Book Reviews - Spring 2019

Shrinking Success

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Psychopharmacology has not lived up to its early promise

By Scott Stossel | March 4, 2019
A patient at French psychiatrist Jean-Martin Charcot's Salpêtrière Hospital, where doctors studied hysteria, then thought to be an inherited disease of the nerves. (Wikimedia Commons)
A patient at French psychiatrist Jean-Martin Charcot's Salpêtrière Hospital, where doctors studied hysteria, then thought to be an inherited disease of the nerves. (Wikimedia Commons)

Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness by Anne Harrington; Norton, 384 pp., $27.95

Psychiatry today is in crisis. By some reckonings, mental illness is more prevalent than ever—yet the effectiveness rates of most treatments are no higher than they were 40 years ago. The profession is riven, as ever, by internecine clashes. The field’s guiding text, the Diagnostic and Statistical Manual of Mental Disorders, its bible since 1952, has been officially abandoned by the National Institute of Mental Health; the DSM’s most recent edition, the fifth, was bitterly denounced by the editor of the fourth. Most of psychiatry’s “cutting-edge” treatments date to the 1950s—and in some cases the 1930s. Even its basic terminology seems to be unraveling: Is “major depression” clinically distinguishable from “bipolar disorder”? From “generalized anxiety disorder”?

Underlying these are more fundamental questions. Are disorders like schizophrenia and bipolar disorder psychological problems, what practitioners since Sigmund Freud and Adolf Meyer have called “problems of living” or “failures to adjust,” and therefore properly treated via psychodynamic means—talk therapy and the like? Or are they medical problems—rooted in genetics and physiology, like cancer or strep throat—and therefore best ministered to biologically, via targeting the brain with drugs or shock therapy? Or, as critics like Thomas Szasz and R. D. Laing have argued, is the entire edifice of psychiatric disease a manufactured construct designed to maintain social control, invalidating certain forms of dissent and alternative modes of perception as the product of “mental illness”? Or is psychiatric illness a confection of Big Pharma marketing departments, with disease categories proliferating and inflating beyond reason in order to enlarge the reservoir of potential customers?

In Mind Fixers, Anne Harrington, a professor of the history of science at Harvard, explores these entangled questions, primarily via a narrative account of, as her subtitle has it, “psychiatry’s troubled search for the biology of mental illness.” Though the basic story Harrington tells is familiar—versions of it having been rendered in dozens of recent accounts of the history of psychopharmacology—her history is premised, bracingly, on the notion that psychiatry has steered itself into a dispiriting cul-de-sac where it has spent decades driving in circles.

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