Johns Hopkins Magazine

Psychiatrists talk shop

A frank discussion of the field, with the doctors who practice it
What is the difference between psychoanalysis, psychotherapy, and psychiatry? Why do psychiatrists respond to patients’ questions with a question? Do psychiatrists still use shock treatments? How, exactly, does the insanity defense work? What’s so bad about Xanax, anyway?
Psychiatrists Dinah Miller, Annette Hanson, and Steven Roy Daviss answer these questions and more in Shrink Rap, their straight-talking guide to psychiatric care.

When Miller, a consulting psychiatrist for the Johns Hopkins Community Psychiatry Program, returned home after spending two weeks in Louisiana working with Hurricane Katrina victims, she needed to write. “At first I couldn’t write, and then I couldn’t stop writing,” she says. So, along with two tech-savvy colleagues—Hanson, a prison psychiatrist with appointments at Johns Hopkins Hospital and the University of Maryland, and Daviss, a hospital-based psychiatrist and assistant professor at the University of Maryland School of Medicine—she created the blog Shrink Rap. On the heels of their blog’s popularity and at Daviss’ insistence, the doctors also embarked on a podcast, which they named My Three Shrinks.
The book grew out of these successful efforts. In it, readers are afforded a “behind the curtain” view of psychiatry from the eyes of patients and from the perspectives of doctors. Each chapter begins with a brief narrative vignette that anchors the information in real-life experiences. Meet Eddie, for example, a young man suffering from mental illness who is arrested on rape charges. Instead of talking in abstract terms about psychiatry in the correctional system, the authors follow Eddie’s story from the time he is a middle school student diagnosed with ADHD through his difficult teenage years with an unstable home life to his struggles with substance abuse and eventual incarceration. Using his story as a jumping-off point, they explain concepts such as mental health court, antisocial personality disorder, forensic psychiatry, and why the insanity defense isn’t exactly a get-out-of-jail-free card.

Although the patients and doctors portrayed in the vignettes are fictional, the authors write, “it’s probably safe to assume that there is a little bit of us in these responses and reactions that we’ve borrowed from our own internal lives to make our fictional psychiatrists all the more real.” In a profession where they are required to be a blank slate—not cultivating friendships with their patients or divulging details about their own personal lives—they remind us that shrinks have feelings, too.
Shrink Rap provides a little something of everything. Because the authors work in diverse areas of psychiatry—Miller works in clinic settings and has a private psychotherapy practice, Hanson works in a correctional facility, and Daviss works in ER and hospital settings—they each bring a distinct area of expertise to the issues they tackle. The authors have an easy rapport, occasionally trading jokes with one another on their blog and in their podcast episodes. The book reflects their collaborative effort and offers insight into a number of different issues and settings. The doctors see eye to eye on many things; however, they don’t shy from issues that psychiatrists often disagree on. In fact, an entire chapter is devoted to “Things We Argue About,” covering everything from health care reform to medical marijuana to which disorders should (or shouldn’t) be included in the Diagnostic and Statistical Manual of Mental Disorders.
Reading this book is like having a significant other who happens to be a psychiatrist—it’s more information than you’d get talking to someone at a cocktail party, but at 272 pages, it avoids being as dense or exhaustive as a textbook. Miller, Hanson, and Daviss confide the things that frustrate them (convoluted insurance practices that hinder good patient care) and the shortcomings of their field (disagreement over classifying disorders). Using this tell-it-like-it-is approach, they demystify psychiatric practices that have long been stigmatized, such as electroconvulsive therapy (which, as it turns out, is still used today, although it looks nothing like the punishment wielded by Nurse Ratched in One Flew Over the Cuckoo’s Nest). They also shed light on the insurance process, explaining why a patient might be stuck waiting hours in an ER and why some private practice psychiatrists don’t accept health insurance.
Although they explain psychiatry in all its merits and failings, acknowledging the limitations of their field, these are clearly three shrinks who love their jobs. “This is an exciting time to be a psychiatrist,” they write. “It is also a hopeful time for our patients.”
—Kristen Intlekofer