A Response to Harari on Shorter

In his sustained cri de coeur against the iniquities of Edward Shorter's History of Psychiatry, Edwin Harrari has provided readers with a polemic that deserves careful reading.

Shorter's book has its faults. It is highly opinionated, under-referenced in some parts and very much a Whig history: the good guy wins, overcoming the pernicious influence of psychoanalysis, to say nothing of other evil agencies, on the development of a modern scientific psychiatry.

Psychoanalysis tends to polarise people; you are either convinced of its virtues or you are not. Even if you belong to the latter camp, it is impossible to deny that for many years, it was those of analytic persuasion who provided the momentum in psychiatry. A clinical insight is after all a clinical insight, no matter what language you use to describe it. We needed to have someone describe schizoaffective disorder and autism for the first time (the borderline state I am not so sure about) regardless of what language they used to explain it.

The issue, it seems, is not as much one of history, but historiography. Shorter believes that psychoanalysis has been a blight on psychiatry, but is now fading into the historical past to betterment of all. Harari differs, not only in his view of the contribution made by psychoanalysis but its continuing importance in future.

Before criticising Shorter for an unabashedly triumphalist approach, proponents of psychoanalysis have to justify the discipline's own tendentious historiography. From an early stage, its founder was determined to ensure that the future of his creation was an heroic one. He repeatedly requested that no biographies be written, going so far as to destroy his half of the Fliess letters and becoming very agitated when Princess Marie Bonaparte insisted on saving the distal half of the correspondence.

This censorious approach was continued by Ernest Jones, Anna Freud (as Jeffrey Masson found out to his cost), Kurt Eissler and hagiographer Peter Gay. Readers who have any doubt about Gay's disingenuousness need only look to his breathless attempt to hose down the Anna O case. As Frederick Crews, Peter Swales and other writers have pointed out, if psychoanalysis has so little to hide, then why put embargoes on access to papers stretching well into the next century?

If the custodians of psychoanalytic history insist on behaving like the proverbial dog in a manger, then they only have themselves to blame when treated badly by historians.

Shorter, on the other hand, deserves more credit than he is given. His work is not half as bad as portrayed and very good in many parts. Taking aim at a sacred cow like Adolph Meyer is not such a bad thing. As any registrar taking a developmental history on an emergency case at 3 am will reflect, the legacy of Adolph Meyer is a very mixed blessing. His work was hugely over-written. He tended to hop on every arriving bandwagon with indiscriminate enthusiasm but contradicted himself on significant issues. Yet he was hugely influential on the development of American psychiatry and was the grandfather of liaison psychiatry as we know it.

Mostly, Shorter's book is racy, witty and highly readable. If there is one thing that Harari and myself would agree on, it is that the history of psychiatry is dreadfully neglected by both trainees and practitioners. If five trainees and three clinicians read this book a year, then Shorter will have accomplished far more than Porter, Berrios and Ellenberger combined. He deserves acknowledgement for this at the very least.