Shrinks (2 page)

I invited Elena’s parents back in. “So what’s the verdict?” Mrs. Conway asked glibly, drumming her fingers on the chair. I told them I could not be completely sure until I had performed more tests, but it appeared likely their daughter had schizophrenia, a brain disorder affecting about 1 in 100 people that usually manifests in late adolescence or early adulthood. The bad news was that the illness was severe, recurrent, and incurable. The good news was that with the right treatment and sustained care there was an excellent chance she could recover and lead a relatively normal life, and even return to college. I knew the next part would be tricky: I looked Mr. and Mrs. Conway in the eyes and urged them to hospitalize their daughter immediately.

Mrs. Conway cried out in protest and disbelief. Her husband shook his head defiantly and fumed, “She doesn’t need to be locked up in a
hospital
, for God’s sake. She just needs to buckle down and get her act together!” I persisted, explaining that Elena needed continuous supervision and prompt treatment to safely restore her to sanity and avoid further hazards like the subway incident. Eventually they relented and agreed to admit her to the psychiatric unit of New York Presbyterian Hospital–Columbia University Medical Center.

I personally oversaw Elena’s care. I ordered blood tests as well as EEG, MRI, and neuropsychological assessments to rule out other causes of her condition, then prescribed risperidone, a very effective antipsychotic medication with only a modest potential for side effects. Meanwhile, in socialization groups, therapists helped her with her social skills. Cognitive therapy enhanced her attention and concentration. Guided instruction in the basic tasks of daily living aided her hygiene and appearance. After three weeks of medication and intensive care, cosmic symbols faded from her attention and Elena’s natural personality started to shine through: She was cheerful and intelligent, with a playful sense of humor. She expressed embarrassment over her recent behavior and the strong desire to return to college and her friends in New Haven.

Her dramatic improvement was a testament to the power of modern psychiatry, and I couldn’t wait to see Elena reunited with her parents. The Conways were delighted to get their daughter back, and I even saw Mr. Conway smile for the first time once he took in her transformation.

But when our treatment team met with the Conways to discuss Elena’s discharge plan and the need for continuous outpatient care, they remained unconvinced that Elena’s dramatic improvements were due to the medical treatment she had just received. Sure enough, a few weeks later I heard from the outpatient clinic that Elena had stopped showing up. I contacted the Conways and implored them to continue Elena’s medical care, insisting that without it she was certain to relapse. While they thanked me for my help, they claimed they knew what was best for their daughter and would arrange for her treatment.

The truth is, if this had happened in the 1970s when I was in medical school and treating my very first patients, I might have sympathized with—or even shared—the Conways’ aversion to psychiatrists. Back then, the majority of psychiatric institutions were clouded by ideology and dubious science, mired in a pseudomedical landscape where devotees of Sigmund Freud clung to every position of power. But the Conways were seeking treatment for their daughter in the twenty-first century.

For the first time in its long and notorious history, psychiatry can offer scientific, humane, and
effective
treatments to those suffering from mental illness. I became president of the American Psychiatric Association at a historic turning point in my profession. As I write this, psychiatry is finally taking its rightful place in the medical community after a long sojourn in the scientific wilderness. Buoyed by new research, new technologies, and new insights, psychiatry does not merely have the capacity to raise itself from the shadows but the obligation to stand up and show the world its revivifying light.

According to the National Institute of Mental Health, one in four persons will suffer from mental illness, and you are more likely to need services from psychiatry than from any other medical specialty. Yet far too many people—like the Conways—consciously avoid the very treatments now proven to relieve symptoms. Don’t get me wrong; I would be the first to admit that psychiatry has earned much of its pervasive stigma. There’s good reason that so many people will do everything they can to avoid seeing a psychiatrist. I believe that the only way psychiatrists can demonstrate just how far we have hoisted ourselves from the murk is to first own up to our long history of missteps and share the uncensored story of how we overcame our dubious past.

That’s one reason I wrote this book: to provide an honest chronicle of psychiatry with all its rogues and charlatans, its queasy treatments and ludicrous theories. Until quite recently, authentic scientific triumphs were rare and bona fide psychiatric heroes rarer still. The history of sibling specialties like cardiology, infectious disease, and oncology are mostly narratives of steady progress punctuated by major leaps forward, while psychiatry’s story consists mostly of false starts, extended periods of stagnation, and two steps forward and one step back.

But the full story of psychiatry is not just a dark comedy of fanciful gaffes. It is also a detective tale, propelled by three profound questions that have vexed and beckoned each successive generation of psychiatrists: What is mental illness? Where does it come from? And, most pressing for any discipline devoted to the Hippocratic oath, how can we
treat
mental illness?

