On Jeffrey Lieberman's Shrinks

May 6, 2015. Congratulations to Leon Hoffman for his excellent discussion of Jeffrey Lieberman's Shrinks: The Untold Story of Psychiatry. I agree with everything Hoffman has written but have a few points to add.

Lieberman depicts psychoanalysis as wizardry and the product of charlatans. In fairness, he does give Freud his due as a genius, but also labels him “a rogue.” His view of the relationship between psychiatry and psychoanalysis is limited by a superficial and often incorrect view of psychoanalytic psychology. He is biased toward psychopharmacology to such an extent that his book is actually an advocacy piece instead of a scholarly discussion of clinical, research, and historical issues.

Lieberman does not point out that the distance between neurobiological advances in psychiatry and therapeutics remains substantial. He presents no psychobiological model of the mind and does not discuss the fact that there are no chemical compounds that cure mental disorders, despite helpful advances in psychopharmacology. For example, Lieberman discusses present understanding of post-traumatic stress disorder (PTSD). Without directly stating so, he implies that psychiatry now has techniques for treating PTSD patients because we understand the neurobiological mechanisms that cause PTSD symptoms. Sadly, this is not the case. There is no pill for treating the symptoms of PTSD, which is an especially complex disorder because the people who experience its symptoms are themselves complex. To understand the disorder one must understand the people who suffer from it, including their unconscious irrational motivations.

Lieberman systematically avoids discussing the side effects of psychopharmacological agents. This conveys the misleading impression (especially to the general reader) that psychopharmacology is effective without being problematical. For example, there is no mention in Shrinks of the commonly experienced sexual side effects of SSRIs (Selective Serotonin Reuptake Inhibitor d