Lying On The Couch

by Irvin D. Yalom

Though Ernest was old, at thirty-eight, to be still in supervision, Marshal considered that a strength, not a weakness. During Ernest’s psychiatric residency, completed over ten years ago, he had staunchly resisted learning anything about psychotherapy. Instead, heeding the siren call of biological psychiatry, he had focused on pharmacological treatment of mental illness, and after residency had elected to spend several years in molecular biological laboratory research. Ernest was not alone in this. Most of his peers had taken the same stance. Ten years ago psychiatry appeared to be poised on the brink of major biological breakthroughs in biochemical causes of mental disease, in psychopharmacology, in new imaging methods of studying brain anatomy and function, in psychogenetics and the imminent discovery of the chromosomal location of the specific gene for each of the major mental disorders. But Marshal had not been swayed by these new developments. At sixty-three, he had been a psychiatrist long enough to have lived through several such positivistic swings. He remembered wave after wave of ecstatic optimism (and subsequent disappointment) surrounding the introduction of Thorazine, psychosurgery, Miltown, Reserpine, Pacatal, LSD, Tofranil, lithium, Ecstasy, beta-blockers, Xanax, and Prozac—and was not surprised when some of the molecular biological fervor began to wane, when many extravagant research claims were not substantiated and when scientists began to acknowledge th...