David Hellerstein

Couch, the Clinic, and the Scanner

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.