What is striking about The Lost Art of Healing (1996) is that its author Bernard Lown (1921-2021), the renowned cardiologist who pioneered life-saving technological advances, makes clear that vital to heart health and recovery are human relationships that are being increasingly ignored in technology-worshipping medicine.
For Lown, two relationship areas that are critical in heart health and recovery are: (1) the relationship between the physician and the patient; and (2) the relationships between patients with their partners, family members, and other significant people in their lives. Tragically, the current absurd reality of psychiatry is that it ignores or merely pays lip to these two relationship areas when it comes to our emotional struggles.
Before delving into Lown and The Lost Art of Healing, a few words in anticipation of rebuttals by apologist psychiatrists such as Awais Aftab who claim that psychiatry does not ignore or merely pay lip service to these two relationship areas. Earlier in 2026, Aftab argued that it is unfair to paint all of psychiatry as completely focused on mental illness symptoms to be corrected by pharmaceuticals or other technological means, and as proof he points to George Engel’s “The Clinical Application of the Biopsychosocial Model” which appeared in the American Journal of Psychiatry in 1980.
The problem with Aftab’s “pluralistic” image of psychiatry is that by 2011, the New York Times, in “Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy,” reported, “A 2005 government survey found that just 11 percent of psychiatrists provided talk therapy to all patients, a share that had been falling for years and has most likely fallen more since.”
Today, the reality is that damn near every psychiatric patient can tell you that a psychiatrist who does anything more than 10-15 minute “medication management” is rare; and even among that small handful of psychiatrists who actually continue to conduct some talk therapy, it would be a highly unusual patient who would say, “I had a healing relationship with my psychiatrist who put great effort into understanding the important relationships in my life, helped me extricate from toxic relationships, and helped me build caring and loving ones.” This is so rare that such a psychiatrist would be, as the saying goes, “the exception that proves the rule.”
Bernard Lown and The Lost Art of Healing
The pioneering cardiologist Bernard Lown is internationally renowned within medicine for his invention of the modern direct-current defibrillator and his introduction of a new use for the drug lidocaine to control heart arrhythmias. However, he saw the downside of technological advances in medicine, “Every advance exacts a cost. Medicine grew even more depersonalized. Technology took precedence and patients became secondary. A paradox of my life and its ultimate irony is that my research work facilitated that which I utterly deplore.”
Despite establishment psychiatry’s pretensions otherwise, when its outcomes are analyzed with scientific rigor, its latest technologies—which consist mainly of drugs and electrical treatments—have not resulted in life-saving or even quality-of-life advances. However, in much of non-psychiatry medicine, there has in fact been life-saving and quality-of-life technological advances; but such advances have resulted in what Lown calls a “childish faith in the magic of technology” which for him, “is one reason the American public has tolerated inhumane doctoring.”
In the world outside of medicine, Lown is even more renowned for his humanistic advocacy that included being the cofounder of International Physicians for the Prevention of Nuclear War, which garnered him (along with his co-founder) the Nobel Peace Prize in 1985. Lown’s humanistic activism extended to medicine itself which he became so troubled by that he wrote The Lost Art of Healing.
In the Introduction to the 1998 edition of The Lost Art of Healing, Lown begins this way: “Patient dissatisfaction is now at an all-time high,” and the present system in health care is “depersonalizing patients.” This dissatisfaction addressed by Lown has only gotten worse, as the majority of people I talk with, both clinically and socially, report being stressed by an increasingly bureaucratic health care system, with some reporting even being traumatized by it. Lown explains how this has happened:
“In a deeper sense the industrialization of medicine now emerging, like that of other commodities, requires two elements: standardization of the product and interchangeability of its parts. . . . It relates to the long-standing marriage of medicine to reductionist science and to burgeoning technology. . . .The elusive properties of mind, accounting for each person’s uniqueness, find scant sympathy in the current state religion that worships business efficiency. Nor do these properties enter the scientific equation. After all, empathy, kindness, altruism, benevolence, insight, joy, suffering, sadness, and tragedy are outside the purview of molecular biology.
The “central thesis” of The Lost Art of Healing, Lown tells is this: “Our health care system is breaking down because the medical profession has been shifting its focus away from healing, which begins with listening to the patient. The reasons for this shift include a romance with mindless technology, which is embraced in large measure as a means for maximizing income.” And Lown notes, “It is uneconomic to spend much time with patients.”
For establishment psychiatrists who dream of status parity with the rest of medicine, I suppose they will be relieved to see that psychiatry is not singled out for being uniquely dehumanizing. However, more rational and compassionate observers would say that for psychiatry, which is societally charged with treating emotional suffering and behavioral disturbances, to be no different than the dehumanizing reality that Lown paints for medicine in general is especially disturbing.
