. Lightner Witmer, Professor Cattell’s successor, to a class principally of school teachers, that the germ of the Psychological Clinic appeared. One of these teachers described the curious case of a pupil, an intelligent boy, who yet could not learn to read. At the professors request he was brought out for examination and became a long standing problem of much interest.”’ The name of this insightful teacher was Margaret T. Maguire. Ac- cording to Witmer, “She was imbued with [the] idea that a psychologist should be able, through examination, to ascertain the causes of a defi- ciency in spelling and to recommend the appropriate pedagogical treat- ment for its amelioration or cure.””’ With this case in March 1896, the work of the Psychological Clinic was begun. At that time, as Witmer was to write later, I could not find that the science of psychology had ever addressed itself to the ascertainment of the causes and treatment of the causes and treatment of a defi- ciency in spelling. Yet here was a simple developmental defect of memory; and memory is a mental process of which the science of psychology is the only au- thoritative knowledge. It appeared to me that if psychology was worth anyrhing to me or to others it should be able to assist the efforts of a teacher in a retarded case of this kind.?’ The boy with the spelling problem may be referred to as Charles Gilrnan, the pseudonym used by Witmer himself. Gilman’s problem, as it turned out, was not a simple spelling problem but instead was much more complex, as is elaborated in the next section; today it would be termed dyslexiu, or learning disability. The first case in the history of clinical psychology was thus a boy with a learning disability. Although this diagnosis lacks the high drama of Freud’s first case, Anna O., in the history of psychoanalysis-which, interestingly enough, had been re- ported in just the previous year, 1895”-0r of the hysterical patients of & R S U L J K W $ P H U L F D Q 3 V F K R O R J L F D O $ V V R F L D W L R Q 1 R W I R U I X U W K H U G L V W U L E X W L R Q THE FIRST PSYCHOLOGICAL CLINIC 77 Jean-Martin Charcot in the previous decade, it does suggest, by the very fact that it refers to an all-too-common human affliction, the wide range of human difficulties that would come to be addressed by clinical psy- chology. Not a great deal is known about this catalytic woman, Margaret T. Mag~ire.~~ In 1907, Witmer referred to her as “now the supervising principal of a grammar school in Philadelphia.”24 Many years later, in 1931, she was in a still different position, as revealed in this paragraph from a Philadelphia newspaper: The woman who offered the first human want and specimen to Dr. Witmer’s consideration was Margaret T. Maguire, the red-haired and vigorous principal of the McCall Vocational School at 7th and DeLancey streets, known in public school circles as a militant for better and more specialized pedagogic methods.15 Evidently Maguire had lost nothing of her innovative style and caring attitude over the years. Spring 1896 Gilman was the first, but not the only, problem child that Witmer saw in the spring of 1896. Later Witmer wrote that during that early period, “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.’’26 /ub 1896 Under the auspices of the American Society for the Exten- sion of University Teaching, Witmer offered a laboratory course, from July 6 through July 3 1, on the Methods and Results of Child-Psychology, with a particular focus on the characteristics of defective children and the special methods of training them. Here is the complete course de- scription: This course is intended for teachers and students of psychology interested in the modern methods of observing the mental and physical characteristics of children at all periods of their development. Class and individual experiments will be made, not upon children but upon members of the class, serving the purpose of illus- trating the methods of experimentation. A feature of the work will be visits to institutions for the training of defective children, for the purpose of studying types of children and the psychology of the special methods of instructing the imbecile and the idiot, the deaf and dumb, the blind and the youthful criminal.’- This brief summer course can be seen as a transition between the & R S U L J K W $ P H U L F D Q 3 V F K R O R J L F D O $ V V R F L D W L R Q 1 R W I R U I X U W K H U G L V W U L E X W L R Q 78 LICHTNER WITMER seminar Witmer had offered earlier on child psychology and the more clearly clinical course he would offer in the summer of 1897. More broadly, it reflects Witmer’s growing commitment to practical, helping work with children. Also in July, Witmer published the paper on the teaching of psy- chology to teachers that was referred to above in connection with his February talk before the Educational The article included a brief summary of the bright boy with a spelling problem seen in March and also quoted a college president who had attended the July extension course on child behavior to the effect that he had never known that such problems were discussed in psychology. For the most