Adam Blatner, M.D.

(Posted February 12, 2010)

This is the first of two related papers I’m posting on this website. I welcome your feedback. (With your feedback, I can always change my wording or insert your comments.) This paper notes how psychotherapists came to be called “shrinks;” how this term in some ways is a little bit true; and how in some ways many modern therapists might better be recognized not as shrinks but expanders.

The second webpage, "Beyond Psychotherapy," notes how there are domains of consciousness expansion that require socio-cultural changes, and though psychotherapists can help by recognizing these issues and talking about them openly, helping with the consciousness-raising, these changes can be implemented only to a limited degree by the individual in his own personal life. Ideally, the changes desired need to happen in a broader arena and therapists can help by at least being advocates for such changes. However, any thoughts that therapy in itself is sufficient to relieve all forms of psycho-cultural sources of stress, oppression, dis-ease would be reductionistic. So that page considers some of the wider issues that might be involved in a true program of mental hygiene.

As a preamble, I think the goal of healing should be “wholeness,”—and both words derive from a similar Indo-European word root. How can humans manifest their human potential more fully?
    "Don't ask yourself what the world needs.
    Ask yourself what makes you come alive, and then go do that.
     Because what the world needs  is people who have come alive."
               -- Howard Thurman (1900-1981)

In the late 19th century the field of psychology began to develop, and Freud’s methods were the equivalent of an early model of the telescope or microscope: They opened up vast and complex realms of phenomena that had been previously ignored or treated as an unreachable mystery. As the field developed it became broader and more refined—as has been true with the advance of most other scientific fields of exploration. Those who stayed stuck in the earlier theories seemed old-fashioned. Relatively, their work seemed to “shrink” the human potential to the “Procrustean Bed” of the limitations of their theories. (Procrustes was a bandit mentioned in the story of Theseus in Greek mythology, a rogue who invited guests to sleep in his special bed: But if they didn’t fit, he made adjustments: If one was too short, the bed acted as a rack, stretching the victim to size; if the victim was too tall, the villain sliced off bits of the feet that didn’t fit! Finally killed by Theseus.)

The Origins of “Shrink”

In the 1950s and 1960s the term “shrink”—perhaps short for “head-shrinker”—became a slang term that referred to psychiatrists, psychotherapists, and especially psychoanalysts. It was a way to mock the mystery and authority of psychiatrists and psychotherapists—and mainly of the mysterious and odd procedures associated with psychoanalysis, which was the dominant approach in the Americas and Europe in the mid-20th century. Even patients or “analysands” used this term to soften their one-down status: Having a slightly derogatory but almost affectionate pet name—i.e., my “shrink”—seemed to neutralize or even reverse the intuitively perceived status gradient experienced by clients. In some urban sub-cultures it was common for several people in a social network to each have their own analysts, and phrases such as “My analyst said...” became part of the cocktail party patter. (I remember drawing a cartoon of two kids and one said, “Oh, yeah? Well my analyst can see right through your analyst!”—a play on the “my dad can lick your dad” gimmick.)

The term also had an edge of the idea of “head-shrinkers,” reacting to the discovery of tribes in South America who actually engaged in a process of removing the skulls of enemies and slowly curing the skin over a smaller frame. (I remember reading about this in Ripley’s  Believe It Or Not and/or some other articles—it appealed to the pre-teen fascination with Halloween Horror.) Stories of cannibalism and voodoo also were an emerging part of the legends in that early mid-century era of comic books and pulp fiction. These images also bled over to the emerging fields of psycho-analytic psychotherapy and similar approaches, because the terminology was obscure and the whole enterprise had an aura of magic and mystery.

Some Historical Perspectives

Actually, the early psychoanalysts were in a sense the “expanders” of their time. Psychoanalysis caught on more among the intelligentsia in the 1920s through the 1940s even more than it caught on in the medical fields—although that came a little later. Considering the depth psychology of human affairs seemed to be an exciting new approach to “mind expansion.” In comparison, the earlier generation, the old-fashioned, post-Victorian world-view, came to be viewed in the early-mid 20th century as self-deceptive. Its “stiff upper lip” attitude relied overmuch on the psychological defense mechanisms of repression and denial. By confronting the “terrible truth” about the unconscious, darker drives underlying human nature, psychoanalysis seemed positively enlightening (Douglas, 1995).

Because of a number of other sociological currents such as the glamour of the European professor, the immigrations from pre-WW2 Europe, the adoption of psychoanalysis by mainstream psychiatry, and so forth, Freudian thought held a hegemony in the USA and Western Europe in the late 1940s and 1950s. (There were also some practicing Jungians and Adlerians, but they had nowhere near the organization or relative popularity.)

