Of Two Minds: The Growing Disorder in American Psychiatry

Cultural anthropologist Luhrmann puts the psychiatric profession on the couch, with devastating results. Psychopharmacology has become ""the great, silent dominatrix of contemporary psychiatry,"" she reports, as a combination of ideology and socioeconomic forces favors treatment via prescription drugs and drives talk therapies out of the marketplace. In the new climate of managed care, doctors have very little time to evaluate patients, psychotherapy is not deemed cost-effective and psychiatrists in hospitals and clinics are pushed into management roles. A professor at the UC-San Diego, Luhrmann spent more than four years in psychiatric hospitals, attending classes and interviewing psychiatrists and administrators. Though she writes in a rather academic style, her valuable report offers an uncensored look at the new biological psychiatry. Luhrmann found that medications often do not work, that most patients are on more than one medicine and that unwanted interactions between drugs are common. In the classroom, discussion of Freud or of the scientific literature on emotion and human development is extremely cursory. Moreover, biomedically oriented doctors are trained to see psychiatric illness as a medical disease, which tends to eliminate ambiguity and nuance in diagnosis. Luhrmann's own view is that the evidence indicates a combination of talk therapy and psychopharmacology works best for most patients. She concludes with a look inside the mental health patient advocacy movement, which, like the profession itself, is sharply divided between lobbies for biomedicine and groups opposed to mandated psychiatric medication. Agent: Jill Kneerim, Palmer and Dodge Agency. (Apr.)