part, however, the article, which paid tribute to Hall and Galton, was a rather academic discussion of the aspects of contemporary psychology that Witmer felt should have a place in psychology courses for teachers. The significance of the article is that it was Witmer’s first publication relating psychology to educational practices, a theme that would be prominent throughout the rest of his career. October 1896 The October 15 issue of the new journal Pediatrics carried an editorial by Witmer titled “The Common Interests of Child Psychology and Pediatrics.”29 This paper related psychology to medicine, just as his July paper had related psychology to education. Further, it suggested that psychology should have a key role in working with prob- lem children. Toward this end, Witmer concluded, the pediatrist, the psychologist, and the pedagogue should join forces. November 1896 In an article in Pediatrics one month later, Witmer was more explicit about a possible helping role for psychologists. The article, “Practical Work in Psychology,” begins with these prescient words: The practical side of psychology deserves serious attention from professional psy- chologists. The practice of psychology may become as well defined a pursuit of a trained professional class as is the practice of medicine. w Witmer suggested four contributions that “practical psychology can offer in the study of the results of mental training”3’: first, “the exami- nation of the physical and mental conditions of school children” ”; sec- ond, “the study of defective children” j3; third, “a psychological mu- seum”: and fourth, “an experimental training In the third of & R S U L J K W $ P H U L F D Q 3 V F K R O R J L F D O $ V V R F L D W L R Q 1 R W I R U I X U W K H U G L V W U L E X W L R Q THE FIRST PSYCHOLOGICAL CLINIC 79 these, the psychological museum, Witmer had in mind collections of work done by defective children, apparatus used in teaching them, and research results, exhibited in the form of tables and graphs. Following the general discussion of the practical contributions that psychology can make in work with children, Witmer presented, by way of illustration, a fairly detailed case study (although not called that) by Mary E. Marvin. The subject was a 10-year-old boy referred to as I? Marvin, who had what Witmer referred to as a cooperative association with the University of Pennsylvania’s Department of Psychology-which meant, of course, with Witmer himself-had developed a specialty in teaching mentally defective children and also in teaching oral speech to the deaf. She had begun working with P in 1892, when he was 7. At that time, the only words he spoke were papa and mama, and these were spoken inarticulately and without any evident idea of their meaning. His sense of smell was acute, and when his hand came in contact with an object he hastily withdrew it and carried it to his nose. Away from home, he was uncontrollable, and the first impulse, on given any object, was to destroy it with his fingers. His attention span was incredibly brief, but Marvin did discover two activities that held his interest: stringing buttons and playing with balls. He also was greatly attracted by music, and it was said that he could hum most of the tunes he had ever heard. During the 4 years that Marvin worked with P (typically 3 hours a day, 5 days a week) he made very notable progress. By playing with him, she had gradually gained his affection and then began teaching him speech through music. By June 1894, he could sing “Way Down Upon the Swanee River.” Using candy as a reward, she taught him to count to 5. By June 1896, he was able to write all of the alphabet to dictation and could frame simple sentences. Although it is impossible from this distance to form a definitive diagnosis of P, it seems probable that today the child would be characterized as having autistic disorder. Note that Witmer, much later-in 1920-described another child who appears to have been autistic. is Although Witmer does not specifically state that he saw P, it can be assumed that he did, although P was clearly Marvin’s case. The important point is that the case made a strong impression on Witmer and, along with the case of Charles Gilman, contributed at a critical juncture to Witmer’s growing vision of a new helping role for psychology. December 1896 On December 29-30, 1896, APA held its Fifth An- & R S U L J K W $ P H U L F D Q 3 V F K R O R J L F D O $ V V R F L D W L R Q 1 R W I R U I X U W K H U G L V W U L E X W L R Q 80 LIGHTNER WITMER nual Meeting in Boston and Cambridge, with 45 members in atten- dance. George Fullerton, now the APA president, gave an address on “The ‘Knower’ in Psy~hology”.~~ Witmer, on December 29, presented a paper titled “The Organization of Practical Work in Psy~hology.”~’ This paper, which called for the application of scientific psychology to prac- tical affairs and which included the first usage anywhere of the term psychological clinic, has generally-and correctly- been considered as marking the first call for a new helping profession, although the more formal designation of clinicalpsychology was 11 years away.38 Under the rubric of practical work in psychology, Witmer included the following: 1. The direct application, whether by professional psychologists; practicing physicians or teachers, of psychological principles to therapeutics and to education. 