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In Mind Fixers, Anne Harrington, author of The Cure Within, explores psychiatry’s repeatedly frustrated struggle to understand mental disorder in biomedical terms. She shows how the stalling of early twentieth century efforts in this direction allowed Freudians and social scientists to insist, with some justification, that they had better ways of analyzing and fixing minds In Mind Fixers, Anne Harrington, author of The Cure Within, explores psychiatry’s repeatedly frustrated struggle to understand mental disorder in biomedical terms. She shows how the stalling of early twentieth century efforts in this direction allowed Freudians and social scientists to insist, with some justification, that they had better ways of analyzing and fixing minds. But when the Freudians overreached, they drove psychiatry into a state of crisis that a new “biological revolution” was meant to alleviate. Harrington shows how little that biological revolution had to do with breakthroughs in science, and why the field has fallen into a state of crisis in our own time. Mind Fixers makes clear that psychiatry’s waxing and waning biological enthusiasms have been shaped not just by developments in the clinic and lab, but also by a surprising range of social factors, including immigration, warfare, grassroots activism, and assumptions about race and gender. Government programs designed to empty the state mental hospitals, acrid rivalries between different factions in the field, industry profit mongering, consumerism, and an uncritical media have all contributed to the story as well. In focusing particularly on the search for the biological roots of schizophrenia, depression, and bipolar disorder, Harrington underscores the high human stakes for the millions of people who have sought medical answers for their mental suffering. This is not just a story about doctors and scientists, but about countless ordinary people and their loved ones. A clear-eyed, evenhanded, and yet passionate tour de force, Mind Fixers recounts the past and present struggle to make mental illness a biological problem in order to lay the groundwork for creating a better future, both for those who suffer and for those whose job it is to care for them.


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In Mind Fixers, Anne Harrington, author of The Cure Within, explores psychiatry’s repeatedly frustrated struggle to understand mental disorder in biomedical terms. She shows how the stalling of early twentieth century efforts in this direction allowed Freudians and social scientists to insist, with some justification, that they had better ways of analyzing and fixing minds In Mind Fixers, Anne Harrington, author of The Cure Within, explores psychiatry’s repeatedly frustrated struggle to understand mental disorder in biomedical terms. She shows how the stalling of early twentieth century efforts in this direction allowed Freudians and social scientists to insist, with some justification, that they had better ways of analyzing and fixing minds. But when the Freudians overreached, they drove psychiatry into a state of crisis that a new “biological revolution” was meant to alleviate. Harrington shows how little that biological revolution had to do with breakthroughs in science, and why the field has fallen into a state of crisis in our own time. Mind Fixers makes clear that psychiatry’s waxing and waning biological enthusiasms have been shaped not just by developments in the clinic and lab, but also by a surprising range of social factors, including immigration, warfare, grassroots activism, and assumptions about race and gender. Government programs designed to empty the state mental hospitals, acrid rivalries between different factions in the field, industry profit mongering, consumerism, and an uncritical media have all contributed to the story as well. In focusing particularly on the search for the biological roots of schizophrenia, depression, and bipolar disorder, Harrington underscores the high human stakes for the millions of people who have sought medical answers for their mental suffering. This is not just a story about doctors and scientists, but about countless ordinary people and their loved ones. A clear-eyed, evenhanded, and yet passionate tour de force, Mind Fixers recounts the past and present struggle to make mental illness a biological problem in order to lay the groundwork for creating a better future, both for those who suffer and for those whose job it is to care for them.

30 review for Mind Fixers: Psychiatry's Troubled Search for the Biology of Mental Illness

  1. 4 out of 5

    Michael

    A lucid introduction into the history of psychiatry as it's developed in America since the mid nineteenth century. In clear prose Harrington tracks American psychiatry's long-fraught quest to identify a biological basis for mental illnesses, from anatomical explanations of psychosis during Reconstruction to today's appeals to chemical imbalances. She succinctly breaks down the reasons for each epochal shift in the nation's treatment of mental illness, homing in on postwar neo-Freudians' rise and A lucid introduction into the history of psychiatry as it's developed in America since the mid nineteenth century. In clear prose Harrington tracks American psychiatry's long-fraught quest to identify a biological basis for mental illnesses, from anatomical explanations of psychosis during Reconstruction to today's appeals to chemical imbalances. She succinctly breaks down the reasons for each epochal shift in the nation's treatment of mental illness, homing in on postwar neo-Freudians' rise and fall, and she draws special attention to how the field's post-1980 medical turn hasn't led to better treatment or richer understanding of major disorders, including schizophrenia, depression, and manic depression. Especially of interest is Harrington's insistence that government neglect and Big Pharma's corrupting influence on practitioners have left the nation's mental health system in shambles today. From start to end her study swiftly catalogues psychiatry's many failings, past and present, and it ends impactfully by imagining new directions that psychiatrists, in conjunction with psychologists and counselors, might take.

  2. 5 out of 5

    Morgan Blackledge

    OMG this book is FIERCE. I couldn’t put it down. It’s a shrewd historical deconstruction and savage critique of modern psychiatry and the psychopharmacology industry. That being said. Nobody comes out unscathed. Including psychoanalysts, social workers, and marital-family therapists. It’s the sad story of how well intended people, who wanted a legitimate medical science of psychiatry, and a rational, humane public mental health system, ultimately ended up massively contributing to the homelessness OMG this book is FIERCE. I couldn’t put it down. It’s a shrewd historical deconstruction and savage critique of modern psychiatry and the psychopharmacology industry. That being said. Nobody comes out unscathed. Including psychoanalysts, social workers, and marital-family therapists. It’s the sad story of how well intended people, who wanted a legitimate medical science of psychiatry, and a rational, humane public mental health system, ultimately ended up massively contributing to the homelessness and addiction epidemic we currently face. Great scholarship. Really great writing. One of my favorite books of 2019.

