Over the course of this book, you’ll learn about a handful of renegades and visionaries who bravely challenged the prevailing convictions of their time in order to elevate their embattled profession. These heroes declared that psychiatrists were not doomed to be shrinks but destined to be a unique class of physicians.
As a result of their pioneering triumphs, psychiatrists now understand that the successful treatment of mental illness requires us to embrace the mind and brain simultaneously. Psychiatry is like no other medical specialty; it transcends a mere medicine of the body to touch upon fundamental questions about our identity, purpose, and potential. It is grounded upon a wholly unique doctor-patient relationship: The psychiatrist often becomes privy to patients’ private worlds and innermost thoughts—their most secret shames and most cherished dreams. The intimacy of this relationship places grave responsibility for the patient’s welfare on the psychiatrist, a responsibility that psychiatrists have often failed to live up to—but no longer. The modern psychiatrist now possesses the tools to lead any person out of a maze of mental chaos into a place of clarity, care, and recovery. The world needs a compassionate and scientific psychiatry and I’m here to tell you, with little public fanfare, that such a psychiatry has arrived at last.
Let me share with you exactly what it took to get here…
Part I
The Story of Diagnosis
To name it is to tame it.
—JEREMY SHERMAN
Chapter 1
The Stepchild of Medicine: Mesmerists, Alienists, and Analysts
A sick thought can devour the body’s flesh more than fever or consumption.
—GUY DE MAUPASSANT
Everything in nature communicates by a universal fluid. Nerves are the best conductors in the body for this universal magnetism and by touching these parts, you effect a happy turn of mind and bring on a radical cure.
—FRANZ MESMER, “DISSERTATION ON THE DISCOVERY OF ANIMAL MAGNETISM”
Burning in the Air and the Soil
Abigail Abercrombie could no longer deny it: Something strange was happening to her, she just didn’t know what. The year was 1946, and Abbey worked as a court stenographer for the Superior Court in Portland, Maine, a job demanding intense mental focus. Until recently, she had relished the daily challenge. But now, inexplicably, she was always distracted. She frequently misspelled words and sometimes omitted entire phrases in her transcriptions of testimony, all because she was preoccupied by the constant fear of having another “spell.”
The spells had begun two months earlier, following her twenty-sixth birthday. The first one struck while she was shopping at a crowded grocery store. Without warning, all her senses screamed on high alert. She felt as if she couldn’t breathe, and her heart pounded so hard she thought she must be dying. She rushed to the hospital, but after the doctors examined her they just patted her on the hand and told her that she was fine.
But she knew something wasn’t right. Over the following month, she was blindsided by two more spells. Each time, for two or three minutes, her emotions seemed to go haywire, her heart raced, and she was filled with frantic terror. She began to wonder… if the doctors say there is nothing wrong with my body, could something be wrong with my head?
How does anyone really know if a disturbing psychic state is a genuine medical abnormality and not merely one of life’s natural ups and downs? How do we recognize whether we—or someone we care about—is suffering from a pathological state of mind, rather than ordinary fluctuations in mental acuity and of high and low spirits? What is mental illness, exactly?
Oncologists can touch rubbery tumors, pulmonologists can peer through a microscope at strings of pneumonia bacteria, and cardiologists have little trouble identifying the yellowish plaques of artery-clotting cholesterol. Psychiatry, on the other hand, has struggled harder than any other medical specialty to provide tangible evidence that the maladies under its charge even exist. As a result, psychiatry has always been susceptible to ideas that are outlandish or downright bizarre; when people are desperate, they are willing to listen to any explanation and source of hope. Abbey didn’t know where to turn—until she saw a story in the newspaper.
The story touted an impressive new treatment for emotional disturbances offered by the Orgone Institute, a mental health facility founded by a celebrated Austrian psychiatrist named Wilhelm Reich. Dr. Reich boasted impressive credentials from top medical institutions. He had been mentored by a Nobel laureate and served as an assistant director at the Vienna Psychoanalytic Polyclinic under the most famous psychiatrist of all, Sigmund Freud. Medical journals wrote favorably about his work, he had published several bestselling books, and even Albert Einstein endorsed his orgonomic treatments for emotional troubles—or so Reich claimed.
