Why did I read Jeffrey A. Lieberman’s new book, “Shrinks: The Untold Story of Psychiatry”? Frankly, I have been befuddled by my profession. I am a psychiatrist — Board Certified, as they say, these past 37 years – for a long time. So finally, I thought, if I read this book, the pieces of the story would fall into place, right? I would be “told” that which has been “untold.” And evidently Siddartha Mukherjee, a talented oncologist and author of “The Emperor of All Maladies,” found Lieberman’s book “Astonishing.”
Indeed, I was astonished! I did not recognize the profession that this former president of the American Psychiatric Association described. He does a nice job of describing some of our ugly, tortuous and nutty roots. You know what I mean: lobotomies and purges, chains and seizure-induction, bleeding, dunking, spinning, gassing, and beating. But now he tells us we psychiatrists have put this sadistic craziness behind us and are on a path of enlightened science, primarily with effective drugs that treat brain diseases. If you need help sorting out fact from fiction, I recommend reading two reviews, one by Robert Whitaker and the other by the author of “The Book of Woe,” Gary Greenberg.
I wish only to address here a few lines that forced me to put the book down and pace the floor for an hour.
Lieberman wishes to defang two monsters that have sullied the reputation of his beloved biological psychiatry: psychoanalysis and the “anti-psychiatry” movement. His disgust with these culprits is evident. “As someone who has worked with thousands of schizophrenic patients, I can assure you that they are just as likely to be talked out of their illness as they are to be bled or purged out of it” (Page 82). I found this attack interesting in that the patients I have seen who have had a bad psychotherapeutic experience usually complain that the analyst did not talk enough! But it is the second “monster” I wish to address here, his vitriolic critique of a colleague, the late Dr. Thomas Szasz.
On page 113 Lieberman devotes a full paragraph to a quote from another biological psychiatrist, E. Fuller Torrey. Torrey and Szasz have vociferously debated in person and in writing the nature of schizophrenia, Torrey sticking to the position that schizophrenia is a brain disease which often must be “treated” with drugs and involuntary hospitalization, and Szasz taking the position that schizophrenia is an arbitrary construct, not a brain disease, which psychiatrists use to justify control and incarceration, in violation of the principles of a free society. Not to mention: bad science.
So when I read Torrey’s quote:
“… Laing’s convictions were eventually put to the test when his own daughter developed schizophrenia. After that, he became disillusioned with his own ideas. People who knew Laing told me that he became a guy asking for money by giving lectures on ideas he no longer believed in. Same with Szasz, who I met several times. He made it pretty clear he understood that schizophrenia qualified as a true brain disease, but he was never going to say so publicly.” (Italics and bolding are mine.)
I had to put the book down. There is nothing sacred about Szasz’s views but this did not make sense. I checked it out with a half dozen other colleagues who knew Szasz quite well. They were non-plussed, so used to criticisms of Szasz’s work as they were. Jeffery Schaler and Robert Whitaker, however, were incensed. I had to probe further. I contacted Torrey by email:
From: Joseph Tarantolo [mailto:[email protected]]
Sent: Monday, April 06, 2015 8:23 AM
To: Fuller Torrey
Dear Dr Torrey,
We met several years ago, perhaps at a book signing, or we may have overlapped at the NIMH (I was a clinical associate 1970-72).
Although I disagree with many of your tenets about the biological origins of schizophrenia, I admire much of your work, particularly as a champion for the mentally ill and your critique of the need for a humane “asylum” policy.
I know you debated Tom Szasz and you respected him and spoke well of him after his death. Therefore I was taken aback by the quote by Jeff A Lieberman in his new book “Shrinks” on page 113. Lieberman quotes you as saying: “… Same[comparing Szasz to Laing] with Szasz, who I met several times. He made it pretty clear he understood that schizophrenia qualified as a true brain disease, but he was never going to say so publicly.”
I never knew Szasz to shy away from saying publicly what he believed privately so I want to check the veracity of this quote.
