Lieberman's book is a welcome addition to the history of psychiatry. The book's sub-title (which are often chosen by the publisher rather than the author) says Lieberman is telling the untold story which is not entirely right. Much of the story he gives has been set out before, often in the sources that Lieberman sites at the end of the book. The first hundred or so pages are a fairly standard setting out of the roots of psychiatry and the debates that raged over theories of the mind and how to cure mental illness. However, Shrinks is distinctive as a part history, part memoir of the last 40 years of psychiatry, with a particular focus on the controversial status of psychiatry and it classification of mental disorders. Shrinks is a passionate spokesperson for modern psychiatry, and advocates for it, telling a story of great progress, overcoming a problematic past.
The cheerleading for psychiatry in Shrinks is not particularly convincing; Lieberman tells the story as if the debates over the scientific status of psychiatry are now all settled and the safeguards for patients are now all in place. Part III of the book is titled "Psychiatry Reborn" and the final two chapters are "The Triumph of Pluralism The DSM-5" and "The End of Stigma: The Future of Psychiatry." He says little about the financial power of the pharmaceutical companies in shaping the direction of research and the reporting of scientific results, and the debates that have raged within psychiatry. He focuses much more on the external critics of psychiatry, and he tends to dismiss them as personally flawed or secretly agreeing with the progress of psychiatry but unable to admit to it because of their reputations. He pays much less attention to the long standing debates and divisions within psychiatry that still plague it. The book doesn't provide a careful and thoughtful reply to the critics of psychiatry; rather, it provides the standard line that psychiatrists have been giving for decades: it is scientific and now has promising solutions for problems. But given the current state of debate over the credibility of the scientific reports and its deeply problematic history, these claims are best seen as expressions of sincere hope rather than reports of established fact.
The rewarding part of Shrinks is the history of the rise of the influence of medication on psychiatric practice and some of the background story behind the creation of the DSMs. The way Lieberman tells the story, the DSM-III and its successors is the most important document in the history of psychiatry in its effect of transforming the practice into a reliable and helpful practice. This part of the story starts with the arrival of Robert Spitzer, who became the editor of DSM-III. The first major issue was the status of homosexuality as a mental illness. In the late 1960s and early 1970s, gay activists were protesting both the criminalization of homosexual behavior and the pathologizing of homosexual identity. In 1973, Spitzer was a main player in the elimination of homosexuality from the DSM, and although the story has been told before, it is interesting to get Lieberman's take on it, since he personally knows most of the psychiatrists involved and so he has an insider's view. He includes quotations from some of the main participants.
The history gets particularly interesting as Lieberman tells how Spitzer started to put together the new version of DSM. He spells out the role of the Feighner Criteria for psychiatric diagnosis, and the Washington University Department of Psychiatry which rejected the hegemony of psychoanalysis, along with Spitzer's work with the DSM-III Taskforce as they worked to make a major change to their profession. The politics and anthropology of the move from the psychoanalytic approach to a more theory-neutral or biological approach was driven by the need to make psychiatry credible again after it had experienced so many insults to its scientific status from many sources.
While Lieberman says little about the history of DSM-IV, he goes into the recent and controversial development of DSM-5, which has been told elsewhere but more by opponents of DSM-5 than its supporters, so we get a slightly different perspective. We still get more of a sense of how much of a crisis there was in the American Psychiatry Association (APA) as the DSM-5 went over budget and there was intense media scrutiny as the draft form of the DSM-5 was subject to severe criticisms. Lieberman became president of the APA in 2012 and the DSM had to be published in his time in the position, and he had been close to many of the main players before that. He tells some of the turbulent story of what went on, making clear what major problems there had been in the leadership of the DSM process, but he does not say much about how it got resolved. The details will have to wait for another longer history of the process.
So Shrinks is a worthwhile resource for those looking into the recent history of psychiatry. Many will wish Lieberman's enthusiasm for the latest trends in psychiatry and his claims for psychiatry finally being on the right track were a bit more measured, but the historical accounts he provides are indeed informative.
© 2015 Christian Perring
Christian Perring, Professor of Philosophy, Dowling College, New York
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