Response to Review of Shrinks: The Untold Story of Psychiatry

To the Editor: The Book Forum section of the May 2015 issue of the Journal contains a review of Shrinks: The Untold Story of Psychiatry by Jeffrey Lieberman, M.D. (1). The review focuses on the author’s personal experiences and his optimistic view of the future of psychiatry. However, it did not address the “untold story” in which the author's inexplicable hostility to psychoanalysis produced an idiosyncratic history of our profession.

For example, the author reports that the psychiatrists of Europe enthusiastically adopted the use of chlorpromazine, while the “shrinks” in the United States derided the drug as “psychiatric aspirin” (p. 179). No references are provided. However, the most commonly used textbook of psychiatry at the time in the United States (1963) stated in a discussion of the treatment of schizophrenia, “Administration of one of the phenothiazines is today the immediate method of choice.” It also contained a 13-page chapter devoted to pharmacological therapy (2). The coauthor, Dr. Lawrence Kolb, was a trained psychoanalyst. The standard reference text at the time (1966) was the multivolume American Handbook of Psychiatry, edited by Silvano Arieti. It devoted a 19-page chapter to drug therapy, neuroleptics, and tranquilizers with 167 bibliographic references (3).

Throughout the book, Sigmund Freud is cast as the leading villainous shrink, primarily responsible for “[p]sychiatry’s long and notorious history” (p. 10). Yet his systematic studies of the psychophysiological properties of cocaine mark him as one of the founders of modern psychopharmacology. The author notes that he diagrammed what may have been the earliest example of a neural network. However, in the late 19th century, he did not have available the knowledge more recently acquired by today’s sophisticated biochemistry, molecular biology, brain imaging, and genetic analysis. There was no giant pharmaceutical industry zealously seeking new pharmaceutical agents for the treatment of mental disorders. In their absence, he had the courage and intellect to create an original theory based on the role of unconscious factors in behavior and some psychiatric disorders. His method was not effective for the treatment of the major psychiatric illnesses. However, he did provide a theory and method to explore the role of unconscious factors in our lives, a profound concept applicable to this day.