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Book Review   |    
Benjamin A. Spinner
Psychiatric Services 2006; doi: 10.1176/appi.ps.57.8.1226
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by Lauren Slater; New York, W. W. Norton and Company, 2004, 256 pages, $24.95

Dr. Spinner is a resident in psychiatry at the Boston Medical Center.

Lauren Slater's book Opening Skinner's Box provides a description of and reflection on ten psychological experiments of the last century. Slater's choice of experiments, which includes Stanley Milgram's obedience experiment and Harry Harlow's experiments of primate attachment, points toward a concern with the social aspects of psychology. In this discussion of the limits and limitlessness of human behavior and human relationships, Slater chooses the Holocaust, which may be the central historical and psychological event of the 20th century, as one of her motifs. By doing so, she sets a tone in which psychology is intimately connected to social behavior and in which psychological inquiry gains immediacy in the aspiration for practical application.

Slater would have written a better book had she not littered her text with purple prose and poorly written novelistic passages. On Milgram's youth, Slater writes "[h]e had spent his childhood years in the South Bronx, where wildflowers grew in gutters and cockroaches scuttled across buckled linoleum." On Milgram's death by myocardial infarction, Slater describes the hospital scene: "[T]hey shocked him once, twice, who knows how often his body rose into the air, flailing like a fish's, shock shock, the black cardiac cuffs beating down." Such passages are unfortunate and peculiar distractions from what is a very informative book. Slater's unacceptable misspelling of names such as those of psychiatrists Thomas Szasz and R. D. Laing, among others, further detracts from the seriousness of the book.

One of the more engaging chapters in the book deals with the 1972 experiment of David Rosenhan, who recruited several participants to visit psychiatric emergency rooms with a single complaint: "I am hearing a voice. It is saying, 'Thud.'" They were to present no other remarkable symptoms or behavior. Rosenhan's participants were purportedly all admitted to inpatient units and diagnosed as mentally ill. Celebrants of Rosenhan's study have a certain sanctimonious "gotcha" glee and criticize psychiatry as a discipline unable to differentiate between illness and health, between insanity and sanity. Slater joins the ranks of the gleeful and repeats a version of Rosenhan's study herself, in which she reports to various emergency rooms with the same single complaint. Slater claims that she was prescribed numerous antipsychotic and antidepressant medications during her visits to the emergency department. Psychiatry and psychiatrists, by necessity, continue to refine diagnosis and treatment. The fact that the system is flawed translates into continued effort to improve our tools, and the fact that the system can be fooled seems to be only a superficial satisfaction for those who wish to criticize the field. Psychiatry will continue to evolve, along with its imperfections as a clinical field. Evolution, after all, is a progress not to perfection but to improvement.

Slater's final chapter is a thoughtful conclusion in which she raises the hope that experimental psychology might inform clinical psychiatry and that the stamp of several remarkable experiments might remain as a reminder of the need to progress by provocation. She stretches her criticism too far when she complains that psychotherapy has failed to incorporate the lessons and inquiries of psychology. "Psychotherapy," writes Slater, "is all about feeling good, to its detriment, I believe." Such silly generalizations tarnish Slater's criticism and her hopes. Nonetheless, the moral context in which she frames psychiatry remains a crucial context in which to continue to study human behavior.




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