Hoping such an eminent physician might be able to finally diagnose what ailed her, Abbey paid a visit to Orgonon—a rural estate in Maine named in honor of Dr. Reich’s research. To her delight, she was seen by Dr. Reich himself. With intense eyes and a high forehead crowned with a horizontal swath of unruly hair, he reminded her of the character Rotwang, the mad scientist in the 1927 film Metropolis.
“Are you familiar with orgones?” he asked her after she sat down.
When Abbey shook her head, Dr. Reich explained that all mental illness—including her own condition, whatever it might be—stemmed from the constriction of orgones, a hidden form of energy uniting all of nature’s elements. “This isn’t a theory, the orgone is burning in the air and in the soil,” insisted Dr. Reich, rubbing his fingers together. Physical and mental health, according to Dr. Reich, depended on the proper configuration of orgones, a term derived from the words “organism” and “orgasm.”
Wilhelm Reich (1897–1957), Freud disciple, psychoanalyst, originator of Orgone Theory. Photograph 1952. (© Bettmann/CORBIS)
Abbey nodded enthusiastically; this was exactly the kind of answer she had been looking for. “What you need,” Dr. Reich continued, “is to restore the natural flow of orgones within your body. Fortunately, there is a way to do this. Would you like me to begin the treatment?”
“Yes, doctor.”
“Please disrobe down to your underclothes.”
Abbey hesitated. Every physician-patient relationship is founded upon a bedrock of trust, since we are granting the doctor unrestricted access to our body, from the blemishes on our skin to the depths of our bowels. But the psychiatrist-patient relationship runs deeper still, for we are entrusting the doctor with our mind—the very crux of our being. The psychiatrist calls upon us to reveal our thoughts and emotions—unveil our furtive desires and guilty secrets. The therapeutic relationship with a psychiatrist presumes that he is a trained expert and knows what he is doing, just like any orthopedist or ophthalmologist. But does the psychiatrist truly merit the same presumption of competence as other physicians?
Abbey hesitated for a moment but then recalled Dr. Reich’s impressive credentials and medical training, slid out of her dress, carefully folded it, and placed it on the desk. Reich motioned for her to sit on a large wooden chair. She nervously sat down. The cool slats raised goose bumps on her bare legs.
The doctor approached her and gingerly began to touch her arms and shoulders, then moved down to her knees and thighs as if probing for tumors. “Yes, here—and here. Do you feel it? These are nexuses where your orgones are constricted. Please hold out your hand.”
She obeyed. Without warning, he briskly smacked her arm just above her elbow, as if swatting a fly. Abbey cried out more from shock than pain. Dr. Reich smiled and raised his finger.
“There! You have released the energy locked inside! Don’t you feel it?”
Each week for the next six months, Abbey returned to the Orgone Institute. During some of her visits, Dr. Reich used an “orgonoscope,” an instrument that resembled a small brass telescope, to view the flow of orgone energy in her body, which—according to the doctor—was a bright electric blue. On other occasions, he instructed Abbey
to strip down to her undergarments and squeeze into a telephone booth–sized box with a rubber hose dangling from her neck. This was an “orgone accumulator,” which amplified Abbey’s orgones and helped to reduce her anxiety.
Orgone Accumulator, device used for Orgone Therapy. (© Food and Drug Administration/Science Source)
Abbey gratefully accepted Dr. Reich’s ministrations. She was not alone. People from all around the world sought help from Reich and his acolytes. His books were translated into a dozen languages, his orgone energy appliances were distributed internationally, and his ideas influenced a generation of psychotherapists. He was one of the most recognized psychiatrists of his era. But was the trust that Abbey placed in him justified?