To note again in its defense, psychoanalysis seemed mind-expanding to its own practitioners at the era (Hobson & Leonard, 2001, pp. 37-41; Dolnick, 1998, pp. 64-68). For a time, many of the brightest, most introspective medical students went into psychiatry because of this many-faceted frontier. (I admit that this was also one of my motivations: Going into psychiatry allowed me to integrate a range of my interests in medicine, philosophy, the history of religion, art, anthropology, and so forth.) Dynamic psychiatry also offered a humanistic alternative to what had been available in psychiatry in the 1930s and 1940s—a tragic and somewhat stagnant impasse and heavy hospital load of the mentally ill. (A muckraking movie at the time titled The Snake Pit portrayed the horrible conditions in some psychiatric hospitals at the time.) Although some well-meaning psychiatrists attempted to promote a variety of of programs, for the most part these reflected the innovator’s own personality and lacked a theoretical foundation that could be used by others. Other treatments offered were desperate—though on occasion able to offer surpising relief for a time—e.g., electroshock treatment, which still offers value for a few patients who are severely disturbed and yet unresponsive to other approaches. For the most part, though, in that era, patients were simply warehoused. Psychoanalysis seemed far more caring, patient, and humane—though its actual effectiveness with the severely mentally ill was minimal.

In actuality, though, psychoanalysis as a socio-economic field made its major inroads not in psychiatric hospitals but in consulting offices in major urban centers where it catered to the much milder neuroses of otherwise fairly highly functioning clients who could afford to pay for this prolonged and intensive treatment. For them it was not just a treatment but a type of mind-expansion.

So, in its defense, Freudian psychoanalysis offered something exciting and expanding, and it was only later that this first generation and its methods were judged as (relatively speaking) more likely to shrink than expand the personality. The theories also were both insightful and yet unrefined. These ideas sometimes overgeneralized, sometimes under-estimated. As a whole, though, they opened up the idea that there were realms of experienced that were to varying degrees not disclosed to others, to oneself clearly, or to oneself at all—i.e., the subconscious and unconscious mind.

Relativism and History

New generations tend to see older ideas as old-fashioned. Saying it another way, as a field of study develops and expands, or as a technology and cultural trend flourishes, it gives rise to a dialectical process: a given set of ideas, a thesis, attracts the attention of critics who notice that some of these ideas merit certain criticisms, which represent the antithesis. Eventually still other theories emerge that seek to capture the best elements of both the thesis and antithesis and generate from these a new synthesis. This set of ideas then acts as a thesis for a further dialectical go-round of thesis, antithesis, and synthesis, and so it progresses.

In this model, then, the dominant school of thought stimulates people to notice what in their opinion is neglected or over-emphasized, and from this they develop compensatory therapeutic and theoretical systems. So, beginning in the 1950s (or earlier!) and flourishing more in the 1960s, a number of approaches emerged as antitheses to the theses of psychoanalysis— within that field as alternative schools of thought and beyond it, as alternative non-analytic therapeutic methods. By the 1970s, there were hundreds of various types of therapy, many of them structured as approaches that compensated for perceived lacks in the mainstream analytic approach. From all these, though, the classical types of psychoanalysis might plausibly have been seen by others as, in a sense, “shrinking” its patients, meaning that this approach was viewed as interpreting the range of human experience within the limitations of its own theoretical boundaries.

This paper will briefly address some of the dimensions of psychotherapy and/or consciousness-raising that emerged in the 1950s through the 1970s that might be recognized as expanding rather than shrinking the image and potential of who patients are and might become. Let us consider then some of the categories that lead to a view of the human mind as something that can be expanded in many different ways.

Beyond the Individual

The first expansion beyond the early model was the opening of the perspective of appreciating that dis-ease can arise not just from the individual, but equally from the relationship. Individuals, as a matter of fact, can be quite healthy in some settings but they just don’t fit or trigger each other off in certain relationships—marriages, groups, etc. Corollary: All dysfunctions may not be traceable to the faults of the individuals involved. There is such a thing as incompatibility. Attention, then, needs to be given to the dynamics of relationships and groups.

Although precursors to group and family therapy emerged from the 1920s on, they were mainly the work of scattered individuals. The movement to group work accelerated after the Second World War (necessitated by the problem of working with veterans). Still, groups were more difficult to work with—an order of magnitude more complexity.

Nevertheless increasing numbers of pioneers sought to note the way humans could be appreciated as much as social beings as individuals, and helped not just through individual work in therapy, but through the power of the group.

