Brain man: Jeffrey A. Lieberman on the evolution of psychiatry
TheStar.com – News/Insight – In his new book, Shrinks: The Untold Story of Psychiatry, author Jeffrey A. Lieberman explores the history of “the most distrusted, feared and denigrated of all medical specialties.”
Mar 20 2015. By: Jennifer Hunter
Jeffrey Lieberman was a child of the ’60s. As a college student in 1968, he dropped acid and “when he came down,” he began to think about its effect on his cognition and the chemistry of his brain. When he was in medical school, he decided to specialize in psychiatry. His book, Shrinks, is about the history of that specialty. Our conversation has been edited for length.
Shrinks is a word we all understand as slang for psychiatrist, but we don’t know the origin of the word.
The term is not the most eloquent. It’s like calling dermatologists pimple poppers or orthopedists bone crunchers. But it is the term people use most often to describe psychiatrists.
In the late 1940s, in Hollywood, it originated with a studio executive trying to control the oversized ego of a temperamental actress. Studios were making adventure movies at the time and the witch doctors they depicted would shrink the heads of their enemies.
The next reference is from Hopalong Cassidy, a cowboy film star, who made reference to the term when he was being profiled in Lifemagazine. He said, “If anyone ever thought when I was growing up that I would become a movie star and a household name, they would need to see a shrink.”
H.L. Mencken also included it in a response to a letter to the editor of the Baltimore Sun.
The idea is that your head is being shrunk.
The reason I think it stuck is because it has so many useful connotations. First, you know the expression “to name it is to tame it.” A psychiatrist is a mysterious and somewhat scary notion. Giving it this name in the vernacular helps to demystify it.
Also, it is a kind of derogatory reference and it reflects the disdain society has for it.
You note in your book that your profession remains “the most distrusted, feared and denigrated of all medical specialties.” So why did you want to become a psychiatrist?
I was fascinated by it. I was always an intellectually curious person. In college I studied Freud and that became like a window opening. Freud was a brilliant theoretician and writer.
It was also the age of the counterculture and mind expansion. Having an experience with a hallucinogenic substance, you understood how drugs could change your material state.
That got me interested in how the mind works.
This is a personal question. The mother is often blamed for her children’s neuroses or psychoses. Is the stain on poor Mom ever going to be eliminated?
Blaming the mother was one of the dark spots in psychiatry’s history. It grew out of the psychoanalytic tradition. At a fundamental level it may be rooted in the same kind of biases, the prejudicial attitudes we are now dealing with in sexism and in preventing full equality for women.
Attributing responsibility for psychopathology to the mother was unfortunate, inaccurate and very damaging.
Freud isn’t taken seriously today, but his theories about the mind were brilliant. He really was the father of psychiatry.
Freud was not a villain. He was the most famous and heroic figure and calamitous rogue. He was a towering genius who had brilliant insights, every bit as extraordinary as Einstein’s theories.
He made two mistakes, though. The first was by dint of his personality: he was overly controlling. He permitted no deviation of his theory and no modification of the method he was applying to his cures. He permitted no empirical verification of his theories.
There was no research done on the brain to see if his theories were valid. His theory in the end was about how the mind was structured, the unconscious, the conscious, defence mechanisms. But it didn’t really have relevance for mental illness. It often prevented people from getting treatments that would work.
For years it was believed you could “cure” homosexuality and this led to terrible consequences. Even today, in Russia, to be gay is to be threatened.
The idea that homosexuality was a sexual deviation and could be treated was an unfortunate period in the history of psychiatry. Psychiatry was being used as an instrument of society to explain its moral attitudes. In Russia it is being used to explain its political attitudes. Homosexuality has become a political issue there.
You include autism as one of the neurological ailments we are trying to treat today. Why has there been such a rise in autism? I never heard of it when I was a child.
This is a classic example of what I call hiding in plain sight. It isn’t a new condition; it is not like AIDS or Ebola, (which) have recently emerged. It’s been around for millennia but it wasn’t recognized until 1943 when it was described in the medical literature by a pediatric psychiatrist.
It took until the 1990s, when prominent people began to agitate for help because their children or grandchildren didn’t seem right. They mobilized advocacy movements. So 95 per cent of what is being seen as an increase in autism is seeing it where we didn’t before. We didn’t choose to see it. These kids were considered weird, funny, mentally retarded, mute.
There seem to be fewer psychiatrists today; most people see social workers or psychologists when they have problems. Many psychiatrists merely write prescriptions for antidepressants or sleeping pills, but you don’t lie on the couch and tell them your dreams. Is psychiatry dying?
Psychiatry is not dying but economics is having an impact on it.
In the book I try to make the point, empathetically, that psychiatry should not become a specialty that focuses just on the biological aspect of a patient’s illness. It needs to be pluralistic and include genetics and other sciences that impact the brain.
Psychiatrists take your history and learn about the overall state of your life. But it is changing. There is progress in developing laboratory-type tests.
But other professions do that, too.
How do you distinguish between psychiatrists, psychologists, therapists, spiritual counsellors? Psychiatrists are physicians trained in the illness of the brain. Psychologists are social scientists who treat the problems of living. They treat what we call the worried well.
The number of psychiatrists hasn’t gone down. I think there is more demand. There is still a stigma but it is not as quite as oppressive. People are becoming aware there may be better care for what they seek. Psychiatrists are the most expensive of health professionals and governments try to use their time in a more economical way.
Psychiatrists have to see more patients for a limited period of time. For talk therapy or cognitive rehabilitation or marital therapy, patients will be encouraged to use a less expensive social worker or psychologist or trained lay therapist do that work. The supply of psychiatrists has gone up but health budgets don’t want to pay more.
I say, OK, you pay a little more in the short run by expanding the benefits, but in the long run you save. The secret to health-care reform and cost is better mental health care.
< http://www.thestar.com/news/insight/2015/03/20/brain-man-jeffrey-a-lieberman-on-the-evolution-of-psychiatry.html >
Tags: disabilities, Health, ideology, mental Health
This entry was posted on Saturday, March 21st, 2015 at 10:17 am and is filed under Health History. You can follow any responses to this entry through the RSS 2.0 feed. You can skip to the end and leave a response. Pinging is currently not allowed.
Leave a Reply
Recent Comments