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Book Review: ‘Shrinks’ tells a one-sided view of psychiatry


 

“Shrinks: The Untold Story of Psychiatry,” by Dr. Jeffrey A. Lieberman with scientist Ogi Ogas, Ph.D.,is an engaging read. Written for the lay reader, with the expressed intention of destigmatizing mental illness by relating the history of psychiatry, it seems like the perfect book for a psychiatrist to recommend to his or her patients who are interested in learning about the field. But it is not. “Shrinks” tells a highly selective, oversimplified, and misleading story, with psychoanalysis as the villain that nearly destroyed the field, and Dr. Lieberman’s utopian version of modern-day psychiatry as the hero.

Dr. Lieberman rails against psychoanalysis for discrediting psychiatry as being “unscientific,” with no evidence base, yet he references no literature that supports his contention, and ignores the last 50 or so years of research in the field. If he has awareness of studies by Leichsenring, Huber, and Shedler, for example, which demonstrate the superiority of psychoanalysis’s and psychoanalytic psychotherapy’s long-term effect sizes over those of cognitive-behavioral therapy and medication, he never indicates so.

Dr. Rebecca Twersky-Kengmana

Dr. Rebecca Twersky-Kengmana

Instead, Dr. Lieberman’s “evidence” against psychoanalysis consists mainly of sneering, with comments such as, “Freud’s theories were ... full of missteps, oversights, and outright howlers. We shake our heads now at his conviction that young boys want to marry their mothers and kill their fathers...” and, “Gradually, physicians came to recognize that focusing on unobservable processes shrouded within a nebulous ‘Mind’ did not produce lasting change ... “.

Psychoanalysts and psychoanalysis are compared with or described as: “omen-divining wizards,” “the primeval sorcery of the jungle witch doctor,” “the psychoanalytic theocracy,” “the circus Big Top,” “a mangled map of mental illness,” “the psychoanalytic hegemony,” “the Oracle of Delphi.”

His tone is so caustic that the book seems like one huge, personal vendetta against psychoanalysis, making his pronouncement at a recent talk at the William Alanson White Institute that, “My analysis failed!” not at all surprising. Certainly, Dr. Lieberman is entitled to his opinion about psychoanalysis, but he presents this opinion as indisputable fact, deterring readers who might benefit from seeking analytically based treatment.

Where the book becomes truly dangerous to the lay reader, though, is in its descriptions of an idealized current-day psychiatry. Dr. Lieberman all but deifies the DSM, stating, “... the book precisely defines every known mental illness),” and referring to it as the “Bible of psychiatry.” Nowhere does he consider its limitations.

Similarly, he describes, “The mind-boggling effectiveness of psychiatric drugs. ... ” with almost no qualifications. He omits any discussion about ghostwritten articles, conflicts of interest, lack of data transparency, manipulated statistics, debilitating and life-threatening side effects, and plain old lack of efficacy. In the world of “Shrinks,” there is no tardive dyskinesia, no metabolic syndrome, no selective serotonin-reuptake inhibitor-induced suicidality, no Thorazine shuffle. The message: If you just take your meds like you’re told, you’ll be fine.

Dr. Lieberman repeatedly conflates describing with understanding. He suggests that knowing there’s an amygdala-hippocampus-prefrontal cortex loop in posttraumatic stress disorder explains why people get PTSD, and that knowing SSRIs inhibit serotonin reuptake explains why they alleviate symptoms of depression.

He is particularly enthusiastic about brain imaging and genetic studies. He makes definitive statements such as, “ We will have scientifically proven methods of diagnosis using brain-imaging procedures,” and, “New drugs are being developed that are more precisely targeted in terms of where and how they act within the brain” .

Although he never outright states this, he leaves the reader with the impression that our ability to image the brain and sequence genes already has led to a full understanding of all mental illnesses, with just a small step left until these illnesses are cured.

“Shrinks” is an insult to readers’ intelligence. Rather than describing the field of psychiatry honestly, and debating the relative merits and limitations of various treatments, the book presents biased opinion as fact, omits important information, and distorts the truth. “Shrinks: The Untold Story of Psychiatry,” is aptly named.

Dr. Twersky-Kengmana is a psychiatrist and psychoanalyst in private practice in New York City.

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