2. Such psychophysical investigation of mental conditions and processes as may serve to throw light upon the problems that confront humanity in the practice of medicine or teaching. 3. The offering of instruction in psychology, to students of medicine or to teachers, that contains a promise of future usefulness to them in their respective professions.” It is evident from these introductory themes that Witmer had not yet fully conceptualized, or at least was not yet prepared to announce, his conception of a separate applied psychological profession. Nevertheless, we see in the three functions listed above the attributes of practice, research, and teaching that were later to characterize clinical psychology. Witmer went on to recommend that a university psychology department should have a close relationship with the medical school and should have access to all classes and grades of children, in order to conduct appro- priate physical and mental tests. Under the concept of “an experimental training school” he proposed: a. Independent schools or homes for such children as can afford to pay for b. A psychological clinic and dispensary. c. Special or ungraded training schools for children who are backward or phys- ically defective [to be controlled by public schools authorities but related to the Psychology Department of the local university] .*‘I expert psychological and pedagogical treatment. The second of these, a psychological clinic, was already in develop- ment at Penn under Witmer’s auspices. The first, special private schools & R S U L J K W $ P H U L F D Q 3 V F K R O R J L F D O $ V V R F L D W L R Q 1 R W I R U I X U W K H U G L V W U L E X W L R Q THE FIRST PSYCHOLOGICAL CLINIC 81 or homes, was possibly suggested in part by Mary Marvin’s experience and plans and was some years later to be realized in Witmer’s own schools. Witmer’s brief paper, the harbinger of a later large and flourishing field in psychology and modern culture, was, according to widely ac- cepted lore, poorly received by the audience, with the only reaction to his presentation being a few raised eyebrows.*’ This retrospective negative evaluation, however, apparently is due in its entirety to the following sentence in the brief biography by Collins, written in 1931: “The only reaction he [Witmer] got from his audience was a slight elevation of the eyebrows on the part of a few of the older members.”** It seems obvious that Collins, who by this time was a well-known author of popular books, was exercising a certain literary license in his phraseology. Since he was not present at the 1896 meeting, it follows that his interpretation of the reception of Witmer’s paper came either from Witmer himself or from his own belief that the profession had not adequately appreciated Witmer-a view clearly indicated in his later comments in the article. It is also conceivable-perhaps even probable-that Collins did not intend his comment to be taken literally but meant it simply as a met- aphorical allusion to point out the importance of Witmer’s overall con- tribution to clinical psychology by emphasizing the modesty of its be- ginning. In fact, it is simply not known how the audience received Witmer’s seminal paper. One suspects that the paper, like most short papers at scientific meetings, was received rather blandly, with no general enthu- siasm one way or the other.“3 It was not, after all, a major address, but was one of 21 brief presentations. Overall Caseload in 1896 After his examination of Charles Gilman in March, Witmer, as already reported, examined several other children in the spring of 1896. Thus initiated, his pioneering clinical work contin- ued throughout the year. I now briefly review the cases that he saw in 1896. This summary is based on the available case records of Witmer’s Psychological Clinic, which have been preserved on rni~rofilrn.~~ The surviving records for 1896 are extremely sparse, but it is possible to discern or to infer from them certain features of Witmer’s case contacts during that year. A few words may be interjected at this point on the case records that were maintained in the Psychological Clinic. Each new case was assigned & R S U L J K W $ P H U L F D Q 3 V F K R O R J L F D O $ V V R F L D W L R Q 1 R W I R U I X U W K H U G L V W U L E X W L R Q 82 LIGHTNER WITMER a number, based on the chronological order in which the child or adult was first seen, and the data for successive cases were filed in separate folders. It is these records that are now on microfilm. I do not know when this systematic numbering system was instituted, but it was cer- tainly not in place at the beginning, and may not have been organized for some years. My supposition is that it was developed after the Clinic was clearly a going concern, and that at this time the early cases were assigned numbers retrospectively-a procedure hardly immune from error-with Gilman being assigned the number 000 1. Returning now to the data for 1896, it is evident, from a perusal of the records, that they were not very systematic and that Witmer had not yet thought through just what the case records should contain or (prob- ably) even that he would keep systematic case records. For the most part, the records consist of abbreviated, informal notes that Witmer made for his own use and of exercises (e.g., writing, spelling, or addition) presum- ably intended to provide some idea of a child’s mental f~nctioning.