FROM THE INTRODUCTION
What’s wrong with psychiatry? For the better part of my career I have been asking myself and others this question about the profession that has been my life’s work.
I ask it having repeatedly witnessed how faddish misdirections of thought and therapeutic practice sweep across the field to dominate opinion and action for years, only to sink from favor and fade away, leaving wounded patients and public scorn in their wake. One must wonder why psychiatrists learn so little from these misdirections, because they all follow the same pattern: seeing in human mental disorders things that do not exist, building treatment programs that are doomed, and then unapologetically retreating from these claims and therapies to await some other apparition to recapture the profession’s loyalty and attention.
As an appalling example, in the early 1980s, a group of prominent psychiatrists claimed that certain mental symptoms indicated a past history of childhood sexual abuse in patients who insisted they had no memory of such experiences, and they alleged that these symptoms could be relieved if, and only if, the patients “recovered” their memories and dealt with them. Within the decade, this idea gained broad support not only from individual psychotherapists but also from such citadels of authority as academic psychiatric hospitals, psychiatry teaching departments, and even the National Institute of Mental Health in Bethesda. And yet the idea rested on claims unsupported by evidence, on speculation unrestrained by caution, and on the trust in authority that leads patients to accept suggestion. It vividly displayed the foundational vulnerabilities to mischief and misdirection that abides in psychiatric thought and practice.
I write about this episode now because it represents in almost pure form the kind of error that psychiatrists regularly fall into and thus has a clear message to teach. I was someone with a front-row seat in American academic psychiatry, who witnessed the injuries to people it exacted, and who, in protesting against it, came upon—as I had before—the power of this discipline to protect itself from criticism. I can tell the story from start to finish and believe that by describing it fully I can accomplish several useful objectives. Not only may I help prevent its repetition and mitigate the willingness of the public to accept such incoherence from psychotherapists, but I can explain just how proper psychiatric practice is carried out and what patients should expect from doctors and therapists as they strive to bring them the best treatments.
In this book, I will describe the calamitous course of the recovered memory movement in psychiatric practice and how the theories on which it was based proved invalid and pernicious. Eventually the public, to its amazement, came to realize that, with the procedures promoted by psychiatric “experts,” a craze reminiscent of the Salem witch hunts had emerged from the psychiatric clinics. Several components, each of interest in itself, make up the story I plan to tell.
The first component describes some of the clinical incidents I encountered. They reveal what I learned from patients and their families as the idea of repressed memory emerged, promoted by a group of zealots so confident of their mission that they never questioned the dangerous and crude therapeutic practices they employed. I describe my part in the history, when—to the mortification of psychiatrists with any pride in their discipline—reform had to come not from the profession itself but from the civil government, which intervened to preserve social justice in the face of vicious abuse of authority and license.
The second component considers the long-term implications of this calamity for the psychiatric discipline. The most obvious effect is the general public’s current distrust in the judgment and even the integrity of psychotherapists. This is not a trivial matter, given that people fearful of mistreatment may resist turning to the help they need. What constitutes proper and safe psychotherapeutic practices must be made clear again.
A subtle but momentous implication is the repressed memory movement’s discrediting of Freudian psychoanalysis. A cozy niche for psychoanalysis was disrupted by the movement’s disastrous misdirection, but as I shall strive to make clear, Freudianism regrouped, somewhat chastened, but just as determined to legitimize equally fallacious if not so crudely injurious views about mental disorders and their causes.
The third and final component of the story deals with the practical questions that dawn on people after any disaster. These include questions of an immediate kind, such as where they or relatives can find services worthy of their trust and how they might protect themselves if another fad or mistreatment emerges in the future...
FROM CHAPTER ONE
A parable familiar to doctors speaks of a man rescuing people from a river—pulling them to safety as they splash helplessly past. He keeps at it: saving some, losing others, fighting the current, suffering the cold. At last he grasps what should have been obvious to him earlier and scrambles upstream to find out who’s throwing these people in. There he discovers a tough gang and faces a new, more difficult challenge.
The parable fits my story. Over the course of eight months in 1990, I tussled with three incidents that I never fully grasped until I looked “upriver.” There I found a group of psychiatrists producing my “downstream” experiences. Their practices and ideas—throwbacks, I thought, to discredited ways of the past—were gathering authority, taking on recruits, and dominating the rounds and conferences of many psychiatric educational programs. They were beginning to move into the public realms of civil and criminal law, where, like witch-hunters of old, they were threatening the defenseless and would ultimately shake public trust in psychiatry.
This discovery drew me into what was the biggest professional battle than I’d ever encountered over matters that were fraught with human meaning and supported by zealous and vocal advocates with whom I would have to quarrel. The quarrels would spill out of the hospital and my office, propelling me into courtrooms for testimony and distant legal offices for depositions, into surly confrontations in auditoriums and ugly professional exchanges in journals, into public attention and private miseries...