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‘Tea with Freud’: Engaging, authentic, but nonanalytic
If I traveled back in time to meet with a 60-year-old Sigmund Freud, the first thing I would say to him is: “Stop smoking, and get out of Austria!”
That was my thought as I read “Tea with Freud: An Imaginary Conversation about How Psychotherapy Really Works” (Dog Ear Publishing, 2016), in which the author, psychiatrist Steven B. Sandler, MD, holds a series of imaginary meetings with Freud to discuss the evolution of psychoanalysis into Sandler’s preferred mode of short-term dynamic psychotherapy (STDP) and to present case material for Freud’s supervision.
The chapters in “Tea with Freud” alternate between the imagined meetings with Freud and Sandler’s clinical work, presented from what I assume are transcripts of videotaped sessions with some disguises and composites to protect patients’ privacy. These clinical vignettes bring the reader into the nitty-gritty of the treatment room, which may be highly instructive for a lay person – particularly one who has never been in therapy.
At the same time, the book has the potential to be quite misleading. This would not be the case if Sandler were simply trying to introduce the reader to STDP. Instead, he attempts to convince the reader, and apparently himself, that the therapy he practices is a modern rendition of psychoanalysis because it tries to access the patient’s unacceptable, unconscious feelings; encourages her to “remember with emotion” or “experience” her feelings; and leads to some sort of cathartic resolution and improvement in symptoms and outlook.
While, “Aha!” moments and cathartic abreaction were characteristic of very early analyses, modern psychoanalysis is about slow but permanent change in character structure. The unwritten message in the book is that Freud’s true heirs practice psychotherapy as Sandler does. He does not seem to consider the significance of the many psychoanalysts, myself included, practicing psychoanalysis today.
Sandler uses a (mercifully) attenuated Davanloo technique to provoke patients into dramatic enactments. He is highly directive, with statements like, “We don’t solve any particular problem if we jump around all over.” I wonder how he can possibly learn about his patients when he begins with a foregone conclusion about where they should be headed.
His treatments are very brief. During his first session with a patient named Carla, he deduces that she is suffering from unresolved anger related to childhood trauma and manifesting it in chronic anxiety with angry outbursts. He then proceeds to “cure” her in five sessions.
Sandler wonders why some of his patients relapse and decides it is because they have not explored their “positive memories” in treatment, as though memories were univalent.
And he talks way too much.
All of this is decidedly un-analytic, which, again, would not matter if he were only trying to demonstrate STDP in action. Nonanalytic psychotherapies are entitled to be nonanalytic. Sandler has Freud point out precisely these analytic errors, so he must be aware that he is making them. And, yet, he stubbornly maintains his position that his work is analytic. What a waste of time travel it would be to meet with Freud only to reinforce one’s own opinions.
“Tea with Freud” is a way for Sandler to promote STDP and his theories about “positive memories” using an established authority, Freud, to validate them. This makes the book disappointing, but fortunately, there is something more to it. I kept wondering why it was so important to the author to seek out Freud’s – that is, his father’s – approval for his work. The book never answers that question. But in his attempts to understand his motives, Sandler, who is very adept at describing his own thoughts and feelings, becomes a model for the awareness of internal states and the effects of unconscious processes. Perhaps this is the most important lesson in “Tea with Freud.”
Dr. Twersky-Kengmana is a psychiatrist and psychoanalyst in private practice in New York.
If I traveled back in time to meet with a 60-year-old Sigmund Freud, the first thing I would say to him is: “Stop smoking, and get out of Austria!”
That was my thought as I read “Tea with Freud: An Imaginary Conversation about How Psychotherapy Really Works” (Dog Ear Publishing, 2016), in which the author, psychiatrist Steven B. Sandler, MD, holds a series of imaginary meetings with Freud to discuss the evolution of psychoanalysis into Sandler’s preferred mode of short-term dynamic psychotherapy (STDP) and to present case material for Freud’s supervision.
