Joseph Hersey Pratt’s Cost-Effective Class Method and Its Contemporary Application: Some Problems in Biopsychosocial Innovation

Abstract

Problems reflecting the stress of illness and the illness of stress account for 20-50% of medical visits and an unquantified but substantial portion of the billions of dollars spent annually on tests and procedures (Stoeckle et al. 1964). The "high-tech" form of practice, favored so powerfully by American medicine and supported so lavishly by financial incentives, produces limited benefits in this domain of suffering and medical care. In an era of increasing panic about the runaway cost of health care, medicine desperately needs cost-effective forms of "low-tech" treatment for patients with psychosomatic conditions and the emotional dimensions of chronic and recurrent illness. Between 1905 and 1955 Joseph Hersey Pratt (1872-1956), an eminent Boston internist and professor of medicine, developed what appears to have been a highly efficient, class-based method for treating such patients in an empathic and biotechnically sound manner. Pratt pioneered his technique in the Emmanuel Church Tuberculosis Class between 1905 and 1923, the work for which he is best known. Seven years later he adapted the method for treatment of patients with chronic psychosomatic conditions, and from 1930 to 1955 he again appears to have achieved considerable success in a highly efficient manner in what was called the Thought Control Class at the Boston Dispensary. Although the treatment of tuberculosis has of course been totally transformed by antibiotics, psychosomatic conditions and the emotional dimensions of chronic illnesses like tuberculosis form an ever larger component of the suffering seen in general medical practices. For this reason, a historical study of Pratt's techniques, theories, and the fate of his innovations may provide practical guidance for contemporary health care practice.