Authors: Jeffrey A. Lieberman and Ogi Ogas
APA Style Citation
Lieberman, J. A. (2015). Shrinks: The untold story of psychiatry. New York, NY: Little, Brown and Company.
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Psychiatry was coined in 1808 by German physician Johann Christian Reil and means “medical treatment of the soul.” Despite its origin over 100 years ago, major discoveries have only recently happened in the last few decades. The author of Shrinks: The Untold Story of Psychiatry is Jeffrey A. Lieberman, MD, the Lawrence C. Kolb Professor and Chairman, Department of Psychiatry, Columbia University College of Physicians and Surgeons; Director, New York State Psychiatric Institute; and Psychiatrist-in-Chief, Columbia University Medical Center of the New York-Presbyterian Hospital. He was a member of the DSM-5 oversight committee and president of the American Psychiatric Association (APA) during the publication of the DSM-5. Dr. Lieberman believes he became the president of the APA at a historical turning point in the profession, when psychiatry finally assumed its rightful place in the medical community. New research, technologies, and insights have allowed the field to come out of the shadows of its dark history. He believes to move forward the field needs to own up to its history of mistakes and how they overcame their problematic past. He shares this controversial history in three main sections: the story of diagnosis, the story of treatment, and psychiatry reborn.
Psychology is not the only field with fake treatments, but it does have more illegitimate treatments than any other one. In order to understand the methods for diagnosis and treatment, Dr. Lieberman takes the reader on a journey through the history of diagnosis. The field of psychiatry has been historically split into two camps. There are the neurologists who work with visible damage to the brain, such as dementia, strokes, tumors, Parkinson’s disease, and Alzheimer’s disease. Then there are psychiatrists who work with mysterious conditions, such as psychoses, manias, phobias, melancholia, obsessions, and hysteria. The field has swung from psychodynamic psychiatry that views mental illness as a result of inner psychic processes to biological psychiatry that supports mental illness as an identifiable physical abnormality in the brain. This dichotomy exits to this day, while most psychiatrists have settled on a pluralistic psychology that accepts both views. Next, the reader is taken on a journey through the early asylums, the movement of alienists, Sigmund Freud’s psychoanalysis, the WWII shift in psychoanalysis from Europe to the U.S., the foundation of American psychiatry, and the formation of the term “shrinks.” In the 1960s, American Psychoanalysts took the U.S. by storm and gained power by influencing universities. With this newfound power they wanted to fix the world and got swept up in America’s social activism. The 1970s was faced with the Rosenhan study, homosexuality controversy, and the antipsychiatry movement. The final part of the story takes the reader through the development of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and its modern day influence.
Psychiatry is often given a black eye for its early start consisting of the harsh treatment of its patients. The unfortunate lack of adequate budgets and overcrowded facilities led to intolerable conditions in the early asylums. Out of desperation physicians tried techniques that sound barbaric by today’s standards. Dr. Lieberman takes the reader on the story of treatment in the field of psychiatry. The American story starts with Dorthea Dix, pyrotherapy (creating an artificial fever), insulin-shock therapy, transorbital lobotomy, convulsive therapy, and electroconvulsive therapy. Next, came the use of psychiatric drugs to pacify disruptive patients. These included morphine, chloral, and sodium bromide. In the 1950s, the first psychopharmaceutical drug was born to relieve anxiety, known as Miltown. But the beginning of the end of asylums didn’t come until the introduction of Thorazine, the first antipsychotic. Soon after came antidepressants, mood stabilizers, and MAOIs. According to Dr. Lieberman, the three flagship illnesses had a solution that took them from “wholly untreatable” to “largely manageable.” The world of psychiatry was changing.
Since the history of diagnosis and treatment, the field of psychiatry has witnessed a rebirth with the study of the brain. Phrenology, the study of bumps on the skull, started in 1809, but it wasn’t until the late 1900s that scientists were able to study the brain inside the skull while their patient was still alive. In the 1980s, brain imaging opened the door in the brain wide open for exploration. The PET scan, which measures the brain’s chemistry and metabolism, was nicknamed the “head-shrinker.” The 1990s became the Decade of the Brain. Eric Kandel was studying memory in the brain and Aaron Beck developed cognitive-behavioral therapy. Thanks to the Human Genome Project and the ROMA technique psychiatrists were able to explore genetics in a way that was never done before. Meanwhile the diagnosis of PTSD was evolving and the DSM was facing revisions in the digital age. In 2006, the DSM-5 Task Force faced a daunting task of updating the DSM while public complaints were expressed on the Internet. Leaders of previous DSMs began to question the process publically. Shrouded in confidentiality agreements and behind closed doors, the revision process put the APA back in the public spotlight. From 2008 to 2013, the media fueled the fire and kept the DSM in the public eye. The APA appointed an oversight committee that recognized a serious problem and then implemented two post hoc review committees to squelch internal conflict. The DSM-5 was confirmed by vote in 2013 and quickly attacked by the National Institute of Mental Health who proposed they would make their own diagnostic system based on neural definitions of psychopathology. This criticism quickly faded after recognizing the size of the task and since then criticism and news involving the DSM has fallen quiet.
The story of psychiatry has taken many turns in recent history, but the future has many more hurdles ahead. Once there were no effective diagnostic criteria or treatments, whereas now the social stigma associated with mental illness prevails as the main hurdle ahead. Hollywood has taken on the issue and has start to put a dent in the problem, but there is a ways to go before society accepts mental illness in the same way as physical illness. The future also offers promising areas of research in genetics and diagnostic testing. Thanks to technology, research, and the use of mobile devices more improvements are on the way. The story of psychiatry is long from coming to a close and it is an exciting time in the field with many advances right around the corner.
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