Sagar Jethani's Reviews > A History of Psychiatry: From the Era of the Asylum to the Age of Prozac

A History of Psychiatry by Edward Shorter
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Feb 09, 11

bookshelves: history
Read from January 24 to February 08, 2011

Shorter does a remarkable job compressing over 200 years of medical history into a single, readable volume. Rather than attempting to provide the reader with an exhaustive chronology of psychiatry, Shorter tells a story which weaves seamlessly between intellectual movements, popular culture, and advances in drug therapy. The principle which guides this narrative-- and, indeed, psychiatry overall-- is the humanitarian impulse to help those who suffer from psychiatric illness.

What I found most surprising was the degree to which Freudian psychoanalysis has become thoroughly discredited:
"All sciences have to pass through an ordeal by quackery," observed Hans Eysenck in 1985. "Chemistry had to slough off the fetters of alchemy, the brain sciences had to disengage themselves from the tenets of phrenology... Psychology and psychiatry, too will have to abandon the pseudo-science of psychoanalysis..."


Far from taking psychological care down an aimless garden path, Freudian analysis is shown to have done real harm to those who suffer from psychological maladies by denying them other forms of care beyond the analyst's couch-- forms of care, including drug therapy, which could have led to real improvement in patient's lives.

Shorter's account begins with the early days of organized asylums, institutions which, despite today's negative associations with the word, were staffed by people who sought to bring relief to hundreds of people who would have otherwise languished being tied to wooden posts or locked in a room for years. The great failings of the asylum system resulted not from its intentions, but from an overwhelming crush of intake. The exponential increase in asylum patients led to substandard care and occasional depictions of gross negligence-- and these latter images are those most strongly associated today with the era, despite their relative infrequency.

After the second world war, psychoanalysts in America insisted that mental problems were solvable by means of obtaining a deeper understanding of the primal drives which govern human action. It rejected other forms of treatment as being purely palliative, and suggested that real cure required one to identify and make peace with his or her unresolved psychosexual impulses. (This, despite significant evidence that patients undergoing psychotherapy actually experienced longer recovery periods than patients with similar conditions who received alternate forms of treatment.)

Finally, advances in psychopharmacology in the last three decades of the twentieth century succeeded in dethroning Freud from the pinnacle of psychological care and allowed psychiatry to plant itself on firmer, scientific ground. New insights into the genetic origins of many forms of mental illness dispelled the Freudian notion that personal insight would lead to recovery. The identification of specific drug treatments allowed many to live happy, public lives who would have earlier suffered lonliness and marginalization in the era of asylums.

'A History of Psychiatry' is an excellent study of the major movements within psychiatric care over the past three centuries. Shorter has contributed a highly-readable story of a subject which, in less capable hands, would have been an unwieldy account.
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01/24/2011 page 6
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01/26/2011 page 37
8.0% "Up to The Age of Asylums-- great name for a band, innit?"
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