Book Review: Shrinks: The Untold Story of Psychiatry (and Antipsychiatry) Gets Told

When a non-fiction book by someone in power, like Shrinks: The Untold Story of Psychiatry by former American Psychiatric Association President Jeffrey Lieberman includes a description of dropping acid you know you're in for a fun read.

My [LSD] trip did produce one lasting insight, though--one that I remain grateful for to this day...I marveled at the fact that [if] such an incredibly minute amount of a chemical...could so dramatically alter my cognition, the chemistry of the brain must be susceptible to pharmacologic manipulations in other ways, including ways that could be therapeutic.

This is a short, informative, highly readable history of psychiatry, and the tools psychiatrists have used over time. It is both an homage to science and expose of the pseudoscience used to justify the massive missteps--like defining homosexuality as a mental illness, and using fevers and induced comas to "cure" mental illness.

Lieberman, the ultimate industry insider, thoughtfully describes how, "driven by compassion and desperation, asylum-era physicians devised a succession of audacious treatments that today elicit feelings of revulsion or even outrage at their apparent barbarism" and "the profession to which I have dedicated my life remains the most distrusted, feared, and denigrated of all medical specialties."

While other books have brilliantly told pieces of the story, like Dr. E. Fuller Torrey's Freudian Fraud and American Psychosis, this book brings together the arc of the movement, describing the role and place of insane asylums through the birth of psychopharmacology, brain imaging technologies, neuroscience and genetics. The best parts of the book describe the rise and fall of theories championed by Freud and how they stymied real science and the description of the motivation behind some of organized psychiatry's most barbaric practices.

The section on the development and different approaches taken in developing the multiple iterations of the Diagnostic and Statistical Manual (DSM) that originally defined 106 mental illnesses and today defines almost 300 mental illnesses is well-done and very informative. DSM is a critical tome because as Lieberman points out

DSM dictates the payment of hundreds of billions of dollars to hospitals, physicians, pharmacies and laboratories by Medicare, Medicaid, and private insurance companies. Applications for academic research funding are granted or denied depending on their use of the manual's diagnostic criteria, and it stimulates (or stifles) tens of billions of dollars' worth of pharmaceutical research and development.

Unlike Dr. Allen Frances, who in Saving Normal, claims that parts of the DSM essentially 'diagnoses normality,' Dr. Lieberman largely defends the manual. I tend to agree with Dr. Frances. For example, one of the 300 illnesses in DSM is Post Traumatic Stress Disorder (PTSD). Lieberman reports that after WWI, "shell shock," the forerunner of today's PTSD, was identified by "profuse sweating, muscle tension, tremulousness, cramps, nausea, vomiting, diarrhea, and involuntary defecation and urination" and that "other symptoms of shell shock read like a blizzard of neurological dysfunction: bizarre gaits, paralysis, stammering, deafness, muteness, shaking, seizure-like fits, hallucinations, night terrors and twitching." Contrast that to today. Thanks to the APA's DSM, nightmares, angst, flashbacks and a claim you have it are almost all that's needed. As a result, those with serious forms of PTSD, have to stand in line with all others.

Given the great job the book does on demolishing Freud, it seems to lapse into pure-Freudian theories when describing the cause of PTSD, positing "another reason for the increased incidence of combat trauma [in Vietnam veterans] was the ambiguous motivation behind the war ....Ambiguity in a soldier's motivation for killing an advisory seems to intensify feelings of guilt." Maybe. But that's not science, it's Freud.

The book intentionally limits itself to the role of psychiatry and what psychiatrists do, not the ability of patients to get effective treatment. Today, partially as a result of what the APA did with DSM, little public attention or funds go to helping people with serious mental illnesses. As Rep. Tim Murphy (R. PA) has noted in a bill Lieberman endorses, the mental health industry has instead decided to improve mental health, fight stigma and focus on a host of other practices that have replaced a useless romp on a Freudian's couch as the non evidence based practices de jure. But that's cause for another book.

Shrinks: The Untold Story of Psychiatry does a good job at criticizing both antipsychiatry and psychiatry. That's a worthy first and well worth reading.

DJ Jaffe is executive director of Mental Illness Policy Org. an independent, non-partisan, science based think tank on serious mental illness.