Hippocrates Cried: The Decline of American Psychiatry

A neuropsychiatric clinician and professor with 45 years of experience, Taylor finds that the contemporary theory and practice of psychiatry has lost its way. He launches a full-throated attack on the still influential Freudian view of the psychodynamic basis of psychopathology, insisting instead that the brain must be “treated as a body organ and not a metaphysical mind.” Among Taylor’s targets are faddish and vague diagnoses: the number of people classed as bipolar is up 40-fold in the past 30 years, while “borderline personality disorder” has become the “somewhat polite term” psychiatrists use when “they think the patient is unpleasant.” He also criticizes psychopharmacology’s reliance on “trial and error,” the underutilization of electroconvulsive therapy in treating severe depression versus the use of less effective antidepressants, and the reality that many psychiatrists, by refusing Medicaid payments, avoid treating the poor. Occasionally, Taylor delivers harsh rhetorical broadsides—“Most brands of psychotherapy... don’t work”—or digresses from his main topic, as in a discussion of early signs of Alzheimer’s in Ronald Reagan during his first debate with Jimmy Carter in 1980. Whether Taylor is correct that biologically based neuropsychiatry will someday subsume psychiatry, his provocative book will give many clinicians and trainees considerable pause. (May)