Shrinks summary

Yes, Benjamin Rush was a humane psychiatrist – but this doesn’t mean that all his theories and therapies worked out for the best. Rush, for instance, believed that psychiatric illnesses were the result of disrupted blood circulation, and treated them accordingly.

Seeking to improve disrupted blood flow in the brains of schizophrenic patients, Rush strapped them into a “rotational chair,” a frightening contraption resembling a merry-go-round, and spun them around until they became quite dizzy. Unsurprisingly, it didn’t help.

In the nineteenth century, medical research improved by leaps and bounds – think germ theory and anesthesia. Psychiatry, on the other hand, was far removed from the rest of medicine, and didn’t progress as quickly.

But at the dawn of the twentieth century, a brilliant Viennese came up with a theory that revolutionized the field forever. Sigmund Freud’s approach to psychiatry placed the subconscious mind at its center. Freud, born in 1856, was a student of Jean Charcot, one of the best neurologists of his time, and, like his teacher, Freud was determined to understand the inner workings of the mind.

Now we know how Freud explained the workings of the human mind. So how did he account for mental illness? Well, Freud maintained that strong conflicts exist between the three components of our mind.

The id and the superego naturally have opposing goals. The id is naturally greedy, and wants to do what feels good. Often in opposition to the id, the superego wants to do what’s morally right. If we’re religious, our superego damns the greed of our id. In this way, one part of our personality effectively condemns another.

Freud’s theories enticed many European intellectuals. In 1908, upon founding the Psychoanalytical Society, Freud started attracting droves of talented followers, including Alfred Adler and Carl Jung. By 1910, psychoanalysis was highly popular throughout continental Europe.

In North America, however, things were moving a little more slowly. From 1909 onward, psychoanalysis gradually began to take root in the United States. Also in that year, Freud traveled to America to give a series of public lectures and receive an honorary doctorate. He made quite the impression, and won the support of influential Harvard professor James Putnam.

Psychiatry had been in need of a good, coherent theory of psychiatric illness and Sigmund Freud provided it, accompanied by a new kind of therapy. Freud’s teachings spread throughout the world. But not all was well. Indeed, psychoanalysis had problems of its own.

Psychoanalysis is dogmatic and more faith-based than scientific. Apparently, Freud didn’t regard his assumptions as hypotheses that required testing; analogous to papal edicts, they were not to be questioned! Scientific rigor was accordingly discouraged in psychoanalysis, and Freud even denounced several of his favorite pupils, including Otto Rank and Alfred Adler, for advocating opposing views.

In the first decades of the twentieth century, individuals with severe mental disorders had very little chance of recovery and many were permanently institutionalized. Hoping to find solutions, some physicians began to take desperate measures.

One Austrian physician, Julius Wagner-Jauregg, experimented with a highly speculative treatment – curing psychosis with fever. To induce a fever, he infected psychotic patients with germs, such as tuberculosis bacteria. This risky treatment was, of course, unsuccessful.

If a person suffers from epilepsy, her neurologist will try everything to prevent her from having seizures. Sometimes, however, the same neurologist, with that person’s best interests in mind, will intentionally induce seizures in a mentally ill patient. It sounds unbelievable. But it isn’t done without good reason.

In 1927, Walter Sakel, another Austrian psychiatrist, used insulin shocks to relieve a patient’s symptoms. This soon became a standard treatment. It’s logical, to an extent: our brains depend heavily on glucose. If blood glucose levels are critically low, we’ll fall into a coma or suffer from seizures. Massive doses of insulin can reduce our blood glucose to such a level.

Back in the nineteenth century, patients that acted up would sometimes receive a calming morphine injection. In the twentieth century, psychiatrists had far more medications at their disposal to make patients sleepy and placid. Yet none of them allowed patients to return to a normal life in society.

At least, not until 1950, when the first modern tranquilizer entered the market. Have you ever heard of the drug meprobamate or “Miltown”? It alleviates anxiety without causing drowsiness, and while uncommon today, it was the first psychotropic blockbuster. In 1956, as many as one in three prescriptions in the United States was for meprobamate.

Perhaps you’re familiar with the ‘70s film One Flew Over the Cuckoo’s Nest? The lively and unruly protagonist, McMurphy, is committed to a mental ward that’s tyrannized by a sadistic head nurse. In the film, drugs and electroshock treatment are employed to coerce, rather than heal, patients.

This film is based on the 1962 novel by Ken Kesey and it encapsulates the public’s fears and misgivings about psychiatry. Back then, even mental health professionals were critical of their own profession.

The anti-psychiatry movement condemned psychiatrists, declaring them unable to distinguish the insane from the sane, citing Rosenhan’s study as evidence. Psychiatry’s credibility was in shambles. So what went wrong?

First off, psychiatric diagnosis had failed to meet strict scientific criteria for a long time. Instead, it was based on psychoanalytic concepts that were often vague, speculative and subjective.

For more than a century, biological psychiatrists yearned to find the bodily substrate of mental illness. They tested the blood of schizophrenics for toxic substances and checked their skulls for conspicuous abnormalities – all to no avail. Eventually, however, they made the breakthrough they’d been searching for. How? With the help of genetics and neuroimaging.

Today, tools like PET, MRI and fMRI are old news. But these powerful imaging technologies have taught us a lot about the differences between the brains of the healthy and the brains of the mentally ill. For instance, MRI studies revealed that in patients with severe depression, the hippocampus is smaller than in healthy subjects. This discovery was a game changer in the treatment of severe mental illness.