The prologue to The Devil’s Castle outlines the movements I’m making in this book, from Nazi euthanasia to contemporary psychiatry and the hope offered by current neuroscience. In later chapters, I visit the preserved gas chamber at Sonnenstein asylum and sink into the mud on Wangerooge Island in the North Sea, where Dorothea Buck grew up. I want my books to be experiences, ideas and arguments that arise through readers sharing with me a process of meditation and discovery. 

I think my readers are surprised to learn that we, in U.S. psychiatry, follow the lead of a man who trained Nazi doctors—Emil Kraepelin. They’re further surprised to discover, in the story of Philippe Pinel, that psychiatric methods that feel impossibly humane now existed in the late 1700s. And that throughout the intervening period better modalities have arisen for treating mental distress. All involve methods we could use now, and all involve downplaying medication. Pinel wrote that a good psychiatrist needs to understand patients’ “hopes and dreams,” and that the best use of medication is understanding when to forego it.

At the end of the book, I return to the promise of neuroscience and no, this isn’t another treatment modality that’s going to be the new one that fixes everything. Psychiatry has been down that road, with pharmaceuticals and treating distress as a “disease like any other,” with shock treatment, with lobotomy, with genetics. Mental states are far too complex for any one methodology to prevail in this way. Neuroscience embraces an understanding of the natural diversity of the human mind and a sense of wonder at the miracle of consciousness, a process we still don’t understand. It’s a wonderful corrective to the reductive, deterministic theories the field has labored under for far too long.