Shrinks Book Summary - Shrinks Book explained in key points

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Shrinks summary

Name: Shrinks
Rating: 4.2 (60 reviews)
Author: Jeffrey A. Lieberman and Ogi Ogas

Jeffrey A. Lieberman and Ogi Ogas

The Untold Story of Psychiatry

4.2 (60 ratings)

29 mins

Topics

Mental Health

Table of Contents

Shrinks
Summary of 12 key ideas

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What’s in it for me? Learn all about the history of psychiatry.

Did you know roughly one in three people will suffer from some sort of mental illness at some point in their life? Mental health issues are incredibly common in society, and yet not many of us know much of anything about treating them.

When we think of psychiatry, we usually imagine something stereotypical – a person lying on a couch, for instance, telling a doctor about their deepest desires. Of course, there is much more than this to the study and treatment of mental illness. So what is the truth about psychiatry? These blinks take us through the history of the practice, showing just how far we’ve come in the last 300 years.

In these blinks, you’ll discover

why some psychiatrists want to know your dreams;
what role animal magnetism played in mental health treatment; and
why a seventeenth-century family outing may have included a trip to the asylum.

In the eighteenth century, reformers tried to improve the horrible, desolate asylums housing those with mental illnesses.

Before psychiatric hospitals, life was nothing less than horrifying for those with mental illnesses. While some sufferers were lucky enough to receive care at home, most were destined for a vagrant life on the street. Many others had it worse and were forced to spend their lives in asylums.

In the eighteenth century, asylums were filthy, dark and overcrowded. Inmates were left locked up in tiny cells for weeks, chained, often beaten with sticks and doused with icy water. As if that wasn’t bad enough, patients, like performers in a freak show, were put on public display on Sundays.

Even in better institutions, treatment was still appalling. Patients were subjected to a whole host of primitive medical practices – bloodletting, purging and blistering, to name a few – that were, at the time, standard. Thankfully, a few reformers were determined to change these conditions.

In Europe, physician Philippe Pinel proposed a new, humane treatment of the mentally ill. In 1792, he became head of the Paris Asylum for Insane Men. There, he ended the practice of bleeding and purging patients, and removed their chains.

Emphasizing the importance of clean, pleasant housing, he treated his patients with fairness and created a structured schedule of activities and light manual tasks that they followed each day. The purpose of this schedule was to give back to patients a sense of self-mastery.

In the United States, the physician and humanist Benjamin Rush established a benevolent approach to psychiatry not unlike Pinel’s. Born in 1745, Rush was among the founding fathers of the United States. Few today know that he was also America’s very first modern psychiatrist. Rush also unshackled his patients and forbade the beating of asylum inmates, and lobbied for the improvement of living conditions for psychological inpatients in the state of Pennsylvania.

In the nineteenth century, more and more psychiatrists came to follow the example set by Rush and Pinel. Psychiatry was on its way to becoming a humane practice. Or was it?

Famous physicians tried to treat mental illness as if it were the consequence of some kind of blockage.

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.

Sigmund Freud revolutionized our understanding of the human mind.

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.

Freud’s “talking cure” was created to cure mentally ill patients of their inner conflicts.

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.

Thanks to Freud, psychoanalysis gained traction in Europe and the United States.

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 became popular, but far-fetched approaches multiplied quickly.

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 early 1900s, new and crude therapies targeted the brains of psychiatric patients.

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.

Shock therapy was developed in the 1930s and is still used today.

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.

New medications were used to treat major psychiatric disorders in the 1950s.

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.

Psychiatry came under fire during a wave of skepticism in the ‘60s and ‘70s.

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.

By the 1980s, diagnosis had become more objective and less speculative.

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.

New scientific discoveries have given psychiatry a bright future.

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.

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What is Shrinks about?

Shrinks (2015) tells the story of psychiatry’s astonishing development throughout the centuries. These blinks take us on a tour of the discipline’s crude past, its strange and shocking therapies and its great improvements.

Best quote from Shrinks

To name it is to tame it. - Jeremy Sherman

—Jeffrey A. Lieberman and Ogi Ogas

Who should read Shrinks?

History buffs interested in the nature of early psychiatry
Individuals wanting to learning more about the methods of psychiatry today
Those wondering why psychology sometimes gets a bad rap

About the Author

Jeffrey Lieberman, MD, is a former president of the American Psychiatric Association. He is the Lawrence C. Kolb Professor and Chairman of Psychiatry at the Columbia University College of Physicians and Surgeons.

Ogi Ogas is a computational neuroscientist. A former Fellow of the Homeland Security department, he’s contributed to two successful science books about sex, including A Billion Wicked Thoughts. Ogas, a passionate game show contestant, once won $500,000 on Who Wants to Be a Millionaire.

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