The chapters in “Tea with Freud” alternate between the imagined meetings with Freud and Sandler’s clinical work, presented from what I assume are transcripts of videotaped sessions with some disguises and composites to protect patients’ privacy. These clinical vignettes bring the reader into the nitty-gritty of the treatment room, which may be highly instructive for a lay person – particularly one who has never been in therapy.
At the same time, the book has the potential to be quite misleading. This would not be the case if Sandler were simply trying to introduce the reader to STDP. Instead, he attempts to convince the reader, and apparently himself, that the therapy he practices is a modern rendition of psychoanalysis because it tries to access the patient’s unacceptable, unconscious feelings; encourages her to “remember with emotion” or “experience” her feelings; and leads to some sort of cathartic resolution and improvement in symptoms and outlook.
While, “Aha!” moments and cathartic abreaction were characteristic of very early analyses, modern psychoanalysis is about slow but permanent change in character structure. The unwritten message in the book is that Freud’s true heirs practice psychotherapy as Sandler does. He does not seem to consider the significance of the many psychoanalysts, myself included, practicing psychoanalysis today.
Sandler uses a (mercifully) attenuated Davanloo technique to provoke patients into dramatic enactments. He is highly directive, with statements like, “We don’t solve any particular problem if we jump around all over.” I wonder how he can possibly learn about his patients when he begins with a foregone conclusion about where they should be headed.
His treatments are very brief. During his first session with a patient named Carla, he deduces that she is suffering from unresolved anger related to childhood trauma and manifesting it in chronic anxiety with angry outbursts. He then proceeds to “cure” her in five sessions.
Sandler wonders why some of his patients relapse and decides it is because they have not explored their “positive memories” in treatment, as though memories were univalent.
And he talks way too much.
All of this is decidedly un-analytic, which, again, would not matter if he were only trying to demonstrate STDP in action. Nonanalytic psychotherapies are entitled to be nonanalytic. Sandler has Freud point out precisely these analytic errors, so he must be aware that he is making them. And, yet, he stubbornly maintains his position that his work is analytic. What a waste of time travel it would be to meet with Freud only to reinforce one’s own opinions.
“Tea with Freud” is a way for Sandler to promote STDP and his theories about “positive memories” using an established authority, Freud, to validate them. This makes the book disappointing, but fortunately, there is something more to it. I kept wondering why it was so important to the author to seek out Freud’s – that is, his father’s – approval for his work. The book never answers that question. But in his attempts to understand his motives, Sandler, who is very adept at describing his own thoughts and feelings, becomes a model for the awareness of internal states and the effects of unconscious processes. Perhaps this is the most important lesson in “Tea with Freud.”
Dr. Twersky-Kengmana is a psychiatrist and psychoanalyst in private practice in New York.
If I traveled back in time to meet with a 60-year-old Sigmund Freud, the first thing I would say to him is: “Stop smoking, and get out of Austria!”
That was my thought as I read “Tea with Freud: An Imaginary Conversation about How Psychotherapy Really Works” (Dog Ear Publishing, 2016), in which the author, psychiatrist Steven B. Sandler, MD, holds a series of imaginary meetings with Freud to discuss the evolution of psychoanalysis into Sandler’s preferred mode of short-term dynamic psychotherapy (STDP) and to present case material for Freud’s supervision.
The chapters in “Tea with Freud” alternate between the imagined meetings with Freud and Sandler’s clinical work, presented from what I assume are transcripts of videotaped sessions with some disguises and composites to protect patients’ privacy. These clinical vignettes bring the reader into the nitty-gritty of the treatment room, which may be highly instructive for a lay person – particularly one who has never been in therapy.
