Shrinks rapped

Psychology: Lauren Slater, the Boston-based clinical psychologist, has long used a novelistic, confessional style in writing…

Psychology: Lauren Slater, the Boston-based clinical psychologist, has long used a novelistic, confessional style in writing about patients, her pregnancy, her illnesses, taking Prozac, and so on.

Here, she vividly "narrativises" some classic American experiments in psychology and psychiatry, and the personalities behind them. It makes for compelling, often outlandish reading, and the book has already caused quite a flap in certain quarters.

Somehow framing her thesis, Slater re-evaluates the oft-demonised behavioural psychologist, B.F. Skinner (1904-90). Skinner's empirical approach to human and animal behaviour - deliberately discounting internal, cognitive processes - led to his idea of a technology of human behaviour which scarified a post-war US increasingly besotted by the idea of personal freedom.

Re-reading Skinner's later philosophical writings, such as Beyond Freedom and Dignity, Slater emphasises Skinner's fundamentally humane principles, and makes much of his influential championing of "positive reinforcement", rather than punishment, in education and child-rearing.

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Along the way, Slater toys with, but ultimately refutes, the myth that Skinner experimented with his daughter Deborah by confining her to a "Skinner box", and that she later committed suicide. Slater tracked down Skinner's elder daughter, Julie Vargas, now a professor of education, who asserts that Skinner merely built a safe, warm, air- conditioned, Plexiglass-walled baby-bed for Deborah, who is now a "successful artist" based in London. (Deborah, whom Slater never contacted, has reacted angrily to Slater's book, but has not sued, it seems.)

Slater then daisy-picks experiments from the 1950s and 1960s, which illustrate how our immediate environment virtually determines our behaviour. First up is Stanley Milgram's oft-cited experiment which, using a fake electric-chair scenario, demonstrated that 62 to 65 per cent of us, in the absence of aggression, follow orders to the point of lethally harming someone. Milgram's controversial findings were immediately taken to explain aspects of the Holocaust, as was work by John Darley and Bibb Latané, which showed that, if in a group, 65 per cent of people will not respond to another person's cries for help - thanks to a "diffusion of responsibility" and an etiquette so incapacitating it can override even mortal fear.

In Slater's most provocative chapter, she considers David Rosenhan's audacious 1972 experiment, which interrogated psychiatry itself. Rosenhan and eight other volunteers arrived, deliberately dishevelled, at various US psychiatric hospitals, claiming to hear a voice saying "thud" but otherwise acting normally. All but one were diagnosed with paranoid schizophrenia, and all were hospitalised for up to 52 days, during which they witnessed dehumanising treatment of patients. Predictably, the psychiatric establishment howled at the publication of these results in Science. One hospital challenged Rosenhan to send more pseudo-patients, and soon boasted of having weeded out 41 - but Rosenhan had sent none.

Thirty years on, Slater herself claims to have shown up at nine psychiatric hospitals with the same "symptom": nervously concealing her own psychiatric history (as a teenager, she was hospitalised for anorexia and self-harm). After brief but respectful consultations with doctors (the longest lasted 12 minutes), she is prescribed "25 anti-psychotics and 60 anti-depressants" (Slater has since clarified that this refers to the total number of pills, not to different drugs). She is also diagnosed, rather seriously, with "depression with psychotic features", but is not admitted to any hospital. Oddly, Slater draws few conclusions - other than that medication, rather than pathological theory, now seems to drive psychiatric diagnosis.

Already, academics from seven US universities have asked Slater to name the hospitals she visited. The eminent psychiatrist, Robert Spitzer, also objects to the way he is quoted in the book, gloating over the tragedies which have since befallen Rosenhan. (Spitzer himself is currently controversial for claiming to have identified 200 people who have been sexually reoriented from gay to straight by psychotherapy. He found his subjects through "ex-gay" evangelical organisations in the US.)

Indeed, some of Slater's observations seem downright barmy. Harvard psychology professor Jerome Kagan denies diving under his desk and remaining there while Slater interviewed him. And what to make of Slater herself visiting Skinner's preserved workroom, where she apparently nibbled the chocolate Skinner was eating when he died in 1990?

Another interviewee to resent Slater's characterisation of her is celebrity psychologist Elizabeth Loftus, who testified for the defence in the cases of the Hillside Strangler, the Menendez Brothers, Ted Bundy and Oliver North. But Loftus is more infamous for her 1993 demonstration of the unreliability of "recovered memory" of childhood sex abuse. In Loftus's experiment, subjects were presented with a false account (written in connivance with their families) of a childhood incident of being lost in a shopping mall. Twenty five per cent "remembered" the incident, embellished it mightily, and were deeply shocked when debriefed.

Slater then ventures into the neurology of memory with Eric Kandel, who demonstrated learning at the cellular and molecular level in sea-slugs. Slater also looks at Brenda Milner's long-term study of the unfortunate "HM", who had the hippocampus suctioned out of his brain in 1953. He still cannot form new memories, and weeps afresh every time he hears his mother has died - back in the 1960s.

This is Slater's cue to delve into the ghoulish origins of psychosurgery. Inspired by the pioneering Portugese physician, Antóni Egas Moniz, US medics Walter Freeman and James Watts developed the 10-minute lobotomy in the 1930s: tap-tapping an unsterilised blade through the upper eye socket, and jiggering it around - a bit like using a wire coathanger to unclog a drain. They reported miracle cures - indeed, one patient later ran his own psychiatric clinic. Freeman announced: "Lobotomy patients make good citizens."

But there were also deaths, seizures, burst blood vessels, infections and blades lost inside people's heads. Nonetheless, US lobotomy rates soared from 100 in 1946 to 20,000 in 1949 (when Moniz won his Nobel Prize). Serious side-effects caused a drastic decline over the 1950s, when the first psychiatric drugs - despite causing stupefaction, sweating and motor dysfunctions - seemed less invasive.

Curiously for someone who straddles the clinical fence, Slater defends Moniz, considering the "cost-benefit ratio" of experimenting on patients in "rapid decline". Slater herself monitored one patient in 1999, a 40-year-old Texan who, having exhausted electro-shock treatment and copious medication, had a "cingulotomy" which hugely reduced his chronic Obsessive-Compulsive Disorder. Slater argues that newly refined "lobotomy" techniques may be more site-specific than psychiatric drugs - even if different psychosurgeons routinely target different sites in the brain. Psychosurgery is now outlawed in several US states.

Musing on her experience as a therapist - and her own drug regimen - Slater bemoans the indiscriminate manner in which drugs such as Prozac are prescribed, even though we know very little about how they work. She cites figures: roughly 30 per cent of patients respond robustly to psychiatric drugs; 30 per cent achieve only moderate relief; while others don't respond at all. Of those that do, 60 per cent develop tolerances which eventually render the drugs useless.

It's all gripping material, which Slater ploughs up in a most arresting, if often extremely unresolved manner. Ultimately, for Slater, studies of the mind have not congealed into any coherent totality of approach. She concludes that neither psychology nor psychiatry can claim to be "sciences", as they both still lack firm knowledge of "practically any physiological substrates to mental illness". As such, the pomposity of psychiatrists, she says, masks an insecurity surrounding their ignorance.

Let's hope no patients get caught in the crossfire.

Mic Moroney is a writer and critic