By Robert Jay Lifton; New York: Free Press; 2011 • 448 pages

Reviewed by H. Steven Moffic, MD
Dr Moffic is a Tenured Professor in the departments of psychiatry and behavioral sciences and of family and community medicine at the Medical College of Wisconsin in Milwaukee. He is a regular blogger on www.psychiatrictimes.com

Although memoirs have become all the rage, they are rarely written by anyone in the field of psychiatry . . . and for good reason. The nature of our clinical work generally should be quite private.

Witness to an Extreme Century is an exception. Early in his career, the now 85-year-old psychiatrist Robert Jay Lifton recognized that regular clinical work took away too much emotional energy from his scholarly projects, so privacy was much less of a concern. Fortunately, though, Dr Lifton was able to maintain the perspective of an ethical and healing clinician in his research interviews.

His decision not to focus on his personal life leaves us with a series of expeditions, in what turns out to be a Campbellian heroic journey. Think of him as the Indiana Jones of the mind; Connecticut Bob, if you will. He encounters what he deems to be manifestations and ramifications of evil as he revisits the prize-winning books, notes, and memories of those "brainwashed" by Chinese thought reform; fallouts of the atomic bombing of Hiroshima; Viet Nam protests; surviving Nazi physicians; and more. 

Along the way, we also meet too many fascinating people to name, who spur him on, one way or another. A surprising absence, though, is any mention of the famous psychiatrist who was a concentration camp prisoner, Viktor Frankl, who survived to write the classic Man’s Search for Meaning. It seems like this journey could only be accomplished by a psychiatrist—someone with the necessary medical training, credentials, and identity. Given that, it may follow that his research has translational relevance for our daily clinical work, including pathological narcissism, sociopathy, trauma, and group cohesion. Lifton's in-depth review also inspires us to reflect on cross-cultural therapy, refugees, prison inmates, and the ethical challenges of managed care. In fact, his findings could apply to managed care systems, because his description of a dissociative "doubling" in Nazi doctors adds a new twist to how managers and medical directors of today can calmly put profit over patients. Given the extraordinary breadth and depth of Dr Lifton's work, it seems greedy for me to have desired explorations into other arenas, such as prisons, which are a kind of natural laboratory for the type of evil he examines. In his interview of the Nazi leader Albert Speer, it seems that Dr Lifton is ambivalent and uncertain whether Speer had really changed for the better after 20 years in prison. I also wish he had mentioned our climate crisis as a potential world threat, especially given his earlier role as an activist for Physicians for Social Responsibility (PSR). PSR had won the Nobel Peace Prize in 1985 for its work on nuclear proliferation, but now PSR concludes that the more insidious risk of global warming may be as dangerous to people and the planet. It would have been informative if Dr Lifton had interviewed fossil fuel executives associated with environmental disasters (eg, someone from BP).

Given the unique path Dr Lifton took in his memoir, how can his work be summarized? He is more than a social psychiatrist, although he gave one of the earliest seminars on that topic. He is more than a cultural psychiatrist, although he successfully used interpreters. He is more than a political psychiatrist, even though his analyses included political leaders and he became a political activist. He mentions the term "historical psychiatrist," but psychohistory can venture into some wildly speculative areas. He goes beyond the Freudian, Jungian, or existential perspectives. He has apparently been unencumbered by any strong ties to professional organizations or sources of funding. Put this all together, and Robert Jay Lifton might be our first global psychiatrist, dedicated to the survival of intellectual freedom.