Psychiatrist Peter Kramer looks back—and always, around

Before he even began his medical training, psychiatrist Peter Kramer already thought of himself as a writer. He never let go of that self-conception.

Now a clinical professor emeritus of psychiatry and human behavior at Brown University, Kramer graduated from Harvard in 1970 with an undergraduate degree in history and literature. “And I thought, ‘why should I give that up?’” he recalls. Over the course of his career, he has followed his interests where they take him.

Best known as the author of 1993’s influential bestseller Listening to Prozac—an examination of the social and ethical implications of what was then a new kind of drug for treating depression—Kramer has seven books currently in print. They include Should You Leave? A Psychiatrist Explores Intimacy and Autonomy—and the Nature of Advice (1997), Spectacular Happiness: A Novel (2001), and Freud: Inventor of the Modern Mind (2006). For 10 years, Kramer was a columnist for trade papers, writing an essay a month. He has published criticism of literature, theater, film, television, cooking, and even cartooning.

He sees himself swimming against the tide of a society increasingly defined by specialization: “I’ve tried to take a stance, whether that was common in the profession or the culture or not, to feel free to say things about other things.”

It used to be common for psychiatrists to be consulted on a wide range of questions, from foreign policy to human behavior in all manner of contexts. But over the course of Kramer’s career, ideas about the proper sphere of psychiatric expertise and the evidence psychiatrists can properly draw on has changed. That transformation is the subject of a lecture he’ll will give on November 8, as part of the Humanities Center Public Lecture Series.

Sigmund Freud “wrote about anthropology and religion and sociology and politics—he had a very broad range of what his standing as a psychoanalyst permitted him to do,” says Kramer. “And the question is, what happened to that?”

Kramer began treating patients in the early 1970s; he closed his practice earlier this year. A specialist in clinical depression, he has been a pivotal figure in debates about depression’s nature and treatments during the intervening years. The Atlantic calls Kramer a “reluctant warrior, or perhaps more accurately a cautious one” on the subject of antidepressant medications. “He makes a case for psychiatry itself as a humanistic science that bridges the impersonal ideals of the laboratory and the pragmatic exigencies of clinical intervention,” writes Jonathan Rosen in the magazine’s review of Kramer’s 2016 book, Ordinarily Well: The Case for Antidepressants.

The book’s context is a dispute over the kind of evidence that should be relied on in evaluating the efficacy of antidepressant drugs. “This book is about two influences on medical practice: rigorous trials and clinical encounters,” Kramer writes in the introduction. He worries that the first—the touchstone of evidence-based medicine—doesn’t leave sufficient place for the knowledge physicians develop in working directly with patients. He calls evidence-based medicine “an attempt to make what we call evidence narrower than it used to be, so that the question, for doctors, is, what counts as evidence?”

Questions about evidence also cut to the heart of a doctor’s expertise, he contends. “When I was entering the field, there was a very broad scope afforded to psychiatrists, just by virtue of their profession. And here we were years later, not asking doctors to comment on broad things, but also doubting the very narrow, specific things that doctors know well.”

In the culture at large, matters of expertise and evidence are generally contentious, but psychiatry, he suggests, is in an especially tenuous position. The anti-psychiatry movement of the 1960s and 1970s—what he calls a response to psychoanalytic “over-reaching”—has become “a critique of medical psychiatry and pharmacology over-reaching,” he says.

Kramer is widely known not just as a practitioner of psychiatry but as one who reflects on the field and its implication for patients and society. As psychiatry has changed, its ties to other areas of intellectual inquiry have altered, too.

“I think the humanities have been very broadly influenced by a form of psychiatry that really is in psychiatry’s past,” he says, “and they’re much less influenced by psychiatry as it is now.”