He applied the “Page 99 Test” to his latest book, When Healing Harms: The Doctor Who Put a Hospital on Trial―and the Case That Shook Psychiatry, and shared the following:
Page 99 of When Healing Harms finds Dr. Raphael Osheroff trying to reclaim the life he had left behind ten months earlier. Once a prosperous physician who owned and operated a thriving dialysis practice, Osheroff had spent seven months at Chestnut Lodge, a prestigious psychiatric hospital outside Washington, D.C., where his doctors treated his severe depression with intensive psychotherapy alone. They documented his physical and emotional deterioration in painstaking detail (the relentless pacing, the forty-pound weight loss, the blackened toes) yet refused to prescribe antidepressant medication that might relieve his suffering. He then spent three months at Silver Hill Hospital in Connecticut, where medication and supportive psychotherapy began lifting his depression within weeks.Visit Eric Caplan's website.
But his homecoming came with no yellow ribbon tied around an old oak tree. What he returned to was not only an empty house, stripped of its furniture and even its grand piano, but a collapsing marriage and a court order denying him the right to visit his two older sons. Worse still, Dr. Robert Greenspan, his trusted associate and friend, “the brother I never had,” as Osheroff called him, had promised to preserve and protect his medical practice during his hospitalization but had been surreptitiously maneuvering to take it from him. When Osheroff returned to the dialysis center, Greenspan and another colleague refused even to speak with him. Having survived a devastating psychiatric illness, he now faced the loss of the professional life he had spent years building.
The Ford Madox Ford-inspired Page 99 Test works remarkably well for this book, although perhaps not for the most obvious reasons.
When Healing Harms recounts a landmark malpractice case that exposed a profound division within American psychiatry over the treatment of depression. Osheroff’s lawsuit against Chestnut Lodge became a cause célèbre, widely understood as a contest between psychoanalysis and biological psychiatry. At its heart, though, was a simpler question: whether a desperately ill patient had received the standard of care. Its consequences reached far beyond the hearing room, accelerating changes already underway in how America treats mental illness.
The case also raises a question psychiatry has yet to answer. The profession has long held unearned confidence in its theories of both mind and brain. It has given us the Oedipus complex and the chemical imbalance, but not yet the mechanisms that would confirm either. We keep substituting metaphor for mechanism. That need not harm patients, since treatments can work even when we cannot fully explain why. That said, uncertainty is no license to persist in a course of treatment that worsens, rather than relieves, a patient’s suffering. Osheroff’s doctors were so sure of their theory that they interpreted his deterioration as evidence that the treatment was working: he had to get worse before he could get better. When theory becomes dogma, the patient becomes collateral damage.
But the book is also about something more intimate: the distance between medical recovery and personal restoration.
Osheroff eventually prevailed in his legal battle, but vindication was not restoration. His victory could not repair his marriage, restore his bond with his sons, or return the years he believed had been stolen from him. His case became a defining episode in the history of American psychiatry, even as the man at its center struggled to rebuild his life.
Page 99 captures that paradox. Osheroff had recovered from his depression. What he had not recovered was the world he had lost.
Readers can follow each of the book’s notes to the underlying primary sources, wherever the law allows, at whhsources.org.
--Marshal Zeringue
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