In Search of the Roots of Psychiatry

Abstract

Lewis Thomas ca lled me d icin e the youngest science and psychi atry is a rg ua bly the younges t discipline of th e youngest science. When a br an ch is new, its root s oft en reveal mo re than its fruits . And, in this book, Leston Haven s, a professor of psychia try at Harvard Medical School, goe s in search of roots. This book, originally publish ed in 1973 a nd recently reissu ed , is lon g a nd fu ll of historical det ails , making for slugg ish reading. But wh en di gest ed bit by bit , especia lly a t th e start of a residen cy, it ca n a id in organizing th e mor ass of experiences te rm ed psychiatry residen cy. Before reading Havens, psychi atric training seemed to me to cons ist of com pe t ing ideologies masquerading as com mon sense. Of course it mad e se nse wh en my supe rvisor, a psych oanalyst , in terpre ted my psychotherapy cases in terms of relation ship need s anc ho re d in child hoo d. And of course it mad e se nse wh en my inpatient supe rvisor, a psychopharmacologist , exp lai ned th e impor tan ce of obse rving symptom s a nd signs for acc ura te d iagnosti c cla r ity in treating psych osis. And it even mad e se nse wh en a no ther psycho therapy supervisor surprised me with th e stat ement th at, a fte r a ll, deep down th ere is no differen ce between us and our patients. But how to mak e se nse of it a ll? How could I det ermine which a pproach mad e more se nse, beyond sim ply deciding based on my own tast es? Then I encoun te re d this book. Haven s reveals his own expe r ience towards th e end of his t rain ing. He des cr ibes how he had come under th e influen ce of two brill iant teach ers, eq ua lly cha risma tic, eq ually en t rancing, and equa lly opposed in viewpoint. Many of his contemporaries were overwhelmed by on e or th e other man; H aven s by both. And so he went backward in searc h of th e roots of psychi atry, seeking to di scover how such a ppa re ntly perfect psychiatrist s could be flawl ess in such opposin g ways. First , he outlines th e object ive-descript ive school, whi ch com pr ises th e me d ica l mod el of psychi atry. It seeks to find th e object ive signs a nd sym pto ms of syndromes t ha t ca n be classified into diseases with spec ific e tiolog ies a nd speci fic trea tment s. Forerunners of this schoo l in psychi at ry are Emil Kraep el in , J ean -Ma rt in Charcot , a nd th e behaviorists . Second, he describes th e psych oan alyti c schoo l, which seeks to