  3. 4 out of 5

    Seth

    The review of this book in The Atlantic was better and more to the point of how psychiatry is a cruel hoax on people who aren’t feeling well. https://www.theatlantic.com/magazine/... The book mostly focuses on the history of what we don’t know of the biological basis of mental suffering. Which is nothing at all. Even psychiatry’s claims to empirical relief of suffering is hard to take on without trepidation. If empirically I feel less anxiety and better able to face the ups and downs of my daily The review of this book in The Atlantic was better and more to the point of how psychiatry is a cruel hoax on people who aren’t feeling well. https://www.theatlantic.com/magazine/... The book mostly focuses on the history of what we don’t know of the biological basis of mental suffering. Which is nothing at all. Even psychiatry’s claims to empirical relief of suffering is hard to take on without trepidation. If empirically I feel less anxiety and better able to face the ups and downs of my daily existence with two or three shots of vodka on board does that mean I have an ‘alcohol deficiency’ or that alcohol is a good ‘medicine’ for a medical condition I’m facing? Absolutely not. But that’s the only argument psychiatry has to stand on in the absence of biological physiological understanding of anything at all. The only proof we have that the mind has any sort of existence at all in the physical brain is that brain trauma and drugs that affect the brain cause alterations in consciousness. But when you think of it, it’s not very strong proof of anything. Analogously, if I hit my TV with a sledgehammer it would alter the images shown on the screen, but that is no proof that the images shown there are actually, physically occurring there. The TV is only a transfer point between radio waves and images. Only a primitive or the very gullible would believe the images on the TV are actually occurring in any physical sense in their living rooms. I understand why psychiatrists are loath to entertain the idea that the mind does not exist in an entirely physical realm and you’ll rarely encounter a fiercely Cartesian Dualist psychiatrist. Physicians after all only deal with things that occur in physical bodies. Yet not a single anatomical, histological or biochemical abnormality has ever been found for a single psychiatric condition. If the brain is only a transmission point between mind and body, then it would place the mind and mental suffering beyond the realm of doctors and back in the hands of theologians, philosophers and shamans. After all the shames of psychiatry such as doctored clinical trials, glib denial of drugs’ side effects and addiction potential, lobotomy, blaming only mothers for every mental affliction under the sun and dumping of seriously unwell people from institutions to wander the streets; the main problem with psychiatry is it purports to physically treat a system, the mind, that we have no evidence or at best tangential evidence exists on a physical plane. As the author suggests, when is it at least time we stop drugging the ‘worried well’? People with depression and anxiety. People who have trouble fitting in because they are nonconformists or introverted. When is it time to stop looking for solutions in a field we know nothing about and instead look for solution in fields we do understand quite well. Our isolating built environment sucks and relies on expensive, 4000 pound death traps on wheels to get from A to B. We have precious few neutral ‘3rd spaces’ that aren’t homes or businesses where people can meet and share interests without an expectation of buying something. The Protestant work ethic that we all work 40 hrs/ 51 weeks to be worthy of employment and a sense of not being a social freeloader makes everyone miserable. A UBI that lets everyone sick or well afford a place to live and Medicare for all that would let people seek medical help without fear of bankruptcy would go miles further in treating mental suffering than any drug. It’s well within our reach. Our inability to practically address known causes of mental suffering can only lead me to conclude that it’s a feature and not a bug of the social system the powerful have designed for us. Any suffering caused by that system can be dismissed via psychiatry as ‘illness’. Psychiatry is a distracting and sometimes harmful sideshow where doctors who have gone through the hassle of years of medical schooling give it all up to look for solutions in a biological understanding of the mind that exists as little now as it did a thousand years ago.

  4. 4 out of 5

    Peter Tillman

    I thoroughly enjoyed reading this fine medical- science history book and commend it to your attention. I didn't take notes, and have nothing substantial to add to the review at Nature, which you should read now, if you're thinking of reading the book. Well-written and well-researched, with some of the high (and low) spots in the search for effective treatments in the past 100+ years. It's quite a story -- even if it's discouraging how little we have figured out about how our minds and brains wor I thoroughly enjoyed reading this fine medical- science history book and commend it to your attention. I didn't take notes, and have nothing substantial to add to the review at Nature, which you should read now, if you're thinking of reading the book. Well-written and well-researched, with some of the high (and low) spots in the search for effective treatments in the past 100+ years. It's quite a story -- even if it's discouraging how little we have figured out about how our minds and brains work (or don't). Good thing empiricism works, and that we do have some drugs that work for some people. Her stuff about the placebo effect, and how poor the diagnosis process still is, were real eye-openers. A must-read for mental health practitioners. Nature review "The sorrows of psychiatry" by Alison Abbott: https://www.nature.com/articles/d4158... Excerpts: "In January 1973, Science published an article called ‘On being sane in insane places’. The author, psychologist David Rosenhan, described how he and seven other healthy people had reported themselves to a dozen psychiatric hospitals, claiming to hear voices uttering odd words such as ‘thud’ or ‘hollow’ — a symptom never reported in the clinical literature. Each person was diagnosed with either schizophrenia or manic-depressive psychosis, and admitted; once inside, they stopped the performance. They were released after an average of 19 days with diagnoses of ‘schizophrenia in remission’ (D. L. Rosenhan Science 179, 250–258; 1973). One research and teaching hospital, hearing about the study, declared that its own staff could never be so deceived. It challenged Rosenhan to send it pseudopatients. He agreed, but never did. Nonetheless, the hospital claimed to have identified 41 of them. . . . Reviewer Alison Abbott was named a European Science Journalist of the Year for 2019. You can see why she won by reading this excellent review. https://www.absw.org.uk/news-and-even...