Lown tells that he was very much interested in psychology before he became interested in medicine, and that, “I intended to become a psychiatrist, but soon after I entered medical school, psychiatry lost its luster for me.” If Lown had gone into psychiatry, I have little doubt that he would have become a radically dissident psychiatrist, as he was troubled enough by medicine’s dehumanization of the doctor-patient relationship, and so he would likely have been appalled by witnessing that same reality in psychiatry. He was deeply saddened by the trajectory of medicine:
“A three-thousand-year tradition, which bonded doctor and patient in a special affinity of trust, is being traded for a new type of relationship. Healing is replaced with treating, caring is supplanted by managing, and the art of listening is taken over by technological procedures. Doctors no longer minister to a distinctive person but concern themselves with fragmented, malfunctioning biologic parts. The distressed human being is frequently absent from the transaction.”
Even in Cardiology, How Technology Alone Fails but Caring Relationships Succeed
The Lost Art of Healing is replete with stories about Lown’s relationships with his patients. In his subsection “Some Chutzpah”—Lown was Jewish and the following anecdotes are about treating Jewish patients—there are two stories that are especially telling about how crucial for heart health and recovery are the relationships (1) between Lown and his patients; and (2) between his patients and their family. What these stories evidence is not only how Lown built enough trust with his patients for them to be receptive to tension-producing confrontations, but how Lown had the wisdom and humility to confront himself about a patient confrontation which, even though having a successful outcome, lacked sufficient caring.
In the first anecdote, Lown tells of a patient seeking medical advice for recurrent atrial fibrillation, which had been treated by various antiarrhythmic drugs that were only temporarily successful. Lown probed for psychologically stressful reasons, and ultimately the wife of the patient told him the family secret that the patient had not told Lown. The patient had reported having three children when in fact he had four. This fourth, denied by the patient, was a daughter who had dated a non-Jewish man and then eloped with him. On learning about this, the patient sat shivah (the Jewish mourning period for the dead), had a “nervous breakdown,” and ordered his wife to remove anything of his daughter from their home.
This patient’s medical situation deteriorated, and he suffered a small stroke. Lown had the feeling that the patient “was committing a slow self-immolation that everyone seemed helpless to prevent.” Lown tells us, “I was frustrated, angry at the whole world for my inept helplessness,” and on one visit Lown began to shout at his patient: “I don’t know why I am wasting my time with a miserable human being like yourself. You make me sick with your self-pity, but more so with what you have done to your daughter, to her family, to your wife, to your other children, and to yourself. You are ruining everyone’s life.” Lown would come to acknowledge that it was improper for him to explode out of anger, but that he couldn’t stop himself from telling the patient that if he had any decency, he should, “On bended knee, ask her for forgiveness.”
The outcome of Lown’s outburst? Lown reports, “I heard a loud suppressed sob” and he saw the patient’s huge body convulsing. Lown was astonished when the patient not only showed up for his next appointment but was a different relaxed man. Acting on Lown’s recommendation to apologize and ask for forgiveness from his daughter, the relationship with her began to heal, and ultimately the patient got along wonderfully with his son-in-law and his family. “Incidentally,” Lown adds, “the atrial fibrillation had ceased to be a problem. The same medicine that previously failed to control his heart rate was now keeping it well in check.”
However, despite this great outcome, Lown would later question his own confrontational behavior, “Poor means are never sanctioned by good intentions or justified by good results. . . . Would gentle persuasion over time have achieved a similar outcome? Provoking such a storm of emotion could have done him great harm, physically as well as psychologically. . . . I never again lost my cool with a patient.”
Lown then tells us how in a similar situation some years later, he accomplished positive results without losing his cool. In this second anecdote, Lown tells us about a sixty-year old man whom Lown was perplexed by his premature coronary artery disease that had resulted in two coronary artery bypasses and one balloon angioplasty, “yet the angina waxed and waned on a substantially hefty medical program.” Lown saw him many times over several years but was “utterly at a loss regarding his treatment,” constantly tinkering with his various drugs but to no avail.
Once again, Lown began to feel he was missing something psychologically crucial. So, Lown pushed harder, asking the patient if he had problems with his children. The patient’s wife attempted to get him to reveal the truth, but the patient told her to shut up because his son had nothing to do with his angina. Lown pushed and discovered that the patient was estranged from his son because he was homosexual, and the patient proclaimed, “I’d rather he was dying of cancer.”
Lown again confronted his patient, but this time kept his cool, relied on gentle coaxing, and told him, “You surprise me. For a decent man whom I have come to respect, your behavior is irrational and even mean.” Lown explained to him that his son’s homosexuality was not sinful but natural and nothing to feel shame or guilt about. The outcome? The patient followed his advice, reconnected with his son, became a different man emotionally, and “for the first time, a smile played across his face.” The patient happily reported having Passover Sedar with his son and his partner, and the patient became active in gay rights. Lown reports that “combatting bias against homosexuality” became the patient’s major social preoccupation, “and his angina had at last ceased to be a major problem.”
Beyond the Obvious Economic Reasons Why Psychiatrists Are Now What Lown Deplored
Psychiatry has moved in the same direction as medicine in general, and for Lown, as previously noted, “The reasons for this shift include a romance with mindless technology, which is embraced in large measure as a means for maximizing income,” and so “It is uneconomic to spend much time with patients.”
