Book Review

Canada and the United States

In this book, Eric Caplan tries to illuminate the process by which Victorian-era physicians came to accept mental healing, or what is now called psychotherapy. Before Sigmund Freud arrived in the United States, Caplan argues, the American medical community began to understand that not all mental disorders had somatic causes. Such a concept was fundamentally at odds with prior medical orthodoxy and signaled a breakthrough in both medical thinking and practice. In tracing the roots of this new faith in psychotherapy, Caplan looks not to the importation of European ideas about the mind and body but rather to the particular experiences of American practitioners ranging from railway surgeons to neurologists.

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In an opening chapter, Caplan describes the lawsuits brought against railway companies by individuals who suffered no discernable physical injury but serious mental derangement following train wrecks. These civil actions prompted new medical thinking. Initially, the mental distress that resulted from train accidents was deemed the result of "railway spine": a functional condition induced by the physical compression of the body. The resulting symptoms—among them disturbed sleep, hot head, and impotence—led to numerous lawsuits and expensive settlements. As the costs of railway spine mounted, some surgeons began to consider whether the injury was indeed physical or might instead be a manifestation of nervous shock that was best treated by rest cure and other mental therapies. Thus, Caplan demonstrates with a bit of irony, the first American medical specialists to embrace psychotherapy were not neurologists but railway surgeons.

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