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In psychiatry, it seems like our traditions are often ignored or discarded as being outdated. Do we not have some time-tested literature that is still relevant to our psychiatric times?
As I awoke on Thanksgiving morning, I thought of many things for which I was grateful. I was primed for that since our family holiday theme for this year was to document what we were thankful for over the 36 days from November 13 to December 18. As usual, I thought of my wife first, then the rest of my nuclear family, my extended family, and my ancestors. I felt fortunate to have dreams of Thanksgivings Past instead of Scrooge’s Ghost of Christmas Past.
As I started to become fully awake, I then thought of what I was grateful for at work. I must have been dreaming of the day before, which was one of my part-time days working at prison. During that day, I had been e-mailing back and forth with a former director of the Illinois Department of Corrections, Peter B. Bensinger. That connection had just been made by my son. In a High Holy Day sermon, my son had mentioned that I took on a new challenge at a late age by going to work at this prison. That snippet had drawn the attention of Mr Bensinger, so some interaction seemed inevitable.
As we discussed our mutual challenges in a prison system, one common reference readily emerged. That was Karl Menninger, MD, perhaps the most renowned American psychiatrist, who had founded the Menninger Clinic. He had provided valuable consultation to Mr. Bensinger. For me, many of Dr. Menninger’s books, including the prison-related The Crime of Punishment (Viking Press, 1968), became early guideposts for my emerging career. Of the dramatic Illinois system transformation led by Mr Bensinger back at that same time period, Dr Menninger had concluded:
“The thing he has demonstrated most clearly is that we don’t have to continue cruel and inhuman prisons. They can be changed, and in the long run they benefit everyone.”
Then I wondered. So why hadn’t I ever consulted my old copy of Dr Menninger’s work to help guide my work in prison? Indeed, I had contacted peers for advice and reviewed the current literature, but nothing from the past? Why not? Were such references obsolete? Irrelevant?
Ever since my son had become a Rabbi, I’ve noticed a profound difference between how religious leaders view and use their tradition and we psychiatrists ours. They are continually referring to the Old and New Testaments to understand current challenges. Sometimes the reference is literal; at other times there is a search for hidden meanings. Almost always there is a connection to our current lives. Of course, religious tradition spans thousands of years, while ours is more like a hundred.
In psychiatry, it seems like our traditions are often ignored or discarded as being outdated. For instance, we seem to rejoice more in proving where Freud was wrong, rather than how his work can still inform our practices. The same seems to hold for Jung, Menninger, and other psychiatric forefathers and foremothers. How often is our tradition referred to in continuing education? Not too often in my academic and continuing education experiences. Do we not have some time-tested literature that is still relevant to our psychiatric times?
So I decided to go to our basement rather than my office. It would be at home where my old favorites would be kept, while current references would be at the office (if not stored on the computer). Hopefully, none were thrown out during a “spring cleaning.”
Ah, yes, here some of them were. The dust partially covered the names on the spines and the books were in no particular order, as if I wouldn’t be needing to find any of them quickly again.
First noticed, probably because I had been discussing Karl Menninger, was the slip-cased, 2-volume set of A Psychiatrist’s World: The Selected Papers of Karl Menninger, MD (The Viking Press, 1959). Upon opening, to my surprise I saw that this was a limited edition, No. 898 out of 990, signed by the author: “For a generous and artistic man, Harry N. Abrams, 8/12/70.” I didn’t remember how I got it. In it, among many other topics, were his reservations about diagnostic categories. His ideas might be worth reviewing, given our contentious debates about ever more categories for DSM-5, I thought. Briefly, way back in the mid-1950s, as he felt the numbers of diagnostic categories were already increasing inappropriately, Dr Menninger recommended a unitary concept of mental illness. Though not precluding some specific diagnoses, this concept was of one illness with 4 degrees of disorganization: nervousness, neurosis, episodic or excessive discharges, and severe disorganization. My, wouldn’t this be nice and easy to use?
