PSYCHIATRY IN TROUBLE

Beck recounts his career as a psychiatrist and reflects on what he sees as the decline of his field in this debut memoir.

The author grew up on the South Side of Chicago and seemed destined for a career in mental health. His father, Samuel, was internationally recognized for his work as a psychologist, and Beck considered his own experience as a psychotherapy patient before he went to college to be meaningful and formative. After attending prestigious schools during the 1950s and ’60s—the University of Chicago, Harvard, and Yale—he became a psychiatrist himself and largely worked at the Metropolitan State Hospital in Waltham, Massachusetts, where he’d worked as an intern. The author’s professional life was eclectic, including stints as an academic physician, a forensic psychiatrist, and a palliative care doctor. He also worked at the National Institute of Mental Health in Bethesda, Maryland. Alongside this astute, if excessively granular, account of his professional career, the author chronicles the historical arc of the field of psychiatry, beginning with the widespread incarceration of the severely mentally ill in asylums before 1920. According to the author, the field was saved by the emergence of psychoanalysis, which “breathed life into a moribund profession.” Beck persuasively argues that predatory insurance and pharmaceutical industries and doctors who prescribe drugs excessively have ruined psychiatric practice: “Psychiatry is failing. We are not giving our patients the time and attention they deserve. Within living memory, we were the physicians who were defined by our listening skills. Now, most psychiatric practice is limited to pushing pills [and] little else.” The author also provides a lucid and accessible account of the ways in which the “quest for scientific respectability” have pushed psychiatrists to view issues of mental health as problems to be classified and managed in chemical terms, thus generating an unfair bias against psychotherapy. As noted, Beck has a tendency to provide far more information than is strictly necessary to make his points; not many readers need to see an outline of a descriptive psychiatric assessment, for example. Nevertheless, he presents a rigorous, thoughtful, and timely discussion.

An eye-opening appraisal of contemporary psychiatric treatment.