When I was 10 and was interviewed for a place at what was then a direct grant school, I was asked about my future occupation; at direct grant schools in England at that time, they were keen on planning your whole career. I said I wanted to be a psychiatrist. When my surprised interviewers asked me to repeat the word ‘psychiatrist’ and justify my selection, I remember saying ‘psychiatrists are doctors, and doctors are respected by society, but as not much is known about mental illness, I quite like the idea of the subject as no one notices if you make mistakes’.
After reading this rumbustious roller-coaster of a book on the history of (largely American) psychiatry, I realise more than ever that my youthful honesty was justified and that the history of psychiatry might be better recast as a litany of error dotted with moments of serendipity. As narrator, Jeffrey Lieberman alternates between two roles – a frightening guide at a horror museum and a reassuring voiceover in a science documentary – and the reader is jolted from one to another so quickly there is no time to rest or reflect.
In the ‘house of horrors’ we are exposed to Benjamin Rush, the father of American psychiatry (who despite his reassuring presence on the logo of the American Psychiatric Association, had some very strange ideas indeed); Wilhelm Reich, the notorious orgone inventor (who claimed he could cure all mental illness by deconstructing orgone energy in the body); L. Ron Hubbard, the ludicrous inventor of Scientology; Walter Freeman, the ice pick lobotomist; R.D. Laing, who lost interest in his theories only when his daughter developed schizophrenia; and a host of psychoanalysts more interested in defending their turf than advancing knowledge.
In the ‘respectable science faculty showroom’ we meet Philippe Pinel, Ugo Cerletti and Lucino Bini, the inventors of electroconvulsive therapy (who Lieberman believes deserved the Nobel prize for medicine much more than Julius Wagner-Jauregg and Egas Moniz); John Cade, who prefaced the use of lithium in psychiatry; Tim Beck, for discovering cognitive–behavioural therapy; Eric Kandel, the scientific psychoanalyst who found the answers to the unconscious in the memory banks of sea slugs; and Henri Laborit, who started the psychopharmacology revolution in 1950. Pride of place is given to Bob Spitzer, the architect of DSM-III. In the author's view, Spitzer was the man who, virtually single-handedly, made psychiatry a scientific subject, and he duly eulogises him throughout the book.
Lierberman also passes down a short corridor between the horror archive and the science museum to visit the ‘done well but could have done better’ showroom – those innovators who had good ideas but who ultimately harmed psychiatry by over-selling their products. They include Franz Mesmer, the hypnotism man; Nathan Kline who (like William Sargant in the UK) believed if three drugs together could not help the patient, adding a fourth, preferably in superhuman dosage, most certainly would; and Sigmund Freud, who is accused of embracing science at first but then rejecting it in favour of dogma.
Lieberman concludes that psychiatry is now set fair and travelling on the smooth highway towards the science uplands. Unsurprisingly, given that he is a scion of US academia, Lieberman gives rather more attention and credit for this to American researchers than to others in the world – with only Eve Johnstone getting a mention for the UK. There are also 58 pages on DSM, which he very unwisely calls the ‘Bible of Psychiatry’, but only one (critical) mention of the international classification, ICD, which will surprise those who live in DSM-free world zones.
Overall, with a little ghost-writing assistance, Lieberman comes across well. He is not afraid to speak his mind (and exposes quite a bit of it in the process). He writes well on the braking effect of stigma in hindering progress, and gives a particularly refreshing account of insights into DSM controversies. The book is not an untold story – it has been told pretty well by Ned Shorter from a more neutral position in Canada – but it accurately reflects US psychiatry and its stated position in the world order. It is apparently written for a general readership, but I think it would be admirably suited, if not required reading, for the aspiring medical student thinking of psychiatry as a career, as well as for psychiatrists in training. It will help, above all (and more than it may realise), to teach humility.
The impression Lieberman leaves us with is that psychiatry has shaken off its past. The new scientific psychiatry may sound hunky-dory, but re-reading the history of psychiatry, the sceptical observer might wonder if we can be confident that we now have it right. I am quite proud to be one of these sceptics.
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