A Shrink Tells the Inside Story of Psychiatry

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Title: Shrinks: The Untold Story of Psychiatry
Author:   Jeffrey A. Lieberman, MD, with Ogi Ogas
Publisher: Little, Brown and Company
Publication date: March 10, 2015
Price: $28.00, hardcover; 352 pages

Jeffrey A. Lieberman, MD, is the Lawrence C. Kolb Professor and Chairman of Psychiatry at the Columbia University College of Physicians and Surgeons. Along with a host of other notable credentials in the world of psychiatry, Dr. Lieberman is the Past President of the American Psychiatric Association. He recently added author to his hefty CV with the publication of his book, Shrinks: The Untold Story of Psychiatry, which he wrote with the help of journalist Ogi Ogas.

The book has been well received. In fact, Pulitzer Prize winner Siddhartha Mukherjee, MD, called it “astonishing.” 

The Era of Lobotomies

One skeleton in the psychiatric closet that Dr. Lieberman reveals is the era of lobotomies, which were pioneered in America by Walter J. Freeman, MD, PhD. Lobotomies first sprang on the psychiatric scene in Europe when Antonio Moniz, MD, a Portuguese neurologist, convinced the medical community that mental illness was a neural condition that could be cured by inflicting permanent damage to the frontal lobe of the brain. Astonishingly, Dr. Moniz won the Noble Prize for his brain mutilation treatment.

Dr. Freeman led the charge in the United States, actually traveling the country doing icepick lobotomies in what he affectionately called the “lobotomobile.” A 30-year-old woman with postpartum depression and an unruly fifth-grade boy were among his thousands of “patients.”

Well-Organized Narrative

Shrinks, with the help of the talented writer Ogi Ogas, is well written and organized in a linear way that gives the narrative a clear trajectory. The book begins with a section called “The Story of Diagnosis,” in which the author rolls out some of the eccentric quacks in psychiatry’s history. He writes with frankness: “Psychiatry has trumpeted more illegitimate treatments than any other field of medicine, in large part because —until quite recently—psychiatrists could never agree on what actually constituted a mental disorder, much less how best to treat it.”

Naturally, “The Story of Diagnosis” is loaded with tales of Sigmund Freud, and the author does a good job filling in many of the blank spaces in Freud’s complicated life and career. Freud’s work held enormous sway on the sociopolitical landscape of Western Europe, and eventually, America. The author writes, “German fascism roused psychoanalysts from its American slumber and invigorated a new Freudian force in North America that would systematically take over every institution of American psychiatry—and soon beget the shrink.”

Dr. Lieberman is at his best when analyzing his predecessors and their impact on people. He writes, “Starting in the late 1950s and early ’60s, the psychoanalysts set out to convince the public that we were all walking wounded, normal neurotics, functioning psychotics … and that Freud’s teachings contained the secrets to eradicating inner strife and reaching our full potential as human beings.”

While oncologists have a battery of cutting-edge tools to help make precise cancer diagnoses, psychiatry does not possess such technology. Dr. Lieberman admits that reading the highly subjective Diagnostic and Statistical Manual of Mental Disorders (DSM) is a mind-numbing exercise. There is such overlap in the multitude of disorders that it becomes a psychiatric stew of mental illnesses and complexes for the various “schools” of psychiatry to sort out. As he notes, a lot of harm was done during its various iterations.

Misguided Views

The most tarnished psychoanalytic diagnosis was undoubtedly homosexuality. In the 1950s, the prevailing thought among psychiatrists was that a controlling mother and weak-kneed father “caused” homosexuality. American psychiatry had long considered homosexuality to represent deviant behavior, and generations of practitioners had labeled it a mental disorder, one that needed fixing. In fact, the first volume of the manual (DSM-I) described homosexuality as a “sociopathic personality disturbance.”

That misguided view carried on well into the 1960s, without any rigorous scientific methodology to back up the claim. As a mea culpa to the malpractice of his profession, Dr. Lieberman offers this, “This unfounded and immensely destructive attribution of unconscious conflicts in homosexual persons illustrates the broad fallibility and potential for misuse of the psychoanalytic approach to diagnosis. In the absence of a rigorous scientific methodology, therapists were prone to projecting their own values and intuitions onto the mental lives of their patients.”

Public Backlash

Given the arbitrary nature of psychiatry and many of the crude methods for “curing” the mentally ill, it’s not surprising that the profession suffered a backlash from the public. In 1961, Hungarian-born psychiatrist Thomas Szasz, MD, published The Myth of Mental Illness, which won him instant fame and ignited the antipsychiatry movement. “Szasz’s ideas helped give birth to an organized activist movement that questioned the very existence of the profession of psychiatry, and called for its eradication,” writes Dr. Lieberman.

He does a thorough job giving the historical context of the public’s growing dissatisfaction at what many felt was a highly subjective profession populated by quacks and opportunists. Psychiatry went through a long and bumpy period before being resurrected by pharmacology.

In one of the book’s best chapters, “Mother’s Little Helper: Medicine at Last,” Dr. Lieberman treats the readers to a lively discussion about the early days of the medication revolution in psychiatry, some of the unfortunate missteps—such as high doses of morphine to treat sleep disorders—and the eventual success stories of medications that truly improved the lives of people with life-altering psychiatric conditions.

But, as he asserts, “Before the psycho-pharmacologists could permanently tip the balance away from the ivory-tower psychoanalysts, one final revolution was still necessary … pioneering the frontiers of the human brain.” With the advent of highly sensitive imaging technology, neuropsychologists could explore the inner workings of the brain. “As a result of these magnificent new technologies, psychiatrists could finally examine the brain of a living person in all its exquisite splendor.”

Remaining Honest

Psychiatric conditions such as manic depression and bipolar disorders have been stigmatized, and Dr. Lieberman ends with a compassionate discussion about these disorders and the crippling effect they have unless treated.

Despite a few areas where the book bogs down, this is a first-rate and enjoyable read. At the end, Dr. Lieberman remains honest about his profession: “I am under no illusion that the specters of psychiatry’s past have vanished, or that my profession has freed itself from suspicion … but psychiatry has arrived at a pivotal moment in its evolution, and it is an opportunity to reflect on the work that lies ahead.” ■