A few years ago, a well-known celebrity — let’s call him Mr. Conway — reluctantly brought his twenty-two-year-old daughter to see me. Elena had taken a leave of absence from Yale, Mr. Conway explained, because of issues surrounding a mysterious drop in her grades. Mrs. Conway nodded assent and added that Elena’s slacking off stemmed from “a lack of motivation and low self-confidence.”
In response to their daughter’s perceived troubles, the Conways had hired a parade of motivational experts, life coaches, and tutors. Despite this pricey coterie of handlers, her behavior failed to improve. In fact, one tutor even volunteered (rather hesitantly, given Mr. Conway’s celebrity) that “something is wrong with Elena.” The Conways dismissed the tutor’s concern as an excuse for his own incompetence and continued to look for ways to help their daughter “snap out of her funk.”

They turned to naturopathic agents and meditation, and when those didn’t help, they shelled out more money for hypnosis and acupuncture. In fact, they had done everything possible to avoid seeing a psychiatrist until “the incident.”

So begins Dr. Jeffrey A. Lieberman’s new book, Shrinks: The Untold Story of Psychiatry. Written with Ogi Ogas, the volume has just been published by Little, Brown and Company.

Dr. Jeffrey Lieberman

This week’s Reading is an excerpt from the book, made available by the publisher. Attached is the full Introduction.

In it, Dr. Lieberman describes the illness of his patient, and the profound denial of her well-meaning parents. More importantly, Dr. Lieberman describes a remarkable story of recovery.

For Dr. Lieberman, it represents the best of modern psychiatry. With the work of a treatment team, with medications and psychological interventions, a young woman is able to overcome her first psychotic break. Welcome to the golden era of our field.

But, if psychiatry has never been able to do more, it’s also true that we remain plagued by stigma and other problems. As Dr. Lieberman comments:

The profession to which I have dedicated my life remains the most distrusted, feared, and denigrated of all medical specialties. There is no anti-cardiology movement calling for the elimination of heart doctors. There is no anti-oncology movement protesting cancer treatment. But there is a large and vocal anti-psychiatry movement demanding that psychiatrists be downsized, reined in, or extirpated. As chairman of the psychiatry department at Columbia University, chief psychiatrist at the New York Presbyterian Hospital-Columbia University Medical Center, and past president of the American Psychiatric Association, I receive emails each week expressing pointed criticisms like [this]:

‘Your bogus diagnoses exist merely to enrich Big Pharma.’

Dr. Lieberman’s book is somewhat unusual. It is largely a history, reviewing the transformation of psychiatry, from a “mystical pseudoscience to a respected medical discipline that saves lives.” And, far from whitewashing the past, Dr. Lieberman explores it.

There are plenty of engaging stories. He begins the chapter on diagnosis, for example, by looking at the influential career of Dr. Wilhelm Reich, who saw physical and mental illness as being the result of poorly aligned orgones (a word he seems to have made up, but derived from the word organism). To that end, he had patients sit in an “orgone accumulator” to purge bad orgones; at other times, he hit his patients to better align these orgones. For the record, Dr. Reich wasn’t practicing in the Arctic but America and he worked in the 1930s and 1940s, not the 1630s and 1640s.

Dr. Reich’s Orgone Accumulator

Dr. Lieberman considers the years where psychoanalysis dominated psychiatry, offering that “Sigmund Schlomo Freud stands in a class of his own, simultaneously psychiatry’s greatest hero and its most calamitous rogue.” Ultimately, he argues that the psychoanalytic years were wasted years, an “intellectual desert.” With psychoanalysis behind us, Dr. Lieberman argues that it’s a new day – with the potential for breakthroughs in the near future.

Dr. Sigmund Freud

When a former president of the APA writes a book, especially one with the profile of Dr. Lieberman, people take note. Dr. Lieberman has been interviewed widely about it, including by CBS Morning News. Shrinks has been reviewed widely, too. Maclean’s, The Boston Globe, National Post have all offered opinions on the book; the Toronto Star ran an excerpt. Many of these reviews have been highly favourable. Maclean’s, for instance, describes the book as “fascinating.”

But not every review has been so kind. Writing in The Wall Street Journal, writer Carol Tavris doesn’t mince her words:

It was an odd decision to put a couch on the cover of Shrinks, given that Jeffrey Lieberman’s book devotes many pages to explaining how Freudian psychoanalytic theory infiltrated psychiatry, nearly strangling the field to death. For that matter, it was odd to call the book Shrinks, given that the author’s goal is, in part, to redeem psychiatry from the “most common epithet for the self-important charlatans believed to populate my profession.”

But then, there’s nothing ‘untold’ in this story of psychiatry either.

That strikes me as a bit harsh, but Tavris has a point. Shrinks isn’t a careful consideration of the field, so much as a love poem to it. Like Dr. Doidge’s book on neuroplasticity, there is something compelling, interesting, and fun about the work. But if much ground is covered, as with Dr. Doidge’s book, that ground is tread lightly. It’s important not to whitewash our past, and Dr. Lieberman doesn’t; it’s equally important, though, not to whitewash our present. Sure, psychiatry is far more advanced and thoughtful than even a couple of decades ago. But, as passionate as we are about our field, we shouldn’t overlook big questions. Has the influence of industry grown too strong? Has the pendulum swung too far for patient rights, leaving some of society’s vulnerable, literally, on the street? And, as stigma fades, what can be done about the fact that two in three North Americans don’t receive the mental health care they need? (The book opens with the story of Ms. Conway. Consider: in her misfortune, she is so lucky, able to get treatment and consistent follow up, unlike so many of our patients north and south of the 49th parallel.) Dr. Lieberman, for the record, doesn’t really address these larger issues in his book – a missed opportunity, given his incredible experience as an accomplished researcher and a past APA president. But he does consider the history of psychiatry, and does so in a way that is both entertaining and moving.

You can find the book at Caversham Booksellers.


And if you want to hear Dr. Lieberman, he will be in town in early April. An event is being organized by RamsayTalks. The details:

Thursday, April 2, 2015

12:00pm – 2:00pm

The Four Seasons Hotel, Vinci Ballroom

60 Yorkville Avenue, Toronto

More information and tickets available at: http://ramsaytalks.com/events/?regevent_action=register&event_id=56

I’ve arranged with the organizer that there be a discounted rate for readers of the Reading of the Week. Quote the code HBG for 15% off the ticket price.

With regard to the excerpt, please note: Copyright © 2015 by Jeffrey A. Lieberman, MD. Reprinted with permission of Little, Brown and Company/Hachette Book Group. All rights reserved.

Reading of the Week. Every week I pick a reading — often an article or a paper — from the world of Psychiatry.