In "The Couch, the Clinic, and the Scanner," psychiatrist David Hellerstein takes readers on a captivating journey through the evolution of psychiatry over the past several decades. With insightful essays and vivid anecdotes drawn from his own experiences practicing in New York City, Hellerstein offers a deeply personal and illuminating exploration of the profession's transformation.

Hellerstein's narrative is both enlightening and engaging as he navigates the shifting landscapes of psychiatric theory and practice. From the heyday of psychoanalysis to the rise of the Diagnostic and Statistical Manual and the current dominance of a neuroscience-inspired model, he skillfully traces the evolution of psychiatric paradigms and their impact on clinicians and patients alike.

One of the book's strengths lies in Hellerstein's ability to blend personal reflection with professional insight. Through his encounters with patients, colleagues, and scientific advancements, he paints a rich and nuanced portrait of the challenges and rewards of working in the field of psychiatry. His prose is evocative and eloquent, offering readers a glimpse into the often-hidden world of psychiatric practice.

What sets "The Couch, the Clinic, and the Scanner" apart is its emphasis on narrative medicine—an approach that prioritises the power of storytelling in understanding illness and healing. Hellerstein skilfully weaves together clinical observations, scientific discoveries, and personal anecdotes to create a compelling narrative that resonates with both professionals and lay readers.

Very good book for people interested in mental health. I enjoyed reading it. You learn a lot of new things about psychiatry.

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.

Thank you to Columbia University Press and NetGalley for an advanced reader copy in exchange for my honest opinion.

The Couch, the Clinic, and the Scanner is a very good description of the evolution of psychiatry from the not too recent past to present.

With hearing Hellerstein talking about his initial training and his experiences, then him having to adapt to a change in how psychiatry is practiced multiple times, I am left understanding why many people have left the field and why many people refuse to go into the field. I think Hellerstein is trying to point this out.

He starts with discussing his initial training which ran parallel to psychoanalysis to what is now neuropsychiatry. He goes into fantastic description as to what each stage has been like, what he has been able to take from one stage and apply to another, and where everything has coalesced and left him now. It shows that he is, and psychiatrists today in general, must be adaptable.

I need to add something else - one thing Hellerstein points out without actually fully coming out and say it - psychiatrists are human too, and like other doctors, they want to be there for their patients and give them the best possible care. However, at present best possible care in psychiatry is totally and has been totally different than the rest of medicine.

Personally, I'm glad to hear a psychiatrist's actual story. To people outside of the mental health system, I think this will give them some perspective as to what really goes on in psychiatry whereas to most people, well, they're clueless.

A great introduction into psychiatry.
It was interesting and you really felt invested in the stories told.
A soild three stars.
I would read other books by this author :)

Sometimes or most of the times as patients we need to understand what the doctors are gonna do "with us" and our body,

This book is a nice text about the health, care and clinics topics, letting you to know and understand a different view of this process.

Very recommended

This isn’t one of those medical memoirs which tells its tale solely through real-life case histories. Sure, the author uses accounts of his patients’ progress (or lack thereof…) to illustrate his themes, but much more is told from his professional perspective as a lifelong practitioner in American psychological / psychiatric medicine.

We follow David Hellerstein through the three defining phases of his career: the first struggling to apply the drawn-out Freudian talking cure, the second using the DSM handbook for diagnosis and practical pharmaceutical treatment, and his recent years using modern technology to investigate the biological origins of mental disorder.
The second two stages are much more interesting than the early part which – to be blunt – was am effort to wade through. This inevitably reflects the career of almost any medical practitioner, gritting through a ghastly decade of stressed-out insecurity and feelings of inadequacy about competency. If anything, this part is about how not to heal the mind…
However, the subsequent sections are far more engaging and rewarding, detailing genuine progress in helping patients – and, on occasion, lifting the lid on where things go wrong. The section on off-label prescribing offers huge insights. The case history of the family where depression was ‘infectious’ was extremely thought-provoking, as was the sad case where a couple were ‘cured’… only to find that their illness was all that united them.
The language may be a little technical for some (not sure how many people actually understand the process of epigenetic modification through methylation or acetylation, for instance). Even if you don’t recognise all the medical terminology there is plenty here to provide insight into modern methods of understanding and possibly treating depression, anxiety and a whole host of cognitive disorders.

So it’s worth slogging through the front end to get to the good stuff. Although you could actually skip most of ‘the couch’ segment and not miss much!
8/10

This is an interesting look at the progression of the mental health field from the 1970s through today. I like the combination of memoir, case studies, and scientific research. One big missing piece is metabolic research, but perhaps Dr. Hellerstein’s research is more focused on psychedelics right now. The formatting of the audiobook distracted from the content somewhat, but I assume all issues will be resolved in final published copies

Thanks to NetGalley and the publisher for the e-ARC. I really enjoyed this engaging journey through both the author's career as a psychiatrist, but also how the field of psychiatry has changed and evolved over the decades. A great read for those interested in mental health and really nicely written.

The Couch, the Clinic, and the Scanner
Pub Date: 09 May 2023

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.

Huge thank you to NetGalley and Columbia University Press for an advanced reader's copy in exchange for an honest review.

I appreciated the different eras of psychiatry and how science has progressed over the years. However, it felt overly verbose and that it could be trimmed down.

DNF due to document errors. I received a free digital copy for review and had trouble reading it due to formatting. The initial premise was interesting and what I read of it was interesting (before I had to give up due to getting a headache from trying to read the poorly formatted document). I'm sure this won't be a problem in the published document and therefore won't leave a negative review on Goodreads or Amazon.
The bit I did read had slow pacing and seemed to take a lot of words to not say much, however this may have picked up as he got into the meat of the book. It was interesting to see a bit of how psychiatry has changed over time and where he anticipates the field is going. He spoke from experience but also showed data where he could. It seems to be an in-depth book on the topic and may be a delight for any one that is interested enough.

I thought this book was absolutely wonderful. Not only does Dr. Hellerstein write a thoughtful narrative of his own career in psychiatry, but an uplifting and insightful account of the state of psychiatry today. As someone who has studied psychology and has personal experience with the world of psychiatry, I felt incredibly inspired and optimistic after reading Dr. Hellerstein's book. I will absolutely recommend this to anyone interested in the field or anyone who is generally interested in another perspective on the human condition.

The Couch, the Clinic, and the Scanner is a psychiatrist’s account of how the practice of psychiatry has changed over time. The approach to treatment of mental illness has radically changed throughout the years. As explained by Dr. Hellerstein, there is a new understanding that mental illness is now related to psychology AND biology. Dr. Hellerstein uses his own experiences as well as, stories about patients to provide insight into his work in hospitals, clinics, and research. This book details Dr. Hellerstein’s experiences of trying to help patients, while dealing with overworked hospital staff and doctors, and navigating medical bureaucracy. Thank you the publisher and NetGalley for the advance review copy in exchange for my honest review.

This book was very hard to read in the formatting of what it was given. I started skimming after awhile because I just couldn't handle it. I would have DNF'd except the book's concept was so interesting. Overall, I liked what I read but I was just so frustrated with the formatting of all the random spaces everywhere. I think the author examines these three eras of psychology in a pretty broad but interesting way. I do feel like it could have been a little longer and dived a bit deeper, but that probably wasn't the author's intent. Really decent for beginners.