Moving outward from this, research in group and family dynamics, the interactions of three or more people in a system, work with business and healthy people as well as patients, all these expanded the sense of what people were about and what they could accomplish together.

Theoretically, it became clear that people operated on multiple levels simultaneously—individual, interpersonal, family, group, organization, culture. We cannot in fact separate neatly that which is micro-sociology from general sociology, or micro-sociology from family or small group dynamics, or family-group dynamics from interpersonal relationships and intrapsychic dynamics. Each level of function affects the others. J. L. Moreno saw this more clearly, though there’s still room for developing the theory in a more systematic fashion (Blatner, 2000). (Moreno was also a pioneer of role theory, which helped to frame this inter-disciplinary sensibility. I think this approach still has great promise as a user-friendly language for psychology).

As psychoanalysis continued to evolve, analysts such as the neo-Freudians such as Harry Stack Sullivan were a bit more alert to the interpersonal transactions and their implications. In the 1960s, Eric Berne took these ideas beyond the boundaries of psychoanalysis and called his approach “Transactional Analysis.” Berne also wrote of the need for recognition, for what he termed “strokes.” Later research in social psychology has confirmed and extended this idea of the power of interpersonal recognition. So widening the focus from individual to include also the family system and group was one kind of expansion.

Body Work

In addition to the levels of social interaction, there’s another direction for expansion: Include non-verbal communications in relationships and more, the way people work their body into habitual patterns of tension and irritability in order to maintain certain subtle attitudes—belligerence, appeasement, anxiety, defensiveness, etc.

Wilhelm Reich was a relatively early pioneer in psychoanalysis who observed this “body armoring” and wrote about it in a classical book titled Character Analysis. (He was also aware of the socio-economic factors in life and flirted with socialistic ideas.) In some ways he went too far for many of his colleagues and lost credibility—his story is too complex to be summarized here. Alexander Lowen resurrected some of Reich’s ideas and around the 1950s systematized them in his own method called “Bioenergetic Analysis).

Other people in the 1960s also worked on the body and its “blocks,” and later people mixed these ideas with other approaches—bits of psychodrama, massage, “subtle energy healing,” and so forth. For many people, expanding into this frontier fostered a greater degree of body awareness.

A related field involved touch—allowing the therapist to touch the client, or patients or family members be helped to touch each other. Though mocked as “touch-y feel-y” by the mainstream of the population, the point was just that: The social norm had become excessively up-tight about even non-sexual forms of comfort and friendliness. This continues to be a frontier for mind-expansion.

Action in Psychotherapy

Equally uncomfortable for many people is the idea of getting out of the chair and showing how one feels or how an uncomfortable interaction was played out. This form of controlled “acting-in” bypassed the defenses that could be used when talking about a problem. Psychodrama’s use of therapeutic role playing, invented by J. L. Moreno (1889-1974) was a most powerful approach, and when people did enact situations, they sometimes experienced more of a catharsis than they might by just talking about the stress. By having patients get up and act out their problems, their feelings, and their fantasies, psychodrama might also be recognized as overlapping with the aforementioned "body" therapies, the following theme of "touch" in psychotherapy, an expansion of the use of imagery (by playing out dream images, for example), and so forth. There was a good deal of insight to be gained from physically encountering, through pulling, pushing, throwing, hitting, and other exertional behaviors. Many people—therapists and others—found all this threatening, too out of control. Those who learned about it correctly found that the seeming out-of-control-ness was really not out of control at all, but rather just more expressive than many people knew was possible. Other approaches, such as Gestalt therapy (using the "empty chair" technique; or Satir's family therapy (using the technique of "family sculpture") adapted some psychodrama techniques, though few acknowledged the source, because these role playing methods are powerful and effective when done well. Action is another part of the opposite of being “shrunk,”—it’s a kind of expansion.


The late Victorian era had become phobic about sexuality, and phobias tend to generalize: Anything that would even vaguely remind people of sex becomes taboo also. Euphemisms were employed, such as the substitution of “limb” for the more suggestive “leg.” Many people never learned actual descriptive words for parts of the genitalia—it was all “down there.” There was a taboo also about touch, not that those of the lower classes, including nannies and wet-nurses bothered with such nonsense. The discomfort with the idea of touching has continued in Europe and the USA, so that being touched, cuddled, held, massaged, and the like became sources of discomfort instead of comfort. Early psychoanalysis was equally ambivalent about this dimension of human experience, and Sandor Ferenczi was scolded by Freud for his explorations of this domain in the 1930s.

