'Madness' Charts Psychotherapy's Wayward Drift

MADNESS ON THE COUCH

By Edward Dolnick

Simon and Schuster

$25, 338 pp.

John Rosen, a psychiatrist from Philadelphia, did not beat around the bush when he treated his patients. Looking into their eyes, he told neurotic patients they were "crazy," accused schizophrenics of "lying," and threatened to "kill" any patient who acted "abnormal." His methodology was drastic, brutal and, surprisingly, well admired by his peers. He was awarded a faculty position at Temple University Medical School and the Man of the Year award from the American Academy of Psychotherapy. From the 1950s to the late 1970s, Rosen was psychiatry's Superman; he soared to the peak of his profession with the claim that he could cure any psychosis.

But like all superheroes, Rosen, too, was make-believe. In 1983 he was forced to surrender his medical license. Rosen faced 67 violations of the Pennsylvania Medical Practices Act that ranged from curing schizophrenics who had never had schizophrenia to sequestering patients in dungeons and cells, extending his definition of "drastic" to a new level of inhumane.

If John Rosen was just one bad apple, his story would be an anecdote; one more example of how quacks and con-men can sometimes infiltrate the most august of professions. But Rosen's story is less of an aberration than it is an archetype. The early history of psychotherapy swells with similar quacks and con-men.

In Madness on the Couch, Edward Dolnick, a veteran science writer for Health magazine and The Boston Globe, explores how Rosen-type therapists saturated the psychoanalytic profession with bad science, unearned hubris and treatment that was patently dangerous to patients and families. Dolnick does not launch into a diatribe against all forms of psychotherapy. Although psychotherapy can be effective for treating neuroses (relatively benign emotional disorders), Dolnick targets psychoanalysts who tried to cure psychoses (marked disorders of perception or reality) with talk therapy alone. From the 1940s to the 1970s an aggressive cabal of psychoanalysts fit such a bill; they scoffed at the biological origins of mental illness, eschewed treating schizophrenia with drugs and thought that their "talking" forms of therapy could single-handedly illuminate the darkest corners of the human psyche. Their intention was to unlock the mysteries of human consciousness. Their legacy, instead, was to open a Pandora's box of misdiagnoses.

Dolnick begins in the 1940s when psychoanalysis first became fashionable. At the end of the second World War, society--consumed by the nature versus nurture effects on behavior--came up on the side of nurture, believing that personality was shaped by the environment. Anything related to genetics sounded disarmingly like eugenics and Hitler's notion of racial superiority. And so society welcomed psychotherapy, with its egalitarian tenet that we are all "brothers" whose personalities are shaped (or misshaped) by our surroundings. As Dolnick observes, "Level-headed men and women occasionally succumb to giddy excitement over the stock market or the million dollar prize." Or psychoanalysis.

But a second reason for the proliferation of psychotherapy was on account of the admiration of its founder. By the 1940s, Sigmund Freud had become a cherished figure in American pop culture; phrases like sibling rivalry, the Oedipus complex and Freudian slips were already seamlessly woven into the vernacular. Psychotherapy seemed like an application of Freudian doctrine. No one thought it could be a perversion.

Freud unequivocally stated that psychotherapy was ineffective at treating psychoses, or what he called "impenetrable darknesses" like schizophrenia. But his disciples set out to prove him wrong. From the onset, their intentions were not necessarily bad. One psychotherapist would sit in the urine of her schizophrenic patients to "prove she was no better than them." Another would bring autistic children to his home, convinced that their real parents were "killing them." Even John Rosen believed that his belligerent methods of "shock therapy" could jolt his patients into reality. But the progeny of these psychotherapists' "good intentions" was not a new cure--only a new method for assigning blame.

Madness on the Couch plumbs how psychotherapy in the 1960s evolved into "an orgy of parent-bashing." Although psychoanalysts changed what parental behaviors were "psychotic-inducing" with the capriciousness that designers of their same era changed hemlines, their theories always retained one constant: the mother was at fault each time. Mainstream thinking dictated that "mechanized and maladroit" (so called "refridgerator" mothers) produced autistic and schizophrenic children. Other Rosen-type psychoanalysts would also blame the victims and their weakness to fend madness off. But there were no statistics, let alone control groups to back such theories. Often, all these psychotherapists relied upon was the "power" of empirical observation. One psychiatric duo, Maurice Green and David Scheter, came to the conclusion that the mothers of autistic children were "all very lonely, frightened women." Their test group was three mothers.

Although Dolnick's delivers a fascinating, often riveting, narrative of psychoanalytic history, the narrative style is a little unsatisfying. Dolnick zealously reports on the history of false theories and therapists, but focuses comparatively little on the patients themselves. Dolnick infers that lives were ruined by dozens of Rosen-type fanatics who blamed psychotic illness on patients, on mothers, on families--on everything, it seems, except biology. But beyond these inferences, Dolnick delves very little into the lives of the people affected--and how (or if) they ever recovered from it. What Dolnick focuses on instead is the professional consequences of malpractice--and how today's psychotherapists dealt with the fact that their predecessors were wrong. This, however, is disturbing enough to be unforgettable. Every discipline produces theories with mistakes. Madness on the Couch shows us the chilling results when those are mistakes with peoples' souls.