  5. 5 out of 5

    Megan Wight

    Whoof, that was something else. She kept herself unbiased, the research was well done! The beginning of the book was very fascinating. It was mostly about all the really messed up things, and the crimes against humanity that occurred to the mentally ill population. I loved the ending the best. Basically, after all these centuries and decades we haven’t gotten too far with understanding mental illnesses through a biological perspective. What do we do next? What approach do we take? From her persp Whoof, that was something else. She kept herself unbiased, the research was well done! The beginning of the book was very fascinating. It was mostly about all the really messed up things, and the crimes against humanity that occurred to the mentally ill population. I loved the ending the best. Basically, after all these centuries and decades we haven’t gotten too far with understanding mental illnesses through a biological perspective. What do we do next? What approach do we take? From her perspective, she sees the social sciences taking over, the psychoanalytic analyst, the counselors, the sociologist, the Eros of philosophy, the arts, music, and spirituality. We are trying to heal people’s hearts through chemistry. Some people have genuine biological problems, some people don’t. We can’t be blinded by big pharma and slap antidepressants at everything. I love the idea of seeing everyone individually, and not putting patients into homunculus boxes. I hate the check boxes of symptoms to diagnose someone with a mental illness. Two weeks of depression symptoms and you have depression on your medical history hospital chart forever. That’s stupid. Biologically, we haven’t discovered much or made much of a difference to change the overall statistics since the 80’s. We need more research. Our minds are so fickle. Solid research is hard to do, our brains are weird, and variables bifurcate and influence things without researchers becoming aware until years down the road. What’s the point? Over the years we have discovered decreased serotonin causes depression. Increased serotonin causes mania. Increased dopamine causes schizophrenia. Decreased dopamine causes Parkinson’s or ADHD in kids. Amphetamines increase dopamine, helps kids concentrate by allowing the transmitter to create better circuitry via the frontal cortex. Those with bipolar experience both mania and depression who must have waves of increased then decreased serotonin? Then research came back refuting all of this? Well, fuck. The psych world has been catapulted back into the dark! Sometimes these neurotransmitters go with these diseases and sometimes they don’t! Well, shoot! What does this mean? Reading this book has brought me into a mild panic and a bit of an existential crisis. The reason psychiatrist seems like they don’t know what they are doing is because they actually don’t know what they are doing! The CBT, EMDR, and counseling aspect seems to be making positive advances but the biological theories are still very lost. To make myself feel less nihilistic about getting into the mental health field, I will share some of the old biological theories that were prevalent. We have come a long way since the early 1900’s. These bullet points are the first half of the book. It was a gnarly time of history for psychiatry. Doctors identified that when people are septic they hallucinate. So, they used to do exploratory surgeries looking for spoiled organs and literarily removed them hoping they were the cause of the patient’s mental illness. Surgeons spent many decades doing autopsies and had brain libraries filled with past patient’s brains to explore, hoping to find some sort of deformity that could be linked to their psychosis. They didn’t find anything. A major problem was the lack of symptoms list, the psychiatrist cared more about their brains than the patients’ lives. They knew they could do nothing to help them while they were alive, but hoped they could learn from their brains. Im sure everyone has heard about lobotomies eh? This became a common treatment plan and it was done on a shit ton of people. Neuro docs would do seminars where they taught lay doctors how to do them. Most of the lobotomies were done on the prefrontal cortex, this pretty much destroyed the patient’s personality, but it was done because it sometimes made the patient more docile, and careless. Docs even designed ways to do lobotomies at the bedside that didn’t require opening the skull, they called them transorbitol lobotomies. Even you can perform this, all it requires is a long pick. You penetrate the patient’s brain via the eye socket, once inside you twist the pick to sever the neuro connections between the prefrontal area and the parts below. The decline of lobotomies didn’t take a sharp decrease until the 1960’s! The former president Joseph Kennedy lobotomized his own daughter Rosemary. She was “intellectually slow”, had a head strong nature, and was known to be “vivacious”. They feared they would not be able to control her strong nature. In 1941 president Joe waited for his wife to go on a trip and behind her back lobotomized their own daughter in secret. The surgery took away her ability to walk, and she would never be able to talk clearly again. She had to be institutionalized for the rest of her life. This fuck face (Joe Kennedy) was John Kennedy’s father, and this is just one example of how it was used to abuse women. Before lobotomies became a thing, some docs in Switzerland discovered insulin could calm agitated patients. Soooo insulin induced comas became a treatment plan. They opened separate little areas for patients and had specialized nurses to care for these patients. They found these patients were doing significantly better. These patients were getting more special attention, which made docs think the insulin comas were helping, this increased the overall prevalence of the procedure. Yikes. I’ve taken care of patients in a coma from low blood sugar and it is scary as hell. They often have seizures, and they become nonresponsive. Not cool. I want to mention one more wild thing; this relates to syphilis. A guy named Wagner-Jauregg found that people with madness from syphilis could be cured when they were injected with the blood from a patient with malaria and then treated them with the medication to treat malaria called quinine. Sooo this turned into some seriously demented procedures. They had patients who didn’t have syphilis be malaria incubators, they couldn’t make the syphilis patients the incubators because they didn’t want to give syphilis to people who already had syphilis?? They even injected malaria blood into orphan children to use them as incubators as well. To summarize, in 1917 docs used orphans, and random psychiatric patients without syphilis, to be injected with malaria infected blood. This gave them the disease, docs then used their blood to inject into the psychotic syphilis pts, the syphilis pts were then sometimes cured by the fever from the illness, and then they were both eventually giving the treatment for malaria, which was quinine. They think somehow the fever deteriorated the STD enough to cure the syphilis along with the madness. Fortunately, in the 1950s this all ended when penicillin was discovered. Phew. But, if you ask me, 1917-1950s is a long time to be doing such nasty procedures. Dang

  6. 4 out of 5

    Paul Ataua

    I enjoyed reading 'Mind Fixers' if only for the fact that it is full of examples of how psychiatry has inflicted suffering on its subjects over the last two hundred years. It is certainly worth reading if you aren’t already aware that we have absolutely no idea what we are doing in the field. Beyond that it doesn’t seem to have much to offer besides a call for a more modest approach, which is a call unlikely ever to be listened to. I enjoyed reading 'Mind Fixers' if only for the fact that it is full of examples of how psychiatry has inflicted suffering on its subjects over the last two hundred years. It is certainly worth reading if you aren’t already aware that we have absolutely no idea what we are doing in the field. Beyond that it doesn’t seem to have much to offer besides a call for a more modest approach, which is a call unlikely ever to be listened to.