From the start of the nineteenth century until the start of the twenty-first, each new wave of psychiatric sleuths unearthed new clues—and mistakenly chased shiny red herrings—ending up with radically different conclusions about the basic nature of mental illness, drawing psychiatry into a ceaseless pendulum swing between two seemingly antithetical perspectives on mental illness: the belief that mental illness lies entirely within the mind, and the belief that it lies entirely within the brain. Regrettably, no other medical specialty has endured such extreme volatility in its fundamental assumptions, and this volatility helped forge psychiatry’s reputation as the black sheep of the medical family, scorned by other physicians and patients alike. But despite its many false leads and dead ends, the detective story of psychiatry has a gratifying finale in which its impenetrable mysteries have begun to be elucidated.

Over the course of this book, you’ll learn about a handful of renegades and visionaries who bravely challenged the prevailing convictions of their time in order to elevate their embattled profession. These heroes declared that psychiatrists were not doomed to be shrinks but destined to be a unique class of physicians.

As a result of their pioneering triumphs, psychiatrists now understand that the successful treatment of mental illness requires us to embrace the mind and brain simultaneously. Psychiatry is like no other medical specialty; it transcends a mere medicine of the body to touch upon fundamental questions about our identity, purpose, and potential. It is grounded upon a wholly unique doctor-patient relationship: The psychiatrist often becomes privy to patients’ private worlds and innermost thoughts—their most secret shames and most cherished dreams. The intimacy of this relationship places grave responsibility for the patient’s welfare on the psychiatrist, a responsibility that psychiatrists have often failed to live up to—but no longer. The modern psychiatrist now possesses the tools to lead any person out of a maze of mental chaos into a place of clarity, care, and recovery. The world needs a compassionate and scientific psychiatry and I’m here to tell you, with little public fanfare, that such a psychiatry has arrived at last.

Let me share with you exactly what it took to get here…

Part I

The Story of Diagnosis

To name it is to tame it.

—J
EREMY
S
HERMAN

Chapter 1

The Stepchild of Medicine: Mesmerists, Alienists, and Analysts

A sick thought can devour the body’s flesh more than fever or consumption.

—G
UY DE
M
AUPASSANT

Everything in nature communicates by a universal fluid. Nerves are the best conductors in the body for this universal magnetism and by touching these parts, you effect a happy turn of mind and bring on a radical cure.

—F
RANZ
M
ESMER
, “D
ISSERTATION ON THE
D
ISCOVERY OF
A
NIMAL
M
AGNETISM
”

Burning in the Air and the Soil

Abigail Abercrombie could no longer deny it: Something strange was happening to her, she just didn’t know what. The year was 1946, and Abbey worked as a court stenographer for the Superior Court in Portland, Maine, a job demanding intense mental focus. Until recently, she had relished the daily challenge. But now, inexplicably, she was always distracted. She frequently misspelled words and sometimes omitted entire phrases in her transcriptions of testimony, all because she was preoccupied by the constant fear of having another “spell.”

The spells had begun two months earlier, following her twenty-sixth birthday. The first one struck while she was shopping at a crowded grocery store. Without warning, all her senses screamed on high alert. She felt as if she couldn’t breathe, and her heart pounded so hard she thought she must be dying. She rushed to the hospital, but after the doctors examined her they just patted her on the hand and told her that she was fine.

But she knew
something
wasn’t right. Over the following month, she was blindsided by two more spells. Each time, for two or three minutes, her emotions seemed to go haywire, her heart raced, and she was filled with frantic terror. She began to wonder…
if the doctors say there is nothing wrong with my body, could something be wrong with my head?

How does anyone really know if a disturbing psychic state is a genuine medical abnormality and not merely one of life’s natural ups and downs? How do we recognize whether we—or someone we care about—is suffering from a pathological state of mind, rather than ordinary fluctuations in mental acuity and of high and low spirits? What
is
mental illness, exactly?

Oncologists can touch rubbery tumors, pulmonologists can peer through a microscope at strings of pneumonia bacteria, and cardiologists have little trouble identifying the yellowish plaques of artery-clotting cholesterol. Psychiatry, on the other hand, has struggled harder than any other medical specialty to provide tangible evidence that the maladies under its charge even exist. As a result, psychiatry has always been susceptible to ideas that are outlandish or downright bizarre; when people are desperate, they are willing to listen to any explanation and source of hope. Abbey didn’t know where to turn—until she saw a story in the newspaper.

The story touted an impressive new treatment for emotional disturbances offered by the Orgone Institute, a mental health facility founded by a celebrated Austrian psychiatrist named Wilhelm Reich. Dr. Reich boasted impressive credentials from top medical institutions. He had been mentored by a Nobel laureate and served as an assistant director at the Vienna Psychoanalytic Polyclinic under the most famous psychiatrist of all, Sigmund Freud. Medical journals wrote favorably about his work, he had published several bestselling books, and even Albert Einstein endorsed his orgonomic treatments for emotional troubles—or so Reich claimed.

Hoping such an eminent physician might be able to finally diagnose what ailed her, Abbey paid a visit to Orgonon—a rural estate in Maine named in honor of Dr. Reich’s research. To her delight, she was seen by Dr. Reich himself. With intense eyes and a high forehead crowned with a horizontal swath of unruly hair, he reminded her of the character Rotwang, the mad scientist in the 1927 film
Metropolis
.