~~ Case 0008, however, included a six-page typed form with blanks for the insertion of data concerning the examination, family data, physical health history and status, pedagogical history, speech, hearing, reading, and understanding of verbal commands. This form was not used in any other 1896 cases for which records survive. For Cases 0009 and 0013, Witmer’s longhand notes were written on a one-page form with “Ob- servation” printed at the top and “University of Pennsylvania/Psycho- logical Laboratory” printed at the upper left. How many cases did Witmer see during 1896? Although a definitive answer is not possible, a good estimate can be derived from the case numbers, even though the case numbers were not assigned until some time-possibly some years-later. Many of the records, including the first one, are not dated, but Case 0023 is dated November 10, 1896,46 and Case 0027 is dated January 14, 1897. From these data, it can be inferred that from 23 to 26 cases were seen by Witmer in 1896. Such a conclusion, however, is somewhat problematic because of the paucity of data in the preserved records; further it can be deduced, on internal evidence, that 2 of the cases were actually initiated later and should not have been included in the 1896 file.47 It is thus possible to settle on 24 as perhaps the most likely (but still highly uncertain) number of cases seen by Witmer in 1896. Most of the case contacts appear to have been in the nature of con- & R S U L J K W $ P H U L F D Q 3 V F K R O R J L F D O $ V V R F L D W L R Q 1 R W I R U I X U W K H U G L V W U L E X W L R Q THE FIRST PSYCHOLOGICAL CLINIC 83 sultations, probably occupying only a single session. Probably, in most instances, a child was brought to Witmer’s office, according to prior arrangement, by a parent or teacher. Witmer interviewed and examined the child, considered whatever other data had been provided, and then made such recommendations as he deemed appropriate. Of the 24 cases referred to above, data are completely missing on 3; of the remaining 21, 1 (Case 0023) was an adult, and the remaining 20 cases were chil- dren, comprising 14 boys and 6 girls. Referrals, when indicated, were from public schools, a nursery, and at least one from a physician. The most general cause of referral appears to have been concern by a teacher, nurse, or parent concerning a child’s developmental progress-in learn- ing, speech, or motor functions-or with respect to possible overall mental deficiency. One child was described as “chronic chorea,” and another, in today’s terminology, would probably be referred to as “hy- peractive.” Still another child had previously been labeled “hydroce- phalic,” although Witmer was evidently skeptical of this diagnosis.48 The adult case (Case 0023) was a woman with reported neurasthenia and delusions of persecution. Witmer did not see the woman herself but was consulted by two men, one a physician, concerning the possibility that the woman’s refusal to visit her mother was due to hypnotic occult influences that others were exercising on her. Witmer rejected this pos- sibility and advised that the only way to restore the relation between mother and daughter would be to win the confidence of the daughter and then persuade her to see her mother. Despite this adult consultation, Witmer‘s central interest was in work- ing with problem children. In doing this, he had few tools with which to proceed. Even rudimentary tests of intelligence did not yet exist, and Witmer necessarily fell back on informal assessments of verbal and nu- merical ability. Despite his feeling that scientific psychology should have something important to offer in helping problem children, in fact, it had very little to provide. Further, Witmer’s own training and clinical experience were also severely limited. It is not surprising, then, to learn that in his early cases he placed great emphasis on a child’s developmental history and on physical characteristics that might possibly be etiologically involved in the child’s status. B E c A u s E o F I T s H I s T o R I c importance, Witmer’s first case, the case of Charles Gilman, merits a closer look. The information to be & R S U L J K W $ P H U L F D Q 3 V F K R O R J L F D O $ V V R F L D W L R Q 1 R W I R U I X U W K H U G L V W U L E X W L R Q 84 LIGHI’NER WITMER presented is abstracted from Witmer’s 1907 case report, published under the title “A Case of Chronic Bad Spelling- Amnesia Visualis Verbalis, Due to Arrest of Post-Natal De~elopment.”