Honorable rivals? Psychiatrists, psychologists, and professional authority in early 20th-century America

Historians interested in psychiatrists' professionalization process in early 20th-century America have typically focused on their relations with neurologists. We often hear a story of psychiatrists moving from asylums to psychopathic hospitals with outpatients, where they began to encroach on the patient jurisdiction of neurologists or "nerve doctors," who had historically treated patients suffering from less severe conditions. This paper contributes an unexplored dimension to the "death of alienism" story by focusing the threat psychiatrists perceived from on a different rival expert: the clinical psychologist. In an era defined by social reform, blurred and fluid boundaries defined the relations between psychiatrists and psychologists, particularly as they began to share clinical spaces devoted to the diagnosis and management of human behavior. Psychiatrists often enjoyed professional authority in these spaces yet still perceived a professional threat from psychologists. Why was this the case? How did psychiatrists attempt to construct their unique professional and clinical attributes in the context of shared clinical spaces? This paper will investigate these questions by examining a key clinical space of this period-the psychopathic hospital-and the ways psychiatrists defined their epistemological and clinical relations with psychologists. I show that psychiatrists did not simply claim authority over a specific patient jurisdiction, but authority over clinical techniques and forms of expertise unique to medicine. These strategies were borne of self-interest but also institutional responsibility. Concerned with forging a space in medicine and the medical school curriculum, psychiatrists highlighted their roles as diagnosticians in which diagnosis was part of a larger medical regime that involved case management, treatment, and cure, and encompassed the whole person. A psychologist can produce test results-only a psychiatrist can properly diagnose.