Psychiatry and Its Discontents by Andrew Scull

Abstract

Reviewed by: Psychiatry and Its Discontents by Andrew Scull Jonathan Sadowsky Andrew Scull. Psychiatry and Its Discontents. Oakland: University of California Press, 2019. xiv + 376 pp. Ill. $29.95 (978-0-520-97357-2). This collection of essays on psychiatry and its critics by Andrew Scull contains a chapter on the “culture of complaint” that has surrounded psychiatry. That culture has been embodied most dramatically in the antipsychiatry movement but is also reflected in less strident forms of distrust toward the profession. The volume suggests that Scull is himself part of that culture of complaint. On page 2, after stating [End Page 262] his opposition to “progress narratives” of the history of psychiatry, Scull assures us that he does not deny that any advances have been made. But what are they? The erudition brought to bear is formidable. Not only does Scull read much of what his peers publish, he’s done primary source research on an incredible array of subjects. Scull covers asylums, somatic treatments and psychopharmaceuticals, biological reductionism (not only in clinical psychiatry but in experimental psychology), Freud and psychoanalysis, Adolf Meyer, and antipsychiatry. None come off very well. Biological reductionism is subjected to effective demolition. Psycho-pharmaceuticals are discussed only with reference to their adverse effect and the drug industry’s avaricious hype of them. Talk therapies, often promoted by critics of biological reductionism, get little attention. Scull does kook at Freud, whom he regards as “dead.” If dead, though, Freud haunts the book like a ghost—seen only occasionally, but preternaturally influential, animating both the cover and the title. Scull points out that both defenders and critics seem unable to leave Freud alone—but neither is Scull, it seems. And what of the antireductionist Meyer, who wanted to look at the patient’s biology, psychology and social context? Meyer’s doctrines, Scull says, are “empty.” Antipsychiatry doesn’t fare better. Thomas Szasz’s rejection of the reality of mental illness is rightly dismissed as silly. Like many historians of psychiatry, Scull feels compelled to note Michel Foucault’s empirical weaknesses. Foucault is another figure historians of psychiatry seem to consider dead but summon at frequent seances, if only for the airing of grievances. We could call this a repetition compulsion. All of Scull’s views have some merit. The question is whether there is more to the story. There is, I dare to say, some evidence that some psychiatric treatments relieve suffering, even if they all have flaws. (Most medical treatments have flaws.) Criticism of the pharmaceutical industry is warranted, but do we really want a world without any psychiatric medications? Odds are good that a lot of people reading this right now are on one. We can blame this on psychiatric overreach if we want, but if you are one of those people, and feel a benefit, don’t you want that represented in the historiography? There is also plenty of evidence that psychotherapy works—even including the psychodynamic therapy inspired by that dead Viennese horse we keep flogging. I dislike hagiographic history as much as the next person. But medical historians have a responsibility to give some weight to therapeutic benefits of what we study. If psychiatry really cannot do any good for its patients, then why shouldn’t we follow Szasz in calling for its abolition? If our loved ones lose all their assets in spending binges during manic states, or suffer psychotic breaks, or have suicidal depressions, a psychiatry so bankrupt has nothing to offer them. In this wide-ranging book that touches on so many clinical developments in psychiatry over the past 150 years, I cannot name a treatment Scull approves of. Psychiatry’s failures, abuses, and limitations are legion, and few have done more than Scull to document them. If indeed there have also been some advances, it’s fair to ask what they are. [End Page 263] Jonathan Sadowsky Case Western Reserve University Copyright © 2021 The Johns Hopkins University Press