  7. 4 out of 5

    Kent Winward

    Another exceptional, if not completely disheartening, history of the failures of psychiatry. Maybe it is a good thing the drug companies couldn't patent ice picks or we would have been too lobotomized to fight the fight that needs to come. The reality is psychiatry knows less about the human condition than William Shakespeare or Harold Bloom's commentary on Shakespeare. Small prediction, but the next version of the various state attorneys general suing tobacco companies will be state attorneys g Another exceptional, if not completely disheartening, history of the failures of psychiatry. Maybe it is a good thing the drug companies couldn't patent ice picks or we would have been too lobotomized to fight the fight that needs to come. The reality is psychiatry knows less about the human condition than William Shakespeare or Harold Bloom's commentary on Shakespeare. Small prediction, but the next version of the various state attorneys general suing tobacco companies will be state attorneys general suing pharmaceutical companies for the harm inflicted by the drugs they pushed through advertising that had minimal or negative efficacy. Want to know how psychiatry decided homosexuality wasn't a disease? They took a vote. Since when was science a democracy? We all know how screwed up elections can be. Psychiatry promised us they knew and they knew nothing. I could go on, but read the book -- even handed and fair in how it exposes the failings of the world of psychiatry. (The author is a professor of the history of science at Harvard and sometimes it reads more like a text book, which actually makes the psychiatric absurdity that we have bought into as a society all the more stark.) And just for clarification, I still hold out hope for the field, but the hope comes from those most basic human emotions of compassion and understanding, coupled with the aspirational aspects of those in the medical field to heal. History is wonderful if you read it, understand it, and make efforts not to repeat it.

  8. 5 out of 5

    Amy

    It took me a long time to get through this. Having various mental illnesses myself, it was very personal and I needed to step away from it for weeks at a time. Very informative covering the timeline of mental illness and the drugs manufacturered to help “cure” it. The conclusion was, we still have a long way to go. Mental illness is messy, unpredictable, and a goldmine for pharmaceutical companies. Meaning those who suffer have to trudge through the mud to find the right cocktail of drugs. And w It took me a long time to get through this. Having various mental illnesses myself, it was very personal and I needed to step away from it for weeks at a time. Very informative covering the timeline of mental illness and the drugs manufacturered to help “cure” it. The conclusion was, we still have a long way to go. Mental illness is messy, unpredictable, and a goldmine for pharmaceutical companies. Meaning those who suffer have to trudge through the mud to find the right cocktail of drugs. And when your mental capacity isn’t even at 50%... that is a lot to ask.

  9. 4 out of 5

    11811 (Eleven)

    And we're still guessing. And we're still guessing.

  10. 5 out of 5

    Campbell

    this book makes the argument that after 150 years of psychiatric research about mental illness, we still don't know shit. people have always wanted to find the biological, chemical cause of mental illness, often because they wanted to shut up freud. can you blame them! The "chemical imbalance" theory has been tossed around for decades, more because people wanted it to be real because it's simple, not because of any actual evidence. There still isn't any definitive evidence that serotonin levels this book makes the argument that after 150 years of psychiatric research about mental illness, we still don't know shit. people have always wanted to find the biological, chemical cause of mental illness, often because they wanted to shut up freud. can you blame them! The "chemical imbalance" theory has been tossed around for decades, more because people wanted it to be real because it's simple, not because of any actual evidence. There still isn't any definitive evidence that serotonin levels or levels of any neurotransmitter have anything to do with mood disorders. In 2019, there is still no understanding of what mental illness has to do with biology. This is partially because brains are complicated and neuroscience is still working on understanding normal brain functions- it's not surprising that in the first century of grappling with the brain at a molecular level we haven't perfectly mapped out an an enormous range of brain dysfunctions. Of course, a particularly daunting research problem isn't the only reason psychiatry has had such a messy history. Scientists are people, and people want to win arguments and get published and get paid. This led to wasted time spent defending dead theories, premature promises of miracle cures, and over-diagnosing and overprescribing patients to get payouts from pharma companies. In the weeks following 9/11, two separate pharmaceutical companies ran ads planting the idea that everyone might have PTSD now, and that they should probably to talk to their doctor about Zoloft. The antidepressant boom was in part caused by a Reagan-era push for profitability in all sectors, bolstered by deregulation that put more and more drugs with questionable effectiveness onto shelves. There still are no antidepressants on the market that work significantly better than placebos in clinical trials. This doesn't mean they don't work; obviously antidepressants have been life saving for many people. The placebo problem just says that the success likely doesn't have that much to do with brain chemistry. After decades and billions of dollars of research, the number of suicides in the US hasn't gone down, and thousands of mentally ill people are homeless or in prison. The book tells us the only thing that can lead to real progress is humility in psychiatric research. Patients and families suffered when researchers made big claims too early, whether it was Freudians telling mothers they made their children schizophrenic by being overbearing or biologists offering false hope with less-than-miraculous miracle drugs. All we need is for people to be more cautious and honest, and to stop caring about fame and money!!! . ...oh no. ANYWAY these articles are good if anyone wants to check out something adjacent to this topic but shorter, first two are reviews with better summaries than the above, and the last two are just related (and so so good). https://www.nytimes.com/2019/04/24/bo... https://www.theatlantic.com/magazine/... https://www.newyorker.com/magazine/20... https://www.newyorker.com/magazine/20...

  11. 5 out of 5

    Chimezie Ogbuji

    It reads like a collection of scholarly work on the foundations of psychiatry, its hubris, and its tentative biological foundations. So, it really will only hold you if you are fascinated by the topic (as I am) as there isn't very much narrative. The scope and depth of the time period covered and the research summarized and cited is the strength of the book. It isn't opinionated at all but simply reveals its very bold and heterodox main argument through layers of detailed, historical account. I i It reads like a collection of scholarly work on the foundations of psychiatry, its hubris, and its tentative biological foundations. So, it really will only hold you if you are fascinated by the topic (as I am) as there isn't very much narrative. The scope and depth of the time period covered and the research summarized and cited is the strength of the book. It isn't opinionated at all but simply reveals its very bold and heterodox main argument through layers of detailed, historical account. I intend to own this book as it is not the kind of thing you only read once

  12. 5 out of 5

    Joell

    Maybe 5 stars... I also listened to Anne Harrington on NPR's Fresh Air on 4/24/19. Quote: "We don't know enough about the biology of these mental disorders to know whether or not some of the reasons are biological--in the sense that medicine likes to think of these things as diseases--and whether it's just because they're having terrible problems." Maybe 5 stars... I also listened to Anne Harrington on NPR's Fresh Air on 4/24/19. Quote: "We don't know enough about the biology of these mental disorders to know whether or not some of the reasons are biological--in the sense that medicine likes to think of these things as diseases--and whether it's just because they're having terrible problems."