A related development was the widespread influence of the behaviorist psychologist John Watson, who believed that babies could be “spoiled” by being picked up and cuddled and held. It was the anxiety generated by this fashion in child-rearing in the 1920s and 1930s that was addressed by the so-called “permissiveness” of Dr. Benjamin Spock in his popular book of the late 1940s. He wasn’t advocating a lack of moderate discipline in child-rearing, but rather just freeing mothers up to not be afraid to pick up and cuddle their babies when they cried!

Gradually, other pioneers began to explore this wider view of the needs of human nature. A few types of mind-body healing emerged that entailed the therapeutic use of touch and pressure, both from others in the group or the therapist. The point here is that touch is a powerful associated modality of healing and enjoying vibrant good health, and touch needs to be recognized as separate from genital sexuality or seduction. Physicians started to be encouraged to touch their patients, hold hands when it seemed right, and break the phony barrier of clinical distance. So this was another type of expansion rather than “shrinking.”

Biological Factors

The renewed attention to the genetic and physiological contributions to dis-ease can be used either to shrink or expand our view of human experience. On one hand, there is such a thing as too much psychological-ization, so that, for example, conditions now appreciated as biological, such as autism, were for a while attributed to defects in parenting. Many parents went through decades of guilt and imposed therapy—if only they weren’t so subconsciously rejecting their child wouldn’t be sick in this way. It turned out not to be so (Dolnick, 1998).

There’s a kind of expansion in recognizing the power of innate temperament and ability, and that such factors transcend what can be willed. This is also true for the proper use of medications to fight major neuro-physiological dynamics in mental illness. Many patients went through—and still go through—years of trying to control these symptoms themselves—and suffering mightily, as well as making others suffer too—because they’re too proud or ignorant—and sometimes under the influence of a “therapist” who is similarly benighted.

I’m ambivalent about the new trend towards biological psychiatry, because there is a fair amount of shallow thinking, overdiagnosis, over-treatment, and art-less treatment. But there’s also a good deal of under-diagnosis and under-treatment because of old-fashioned attitudes. I do think there is a relatively wise and art-ful optimal response, and it’s an expansion of our view of psychological dis-ease to recognize this.

There’s also an incresaing sensitivity to innate differences in types and sub-types of ability and disability, with the paradigm of reading disability as a relatively early opening of this category. Other types of over-sensitivity or relative insensitivity are being recognized. There’s a kind of consciousness-raising or mind-expansion in knowing how better to assess strengths and weaknesses and to deal wisely with them—for self-development and education.


A major expansion of psychotherapy has been in the direction of recognizing that while some issues really have to do with more significant degrees of disease or disability, many if not most of the insights and methods developed in psychotherapy can be adapted for helping healthy people become even healthier, more resilient, wiser, more mentally flexible. The “human potential movement” involved the adaptation of many types of psychotherapy, plus the power of the “encounter group” or other group contexts, to further this goal of consciousness-raising or mind-expansion. Indeed, harvesting these insights and applying them in education, business, and other parts of the world may be the most important derivative of dynamic psychology in the 21st century.


It might be plausibly argued that our industrial era has failed to adequately investigate and promote the true power of imagination. I think the dynamics of hypnosis have only begun to be tapped.. Imagery, guided fantasy, and other ways of cultivating imagination were proposed by a number of therapeutic innovators. Some cases responded dramatically. These approaches should continue to be explored.

Expressive and Creative Arts

Related to imagery, it became recognized also that working through art, sculpture, poetry, drama, dance, music, sculpture, drumming, creative writing, story-telling, puppetry, mask-making, and other expressive approaches could be used for several purposes: First, these productions could be a source for reflection and analysis, insight and appreciation of the aesthetic complexities of the subconscious mind. The aforementioned Moreno emphasized the power of spontaneity, and improvised expressions through these art media also offered a strengthening of the connection between the ordinary self-controlled sense of self and the source of inspiration, the creative subconscious, the muse, the soul. Developing such connections generates a more multi-dimensionsal sense of self, a kind of “expansion.”

Humanistic Psychology

Around the 1950s and 60s, a number of eminent psychologists such as Abraham Maslow, Carl Rogers, James F. T. Bugental, James Fadiman, and many others generated a loose association of “humanistic psychologists” who emerged as a “third force” to counter the first two forces in American Psychology in the mid-20th century—i.e., the reductionistic and deterministic (“shrink”) forces of behaviorism and psychoanalysis (Goble, 1970). Humanistic psychology sought to explore and utilize those potentials that only mature humans could manifest—not rats or young children—, such as creativity, community-building, more refined arts, the potential of the mental mechanism of sublimation to truly contain and expand the human potential. (A fair number of psychiatrists, clinical social workers, pastoral psychologists and other therapists also were part of this trend.)

