A HISTORY OF PSYCHIATRY: From the Era of the Asylum to the Age of Prozac

An opinionated, anecdote-rich history of a branch of medicine strongly shaped by culture. Canadian physician and medical historian Shorter (Univ. of Toronto) begins his lively account by describing the horrific treatment of the mentally ill before the advent of the custodial asylum. It was, he says, the discovery that asylums could have a therapeutic role that led to the birth of psychiatry at the end of the 18th century. Shorter examines the failure of the therapeutic asylum movement, attributing it largely to an overwhelming number of inmates in the 19th century. Always divided by two visions of mental illness, one finding its origins in the biology of the brain and the other looking to psychosocial factors, psychiatry was dominated by the biological view throughout the 19th century. Shorter presents the German physician Emil Kraepelin, who revolutionized the approach to categorizing and diagnosing mental illnesses, as the central figure in ending the sway of biological psychiatry. As for Freud, says Shorter, ""His doctrine of psychoanalysis, based on intuitive leaps of fantasy, did not stand the test of time."" Citing studies indicating that the majority of American psychoanalysts and their patients were Jewish, the author links the growing social assimilation of Jews (and their abandonment of their ""encapsulated little subculture"") with the post-'60s decline in popularity of psychoanalysis--a theory sure to arouse controversy. Shorter chronicles the discovery of the various drugs that formed the pharmacological basis of the new biological psychiatry and hails the alliance of psychiatrists with geneticists, biochemists, and other scientists that has brought the scientific method to the investigation of mental illness. Where does psychiatry go from here? Shorter predicts a combination of the neuroscientific and the psychotherapeutic, that is, a blend of ""neurochem"" and ""neurochat."" While psychiatrists may quibble and Freudians and other psychoanalysts will surely squawk, those without a vested interest will be thoroughly entertained and certainly enlightened.