  13. 4 out of 5

    Luis

    Great book on the history of psychiatry It is an excellent review of the history of psychiatry and the different approaches to mental illness that have prevailed through the XXth century. Highly dependable for those interested in mental illnesses and it's treatment. Great book on the history of psychiatry It is an excellent review of the history of psychiatry and the different approaches to mental illness that have prevailed through the XXth century. Highly dependable for those interested in mental illnesses and it's treatment.

  14. 4 out of 5

    Mary Jo

    A timely read, given our nation's debate regarding mental health. It covers the history of psychiatry as it transitioned from a psychoanalytical to biological-based perspective; the pitfalls of diagnosis and the role of pharma companies. Last chapter and Afterthoughts were well-worth the read. A timely read, given our nation's debate regarding mental health. It covers the history of psychiatry as it transitioned from a psychoanalytical to biological-based perspective; the pitfalls of diagnosis and the role of pharma companies. Last chapter and Afterthoughts were well-worth the read.

  15. 5 out of 5

    Elari

    Great book — no complaints — purely historical account, no deep analysis.

  16. 4 out of 5

    Joan Lieberman

    In 1959, when I was 17 years old, I learned that I had grown up with a mother who had paranoid schizophrenia. Full of teenage hubris and hoping to help her, I began researching the disease by reading "The Perverse Mother," an article by Dr. John Nathaniel Rosen (1901- 1993), then one of the leading psychiatric theorists of that era. His written words haunted me for years: “A schizophrenic is always one who is reared by a woman who suffers from a perversion of the maternal instinct.” Reading thos In 1959, when I was 17 years old, I learned that I had grown up with a mother who had paranoid schizophrenia. Full of teenage hubris and hoping to help her, I began researching the disease by reading "The Perverse Mother," an article by Dr. John Nathaniel Rosen (1901- 1993), then one of the leading psychiatric theorists of that era. His written words haunted me for years: “A schizophrenic is always one who is reared by a woman who suffers from a perversion of the maternal instinct.” Reading those words, I felt as if the top of my head had been blown off. For the next two decades, my life was shaped by the fear that I too would develop schizophrenia. I survived by trying to believe the words of Dr. Maurice Fox, then Chief Resident at the University of California Medical School in San Francisco, who told me: “If inept or cold mothering caused schizophrenia, the majority of people in America would be locked up in mental hospitals, including myself.” Harvard Professor Anne Harrington avoids harsh blame of both practitioners and pharmaceutical companies. Instead, like a good-enough mother, she encourages both practitioners and pharmaceutical researchers to avoid the pitfalls of hubris and to “make a virtue of modesty.” One criticism I have of Professor Harrington's narrative is that she failed to note that Dr. John Nathaniel Rosen had engaged in what might be called "Fraudulent Hubris." In 1971 Dr. Rosen had been named "Man of the Year" by the American Academy of Psychotherapy for his claim that he could cure schizophrenia with "direct analytic therapy," but 12 years later, on March 29, 1983, he avoided being charged with sixty-seven (67) violations of the Pennsylvania Medical practice Act and thirty-five (35) violations of the rules of the State Board of Medical Education by giving up his license to practice medicine. He had been caught lying about his professional training, but more importantly he had been physically and emotionally abusing patients at his Temple University Clinic near Philadelphia, as well as in his Florida facility.

  17. 5 out of 5

    Rachel Paster

    Although this book was extremely readable, I was a little troubled by her conclusions. Harrington's claim that psychiatry has failed to identify biological conditions of mental illness is partly true and partly not. While it is probably the case that there is really not enough evidence to know why certain medications treat certain sets of symptoms, yet, the fact is that they do. Yes, those facts are based on observation; yes, observation is subjective. However, there is a danger in being so dism Although this book was extremely readable, I was a little troubled by her conclusions. Harrington's claim that psychiatry has failed to identify biological conditions of mental illness is partly true and partly not. While it is probably the case that there is really not enough evidence to know why certain medications treat certain sets of symptoms, yet, the fact is that they do. Yes, those facts are based on observation; yes, observation is subjective. However, there is a danger in being so dismissive of the usefulness of medication (or certain other treatments). On the other hand, any foray into the diagnoses of mental illness/mental health does beg the question of what we mean by mental "health". It seems that the meaning of mental health has become narrower and narrower, maybe as a result of capitalist society needing all workers on deck. The idea that some people do not conform to a narrow range of behaviors and are therefore not mentally "healthy" is a problem as well (and seems to be a partial driver of the increase in thickness of the DSM).

  18. 4 out of 5

    Meepspeeps

    This is a damning view of psychiatry over the last century or so, especially its complicity with Big Pharma favoring greed over patient care and recovery. That there is so little evidence or no evidence of a biological basis to mental illness is sobering, given so many attempts to change someone’s brain biology to improve mental health. Yet some peeps ARE helped by meds, including those given placebos. She recommends practitioners rethink the walls they’ve built, e.g., between mental health coun This is a damning view of psychiatry over the last century or so, especially its complicity with Big Pharma favoring greed over patient care and recovery. That there is so little evidence or no evidence of a biological basis to mental illness is sobering, given so many attempts to change someone’s brain biology to improve mental health. Yet some peeps ARE helped by meds, including those given placebos. She recommends practitioners rethink the walls they’ve built, e.g., between mental health counselors and MDs, and accept the overwhelming data in order to move forward to improve mental health patient care. I recommend it to those who want to understand the history of psychiatric practices and what the current data tells peeps.

  19. 5 out of 5

    Angie

    Worth a read for the epilogue alone. Anne displays not only her thorough knowledge of the history of psychiatry, but also her compassion towards those who struggle with mental illness (and her students).

  20. 5 out of 5

    Nathan

    Simply brilliant. Brought me from near complete ignorance to a respectable level of knowledge and insight into the evolution of the psychiatric model and practice. Highly recommended

  21. 4 out of 5

    Mohammad Sadegh Jazayeri

    A scathing indictment of psychiatry and pharmaceutical companies. A must read for basically everyone.