At the same time, the book has the potential to be quite misleading. This would not be the case if Sandler were simply trying to introduce the reader to STDP. Instead, he attempts to convince the reader, and apparently himself, that the therapy he practices is a modern rendition of psychoanalysis because it tries to access the patient’s unacceptable, unconscious feelings; encourages her to “remember with emotion” or “experience” her feelings; and leads to some sort of cathartic resolution and improvement in symptoms and outlook.
While, “Aha!” moments and cathartic abreaction were characteristic of very early analyses, modern psychoanalysis is about slow but permanent change in character structure. The unwritten message in the book is that Freud’s true heirs practice psychotherapy as Sandler does. He does not seem to consider the significance of the many psychoanalysts, myself included, practicing psychoanalysis today.
Sandler uses a (mercifully) attenuated Davanloo technique to provoke patients into dramatic enactments. He is highly directive, with statements like, “We don’t solve any particular problem if we jump around all over.” I wonder how he can possibly learn about his patients when he begins with a foregone conclusion about where they should be headed.
His treatments are very brief. During his first session with a patient named Carla, he deduces that she is suffering from unresolved anger related to childhood trauma and manifesting it in chronic anxiety with angry outbursts. He then proceeds to “cure” her in five sessions.
Sandler wonders why some of his patients relapse and decides it is because they have not explored their “positive memories” in treatment, as though memories were univalent.
And he talks way too much.
All of this is decidedly un-analytic, which, again, would not matter if he were only trying to demonstrate STDP in action. Nonanalytic psychotherapies are entitled to be nonanalytic. Sandler has Freud point out precisely these analytic errors, so he must be aware that he is making them. And, yet, he stubbornly maintains his position that his work is analytic. What a waste of time travel it would be to meet with Freud only to reinforce one’s own opinions.
“Tea with Freud” is a way for Sandler to promote STDP and his theories about “positive memories” using an established authority, Freud, to validate them. This makes the book disappointing, but fortunately, there is something more to it. I kept wondering why it was so important to the author to seek out Freud’s – that is, his father’s – approval for his work. The book never answers that question. But in his attempts to understand his motives, Sandler, who is very adept at describing his own thoughts and feelings, becomes a model for the awareness of internal states and the effects of unconscious processes. Perhaps this is the most important lesson in “Tea with Freud.”
Dr. Twersky-Kengmana is a psychiatrist and psychoanalyst in private practice in New York.
‘Committed’ takes a nonpatronizing approach to involuntary care
Psychiatrists are trained to view involuntary treatment as an unpleasant means to a desirable end, a necessary evil. And we make the assumption that patients who are helped by the care they receive involuntarily will ultimately be grateful for that care.
Dinah Miller, MD, and Annette Hanson, MD, were inspired to write “Committed: The Battle Over Involuntary Psychiatric Care,” when they discovered that this assumption is false, that there are no clear data about the long-term effects of involuntary care, and that many patients whose mental illnesses improved as the result of involuntary care were terribly traumatized by their experiences of being forced into treatment. In writing “Committed,” Dr. Miller and Dr. Hanson set out to understand those experiences, and the contexts, both psychiatric and legal, in which they occurred.
There are two main cases that help tell the “Committed” “story,” Eleanor and Lily. Both were hospitalized involuntarily for psychotic episodes; both improved psychiatrically because of hospitalization; and both currently are functioning well. But years later, Eleanor is still resentful and traumatized, and Lily is grateful.
One of the many strengths of “Committed” is in the open-minded, nonpatronizing way it approaches differences in perspective. Numerous patients were interviewed for the book, and their complaints are taken seriously, not simply dismissed as manifestations of psychosis or “borderline traits.” At the same time, Dr. Miller and Dr. Hanson are well aware of distortions and errors in memory, as well as misperceptions about care, and they share their questioning of patients’ stories.
