Couch, the Clinic, and the Scanner

Over the past several decades, psychiatry has undergone radical changes. After its midcentury heyday, psychoanalysis gave way to a worldview guided by the Diagnostic and Statistical Manual, which precisely defined mental disorders and their treatments; more recently, this too has been displaced by a model inspired by neuroscience. Each of these three dominant models overturned the previous era’s assumptions, methods, treatment options, and goals. Each has its own definitions of health and disease, its own concepts of the mind. And each has offered clinicians and patients new possibilities as well as pitfalls.The Couch, the Clinic, and the Scanner is an insightful first-person account of psychiatry’s evolution. David Hellerstein—a psychiatrist who has practiced in New York City since the early 1980s, working with patients, doing research, and helping run clinics and hospitals—provides a window into how the profession has transformed. In vivid stories and essays, he explores the lived experience of psychiatric work and the daunting challenges of healing the mind amid ever-changing theoretical models. Recounting his intellectual, clinical, and personal adventures, Hellerstein finds unexpected poetry in hallways and waiting rooms; encounters with patients who are by turns baffling, frustrating, and inspiring; and the advances of science. Drawing on narrative-medicine approaches, The Couch, the Clinic, and the Scanner offers a perceptive and eloquent portrayal of the practice of psychiatry as it has struggled to define and redefine itself.

What is the self to itself? In this wise and beautifully written book, psychiatrist David Hellerstein suggests that we are the tools we use to measure and medicate ourselves. Over a few decades, the same anxious patient has been interpreted as having father issues, a chemical imbalance, and troubles embodied in a brain scan. All may be true and useful. All may deceive and keep patients from getting help. Must we see some views of self as showing progress over others? Hellerstein‘s personal and provocative narrative will spark necessary conversations., David Hellerstein began his career by learning psychoanalysis. Forty years later, he conducts groundbreaking research on brain imaging, neuroplasticity, and personalized therapeutics. In this warm, insightful, and honest book, Hellerstein tells two coming of age stories: a fascinating account of the evolution of modern psychiatry and a deeply moving memoir of his own growth as a psychiatrist and as a human being., David Hellerstein provides engaging and remarkably honest insider’s perspectives on the past few decades of psychiatry in America, a fascinating period of struggles to understand one of the last great scientific frontiers—the human brain. His personal and professional experiences shed important light on this complex world., The Couch, The Clinic, and the Scanner is a well-written autobiographical account of the transformations of psychiatric practice over the past four decades.

David Hellerstein is professor of clinical psychiatry at the Columbia University College of Physicians and Surgeons and director of the Depression Evaluation Service at the New York State Psychiatric Institute. His previous books include Heal Your Brain: How the New Neuropsychiatry Can Help You Go from Better to Well (2011); the memoir A Family of Doctors (1994); and two novels. Hellerstein is currently researching psychedelic treatments of depression and other disorders.