  22. 5 out of 5

    Diogenes

    “I have written this book because I believe history matters. We perhaps don’t need history to see that psychiatry today is not a stable enterprise marked by a consensus about mission, but rather a fraught one, where rhetoric still far outstrips substance, where trust is fragile, and where the path forward is unclear. But we do need history to understand how we came to be where we are now and therefore what might need to happen next. Heroic origin stories and polemical counterstories may give us “I have written this book because I believe history matters. We perhaps don’t need history to see that psychiatry today is not a stable enterprise marked by a consensus about mission, but rather a fraught one, where rhetoric still far outstrips substance, where trust is fragile, and where the path forward is unclear. But we do need history to understand how we came to be where we are now and therefore what might need to happen next. Heroic origin stories and polemical counterstories may give us momentary emotional satisfaction by inviting us to despise cartoonish renderings of our perceived rivals and enemies. The price we all pay, though, is tunnel vision, mutual recrimination, and stalemate. For the sake not just of the science but of all the suffering people whom the science should be serving, it is time for us all to learn and to tell better, more honest stories” (p. xviii). Wow. Kudos to Dr. Harrington for opening this book with such a strong statement of purpose. In my humble opinion, I couldn’t agree more. I guess it’s ironic that my most liked review on Goodreads is a condemnation of the DSM-5. Look, I’m not a practicing psychotherapist, but I do possess a Masters in Community Counseling, a field that floats between social work and psychology, based on person-centered talk therapy and a holistic approach to mental wellbeing where one can cherry-pick their preferred discipline/philosophy, from Freudian psychoanalysis re-surging in some circles to the shrink-wrapped pop-Buddhist mindfulness currently trending strong, so I have some deep knowledge of this. Dr. Harrington has written an incredibly important book, illustrating the history of this terribly soft science and all the powers that have tried to harden its existence for legitimacy’s, and self-preservation’s, sake. This book is for practitioners and laypersons, legislators and educators. While there should be no doubt that mental health issues have been with homo sapiens since our primordial cave-dwelling days, and that mental health infrastructure is crucial today now more than ever, I tend to side with Dr. David L. Rosenhan back in 1973, when he wrote his essay “On Being Sane in Insane Places”: “The view has grown that psychological categorization of mental illness is useless at best and downright harmful, misleading, and pejorative at worst. Psychiatric diagnoses, in this view, are in the minds of observers and are not valid summaries of characteristics displayed by the observed.” Big Pharma and the insurance consortium play titanic roles in the evolution of mental health and therapeutic approaches, as the current opioid crisis simply reflects the halcyon days of Valium, with psychiatrists writing scripts for pills to just about anyone who asked for them, creating monstrous statistics on pill-poppers as a form of “healing-the-symptoms” from the struggles of Life. The whole “mindfulness” movement that has cashed in hugely also has harsh critics (https://www.theguardian.com/lifeandst...), and (https://aeon.co/essays/mindfulness-is...), with strong validity. Most in ”the West” don’t understand Buddhism at all.

 Don’t get me wrong, if something works well for an individual, doesn’t harm them, others, or society at large, then great! Smoke dope, mosh out, take selfies doing goat yoga or whatever Newest-Age b.s. flotsam is floating around the social media gyres, and enjoy the betterment it brings to your life and outlook. However, the way mental health and its accepted treatments have evolved into what they are today are painfully problematic, and they affect society overall. The human brain is truly the most complicated organ in the known world, and the best minds have barely broken through the elemental understanding of it when it comes to mental health and mental illness. The best part of this book is the author’s wonderful “Afterthoughts” chapter at the end. I wish I could just copy the entire six pages here, but I’ll instead encourage you to seek this title out and read it for yourselves. Like many other facets of human existence in the early twenty-first century, the understanding and treatment of mental health need a radical paradigm shift, and I believe it starts with how mental-health practitioners, from social workers to psychiatrists, are educated. If the system begins to change by fledgling practitioners, over time the legislation will adapt to meet the new paradigm, if the powers of Big Pharma and the insurance industry can be assuaged. It’s encouraging to know Dr. Harrington is on the front lines of this desperately needed renaissance.

  23. 5 out of 5

    P D

    A relatively high level summary of the history of psychiatry, albeit one that moves further in addressing how minorities were impacted than other, more in-depth books I've read on these topics. Stonewall gets a mention, even. Apparently a couple months later, activists went to the APA and started the chain of events that got homosexuality removed from the DSM-III. There's also a pretty interesting bit on approaches for black Americans, as well as the recognition that dealing with racism generate A relatively high level summary of the history of psychiatry, albeit one that moves further in addressing how minorities were impacted than other, more in-depth books I've read on these topics. Stonewall gets a mention, even. Apparently a couple months later, activists went to the APA and started the chain of events that got homosexuality removed from the DSM-III. There's also a pretty interesting bit on approaches for black Americans, as well as the recognition that dealing with racism generates higher rates of depression in a way comparable to how more white women than men are diagnosed with depression. Before I go further, I do think this book should have explained alternatives to the chemical hypothesis of mental illness, since we know that's not quite right. The one I learned - and which explains why psychotherapy is just as, or more, effective as drugs under the right circumstances - is that it's issues with networks in the brain. Of course, networks generate neurotransmitters, so modulating their levels helps (and the further back you go in the pathway, the more potential to help more patients). But it's technically a treatment foot a symptom, not a cure. (If I recall correctly, schizophrenia has been tied to an overpruning of synapses, while autism is tied to underpruning.) Harrington also doesn't pull punches when it comes to the modern pharmaceutical invasion of the psychiatry field (which, as she notes, isn't entirely without benefit to patients. It's worth noting that people were also reluctant to report increased suicidal ideation with Prozac at first because it was working so well overall). Unfortunately, an unintended side effect of tighter regulations on drug approval was a near total withdrawal of investment in researching new molecular compounds - the placebo effect in psych studies is huge. (Also, and this isn't in the book, it's not cheap to test drugs in lab mice, which is required before clinical trials for obvious reasons, but then our brains don't align all that well so a lot of "promising" therapies fail. If only big pharma weren't obligated to spend all that money directly advertising to consumers. Yes, I'm rolling my eyes.) The cool thing about this is she doesn't leave us hanging, but rather offers a broad solution - a paradigm shift that to some degree has already begun - in the role psychiatrists play relative to psychologists, social workers, patient organizations, etc. I'm never going to be the best judge of this, but to me the book was a pretty easy read with a lot of interesting facts. There are some details which I wish had been included, in particular the above, but overall this does a better job of explaining how the repeated sea changes in psychiatry affected groups besides the relatively well off.