~‘ Description of this case will take the reader up to the year 1907, but it seems best to summarize the entire case history here rather than to postpone aspects of it until later chapters. Gilman, at the time he first came to Witmer’s attention in March 1896, was 14 years of age, in apparent good health, and a pupil in a Philadelphia grammar school. In the opinion of his teacher, however, he was endowed with at least normal intelligence but nevertheless was three grades retarded. His problem, as Maguire saw it, was a specific difficulty in spelling. Witmer’s initial examination confirmed the boy’s difficulty in spelling and revealed an equal problem in reading. The only written words that Charles could pronounce without first spelling them were an, the, and a few other monosyllables. He was unable to recognize such a simple word as house on sight. When copying a word from the blackboard, he could never copy more than one syllable at a time, and his copy showed many blunders. In geography, he had some difficulty locating places on a map, but he was good at drawing and was reported to be remarkably good in history and in science, where he was quick to find causes for observed effects. He was able to make logical inferences and expressed himself well in spoken language. Witmer concluded that Charles was of at least average intelligence. He had good memory for sounds, as well as good visual memory for colors, single figures, and even separate letters; however, he could not visualize the appearance of whole words. Witmer’s first thought was that Charles’s problems were due to inefficient school training, and accordingly in the spring of 1896, he arranged for Charles to have special exercises in the rapid apprehension of words, to improve his visual memory. When the teacher was unable to find adequate time for this, Charles came regularly to the university for special treatment by Witmer himself. Witmer identified certain specific errors; for example, he learned that Charles would read “was” for “saw” and “weather” for “water.” Further, he discovered that Charles was afflicted with a problem of double vision and referred him to an oculist. The oculist determined that although Charles had practically normal vision in each eye, there was a tendency, due to a defect in the ocular muscles, for the one eye to focus slightly & R S U L J K W $ P H U L F D Q 3 V F K R O R J L F D O $ V V R F L D W L R Q 1 R W I R U I X U W K H U G L V W U L E X W L R Q THE FIRST PSYCHOLOGICAL CLINIC 85 lower than the right. This problem was largely alleviated by prescription glasses. Despite this correction, Charles could not spell or read any better than before. Witmer felt, however, that educative processes could now be undertaken with some hope of success, and both he and Maguire renewed their efforts. For some time, Charles still had to spell each word before recognizing it, but on December 7, 1896, he recognized by sight two words: happy and following. He continued to progress, and by March 1897, he could recognize many words and could even read something from newspapers. Regular training ceased in April, but when Witmer saw him in May, Charles still showed certain curious confusions and transpositions (e.g., he would read “especially” for “particularly,” or vice versa, and he would write “htat” for “that”). In October 1897 an operation was performed to improve Charles’s vision, but when Witmer saw him on December 31, 1897, he showed only very little improvement in reading from the time the special training had ceased in April. In June 1899, when Charles was 17 years of age, he graduated from grammar school and enrolled in a school of industrial arts, where, because of his talent for drawing, he did excellent work in a textile department. However, he unfortunately developed tuberculosis of the muscles and joints, and when Witmer saw him on July 9, 1903, his physical condition was serious. Although Charles was over 6 feet tall, he weighed only 120 pounds and was easily fatigued. He reported, how- ever, that he greatly enjoyed his recently acquired ability to read. He reported that he had read Dumas and Balzac, and he successfully read a passage for Witmer. His conversation was that of an entirely normal young man. In January 1907, Charles died of tuberculosis. Witmer’s final conception of the boy’s basic problem was that he was deficient in the ability to call up visual images of words, a condition that Witmer labeled verbal visual amnesia; such stored visual word mem- ories, Witmer theorized, were necessary for a person to readily identify perceived words. Charles, Witmer speculated, had from infancy been affected with an ocular muscular limitation that had prevented him from building up a normal repertoire of visual word images until its correc- tion, or near correction, by wearing glasses at the age of 14. In today’s nosological system, Charles’s affliction, on the basis of the information available, would be termed dysle~ia.