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Madness on the Couch could have been an important, cautionary history of a failed effort to treat three recalcitrant illnesses—schizophrenia, autism and severe, intractable obsessive-compulsive disorder (OCD)—and errors, including those of hubris, that psychoanalytic psychotherapists made in the 1950s and 1960s. It is dotted with insights and fascinating details about individuals such as Sullivan, Fromm-Reichmann, Laing, Kanner and Kety. Dolnick's subtle concluding chapter on current trends in psychiatry, placebos and fashions in science is wonderful in places. But these gems stand out because in their fairness, balance and depth, they differ dramatically from most of the book's offerings.
I am not a psychoanalyst. However, as a practitioner familiar with the field and many people Dolnick discusses, including my friend and coauthor Bruno Bettelheim, I found the book
highly flawed. It uses pop language (Laing was ‘Lidz in love beads”, p. 132) charged analogies (psychoanalysis to Communism), hyperbole (Freud's ‘monomania … made Ahab seem like a Sunday fisherman”, p. 22), and highly selected informants. Dolnick sometimes even orders chapters counter-intuitively to support the desired impression. Ice pick lobotomies and ECT of the 30s, 40s and early 50s are discussed in depth only after chapters about treating schizophrenia in the 50s and 60s. Were these chapters put in proper chronological order, readers might praise those Sullivanians who saved psychotic patients from personality-obliterating lobotomies. Furthermore, Dolnick misinforms readers about contemporary ECT, calling it brutal, ignoring the miracle it is for well-selected depressed patients who do not respond to medication; he seems unaware