  24. 4 out of 5

    Sarah Butler

    This is an entirely worthy read for anyone interested in not just the history of treatment attempts for those with mental illness (or those who were assumed mentally ill) but also for those who wonder where we are today. (Spoiler or sorts: Not very far.) As a PA with a fair number of patients with mental health, I found it disturbing to be reminders about how little we know and how poorly we understand what we are trying to treat. I mean, I go to wake I knowing that, but it’s hard to be reminded This is an entirely worthy read for anyone interested in not just the history of treatment attempts for those with mental illness (or those who were assumed mentally ill) but also for those who wonder where we are today. (Spoiler or sorts: Not very far.) As a PA with a fair number of patients with mental health, I found it disturbing to be reminders about how little we know and how poorly we understand what we are trying to treat. I mean, I go to wake I knowing that, but it’s hard to be reminded of it. My take-home is that we’ve been fumbling in the dark for all of time and are doing the same now,albeit with more drugs to give. If money was invested in appropriate counseling/therapy, education, support (parental leave, care for elders, daycare, and even food and housing), we would probably make more gains than we do with medications. Meds have their place, but they don’t make the rent more manageable or resolve traumas. My only complaints are about pacing and organization. Those are minor, though. If you are interested in psychiatric treatment, read this book!

  25. 5 out of 5

    Ailith Twinning

    Still say psychology is, in practice, a defense mechanism of fascism. Papering over the cracks in the souls of those it crushes. Birthed in eugenics, and now handmaiden of neoliberal commodification of all social ties, constantly selling drugs, ideas, a self -- and turning people away from the cause of frustration, alienation, stress, pain, depression, anger, you name it: The self entire, and suffering specifically, are alienated and made the product of (dis)genic heritage, medical in nature, no Still say psychology is, in practice, a defense mechanism of fascism. Papering over the cracks in the souls of those it crushes. Birthed in eugenics, and now handmaiden of neoliberal commodification of all social ties, constantly selling drugs, ideas, a self -- and turning people away from the cause of frustration, alienation, stress, pain, depression, anger, you name it: The self entire, and suffering specifically, are alienated and made the product of (dis)genic heritage, medical in nature, not political. Also, psychology is, at best, still entirely stuck in WEIRD subjects. I was diagnosed with "Gender Confusion" and "Homosexuality" (among other things) only 15 years ago, in the United States. They're doing good to not call these things mental illnesses now, in the US, in general -- but that's hardly a compliment to the 'science'. You know how they talked about brainwashing must be happening in the USSR? I mean, what the hell do you call CBT? Sounds like real-life brainwashing to me, not some fictional mind control, just persistent calls from authority to conform, for your own good. Act Out, Keep Fighting.

  26. 4 out of 5

    João

    Great! This is a great book, and it should be required reading for anyone with an interest in mental health. It’s a good history of psychiatry, but it is also about modern psychiatry’s attempt to reassert its authority as a medical specialty, and all the ensuing difficulties. Wanting to embrace biology is all well good, but not if you lack the biological science to back you up. As made very clear in the last chapter of this book, we do not know how a normal thought or emotion is biologically gene Great! This is a great book, and it should be required reading for anyone with an interest in mental health. It’s a good history of psychiatry, but it is also about modern psychiatry’s attempt to reassert its authority as a medical specialty, and all the ensuing difficulties. Wanting to embrace biology is all well good, but not if you lack the biological science to back you up. As made very clear in the last chapter of this book, we do not know how a normal thought or emotion is biologically generated, so how could we possibly presume to understand how a pathological one is? I highly recommend it.

  27. 5 out of 5

    Elizabeth Holter

    There is nothing like immersion in the history of medicine to promote a little skepticism about the so called consensus of the current thought leaders on the issues of the day. With so many people bathing their neuronal synapses in drugs to fix their feelings, at the same time that they scrutinize food for potential danger, this book is timely. I was glad to have my view of the psychiatry bible, the Diagnostic and Statistical Manual of Mental Disorders - a view I’ve held since first encountering There is nothing like immersion in the history of medicine to promote a little skepticism about the so called consensus of the current thought leaders on the issues of the day. With so many people bathing their neuronal synapses in drugs to fix their feelings, at the same time that they scrutinize food for potential danger, this book is timely. I was glad to have my view of the psychiatry bible, the Diagnostic and Statistical Manual of Mental Disorders - a view I’ve held since first encountering it during neurology residency - vindicated.

