Of Two Minds : An Anthroplogist Looks at American Psychiatry (Vintage)

Rating:
Summary: A major disappointment
Review: I read this book based on the glowing reviews it had received. It seemed to promise to be an outsider critique of psychiatry in the same lague as such classics as "Asylums". Instead, I found the book to be superficial on a number of different levels and rather unfair to both the psychoanalytic and biological approaches to psychiatric treatment. As a clinical psychologist, I have had alot of exposure to psychiatric training, psychoanalytic therapy, and the scienitific foundations, as well as practice of biological psychiatry. It is from this background, that I found the book lacking on so many fronts.

Luhrmann never provides a satisfactory definition of what she means by psychoanalytic psychotherapy. What she does is proceed to rule out many contemporary forms of this treatment (e.g., interpersonal psychotherapy), without opeartionalizing what's left. She further confuses writings about different forms of psychoanalytically-oriented treatment, for example misattributing Roy Shafer's opinions from "The Analytic Attitude" to psychoanalysis, when in fact he was talking about psychotherapy. The treatment of biological approaches is even worse. She reduces an evolving area of science into opinion-ridden discourse. Indeed, it appears that she simply has made little effort to understand the biology and pharmacology of psychiatric disorders. Any number of undergraduate or graduate courses in phyisological psychology, pharmacology, etc. could have made this relatively accessible to her. Instead she dismisses science as "just jargon". The shortcomings in this analysis are, unfortunately, obvious for someone with a basic foundation in these biological areas.

The book contains many footnotes, yet the author seems compelled to make sweeping statements about custom & practice in mental health that are unsupported by references. For example, Luhrmann claims that psychanalytic therapy forms the primary basis for psychotherapy training in psychiatry but provides no reference for this. In practice, many psychitaric training programs emphasize other approaches, such as cognitive-behavioral therapies, whose research base fits an evidence-based model of treatment better than most psychoanalytic approaches. Luhrmann also seems surprisingly unaware of the roles and backgrounds of other mental health fields. Nurses, for example, are the backbone of inpatient psychiatry and psychiatric nurse clinicians play a growing role in ERs and in consultation-liaison psychiatry. But she relegates them to a very minor role here.

The writing of this book is often condescending and jargon-ridden which probably makes it inaccessible to much of its intended audience. In this respect it resembles the calssic "Asylums" but it lacks Goffmann's detail and rigor.

People really interested in mental health practice seem more likely to learn from journalistic accounts such as the upcoming history of McLean's or Susan Sheehan's classic "Is There No Place on Earth for Me?".

Rating:
Summary: History and Critique of the state of Modern Psychiatry
Review: This is a terrific history and critique of the state of modern psychiatry.The author writes with clarity, precision and enthusiasm about her topic. It is an insightful look at the crisis of "brain-as-mind" thinking, and the idea that the "whole" is greater the sum of its percieved parts. Luhmann is about as even handed as a writer can hope to be, but ultimately seems to conclude that the whole person approach to psychiatry is probably best for the individual and the larger culture.

The book works equally well as a piece of cultural criticism depicting the competing points of view among the schools of psychiatry as a thought provoking paradigm used to portray "kinds of mind" and the ways we think about ourselves and each other. There are, to be sure, many more than TWO MINDS, but there does seem to be Two Dominat Camps. One that thinks we are little more than a collection of our symptoms and one that thinks we are much more imaginative and capable than the limitations of our physical selves.

Great piece of social history!