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The Couch, the Clinic, and the Scanner: Stories from Three Revolutionary Eras of the Mind

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Winner, 2023 Choice Outstanding Academic Title 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. Read more Read less

Publisher ‏ : ‎ Columbia University Press (May 9, 2023)


Language ‏ : ‎ English


Hardcover ‏ : ‎ 272 pages


ISBN-10 ‏ : ‎ 0231207921


ISBN-13 ‏ : ‎ 28


Item Weight ‏ : ‎ 1.2 pounds


Dimensions ‏ : ‎ 6.2 x 1.1 x 9.4 inches


Best Sellers Rank: #510,977 in Books (See Top 100 in Books) #422 in Medical Psychoanalysis #501 in Psychiatry (Books) #602 in Popular Psychology Psychoanalysis


#422 in Medical Psychoanalysis:


#501 in Psychiatry (Books):


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Top Amazon Reviews

    • Excellent book!
Gives compelling, behind-the-scenes perspective on the role of the psychiatrist and its evolution over the past fifty years. Written by a leading, thoughtful practitioner and researcher; Dr. Hellerstein is as critical of the profession as he is hopeful for what it can do to truly heal people. For the latest in psychiatric thinking, read this book! ... show more
Reviewed in the United States on May 29, 2023 by Laurie Manfra
    • A Fascinating Look at Psychiatry’s Evolution
The Couch, the Clinic and the Scanner provides a compelling account of how psychiatry has changed as experienced by a practitioner (from1980 to the present). It is a fascinating inside and candid look at Dr. Hellerstein’s life, his patients and his research. What makes The Couch, the Clinic and the Scanner especially captivating is that Hellerstein’s career and experiences mirrors the evolving science of psychiatry. The Couch, the Clinic and the Scanner is not at all technical or clinical. In fact, it reads more like a memoir, which it sort of is, while also reporting on the recent history of psychiatry. The title aptly captures the three stages of psychiatry’s recent evolution and Dr. Hellerstein’s career. The Couch refers to the “talking cure” advanced by Freud. Hellerstein discusses his early training and his experiences applying psychoanalysis. When the DSM-III was released in 1980, psychiatry went through a major transformation. This third version of the DSM was so revolutionary because it replaced psychodynamic information with explicit diagnostic criteria and utilized a neutral approach with respect to the causation of the illness. The Clinic stage brought about new treatments including psychotherapies to target particular diagnoses. The third and current stage consists of brain imaging (MRI and Petscans) and alternative therapies that are more personalized treatment of the individual. Neuro-imaging techniques are becoming useful diagnostic tools but the research here is ongoing. This approach considers that mental illness causes damage to the brain if untreated and that proper treatment may include a healing of sorts. Treatments include supplements, yoga, mindfulness, exercise, and psychedelics. Dr. Hellerstein, besides sharing his experiences and his patients, also asks thoughtful questions throughout his book, such as Has psychiatry improved through these three eras? Does each one build on the former? Are patient treatments more successful? Anyone interested in psychology or psychiatry would like this book and find it to be very interesting and informative. Due to my own background in psychology, I found Dr. Hellerstein’s account to be an important record of how both diagnoses and treatments have changed over the years and where we are headed. I hope that in a few years or so, Dr. Hellerstein will inform us of the progress made in the Age of the Scanner ... show more
Reviewed in the United States on June 14, 2023 by Zgirl
    • A most enjoyable trip!
I purchased the book, interested in the trends in psychology. Hence, I was expecting some boring textbook but was fully engaged in this memoir by a road warrior clinical psychotherapist on his journey up from the couch to his admirable clinical work and onto the latest in brain activity exploration then as a disciple of the therapeutic psychedelic pioneers and yogic masters. Should be a dramatic Netflix series, but read it first! ... show more
Reviewed in the United States on September 26, 2023 by Indiana Steven
    • Introspective view on the past, present, and future of psychiatry
This book is a wild, introspective ride, and not anything I would have expected given the docile cover. I expected a tour through the history of psychiatry, but I received worlds more. I got the tour of an amazing man's career, starting from his training and early attempts at psychoanalysis, the emergence of the DSM, to the heigh of big pharma pushing pills on everyone for everything, to the age of brain imaging, and finally to the him starting his own psilocybin (aka, magic mushrooms) center at Columbia University! All along the way, there are incredible personal stories about his career and personal life, client stories (some sad, some lighthearted and entertaining-- perfect balance of both), and a thought-out connection of how one same case could be interpreted and treated across all three different ages of psychiatry. Above all, David Hellerstein's rollercoaster career path is inspiring and relatable to anyone who ended up in a job they never expected but one they couldn't imagine their lives without. He trained as a psychoanalyst at Payne Whitney (the center famous for having clients like Marilyn Monroe!), realized that wasn't a great fit for his personality or abilities, decided to be a clinician at a city hospital, succeeded at that path to the point of gettin a leadership position, before transitioning into academic research, something he vowed to never do. Regardless of this nonlinear career trajectory, Hellerstein still made a huge impact on psychiatric research, late starts aside. He is a well-established researcher with over 100 publications, 4,000+ citations, and collaborates with field giants like Brad Peterson. Throughout the book, Hellerstein is stunningly open, honest, and blunt about his life, career, and the past, present, and future of the field of psychiatry. This book felt like having a really long lunch chat with a senior professor rather than reading a history nonfiction book. 10/10, highly recommend. ... show more
Reviewed in the United States on June 1, 2023 by Dea

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