From Freud To Possession, A Doctor Faces Psychiatry's Demons
People don't talk about psychiatrists the way they talk about neurologists, dentists or vets. In fact, there are those who call psychiatry voodoo or pseudoscience; and, to be fair, the specialty does have a history of claims and practices that are now considered weird and destructive.
In Shrinks: The Untold Story of Psychiatry, Dr. Jeffrey Lieberman looks at the development of what he himself calls the most distrusted, feared and denigrated of all medical specialties. Lieberman is chairman of psychiatry at the Columbia University College of Physicians and Surgeons, chief psychiatrist at the NewYork-Presbyterian Hospital Columbia University Medical Center and former president of the American Psychiatric Association. He tells NPR's Scott Simon about why it took so long for psychiatry to establish itself as a science.
On why so many people are put off by psychiatry
Mental illness has always been a mystery and in ancient times it was considered to be some kind of supernatural phenomenon — demon possession. In the modern era, meaning the beginning of the 19th century, there was an effort to consider mental disorders as illnesses; but then when researchers attempted to see what the pathology of the illness was in individuals ... they couldn't find anything.
And I think then what happened is that ... as an alternative [to asylums], people sought treatments. But the treatments turned out to be, in retrospect, pretty barbaric. And it's only really been in the last 50 years that psychiatry has established a scientific foundation for itself and developed treatments that truly work beyond a shadow of a doubt and are safe.
On Sigmund Freud's contributions to psychiatry and what he got wrong
Freud is undisputedly a towering figure and the most famous person in the history of psychiatry. And in the absence of any scientific theory of mental illness, he introduced concepts that were completely novel to civilization and endure today as valid and have really been given new life in the context of cognitive neuroscience. ...
I think his biggest mistake was that he was a very strict controller of how the theory was handled by his disciples. In other words, he permitted no deviation or modification of his theory or methods, and he didn't encourage any research to empirically validate his theory. So basically people that followed him and embraced this theory had to take it on faith.
On psychiatrists going back and forth as to whether mental disorders are inherited
It's long been known that specific mental illnesses tend to run in families. But then, you know, the notion of this being kind of a Mendelian type of genetic condition was really not accurate. And if you looked at a family pedigree, you could see that schizophrenia or bipolar disorder, depression, autism often skipped generations in families or would occur in families that had no other biologic relative. So the mystery of the genetics of mental illness was really much more complicated than ever imagined and it's only recently started to be solved.
On whether the future of psychiatry is in the medicine chest
Not solely, no. And this is something that is commonly, I think, misunderstood. The cornerstone of the healing profession and the physician is the patient relationship. ... So medications were extraordinarily important — they were miraculous developments — but medications alone can't do it.
On why he wrote the book
In order for us to genuinely make a case for why psychiatry is a medical discipline that deserves sort of equal footing and respect as other medical specialties, we needed to fess up in terms of what the past was. And so in order to do so, we needed to tell the unvarnished history of the field and then describe why things may not have been helpful — and [in] some cases harmful — then [and] why that's different now. And nobody should avoid seeking treatment if they think they need it because of uncertainty or fear.
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