Related to this book, out popped Robert Cole’s The Mind’s Fate: A Psychiatrist Looks At His Profession (Little Brown & Co., 1975). Though expanded for a revised edition in 1995, the original was given to me when I finished residency training in 1975. Maybe whoever gave me the book already knew I’d be an iconoclast like Dr Coles, who focused on the moral development of children of different cultures, as well as on the interaction of his strong Christian beliefs with being a psychiatrist.
More reader beaten was my book by William James, The Variety of Religious Experiences (Collier Books, 1961). Not very religious myself at the time, I recalled my fascination with the psychology of such experiences in the chapters on “Conversion,” “Saintliness,” and “Mysticism.” Akin to crime, where did religion end and psychiatry begin, and how much may they be interconnected?
But actually, the most worn book of all was The Inner World of Mental Illness, edited by Bert Kaplan (Harper and Row, 1964). I must have first read this in college at the University of Michigan, given the inscription by my then-recent girlfriend and soon wife-to-be. We had done a psychology class together at Northville State Hospital and these patient descriptions gave me some more sense and empathy for how the patients in this very overcrowded hospital looked and communicated. Those chapters that were starred under the section The Psychotic Experience, I had read more than once. Later on, during residency training, I even took some Thorazine to briefly try to experience some of the side effects they complained about. Now, I noticed and plan to read some I missed from the section Some Historic Statements, which include: “My Life had Come to a Sudden Stop: I Was Able to Breathe, to Eat, to Drink, to Sleep . . . but There Was No Real Life in Me,” from My Confession by Leo Tolstoy, and “The Doctors Do Not Understand My Illness,” from the Diary of the famous dancer, Vaslav Nijinsky.
Nearby were some other books that had helped me to try to be therapeutic with those who were psychotic. This was from a time when the schizophrenogenic mother and intensive psychotherapy were being reconsidered in favor of a more biological explanation and medication. There was Therapy In the Ghetto: Political Impotence and Personal Disintegration by Barbara Lerner (John Hopkins Press, 1972). What a comfort it had been for a first year resident to find that her research indicated that inexperienced therapists, as long as they had respect, curiosity, some supportive supervision, and a modicum of enthusiasm, could get somewhat better results than more experienced therapists. No wonder that recently, as opportunities for our residents to do some psychotherapy with those with schizophrenia were diminishing, I mentioned this in protest.
A supplement to that book in my early years was The Treatment Relationship and Its Impact: A Study of Psychotherapy With Schizophrenics, edited by Carl Rogers, et al (University of Wisconsin Press, 1967). Yes, this is the same Carl Rogers who later became so well known for his reflective and supportive psychotherapeutic approach, early on showing how it could be used for those having schizophrenia. It seems to me that I still try to mirror him.
The last I pulled out that I could carry up the steps was Magic, Faith, and Healing by Ari Kiev (The Free Press, 1964). Dr Kiev was one of the pioneers of what has become known as cultural psychiatry, one of the main foci of my career. In fascinating cross-cultural reports, it became clearer how the role of the shaman was transformed into the psychiatrist or psychologist, and how cultural values influenced the expression and response to psychiatric illness.
Take that back. I had pulled out one more classic, but I think I’ll wait awhile before I peruse it again. That is Ernest Becker’s The Denial of Death (The Free Press, 1973), also released and read during my psychiatric residency. Not to be superstitious or anything that would be unbecoming for a psychiatrist, but I’m getting on in years, and Dr Becker died a few months after this book on denying (the fear of) death was published. Surely, though, this book survives and transcends his death.
If interested in any of these books, they must be easy to locate online nowadays. I know that it is often recommended to re-read classic literature that one had read many years before. Why shouldn’t the same be true for psychiatric classics? I can’t wait to do this again, maybe next year.
In the meanwhile, do you have some old favorites around or that you remember? If so, what would you recommend to us?