  28. 5 out of 5

    Tiago Faleiro

    The book gives a very in-depth history of psychiatry, especially as it is relevant for a biological account of mental illness. It has roughly 3 parts. The beginning of American psychiatry and its roots, the post-Freudian biological search for mental illness (focused mostly on schizophrenia, depression, and bipolar), and ends with more recent developments in the 21st century and some thoughts on contemporary psychiatry and how it can improve from its current state. It starts in the 19th century w The book gives a very in-depth history of psychiatry, especially as it is relevant for a biological account of mental illness. It has roughly 3 parts. The beginning of American psychiatry and its roots, the post-Freudian biological search for mental illness (focused mostly on schizophrenia, depression, and bipolar), and ends with more recent developments in the 21st century and some thoughts on contemporary psychiatry and how it can improve from its current state. It starts in the 19th century with the obsession of brain anatomy, then moves into psychoanalysis, the first shock treatments, lobotomies, and obsessions with mothers and parenting. More recently, it goes into the first anti-anxiety medication, the hypothesizing of neurotransmitters as biological causes (dopamine, neuro epinephrine, and serotonin), the popularization of anti-depressants, the impact and development of the DSM, and more. Some of it is a typical account of psychiatry. However, it gave a good emphasis on some topics that are usually barely talked about or completely skipped, such as the anti-psychiatry movement with figures like Lang, Szasz, and Foucault, the controversies of the SDM, and also the role of psychedelics in psychiatry in the 50s and 60s. And while it has a biological perspective, it covers very well the field as a whole and how the profession progressed. What I really enjoyed about the topic is that I felt I gave a fair narrative of how psychiatry developed, without being pretentious at the views it is describing based on its posthoc knowledge. It is easy to mock why early shock treatments were implemented, the theories of psychoanalysis, or the serotonin hypothesis of depression. However, at the time, they were relatively reasonable positions. They were products of their time and the evidence available to them. This book is also a great reminder of how science can be wrong and how it can overstep in our lives. While I was already familiar with much of it, nevertheless just re-reading the history is incredibly depressing. The amount of suffering it caused, despite the best intentions, is hard to fathom. Mothers that had their autistic children taken away because they were supposedly bad mothers, mothers that were told their schizophrenic children were better not have been born, or even forced euthanasia of the mentally ill. What I didn't like about the book is that is heavily focused on its early history until the mid 20th century or so. Anything more recent, especially after the 80s and 90s, is mentioned at the very end feeling very rushed and without much substance. It does cover recent controversies of the pharmaceutical industry but without much depth. And recent developments in genetics and neuroscience in regards to mental illness, despite often being overvalued or misinterpreted, deserved some attention, and they were completely skipped. Despite the more modern shortcomings, it is nevertheless a book about the history of psychiatry. So I can't put a lot of blame that it focused more on its roots and how we got here. I was already familiar with the topic, and I still learned tons of new things and looked at many subjects with a fresh and more insightful perspective. "The scale of this complexity is not something about which psychiatry needs to feel in any way embarrassed. After all, current brain science still has little understanding of the biological foundations of many—indeed, most—everyday mental activities. This being the case, how could current psychiatry possibly expect to have a mature understanding of how such activities become disordered—and may possibly be reordered? In the early years of neurophysiology, Sir Charles Scott Sherrington predicted that when all was said and done, the effort to understand how different brain systems related to mental activity would likely “resolve into components for which at present we have no names.” If we think Sherrington was right, we may well anticipate that the psychiatry of the future will have little use for diagnostic categories like “schizophrenia,” “bipolar disorder,” and “depression.” The fact that we don’t know what terms it will use instead is just one measure of how far we still are from the promised land of real medical understanding of real mental illness."

  29. 5 out of 5

    Cav

    This was an interesting look at psychiatry, and more specifically, its troubled history of getting things wrong. From unfit mothers causing schizophrenia, to the "cure" of lobotomizing people, this book tells the scary history of the failings of modern psychiatry. Although it tended towards dry, tedious reading more suitable to a school textbook IMO, there was none-the-less quite a lot of good info in here. Psychiatry still doesn't know what it's doing, and cannot achieve consensus on the diagnosis This was an interesting look at psychiatry, and more specifically, its troubled history of getting things wrong. From unfit mothers causing schizophrenia, to the "cure" of lobotomizing people, this book tells the scary history of the failings of modern psychiatry. Although it tended towards dry, tedious reading more suitable to a school textbook IMO, there was none-the-less quite a lot of good info in here. Psychiatry still doesn't know what it's doing, and cannot achieve consensus on the diagnosis, or treatment of many common illnesses. Coupled to the problem of mass misdiagnosis, is the greed of the pharmaceutical companies, who incentivize practitioners to over-prescribe medication whose efficacy is questionable, especially compared to placebo. She talks about how the DSM, once praised for being the field manual of brain disorders, is actually quite a contentious publication in its own right, having undergone 5 iterations, increasing in size virtually exponentially though every subsequent version. The previous head of the National Institute of Mental Health (NIMH) Thomas Insel, wanted to scrap it altogether. He wrote: "The goal of this new manual, as with all previous editions, is to provide a common language for describing psychopathology. While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment." That never came to fruition, however, and they published the DSM-5 in 2013. Insel ended up leaving the NIMH and founding his own organization called "Mindstrong". The author wraps up the book nicely at the end with this pointed and candid quote about the current state of psychiatry: "After all, current brain science still has little understanding of the biological foundations of many, indeed most everyday mental activities. This being the case, how could current psychiatry possibly expect to have a mature understanding of how such activities become disordered, and may possibly be re-ordered?" I would recommend this book to anyone curious about the history of psychiatry, and psychiatric medicine.

  30. 5 out of 5

    Donna

    This was a well written and researched history of the treatment of those with mental health disorders in Western culture from the late 1800s to present. It is an appropriate time in the field to get this higher level view of where we've been, as part of a movement to change where we've been going. Her main focus was to review how we got to the Biological explanations of the 1980s which led to a system of characterizing people with ailments that did not previously exist and pinpointing drugs to s This was a well written and researched history of the treatment of those with mental health disorders in Western culture from the late 1800s to present. It is an appropriate time in the field to get this higher level view of where we've been, as part of a movement to change where we've been going. Her main focus was to review how we got to the Biological explanations of the 1980s which led to a system of characterizing people with ailments that did not previously exist and pinpointing drugs to sell them for each ailment. There is criticism of the DSM and how subjective it can be, and also of the pharmaceutical companies that were driven by profit but also criticized for not coming up with better treatments. But the transition away from Freudian therapy and the advent of many therapies from that time and earlier has allowed many sufferers to live more meaningful lives and also a start at destigmatization of mental health disorders. The dramatic changes in people's lives enabled by the use of lithium for bipolar disorder is one example given, but antipsychotics, although not perfect, have also helped the lives of many patients. I felt she tried to make the presentation of the information fair and unbiased, and I applaud the author for that, although I still felt some bias against drug companies and psychiatrists only wanting to make money. What I felt she did very well was to put all of this history into a perspective to allow our society to see where we can do better. There is probably a larger role for counselling (and probably other therapies, not mentioned in the book) than has been supported by the field in the more recent past, especially for those who, as she puts it, who have very real "mental suffering," but not necessarily "disease." What she doesn't really discuss is the fuzzy barrier between the biological basis of our brain's activities, which include our genetics, experiences, and reinforced methods of facing life and with our emotions, sense of well being, and ability to sense and respond within a range of normalized behavior. All of this is much more complicated than previously understood, as the genetic research into each of these diseases is telling us. There is no one gene, one magic bullet and one drug that is going to be perfect for everyone that suffers. And yes, there is a placebo effect, which has a biological basis, so our society should really be looking at more comprehensive solutions of how to help those at all levels of mental suffering.

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