~” The summary above is based on Witmer’s 1907 case report. The sur- viving material in the microfilm record for the case of Charles Gilman & R S U L J K W $ P H U L F D Q 3 V F K R O R J L F D O $ V V R F L D W L R Q 1 R W I R U I X U W K H U G L V W U L E X W L R Q 86 LIGHTNER WITMER (Case 0001) is extremely meager. Of the four sheets (all undated), three include brief samples of spelling and arithmetic, and the other is limited to physical measures. Most interesting is a typed note added by GGI on February 17, 19 19. GGI undoubtedly refers to Gladys Geneva Ide, who took her doctorate under Witmer in 1919. It seems probable that Ide, in looking over the early records in 1919, noted that the folder for the first case was largely vacant and inserted a note referring to a lecture by Witmer in which she had heard him describe his first case as a bad ~peller.~’ In his lecture, as recalled by Ide, Witmer attributed the boy’s problem to weak eye muscles and stated that with glasses, eye surgery, and teaching at the Clinic, the boy was able to read for pleasure in 6 months. This is a much more casual and sanguine picture than that in the 1907 case report. Whether this difference is due to Witmer’s later imperfect recollection or more likely to Ide’s reconstruction of it cannot be determined, but in any event, the detailed 1907 report should be considered the more accurate. THE TWO PRECEDING SECTIONS were devoted to the origins, during 1896, of what later became known formally as the Psychological Clinic. The pioneering steps, all taken by Witmer before he was 30 (his 30th birthday would come in June 1897) were, from the biographical perspective, obviously the major events of the year. However, there were also other developments, in the latter part of 1896, that are of interest. Although Witmer’s role at the 1896 APA Meetings in Boston and Cambridge is memorable chiefly because of his paper on practical work in psychology, his presence was also notable in other respects. One such respect was the presentations by two of his students, Albert L. Lewis5’ and Mary I? Harmon,” of experimental papers. Both of these papers reported research on reaction times and muscle movements. The reader will recall that in 1890, when Witmer was a graduate student and Cat- tell’s assistant, Cattell had assigned him the task of collecting reaction times on ordinary persons and that Witmer had continued this line of research after his return from Leipzig, and, further, that he had presented a provisional summary of his findings on individual differences in re- action time at the meetings in 1892 in Philadelphia. The papers by Lewis and Harmon at Boston were follow-ups of this general line of re~earch.’~ Lewis, who had obtained his bachelor of arts & R S U L J K W $ P H U L F D Q 3 V F K R O R J L F D O $ V V R F L D W L R Q 1 R W I R U I X U W K H U G L V W U L E X W L R Q THE FIRST PSYCHOLOGICAL CLINIC 87 degree (BA) in 1894 and who was destined to become a prominent Philadelphia attorney in later years, compared four groups, described as American men, American women, Negroes, and Indians, on reaction times to light, sound, and touch and on free-arm movements (extension and flexion). No meaningful overall group differences were found, but a relationship between reaction time and rate of movement was reported. Harmon obtained a variety of physical and mental measurements on 100 women in a normal school and on 34 boys and 63 girls in a kin- dergarten. This study was conceived as part of a broader plan to obtain extensive normative data on a wide range of The 1896 APA meeting also received the Preliminary Report of the Cattell Committee on mental and physical The committee, which included Witmer, had looked into the various sensorimotor tests, or- as they were tending to be called-physical and mental, or psycho- physical, tests. The report set forth 25 tests and types of measurements (plus a background data form), which it felt merited further study and use. Among the test procedures considered- to give a brief sampling- were keenness of vision, color vision, sensitiveness to pain, dynamic pressure, and reaction time for sound, memory, and imagery. Witmer was identified as being involved in the appraisal of most of the 25 and as being particularly interested in speed of movement, will power, vol- untary attention, and modifiability of the knee jerk (patellar reflex).” The business session of the 1896 APA meeting brought up some contentious issues. These revolved around the question of the general purpose of the association and the related question of criteria for mem- bership. The fact is that APA, as its membership increased, was under- going growing pains. The underlying issue was whether the organization should encompass all interests, including philosophical psychology, un- der its umbrella or whether it should focus on the newer, scientifically oriented experimental psychology. The matter had arisen at the 1895 meeting in Philadelphia, with the result that at the 1896 meetings, phil- osophical papers were grouped together in their own session. This ad- justment, however, was not deemed adequate by the experimentalists, which included Witmer. Their aim was to complete the divorce between philosophy and scientific psychology. To this end, Witmer, at the 1896 business session,58 offered three motions, which can be summarized as follows: first, that only psychological papers be accepted for the annual meetings; second, that a plan be made for the organization