Abstract
The title of this monograph is a little misleading in that it also describes the rise not just the fall. The author is head of psychiatry at McGill University in Montreal where he was first a medical student and then a resident in psychiatry in the mid 1960s. By coincidence, this reviewer also trained in psychiatry and worked for a time at McGill although his startup date was 10 years earlier. It is of interest then to validate the author's view against my own.
The author makes his case through cited literature, interviews with a number of psychiatric leaders in the US and Canada and his own personal experience. The book has value as a history and, as with any history has the author's own perspective which some may view as a distortion. I do not – in fact if there is any distortion it is in the direction of being too kind to this ideological and therapeutic falsehood. The author bends over backwards to be fair, although it is clear that his view is highly critical and unfriendly especially of its physical isolation from medicine and its failure to submit its hypotheses and therapy to scientific scrutiny.
For me one of the unadressed puzzles is how so many apparently smart and well-educated medical academics could have been so mesmerized by psychoanalysis which is much more like a religious cult than a branch of science. The first time I read Freud in my first year as a resident at McGill, I rapidly concluded that the man was mad, afflicted by a kind of paranoia which saw (false) meaning in everything. I put it away not to read it again for 40 years. The problem for me was that it allowed no such thing as random or innocently present or ununderstandable behaviour or what neurophysiologists described as Gaussian noise in the brain. (As a joke when I retired my staff gave me a tattered copy of Freud which I did open and took great comfort in finding that my evaluation of 40 years ago that is was rubbish still stood firm.) The answer to this unseemly credulity I think, lies in the seductive message that psychoanalysis sounded in an era of knowledge vacuum and therapeutic impotence – that it knew both the cause of psychopathology and the way to fix it. I was saved from this nostrum by the advent of psychopharmacology with chlorpromazine 2 years before I arrived at McGill. In my first year as a resident the first international symposium on imipramine was held there and after that the tide was turned.
The second unaddressed puzzle is why despite psychoanalysis, academic American psychiatry has been by a country mile the most prolific contributor to the rise of biological psychiatry. I met many academic psychiatrists in the US who somehow kept their religion of psychoanalysis separate from their research in biological psychiatry. I suppose the answer to this is that there are many scientists who cleave to some transcendental religion because science still cannot answer some fundamental problems about ontogeny, ethics and the biggest cruel joke of all our inevitable mortality. I used to try to tell colleagues and students that false understanding is not understanding at all. The hard task in life is to accept our ignorance as just that.
One other beef I have about this book is that it is ‘adultocentric’ although I have long ago given up any expectations that greedy, narcissistic adult psychiatry which monopolizes a disproportionate share of the available resources would ever disdain to consider the extremes of life. Arguably the best research to come out of McGill in the Dark Ages of psychoanalysis came from the Montreal Children's Hospital in Weiss and Hechtman's lifelong study of what is now called attention deficit hyperactivity disorder – yet no mention is made of this despite the fact that the head of the department in which this research occurred and nearly all the staff psychiatrists were fervent psychoanalysts. However, the head, Dr Taylor Statten, had one supreme virtue – he recognized and supported talent in his rangatahi. Put another way, like any religion, psychoanalysis proved incapable of suppressing the human spirit and humanity.
This book is of interest primarily to those interested in the history of psychiatry and of ideas. For most it is as irrelevant as psychoanalysis itself. My own view is why kick a man when he is down and dying?