Another strength of “Committed” is that it does not shy away from controversy. It takes an honest look at the gamut of positions with regard to involuntary treatment, from Dr. E. Fuller Torrey’s Treatment Advocacy Center, which takes the view that it is a disservice not to force patients who are unaware that they are ill into treatment, to the Church of Scientology’s Citizens Commission on Human Rights, which doesn’t believe in the existence of mental illness, and therefore views involuntary treatment as unacceptable under any circumstance. The authors genuinely try to understand each group’s rationale, but they are also courageous enough to state their own position: that involuntary care should be avoided if at all possible but is sometimes necessary as a last resort. They also make the invaluable point that simply placing someone in a locked ward, or assigning him to involuntary outpatient care, will accomplish nothing if there are no adequate services to support his long-term care plan, and that those services require funding.
The book’s one drawback for me is the authors’ choice to break up Eleanor’s and Lily’s cases into segments. I found it a little difficult to pick up where the case had been left off several chapters earlier. But the reason for this choice is clearly that it allows the reader to consider an individual topic in the context of that topic’s application to the main cases.
“Committed” is easy to read and well-written, even waxing poetic at times. In describing Lily, Dr. Miller writes, “Her right cheek was punctuated by the best of dimples.” It is written in such a way that it is easily understandable by a lay person but still has a plethora of information that will be new and useful to mental health professionals. In fact, I am flabbergasted by the amount of research that went into writing it.
Committed bravely addresses the complex question of what it means to take away someone’s rights, not because she committed a crime, but because her mind is not working “normally.” It is an excellent book that should be required reading for anyone interested in the concept of autonomy, which is to say, everyone.
Dr. Twersky-Kengmana is a psychiatrist and psychoanalyst in private practice in New York City.
Psychiatrists are trained to view involuntary treatment as an unpleasant means to a desirable end, a necessary evil. And we make the assumption that patients who are helped by the care they receive involuntarily will ultimately be grateful for that care.
Dinah Miller, MD, and Annette Hanson, MD, were inspired to write “Committed: The Battle Over Involuntary Psychiatric Care,” when they discovered that this assumption is false, that there are no clear data about the long-term effects of involuntary care, and that many patients whose mental illnesses improved as the result of involuntary care were terribly traumatized by their experiences of being forced into treatment. In writing “Committed,” Dr. Miller and Dr. Hanson set out to understand those experiences, and the contexts, both psychiatric and legal, in which they occurred.
There are two main cases that help tell the “Committed” “story,” Eleanor and Lily. Both were hospitalized involuntarily for psychotic episodes; both improved psychiatrically because of hospitalization; and both currently are functioning well. But years later, Eleanor is still resentful and traumatized, and Lily is grateful.
One of the many strengths of “Committed” is in the open-minded, nonpatronizing way it approaches differences in perspective. Numerous patients were interviewed for the book, and their complaints are taken seriously, not simply dismissed as manifestations of psychosis or “borderline traits.” At the same time, Dr. Miller and Dr. Hanson are well aware of distortions and errors in memory, as well as misperceptions about care, and they share their questioning of patients’ stories.
Another strength of “Committed” is that it does not shy away from controversy. It takes an honest look at the gamut of positions with regard to involuntary treatment, from Dr. E. Fuller Torrey’s Treatment Advocacy Center, which takes the view that it is a disservice not to force patients who are unaware that they are ill into treatment, to the Church of Scientology’s Citizens Commission on Human Rights, which doesn’t believe in the existence of mental illness, and therefore views involuntary treatment as unacceptable under any circumstance. The authors genuinely try to understand each group’s rationale, but they are also courageous enough to state their own position: that involuntary care should be avoided if at all possible but is sometimes necessary as a last resort. They also make the invaluable point that simply placing someone in a locked ward, or assigning him to involuntary outpatient care, will accomplish nothing if there are no adequate services to support his long-term care plan, and that those services require funding.
The book’s one drawback for me is the authors’ choice to break up Eleanor’s and Lily’s cases into segments. I found it a little difficult to pick up where the case had been left off several chapters earlier. But the reason for this choice is clearly that it allows the reader to consider an individual topic in the context of that topic’s application to the main cases.