In 1947, after Reich claimed his orgone accumulators could cure cancer, the FDA intervened. They soon concluded that his therapeutic devices and theory of orgone energy were a “fraud of the first magnitude.” A judge issued an injunction banning all orgone devices and advertising. Reich—who genuinely believed in the power of orgones—was crushed. As the investigation progressed, former confidants reported that Reich was becoming increasingly paranoid and delusional; he believed that Earth was being attacked by UFOs, and he had taken to wandering through the Orgone Institute at night with his neck swathed in a bandana and a revolver at his waist, like some frontier gunfighter. During the subsequent trial for illegally selling orgone devices, the judge privately suggested that Reich might need his own psychiatrist. The jury found Reich guilty, the institute was shut down, and Reich was sentenced to prison. In 1957, he died in the Lewisburg Federal Penitentiary from heart failure.
We don’t know exactly what Reich’s patients felt when they learned that Wilhelm Reich’s treatments were poppycock. But I can hazard a reasonable guess. Psychiatric chicanery, sadly, remains a problem to this very day, and I’ve encountered numerous patients who were treated by twenty-first-century charlatans. Not many things in life make you feel as violated as trusting your most intimate needs to a medical professional, only to have that trust betrayed through incompetence, deception, or delusion. I imagine Abbey repeating something a woman once told me upon discovering that her daughter’s charismatic psychiatrist was trying to manipulate the twelve-year-old girl for his own purposes and turn her against her family: “He was a total phony. But how would we have ever known? We needed help, and everything about him seemed legitimate. How could anyone have known?”
As a psychiatrist myself, born while Wilhelm Reich was still treating patients, I have always been particularly troubled by one aspect of Reich’s story: the failure of the psychiatric profession to expose one of their own as a fraud. Indeed, in the eyes of the public, the institution of psychiatry often seemed to endorse Reich’s preposterous methods. Why was psychiatry unable to inform a public desperate for guidance that Reich’s methods had no scientific basis whatsoever?
Unfortunately, unsound methods have never been far from the main currents of psychiatry, and leading psychiatric institutions have often credited techniques that were questionable, if not wholly inept. The sobering truth is that Wilhelm Reich is not a historical anomaly at all, but a discomfiting emblem of medicine’s most controversial specialty.
Psychiatry’s attempts to help the public distinguish evidence-based treatments from unsubstantiated fabrications have long been inadequate, and remain so today. You may wonder how thousands of educated intelligent people—teachers, scientists, and businesspeople, as well as court reporters—could have ever believed that an invisible network of orgasmic energy was the key to mental health. Yet even now, charlatans drawn from the ranks of professional psychiatry continue to dupe desperate and unsuspecting patients as the institutions of psychiatry passively stand by.
Daniel Amen, author of the popular Change Your Brain series of books and the star of PBS programs on the brain, might be the most recognized living psychiatrist. Joan Baez, Rick Warren, and Bill Cosby tout him, while the high-end motivational speaker Brendon Burchard once introduced Amen as “the number one neuroscience guy on the planet.” Yet Amen’s current fame rests entirely on spurious practices unproven by scientific research and rejected by mainstream medicine.
Amen suggests that by looking at images of the brain from SPECT scans (single photon emission computed tomography), he can diagnose mental illness—a practice that has more in common with skull-bump phrenology than modern psychiatry. “There is absolutely no evidence for his claims or practices,” asserts Dr. Robert Innis, chief of molecular neuroimaging at the National Institute of Mental Health. In his opinion, “It is unscientific and unjustified, like using an unapproved drug.” In an August 2012 Washington Post article, Dr. Martha J. Farah, director of the Center for Neuroscience & Society at the University of Pennsylvania, described Amen’s technique more bluntly: “A sham.” Dr. Amen also advocates the use of hyperbaric oxygen and markets his own brand of natural supplements as “brain enhancers”—treatments for which there is also no scientific evidence of efficacy.
Incredibly, current regulatory policies do not prevent someone like Amen from plying his SPECT mumbo jumbo. Even though every member of the governing board of the American Psychiatric Association regards his practice as medical flimflam, Amen continues unimpeded and largely unexposed. Even more frustrating to bona fide mental health practitioners, Amen brazenly claims that his unique methods are far ahead of the ponderous creep of mainstream psychiatry, which is rather like Bernie Madoff ridiculing the lower rate of return on a Fidelity mutual fund.
