From Freud To Possession, A Doctor Faces Psychiatry's Demons

Transcript

SCOTT SIMON, HOST:

Psychiatry makes a lot of people nervous, except maybe Woody Allen. People don't talk about psychiatrists the way they talk about neurologists, dentists, vets or proctologists. There are still people who call psychiatry voodoo or pseudoscience. And to be fair, it's got a history of some claims and practices that are now considered weird and destructive. Dr. Jeffrey Lieberman has written, with Ogi Ogas, a new book that looks at the development of what he himself calls the most distrusted, feared and denigrated of all medical specialties. Their book is called "Shrinks: The Untold Story Of Psychiatry." And Jeffrey Lieberman, who's chairman of psychiatry at the Columbia University College of Physicians and Surgeons, chief psychiatrist at the New York Presbyterian Hospital Columbia University Medical Center and former president of the American Psychiatric Association joins us from New York. Doctor, thanks so much for being with us.

DR. JEFFREY LIEBERMAN: My pleasure, Scott.

SIMON: Why do you think so many people are rattled by your vocation?

LIEBERMAN: Well, I think it's been a historical thing. It's not a new thing. 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 who, when they were living, were ill - when it came to mental illnesses, they couldn't find anything. And I think then what happened is that in the desperation of psychiatrists who, by and large, were the custodians of asylums - as an alternative, 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. But the lulled attitudes still persists.

SIMON: Yeah. No name is bigger still, in a way, than Sigmund Freud. What did he get right, and what do we now know was not as helpful?

LIEBERMAN: Well, 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.

SIMON: What did he get wrong?

LIEBERMAN: Well, 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 his theory had to take it on faith.

SIMON: A somewhat lesser-known figure I found fascinating to read about, Dr. Benjamin Rush, the only doctor to sign the Declaration of Independence. I guess he's known as the father of American psychiatry. But I've got to tell you after reading about him, I wonder why a pretty good medical school is named after him.

LIEBERMAN: Again, we have to understand that to view things through the lens of the 21st century, it puts things in a really - a different light. Benjamin Rush was a physician, and what he did was to really take seriously the plight of people who were mentally ill. He wasn't a psychiatrist. He was a physician. The problem is is that the knowledge was so limited at the time, they really weren't able to gain any traction in understanding the underlying basis of severe mental illnesses. And so they came up with these ideas and these treatments that now seem to be either cockamamie or cruel.

SIMON: Yeah. Psychiatry over the years has been back and forth on if mental disorder - for example, bipolar disorder, schizophrenia - is inherited.

LIEBERMAN: Yes. Well, it's long been known that specific mental illnesses tend to run in families. But then 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 relatives. 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.

SIMON: Is the future of psychiatry in the medicine chest?

LIEBERMAN: 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. But psychiatry more than any other really has an imperative to maintain the primacy of the patient relationship, so medications were extraordinarily important; they were miraculous developments, but medications alone can't do it.

SIMON: Yeah. Between fever cures and induced comas and drilling holes in the skull and lobotomies, psychiatry has done some painful things to people in the name of science over the years, hasn't it?

LIEBERMAN: Well, that's the point. That's why it's the untold story. 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, but why that's different now. And nobody should avoid seeking treatment if they think they need it because of uncertainty or fear.

SIMON: Dr. Jeffrey Lieberman has written, with Ogi Ogas, a new book "Shrinks: The Untold Story Of Psychiatry." Thanks so much for being with us.

LIEBERMAN: Thank you, Scott. Transcript provided by NPR, Copyright NPR.