Shrink Rap: Three Psychiatrists Explain Their Work

As a psychiatrist, I get many calls from people in distress whose questions follow a common theme: How do I find a therapist? Do you prescribe medications? How do you work with patients? What is your fee? I serve as a psychiatric navigator to help these callers decide whether my office or some other venue should be their first stop on the journey of mental health care. I can recommend a book that might also help guide them along their way.

Shrink Rap grew out of a blog started by consult-liaison psychiatrist Dinah Miller, here joined by her fellow bloggers, forensic psychiatrist Annette Hanson and inpatient psychiatrist Steven Roy Daviss. The book, structured around fictional case vignettes, presents the different pathways through which one enters the mental health system. Through this book, patients can better judge whether they are being offered the optimal treatment modality and can more effectively assess the stylistic match between themselves and their therapist. Shrink Rap further explains the impact of economics and insurance coverage on patient choices.

However, Shrink Rap is more than a guide to starting and sustaining a treatment. It offers information on the diverse principles and history of concepts in psychiatry, including informed consent, ECT, psychotherapy, consult-liaison psychiatry, inpatient psychiatry, psychopharmacology, forensic psychiatry, and how psychiatrists think about their work.

To cite one example, there is the case of Eddie, seen first as a traumatized child who has sustained many losses, then as a young adult accused of rape. Eddie wants to enter an insanity plea. The authors make clear how this defense is determined and why it was not appropriate for Eddie. Convicted and sent to prison, Eddie strives to become a model inmate, earning his GED and completing a relapse prevention program. There is a poignant exchange with a prison psychiatrist where Eddie learns that, despite his accomplishments, the sex-offender statutes might send him to a psychiatric hospital at the end of his term. Initially buoyed by the prospect of more intensive psychiatric treatment, he is taken aback when told that such a civil commitment might be for life.

In fact, it is Eddie’s case that illuminates my one criticism of this otherwise well-organized, informative, and reader friendly book: the sheer volume of information about incarceration and mental illness, including the McNaughton Act, sociopathy, psychopathy, sex offenders, history of interrogation, and more. I found myself on an unwanted detour from Eddie’s compelling narrative. An appendix or two might have left the story intact. Do the authors want this book to be a reference for patients and physicians or a breezy, case-oriented read-through? This apparent weakness, however, is also the book’s strength depending on what a particular reader seeks from Shrink Rap.

The chapters concerning psychotropic medications are equally expansive, but these work better, as they remain more closely tethered to the clinical case at hand. Here readers learn about the types of psychotropic medications, how a medication is chosen for a given patient, side effects, the interval before a medication takes effect, and a host of other considerations.

I will be recommending Shrink Rap to my patients and colleagues. No matter how they use this book-as a resource, a collection of case studies, or a straight through read-they will feel satisfied with knowledge gained.