Jeffrey A. Lieberman - Shrinks: The Untold Story of Psychiatry

The Brain is wider than the Sky,

For put them side by side

The one the other will contain

With easeand Youbeside.

The Brain is deeper than the sea,

For, hold them, Blue to Blue

The one the other will absorb

As Sponges, Buckets do.

The Brain is just the weight of God,

For, Heft them, Pound for Pound

And they will differif they do

As Syllable from Sound.

E MILY D ICKINSON

Anyone who goes to a psychiatrist ought to have his head examined.

S AMUEL G OLDWYN

A few years ago, a well-known celebritylets call him Mr. Conwayreluctantly brought his twenty-two-year-old daughter to see me. Elena had taken a leave of absence from Yale, Mr. Conway explained, because of issues surrounding a mysterious drop in her grades. Mrs. Conway nodded assent and added that Elenas slacking off stemmed from a lack of motivation and low self-confidence.

In response to their daughters perceived troubles, the Conways had hired a parade of motivational experts, life coaches, and tutors. Despite this pricey coterie of handlers, her behavior failed to improve. In fact, one tutor even volunteered (rather hesitantly, given Mr. Conways celebrity) that something is wrong with Elena. The Conways dismissed the tutors concern as an excuse for his own incompetence and continued to look for ways to help their daughter snap out of her funk.

They turned to naturopathic agents and meditation, and when those didnt help, they shelled out more money for hypnosis and acupuncture. In fact, they had done everything possible to avoid seeing a psychiatrist until the incident.

While traveling uptown on the New York subway to meet her mother for lunch, Elena was accosted by a balding middle-aged man in a grimy leather jacket who coaxed her off the subway car. Without informing her mother, Elena abandoned the lunch appointment and accompanied the man to his seedy basement apartment on the Lower East Side. The man was in the kitchen preparing something alcoholic for her to drink when Elena finally answered a call from her frantic mother on her cell phone.

When Mrs. Conway learned where Elena was, she speed-dialed the police, who swooped in and carted her back to her parents. Elena didnt protest her mothers abrupt intervention; in fact, Elena didnt seem fazed by the incident at all.

As the Conways narrated these events in my Manhattan office, it was apparent that they loved their daughter and were genuinely concerned for her welfare. Having two sons of my own, I could easily empathize with their distress over the possible fate that could have befallen their daughter. Despite their concern, they made plain their doubts about the need for my services. After he sat down, the first thing Mr. Conway said was, I gotta tell you, I really dont think she needs a shrink.

The profession to which I have dedicated my life remains the most distrusted, feared, and denigrated of all medical specialties. There is no anti-cardiology movement calling for the elimination of heart doctors. There is no anti-oncology movement protesting cancer treatment. But there is a large and vocal anti-psychiatry movement demanding that psychiatrists be downsized, reined in, or extirpated. As chairman of the psychiatry department at Columbia University, chief psychiatrist at the New York Presbyterian HospitalColumbia University Medical Center, and past president of the American Psychiatric Association, I receive emails each week expressing pointed criticisms like these:

Your bogus diagnoses exist merely to enrich Big Pharma.

You take perfectly normal behaviors and call them illnesses to justify your existence.

There is no such thing as mental disorders, only diverse mentalities.

You quacks dont know what the hell youre doing. But you should know this: Your drugs destroy peoples brains.

Such skeptics dont look to psychiatry to help solve mental health problems they claim psychiatry is the mental health problem. All around the world, people have an abiding suspicion of shrinksthe most common epithet for the self-important charlatans believed to populate my profession.

I ignored the Conways skepticism and began Elenas evaluation by taking her history, soliciting biographical and medical details from her parents. Elena, I learned, was the oldest and brightest of the Conways four children and the one who seemed to hold the greatest potential. Everything in her life had been going great, her parents confided wistfullyuntil her sophomore year at Yale.