Customer Reviews

A History of Psychiatry: From the Era of the Asylum to the Age of Prozac

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Shorter does a remarkable job compressing over 200 years of medical history into a single, readable volume. Rather than attempting to provide the reader with an exhaustive chronology of psychiatry, Shorter tells a story which weaves seamlessly between intellectual movements, popular culture, and advances in drug therapy. The principle which guides this narrative-- and, indeed, psychiatry overall-- is the humanitarian impulse to help those who suffer from mental illness.

What I found most surprising was the degree to which Freudian psychoanalysis has become thoroughly discredited:

"All sciences have to pass through an ordeal by quackery," observed Hans Eysenck in 1985. "Chemistry had to slough off the fetters of alchemy, the brain sciences had to disengage themselves from the tenets of phrenology... Psychology and psychiatry, too will have to abandon the pseudo-science of psychoanalysis..."

Far from taking psychological care down an aimless garden path, Freudian analysis is shown to have done real harm to those who suffer from psychological maladies by denying them other forms of care beyond the analyst's couch-- including drug therapy --which could have led to real improvement in patient's lives.

Shorter's account begins with the early days of organized asylums, institutions which, despite today's negative associations with the word, were staffed by people who sought to bring relief to those who would have otherwise languished tied to wooden posts or locked in a room for years. The great failings of the asylum system resulted not from its intentions, but from an overwhelming crush of intake. An exponential increase in asylum patients led to substandard care and occasional depictions of gross negligence-- and these latter images are those most strongly associated today with the era, despite their relative infrequency.

After the second world war, psychoanalysts in America insisted that mental problems could be cured by means of obtaining a deeper understanding of the primal drives which govern human action. It rejected other forms of treatment as purely palliative, and suggested that real treatment involved a self-discovery of the patient's unresolved psychosexual impulses. (This, despite significant evidence that patients undergoing psychotherapy actually experienced longer recovery periods than patients with similar conditions who received alternate forms of treatment.)

Finally, advances in psychopharmacology in the last three decades of the twentieth century succeeded in dethroning Freud from the pinnacle of psychological care and allowed psychiatry to plant itself on firmer, scientific ground. New insights into the genetic origins of many forms of mental illness dispelled the notion that personal insight alone could lead to a full recovery in the majority of cases. The identification of specific drug treatments allowed many to live happy, public lives who would have earlier suffered lonliness and marginalization in the era of asylums.

'A History of Psychiatry' is an excellent study of the major movements within psychiatric care over the past three centuries. Shorter has contributed a highly-readable story of a subject which, in less capable hands, would have been an unwieldy account.

Shorter's book is an important addition to the history of psychiatry. It falls short because of Shorter's "over kill" in his polemic against psychoanalysis. The Freudian perspective needs thoughtful criticism, but Shorter's attacks become carping. Psychoanalysis has made important cultural contributions, and many people have received benefit from the analyst's couch. Good history should have a direction, even a perspective. But Shorter's history would have been better served with a calmer and more balanced voice.

Excellent, well written and researched historic account of the history of psychiatry during this period. Well worth reading for everyone interested in mental health care.

I really enjoyed the part of this book on the history of psychiatry. Unfortunately only about 60% of the book is on this topic and the rest consists of Shorter's unbalanced opinions. As a Psychiartic Registrar/resident slightly more simpathetic to the Biological approach, even I found this book extremely biased. Shorter's concrete style of reasoning makes him far more suitable to write a book on the history of surgery. The finer nuances and richness of the field of psychiatry is clearly outside his grasp.

I was disappointed already by the preface, after having expected so much from the book (it is widely referenced). This author does not recognise that there is a great variety of nosological categories that are treated by psychiatry, which cannot be justly claimed to have the same origin. Further reading convinced me that this author "writes history", literaly. It is an ideological work par excellence. His comments are apologetic for a bio-medical model and cynically dismissive against socio-psychological ones. Also, his understanding of some of the works he refers to, such as Foucault's, is disputable (he clearly makes the mistake Foucault warns against: history of knowledge independent of power relations). I regret to have bought the book.

I loved this book. Terrific. Over and over it tied together and made sense of things that had puzzled me.

To get personal: in the fifties, my father spent a small fortune on traditional Freudian psychoanalysis. And it did him a lot of good. For years, I believed Freudian psycyoanalysis was scientific. For one things, it just _had_ to be. No charlatan could go to the effort and expense of getting an MD, then board certification in psychiatry, then undergo psychoanalysis, just in order to con people.

Yet in some way that I didn't quite understand, I became aware than nowadays Freudian psychoanalysis is considered to be a pseudoscience, on about the same level as orgone boxes or homeopathy or Christian science.

How _could_ my parents have fallen for it? How _could_ the medical community?

Well, Shorter explains what happened in a way that makes sense, seems clear, and (to my mind) is really quite sympathetic to the psychoanalytic community and its clients.

Along the way he ties up a lot of loose ends. All through the book I kept saying to myself things like, "Oh, so _that's_ what 'neurasthenia' was" (people in novels written early in the century often had it). "Wow, so that's what the word 'degenerate' is really referring to."

This book is a one-sided polemic. The author clearly believes that only the "biological" approach to psychiatry is worth anything, but instead of presenting his case as an honest argument, he gives us a weighted, colored, and biased view of history. I was very disappointed.

First off, any attempt to chronicle the history of psychiatry is commendable. The radical changes in the perception of the mentally ill and the treatment of mental illness requires a great deal of research and discernment. However, I found this book more encyclopaedic than a fluent historical account. Personally, it will probably serve as more of a reference than a straight through read. It does include many interesting anecdotes, just not fluently enough for me to read as intended.

Shorter's book is an important addition to the history of psychiatry. It falls short because of Shorter's "over kill" in his polemic against psychoanalysis. The Freudian perspective needs thoughtful criticism, but Shorter's attacks become carping. Psychoanalysis has made important cultural contributions, and many people have received benefit from the analyst's couch. Good history should have a direction, even a perspective. But Shorter's history would have been better served with a calmer and more balanced voice.

Shorter does not know much about medicine and doesn't research before he writes so I wouldn't credit anything he writes.
In his From Paralysis to Fatigue, Shorter talks about ME/NEIDS (Myalgic Encephalomyelitis/ NeuroEndocrine Immune Disease) (aka CFS) as a modern example of psychosomatic illness. The only problem is he didn't research the disease before writing his musings. There are over 5,000 articles in peer reviewed medical journals showing significant biological pathology (disease) in ME/NEIDS.