This obvious economic reason was the focus of the previously mentioned 2011 New York Times article “Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy.” Along with statistics, the article features psychiatrist Dr. Donald Levin who once conducted talk therapy but no longer does so, as the Times reported, “Now, like many of his peers, he treats 1,200 people in mostly 15-minute visits for prescription adjustments that are sometimes months apart. . . .now, he often cannot remember their names.”
Unlike apologist psychiatrists such as Awais Aftab, Levin was candid, though pathetically so, “I had to train myself not to get too interested in their problems.” Levin lamented, “I miss the mystery and intrigue of psychotherapy. Now I feel like a good Volkswagen mechanic.”
Levin claimed that, initially, he and many other psychiatrists didn’t want to relinquish conducting therapy, “But one by one, we accepted that that craft was no longer economically viable. Most of us had kids in college. And to have your income reduced that dramatically was a shock to all of us.”
The Times pointed out that Levin and other psychiatrists could have accepted less money and provided time to patients even when insurers did not pay, but Levin reacted to that reality this way, “I want to retire with the lifestyle that my wife and I have been living for the last 40 years. . . . Nobody wants to go backwards, moneywise, in their career. Would you?”
While there remains the rare “exception-that-proves-the rule” dissident psychiatrist, psychiatry is almost completely comprised of disingenuous apologists such as Aftab and candid albeit pathetic drug prescribers such as Levin.
The obvious reason that psychiatrists have abandoned putting time and energy into creating safe, trusting, and healing relationships with their patients is an economic one. However, there are other reasons, and these reasons explain why other mental health professionals who do conduct talk therapy often provide crappy talk therapy.
Many mental health professionals are trained to be technicians rather than provided with the opportunity to discover the craft of healing. It would be an unconventional training program that would teach that the job of a psychotherapist is not to try to fix “symptoms” but rather to help create conditions for natural healing, and that the way to do so is to take great care in creating a safe and trusting healing relationship. When such healing conditions are in place, the barriers and defenses to healing are reduced, and this allows us to become open to feeling cared about, which results in us being more likely to become open to caring about others—and this results in healing.
For Lown, properties necessary for healing, as noted, “find scant sympathy in the current state religion that worships business efficiency,” as these properties such as “empathy, kindness, altruism, benevolence, [and ]insight” fall outside of “the scientific equation.” Healing is a phenomena that cannot be quantified and scientifically measured, and so it does not fit into a mechanical model.
Given the current state of health care—termed by Lown as the “the industrialization of medicine”—perhaps Lown’s most radical characteristic is that he loved his patients, and he knew that such love facilitated healing. No doubt his love for his patients was a very different type of love than his love for his spouse and family members, but he was able to discover a type of love that one can have in a professional relationship. Love is the opposite of fear, and Lown was fearless, for example, detesting and rejecting defensive medicine. Lown knew that love is a deep affection for the uniqueness of another, and a valuing and respect for another. It is a heartfelt concern for another’s pain, and an experience of resonation to another’s being.
In summary, in addition to the economic reasons why mental health professionals have either nonexistent or worthless relationships with their patients, another reason is that many of them lack the talent and wisdom when it comes to the craft of psychotherapy And still another reason is that they lack the recognition of how crucial love of their patient is to true healing; and even if recognized, they often avoid the existential struggle required to discover how in a professional role, love can be experienced and communicated. To be clear, it is no easy matter to existentially sort out how love can be felt and expressed in a professional relationship, and so there are soulful individuals who enter professional training and grasp the importance of love to healing but quit the mental health profession because they cannot resolve this existential dilemma.
Thus it is not surprising why many ex-psychiatric patients, including many Mad in America readers, have contempt for mental health professionals. It is not simply the damage caused by chemical and electrical technologies. It is also because they have dealt with psychiatrists who have spent almost no time and effort to develop caring and collaborative relationships, and they have dealt with other mental health professionals who attempted to be merely symptom-fixer mechanics.
All of this has resulted in ex-psychiatric patient activists, their family members, dissident mental health professionals, and others becoming engaged in a rebellion against dehumanizing psychiatry. Lown predicted the growth of a rebellion against all of dehumanizing industrialized medicine:
“Patients will not acquiesce to the ultimate alienation of being reduced to standardized objects. No one will accept for long being merely identified by their illness, as nothing but an assemblage of broken down biologic parts. Patients crave a partnership with their physicians who are as sensitive to their aching souls as to their malfunctioning anatomy. They yearn not for a tautly drafted business contract but for a covenant of trust between equals earned by the doctor while exercising the art of caring.”
Today, the Lown Institute works toward a health system “that rejects low-value care, incentivizes healing over profits, promotes health equity, and honors the value of the clinician-patient relationship.” In addition to many other projects, each year the Lown Institute acknowledges investigative healthcare journalism by conferring the Shkreli Awards “documenting the worst in healthcare dysfunction & profiteering.”
