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The initial takeaway from Osheroff v. Chestnut Lodge was that drug treatment was superior to talk therapy.

The case found that psychoanalytic psychiatry should cease being an exclusive treatment option for inpatients.

New information about the case paints a far more complex picture.

When Eric Caplan, a medical historian, visited someone close to him being treated for depression at McLean Hospital in Belmont, MA, in the early 2020s, next to the reception was a sign that read—“ECT and Ketamine”—with an arrow pointing the way.

Like many other psychiatric institutions across the United States, Caplan explains in When Healing Harms: The Doctor Who Put a Hospital on Trial—and the Case That Shook Psychiatry, published today by the University of California Press, “treatment for those with depression now focused almost exclusively on the brain—procedures, medications, neuromodulation—with little attention to the mind or person inhabiting it.”

It wasn’t always that way, least of all at McLean: “Once a bastion of psychoanalysis and psychotherapy, McLean had largely abandoned any attempt to alleviate the disorder through conversation.”

An End to the Talking-Cure?

The dwindling of treatment options to two such highly contested measures, electroconvulsive therapy and ketamine, each with track records documenting numerous short- and longer-term harms, owes much to the influence of a single legal case, Osheroff v. Chestnut Lodge.

Settled before trial in 1983, though quickly assuming the status of a landmark ruling, the case was widely debated in American psychiatry journals and at conferences. The settlement reached helped determine institutional liability and inpatient protocols for years, if not decades.

The case was meant to put Chestnut Lodge, a Maryland-based psychiatric hospital, on trial for not prescribing antidepressants and tranquilizers to Raphael (“Ray”) Osheroff, an MD and well-regarded kidney specialist. On the verge of a painful third divorce and an ugly custody battle from his second marriage, Osheroff had voluntarily checked himself in for inpatient treatment.

He was diagnosed with severe........

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