of an Amer- & R S U L J K W $ P H U L F D Q 3 V F K R O R J L F D O $ V V R F L D W L R Q 1 R W I R U I X U W K H U G L V W U L E X W L R Q 88 LIGHTNER WITMEK ican Philosophical Association; and third, that election to membership in APA be made more selective. The motions were referred to the APA Council (its governing body), but no formal action was taken. It is notable, however, that at the Sixth Annual Meeting of the Amer- ican Psychological Association, at Cornell, more stringent membership requirements were adopted. This change, however, did not fully satisfy Witmer, as shown by the fact that a few months later he wrote to Hall proposing the formation of a new society exclusively for experimental psychologists. Witmer’s letter has not survived, but we know of its ex- istence through a letter from Hall to Titchener in March 1898, which included the following: A line from Witmer says that he wants to join you, me and others in forming a new Psychological organization which shall put the lab on a proper basis and exclude half-breeds and extremists. Do you want to consider it?5‘ As Goodwin puts it, “This Witmer-led revolt failed to materialize,”“ primarily because Titchener opposed it. Although Titchener was doubt- less the most passionate of the group in espousing the cause of the experimentalists, he felt that setting up a new society, at least at that time, would be divisive and injurious to the fledgling APA. The reader may be surprised to learn that Witmer, even while he was in the process of developing what would come to be known as clinical psychology, should so strongly have championed the banner of experi- mental psychology in its strict laboratory sense. The fact that he did so is clear evidence, if any were needed, that at this point in his career Witmer not only considered himself an experimentalist but also consid- ered his approach to practical psychology, as presented in his 1896 APA presentation, to be fully in keeping with a scientific orientation. The episode also tells something about Witmer as a person. He was not only forceful and strong-willed but also quite willing-more willing than his friend Titchener, evidently-to undertake a move that would be unpopular among many of his colleagues, if he considered it to be the right action to take. 1 N 0 C T 0 B E R 1 8 9 6 , the North American Review published an article by R. Osgood Mason titled “Educational Uses of Hypnosis.””’ In this & R S U L J K W $ P H U L F D Q 3 V F K R O R J L F D O $ V V R F L D W L R Q 1 R W I R U I X U W K H U G L V W U L E X W L R Q THE FIRST PSYCHOLOGICAL CLINIC 89 article, Mason, a physician, held that hypnosis had already demonstrated its usefulness in therapeutics and psychological research and argued that it could also be of value in educational practice. Witmer, who had gained familiarity with hypnosis, took a skeptical view of Mason’s article, which he considered uncritical, and wrote a strong, but courteous, response to it, “The Use of Hypnosis in Education.””’ The most interesting part of Witmer’s article is the revelation that he had a 27-year-old college woman under treatment for stuttering, and that he had used hypnosis in her treatment. It was his opinion, however, that hypnosis could provide only transient benefit for her affliction. For more permanent improvement, he felt she needed to develop greater self-con- fidence. For this reason he had assigned her to receive special lessons in articulation from an instructor trained in teaching the deaf to speak.63 It is conceivable, perhaps even probable, that this case was one of those seen in the latter part of 1896 for which no written record remains. F o R WITM ER, 18 96 HAD been a year of transition. As such, it was the second major transition of his adult life-the first having been when he decided, some 6 years earlier-to enter into the field of psychology. This second transition, which drastically changed the course of his life, was in his decision, along with its resulting actions, to enlarge the borders of scientific psychology to include the evaluation and treatment of indi- viduals with mental and behavioral problems. The emphasis was on chil- dren and adolescents, as it was to be throughout his career, but even in this first year, adult cases were seen, and the idea of making psychology practical, as well as scientific, applied, in principle, to adults as well as to younger persons. Witmer’s radical step was without precedent. He was, of course, in no sense the first person to attempt to help psychologically limited and distressed individuals: Certainly teachers, physicians, pastors, and others had given generously of themselves to this end since time immemorial. What was unique about Witmer’s action was that he took on the helping role in his capacity as a psychologist. No psychologist had put forth this idea before Witmer. Some, like Hall, had espoused the scientific under- standing of children, and others, like Cattell, had pioneered psycholog- ical assessment, but it had remained for Witmer to propose that the scientific study of human behavior could be brought directly to bear on the alleviation of human problems.