I can imagine Tom saying that whether Schizophrenia was “organic” or not, still no one should be locked up unless they broke the law.
The schizophrenics I have treated have seemingly had brain disease but they have been maintained on neuroleptics for decades so how might I distinguish iatrogenic damage from primary disease damage. I believe the jury is still out!
If Tom made the above statement to you, so be it. It just doesn’t sound true. Please enlighten me.
Joe Tarantolo, M.D.
908 Pa Ave, Se
Wash, DC 20003
Several days later he replied:
From: Fuller Torrey <[email protected]>
Sent: Apr 20, 2015 9:44 AM
To: Joseph Tarantolo <[email protected]>
Subject: RE: “SHRINKS”/Szasz
Dear Dr. Tarantolo,
Periodically in recent years I sent Tom articles such as the attached.[see below] In fact now there are over 200 such studies. I had lunch with him a year prior to his death and urged him to acknowledge what has become overwhelmingly obvious–that schizophrenia is a disease of the brain. He just smiled his enigmatic smile. Tom was an honest man but also a stubborn man and there was nothing in it for him to recant at the age of 90. After Tom’s death I had a similar conversation with Dr. Mantosh Dewan, on the faculty at Syracuse and one of Tom’s closest friends there. Mantosh agreed with me that Tom realized that schizophrenia is a brain disease but was not going to say so publicly. Thus my statement to Jeff Leiberman.
Fuller Torrey, MD
So now I knew that what was said in Lieberman’s book, that Szasz made these comments directly to Torrey was false, they were alleged second hand, but it still left hanging whether there was any truth to Szasz’s self-repudiation. Next I contacted Mantosh Dewan:
Dear Dr Dewan,
I am a psychiatrist in DC. I am an admirer of Tom Szasz and got to know him late in his life. I had the honor of introducing him at the ISEPP conference in LA 3 years ago where he gave perhaps his last significant public talk. Knowing his views about schizophrenia, then, I was taken aback when I read in Jeffrey A. Lieberman’s new book, ” Shrinks”: on page 113. Lieberman quotes E Fuller Torrey as saying:”.Same [comparing Szasz to Laing] with Szasz, who I met several times.He made it pretty clear he understood that schizophrenia qualified as a true brain disease, but he was never going to say so publicly.”
I never knew Szasz to shy away from saying publicly what he believed privately so I checked the veracity of this quote with Dr Torre[y].
I told him Torrey’s response.
Dr. Dewan got back to me within a day:
From: Mantosh Dewan <[email protected]> [Edit Address Book]
To: Joseph Tarantolo <[email protected]>
Subject: Re: Szasz/”Shrinks”
Date: Apr 21, 2015 10:00 PM
Attachments: The psychology of schiz.docx
Dear Dr Tarantolo,
Tom was not merely brilliant but also capable of unusually sophisticated thinking; thinking that “schizophrenia qualified as a true brain disease” is entirely too simplistic. Tom would not agree to this statement in the way it is written- and I certainly did not say or mean in any way to say [italics mine] “Tom realized that schizophrenia is a brain disease but was not going to say so publicly.”
Tom wrote an amazing paper, The psychology of schizophrenia, in which he describes the deficits in object relations/developmental terms. Later, when biological findings were being reported, he wrote a superb paper, “Schizophrenia: the sacred symbol of psychiatry” in the British J Psychiatry. I published a dozen articles on CT scan findings and discussed this with him. His view:
- isolated findings in some persons is not necessarily meaningful since these findings are also found in other conditions. eg poverty runs in families, and has many biological stigmata [shorter, lower IQ, etc].
- Schizophrenia is a consequence of poverty of internal objects. [his more challenging notion was that people make up voices and pithy quotes such as : “If you talk to God, it is prayer; if God talks to you, it is schizophrenia’]
- in persons who have a brain disease [which are known to cause psychosis, delirium, etc] and [not] ‘schizophrenia’, it is a neurological disease and therefore not a psychiatric disease[like schizophrenia] to be treated under coercive ‘mental health laws.’