“Committed” is easy to read and well-written, even waxing poetic at times. In describing Lily, Dr. Miller writes, “Her right cheek was punctuated by the best of dimples.” It is written in such a way that it is easily understandable by a lay person but still has a plethora of information that will be new and useful to mental health professionals. In fact, I am flabbergasted by the amount of research that went into writing it.
Committed bravely addresses the complex question of what it means to take away someone’s rights, not because she committed a crime, but because her mind is not working “normally.” It is an excellent book that should be required reading for anyone interested in the concept of autonomy, which is to say, everyone.
Dr. Twersky-Kengmana is a psychiatrist and psychoanalyst in private practice in New York City.
Psychiatrists are trained to view involuntary treatment as an unpleasant means to a desirable end, a necessary evil. And we make the assumption that patients who are helped by the care they receive involuntarily will ultimately be grateful for that care.
Dinah Miller, MD, and Annette Hanson, MD, were inspired to write “Committed: The Battle Over Involuntary Psychiatric Care,” when they discovered that this assumption is false, that there are no clear data about the long-term effects of involuntary care, and that many patients whose mental illnesses improved as the result of involuntary care were terribly traumatized by their experiences of being forced into treatment. In writing “Committed,” Dr. Miller and Dr. Hanson set out to understand those experiences, and the contexts, both psychiatric and legal, in which they occurred.
There are two main cases that help tell the “Committed” “story,” Eleanor and Lily. Both were hospitalized involuntarily for psychotic episodes; both improved psychiatrically because of hospitalization; and both currently are functioning well. But years later, Eleanor is still resentful and traumatized, and Lily is grateful.
One of the many strengths of “Committed” is in the open-minded, nonpatronizing way it approaches differences in perspective. Numerous patients were interviewed for the book, and their complaints are taken seriously, not simply dismissed as manifestations of psychosis or “borderline traits.” At the same time, Dr. Miller and Dr. Hanson are well aware of distortions and errors in memory, as well as misperceptions about care, and they share their questioning of patients’ stories.
Another strength of “Committed” is that it does not shy away from controversy. It takes an honest look at the gamut of positions with regard to involuntary treatment, from Dr. E. Fuller Torrey’s Treatment Advocacy Center, which takes the view that it is a disservice not to force patients who are unaware that they are ill into treatment, to the Church of Scientology’s Citizens Commission on Human Rights, which doesn’t believe in the existence of mental illness, and therefore views involuntary treatment as unacceptable under any circumstance. The authors genuinely try to understand each group’s rationale, but they are also courageous enough to state their own position: that involuntary care should be avoided if at all possible but is sometimes necessary as a last resort. They also make the invaluable point that simply placing someone in a locked ward, or assigning him to involuntary outpatient care, will accomplish nothing if there are no adequate services to support his long-term care plan, and that those services require funding.
The book’s one drawback for me is the authors’ choice to break up Eleanor’s and Lily’s cases into segments. I found it a little difficult to pick up where the case had been left off several chapters earlier. But the reason for this choice is clearly that it allows the reader to consider an individual topic in the context of that topic’s application to the main cases.
“Committed” is easy to read and well-written, even waxing poetic at times. In describing Lily, Dr. Miller writes, “Her right cheek was punctuated by the best of dimples.” It is written in such a way that it is easily understandable by a lay person but still has a plethora of information that will be new and useful to mental health professionals. In fact, I am flabbergasted by the amount of research that went into writing it.
Committed bravely addresses the complex question of what it means to take away someone’s rights, not because she committed a crime, but because her mind is not working “normally.” It is an excellent book that should be required reading for anyone interested in the concept of autonomy, which is to say, everyone.
Dr. Twersky-Kengmana is a psychiatrist and psychoanalyst in private practice in New York City.
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.
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.
“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.
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.
“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.
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.