Just like Wilhelm Reich once was, Daniel Amen is cloaked in a veneer of respectability that makes his techniques seem legitimate. If you were wondering how any of Reich’s patients could have believed that stripping half-naked and climbing inside a strange orgone-collecting apparatus could enhance their mental health, you only need to consider the persuasive power of Amen’s SPECT technique, which presents a striking parallel to orgone accumulators: Patients submit to the injection of radioactive agents into their veins and then dutifully place their heads in a strange gamma ray–collecting apparatus. The mystifying aura of SPECT, with its promise of cutting-edge science, seems as marvelous and bewitching as electric blue orgonomy. How can a layperson hope to distinguish between technologies that are scientifically proven and those conjured out of credible fancy?
To be sure, all medical specialties have suffered from their share of bogus theories, useless treatments, and misguided practitioners. Bleeding and colonic purges were once standard treatments for every malady from arthritis to the flu. Not so long ago, breast cancer was dealt with by radical mastectomies that gouged out most of the chest, including a woman’s ribs. Even today, the FDA lists 187 oft-touted but apocryphal remedies for cancer. The use of antibiotics for colds is widespread, even though antibiotics have no effect on the viruses that cause colds, while useless arthroscopic surgery is too often performed for osteoarthritis of the knees. Bogus stem cell treatments for incurable neurologic illnesses like ALS and spinal cord injuries were the topic of a recent 60 Minutes exposé. Sham treatments for autism abound, including vitamins, neutraceuticals, dietary supplements, stem cell injections, purges, and the removal of heavy metals from the body by chelation therapy. Patients trek across oceans in order to obtain exotic, expensive, and entirely worthless treatments for every imaginable disease. Even someone as intelligent as Steve Jobs was susceptible to far-fetched practices, delaying medical treatment of his pancreatic cancer in favor of “holistic medicine” until it was too late.
Nevertheless, psychiatry has trumpeted more illegitimate treatments than any other field of medicine, in large part because—until quite recently—psychiatrists could never agree on what actually constituted a mental disorder, much less how best to treat it. If each physician has his or her own definition of illness, then treatments become as varied as shoes, each season bringing a parade of new colors and fashions… and if you don’t know what you are treating, then how can treatment ever be effective? Many of the most prominent names in the annals of
psychiatry are better known for the dubiousness of their treatments than the good they achieved, despite their mostly charitable intentions: Franz Mesmer’s animal magnetism, Benjamin Rush’s “Bilious Pills,” Julius Wagner-Jauregg’s malaria therapy, Manfred Sakel’s insulin shock therapy, Neil Macleod’s deep sleep therapy, Walter Freeman’s lobotomies, Melanie Klein’s sexual orientation conversion therapy, and R. D. Laing’s existential psychiatry.
I’m sorry to say that much of the responsibility for this state of affairs rests squarely on my profession. As the rest of medicine continues to enhance longevity, improve quality of life, and elevate expectations for effective treatments, psychiatrists are regularly accused of overprescribing drugs, overpathologizing normal behaviors, and spouting psychobabble. Many people harbor suspicions that even the best practices of twenty-first-century psychiatry might ultimately prove to be modern versions of Reich’s orgonomy, spurious methods unable to relieve the suffering of individuals with bona fide illnesses—individuals like Abigail Abercrombie and Elena Conway.
Yet I would assert that today, my profession would help Abbey and Elena. Abbey would be confidently diagnosed as suffering from panic disorder without agoraphobia, a kind of anxiety disorder that is linked to dysfunction in neural structures in the medial temporal lobe and brain stem that control emotional regulation and fight-or-flight reactions. We would treat her condition with serotonin reuptake inhibiting medications (SRIs) and cognitive-behavioral therapy. With continued care, Abbey’s prognosis would be quite optimistic, and she could expect to live a normal life with her symptoms controlled by treatment.
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