He continued to believe that the essential facts are: the state or majority will always subjugate the unwanted social groups and that ‘mental illness’ including schizophrenia is a fiction that is manufactured to justify this oppression.
Personally, I do not care whether folks agree or disagree with Tom. I just hope they do not dismiss him by calling him ‘like Laing’ [a major disservice; Szasz thought Laing so bad he wrote a book about it: “Antipsychiatry, Quackery Squared”, 2009, Syracuse Press] or as ‘antipsychiatry’ without giving his views thoughtful consideration – and sometimes even without ever reading him.
I presented the “Clinical wisdom of Thomas Szasz” at a celebration of his life that the Department held last year and have built on his ideas on the psychology of schizophrenia in a paper recently submitted. I have attached it in case it is of interest.
So there you have it. In Whitaker’s book review he says tersely about “Shrinks…,” “This is not a serious book.” I think, however, we should take seriously the egregious nature of a former president of the APA attempting to tarnish the reputation of a legitimate critic. Yes, I understand that any of us can get careless in our private conversations. I still don’t know what actually went on between Torrey and Dewan. Whatever was said, however, pales before the corpus of Szasz’s work: 30 published books, hundreds of articles in dozens of journals, countless lectures and speeches. I am not calling Lieberman a liar, but I do think his besmirching of Szasz’s psycho-philosophical-political views was intellectually cowardly.
I did read Torrey’s paper “proving” that schizophrenia is a brain disease. (“Studies of individuals with schizophrenia never treated with antipsychotic medications: a review” in Schizophrenia Research 58 (2002) 101-115). It is a good review but it proves only that we should be much more humble when trying to explain madness using medical language. I shared with Torrey the following:
Date: Apr 21, 2015 4:53 PM
Thanks for the article, well written, I’m still studying it.
I am agnostic about the issue: brain or Mind. Off the top here are some thoughts that concern me: (Note: I made some minor editorial changes for this article)
1) There is no diagnostic organic test to diagnose schizophrenia, only clinical impression.
2) All the physical findings described are non specific. The papers are awash with statistical probabilities, nothing definitive.
3) What comes first: schizophrenia symptoms or organic disease. (abnormal MRI’s, etc)?
4) I’d prefer not to make a radical distinction bet/psychological and biological: psychosomatic AND somatopsychic are both legitimate notions. Body impacts mind. Mind impacts body.
5) Contrary to organic diseases, madness takes different forms in different cultures. Culture defines madness, not physiology.
6) Contrary to your view that schizophrenia is like Parkinson’s disease and Multiple Sclerosis, we can make an autopsy/biopsy diagnosis in Parkinsons and Multiple Sclerosis, but not in schizophrenia.
7) Isolation of lab rodents will lead to brain changes. i.e. psychosocial factors lead to brain changes. Brain changes are pertinent but psycho-social factors may produce the brain changes. In other words we don’t know cause or effect.
8) Madness has taken different forms over the ages. Not true of organic diseases.
9) Organic disease is profoundly influenced by psychological factors. (see Dean Ornish “Love and Survival”)
10) Charles B Dunlap’s 1924 autopsies (American Journal of Psychiatry Vol.3 page 403) showed no difference in brains of Schizophrenics and “normals.”
11) There really is a “dementia praecox” (i.e.chronically institutionalized/dysfunctional people who never get better) but is that the same illness as the significant % of schizophrenics that do get better. Does the so called brain disease heal?
12) If Schizophrenia is first and foremost a brain disease, then all treatments that damage the brain (ECT, lobotomy and neuroleptics) should be contraindicated. Why would one want to damage an already damaged brain?
13) Virtually all the “risk factors” are psychosocial not humoral, immunological, morphological, or genetic.
Best, joe t
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.