Prominent leaders in the fields of neurology and psychiatry have both published books during the past year. In this post, HCTA reviews neurologist Dr. Allan Ropper’s book Reaching Down the Rabbit Hole: A Renowned Neurologist Explains the Mystery and Drama of Brain Disease, as well as former APA president Dr. Jeffrey Lieberman’s book Shrinks: The Untold Story of Psychiatry.
Reaching Down the Rabbit Hole: A Renowned Neurologist Explains the Mystery and Drama of Brain Disease
Dr. Ropper has crafted a fascinating account of many truly peculiar cases at Brigham and Women’s Hospital in Boston. Ropper uses an Alice in Wonderland metaphor throughout the book, which plays well with his patients’ strange behavior. The oddity of some of the cases make the reader realize the incredible compartmentalization of the human nervous system. When one part of the brain is damaged, the rest of the brain (and person) continues to function with one or more glaringly deficiencies.
Dr. Ropper uses several different patient cases to show when you brain’s memory breaks, it breaks both forwards and backwards. For instance, if you claim to have amnesia Dr. Ropper will be able to tell if you are lying about your memory lapse. A patient who is not coding memories in his or her brain will keep reintroducing themselves and have the exact same conversation with Dr. Ropper over and over and over again, while a patient who is faking amnesia will have the same conversation once. It quickly becomes evident that you can have a perfectly working processor in your brain, and a broken memory.
Conversely, it also appears that you can have a perfectly working memory and a broken processor in your brain. One of Dr. Ropper’s patients could actively listen and respond to Ropper’s questions. However, the patient’s responses were magnificent soliloquies of grammatically correct nonsense. Dr. Ropper and his colleagues became lost trying to extract meaning, and some type of patient history, from a seemingly endless stream of beautiful babble.
Ropper describes several cases of ALS (Lou Gehrig’s disease), Guillain-Barré syndrome, and Parkinson’s disease. Reading real stories about normal people with these diseases forces readers to ask themselves very personal questions about what they would be willing to endure themselves.
Questions like ‘What does it mean to be human?’ and ‘What does it mean to be alive?’ become very pertinent for fully aware ALS patients who are physically paralyzed in their bodies without the ability to move, speak, or even breath on their own. Dr. Ropper describes the tale of one very rare and special ALS patient who chose to remain at home on a respirator so he could see his child grow up. It becomes very evident that the ability of ALS patients to communicate and live with their conditions will improve greatly from recent and future advances in computer technology that can support them.
Shrinks: The Untold Story of Psychiatry
In Shrinks, the former president of the American Psychiatric Association, Dr. Jeffrey Lieberman, pulls no punches while taking a hard look at the history of the psychiatry profession.
Psychiatry was first organized as the medical specialty for treating illnesses that presented no physical abnormalities of the brain, while neurologists focused on brain disorders with a physiological underpinnings. The term psychiatry was in fact coined in 1808 by Dr. Johann Reil and literally means medical treatment of the soul. A core theme throughout Dr. Lieberman’s book is the ongoing struggle of psychiatry, as a profession, to develop a generally accepted definition of mental illness that distinguishes the difference between medical diseases and non-medical conditions.
According to Dr. Lieberman, psychiatry’s early beginnings focused on institutional medicine. Long before patients with mental illness were ever treated to get better, Dr. Lieberman reminds us that psychiatry’s primary goal was once to minimize the physical harm that their patients inflicted on themselves and their caretakers. Discovering the means to sedate patients was a fundamental first step on the road to pursuing treatments.
The emergence of Dr. Sigmund Freud’s psychoanalytic theories around the year 1900 dominated the psychiatry profession for a long time. Many of Freud’s theory have since been discharged from popularity, but his lasting impact was likely his promotion of the efficacy of talk therapy. At a very basic level, Freud understood that when his patients talked at length about their problems, they often tended to feel and behave better.
This discovery and the popularization of psychotherapy created a large shift in the profession by allowing psychiatrists who disliked the practice of institutional medicine to pursue ambulatory clinic practices where they could treat the so called worried well patients.
Lieberman openly discusses his firsthand experience with such misunderstood treatments as electroconvulsive therapy, while also daring to wade deep into his profession’s past failings to discuss Wilhelm Reich, pyrotherapy, and lobotomies.
The treatment of trauma has become another prominent focus of psychiatry. For decades, large numbers of military veterans have suffered from traumatic experiences for years after the original events. What the military once attributed to personal weakness has now been attributed to an underlying brain mechanism which is well understood. Lieberman uses his own personal experiences to explain why he was traumatized by one terrifying event and not by another.
As Lieberman describes in great detail, disagreements between psychiatrists and social science professionals manifest pointedly every time the Diagnostic Statistical Manual (DSM) is updated by the American Psychiatric Association. Over the past 200 years the differences between medical diseases and social disorders have changed periodically, and psychologists and therapists now have vested interests in where the psychiatry profession draws the line.