Transpersonal Psychology and Spirituality

Emerging from Humanistic Psychology in the late 1960s, a group of psychotherapists sought to bring some emphasis to the realm of spirituality, as the earlier approaches tended to marginalize this major source of conflict and healing. Drawing on Eastern (e.g., Zen, Yoga, etc.) traditions as well as the mystical and contemplative practices of Western religions, this approached recognized the artificiality of psychology and psychotherapy as imagined to be separate from spirituality. Explorations into ways of expanding the mind in this direction have continued to make progress.

The analytical psychology of Carl G. Jung and a number of his followers for many holds value because it partakes of a sensitivity to such spiritual categories as soul or deep psyche—not just as a repository of the repressed, but as a source of comfort and inspiration. There has been increased interest in this general field because (it seems to me) only those psychologies influenced by Jung’s thinking about archetypes have been able to truly illuminate the kinds of experiences associated with psychedelic agents or mysticism. Joseph Campbell’s expansion of Jung’s sensibility in the direction of considering our culture’s myths has extended this approach further.

Though not widely appreciated, the Psychosynthesis system developed Roberto Assagioli, beginning in the late 1920s, offers further insights, extending elements of transpersonal psychology, inner dialogue, and the like.

Feminist Psychotherapy

Another important development associated with the feminist movement of the 1960s through the 1980s has been the recognition of what will be discussed further in the essay on the other website (Beyond Psychotherapy), namely, that in addition to working one-to-one or in groups, some recognition of our problems needs to open out to the idea that the socio-cultural system also merits analysis and change. Sometimes what seem to be our personal problems are really due to ways the social systems is set up so that some folks are stressed far more than others, and far more than they really need to be. A “good diagnosis” of this predicament itself serves to relieve a fair amount of self-blame.

Interestingly, this idea is not entirely new. A number of early psychoanalysts came to a similar conclusion, that the social, religious, cultural, and economic systems of the time added a significant burden on the individual’s psyche. The aforementioned J. L. Moreno as a beginning medical student around 1912 noticed that the prostitutes in Vienna were being exploited not only by their pimps, but also harassed by local governmental bureaucrats. He encouraged their organization into self-help groups. Social action might be recognized as being as much a part of a more holistic view of psychotherapy as any action in one’s personal life.

Beyond Psychotherapy

In the last few decades, even the idea that significant problems can be “solved” or “worked through” on a personal level seems to be a kind of “shrink”-like thinking. We need to recognize the power of the larger culture—carrying forward the insights of the aforementioned feminist psychotherapy. To be an expander may require a willingness to include other issues of oppression. This will be explored more in Beyond Psychotherapy paper on this website.

Thus, the social institution of psychotherapy may be a kind of shrink-like thinking, including many of the following components:
 -  One-to-one or office-based psychotherapy, requiring some participants to be in the sociological “sick role.”
 - Patients or clients expected to pay substantial amounts of money—or to arrange for third parties to pay therapists for consultation
 - The gradient of expertise, the  qualifications of the “therapist” as a professional (versus those not so qualified), including government-supported licensure requirements and sanctions for those practicing without a licence
 - The infrastructure of payments from third party payers—insurance companies, government disability or medicare programs
     ... some day all these elements might be viewed as having some “shrink-like” elements, compared to an even more expanded view of dis-ease and healing!


Psychotherapists have been called “shrinks” for largely invalid reasons—to soften the power gradient felt by patients—, but there is, ironically, a germ of truth to the term. Whereas in the early years, therapists—mainly psychoanalysts—were “expanders” insofar as seeking to raise consciousness about the realities of the inner life, by the 1970s the first generation came to be viewed as overly constrained by their own theories. The theories arising in the last quarter of the 21st century seek to expand the vision of the human predicament and the variety of approaches that might be useful in maximizing the human potential. Many therapists nowadays might better be thought of not as “shrinks” but rather “expanders.”
     (Nevertheless, there are perspectives that might expand the vision of the nature of health and disease even further—to be continued on a related page, Beyond Psychotherapy.)


Blatner, A. (2000). Foundations of psychodrama: history, theory, & practice (4th ed.). New York: Springer.

Dolnick, E. (1998). Madness on the couch: blaming the victim in the heyday of psychoanalysis. New York: Simon & Schuster.

Douglas, Ann. (1995). Terrible honesty: mongrel Manhattan in the 1920s. New York: Farrar, Straus & Giroux.

Goble, F. G. (1970). The Third Force: The Psychology of Abraham Maslow.  New York: Grossman.

Hobson, J. A. & Leonard, J. A. (2001). Out of its mind: psychiatry in crisis—a call for reform. Cambridge, MA: Perseus.

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