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Mind Fixers: Psychiatry's Troubled Search for the Biology of Mental Illness
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.
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.
384 pages, Hardcover
First published April 16, 2019
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December 24, 2019
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.
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.
May 23, 2019
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.
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.
December 10, 2019
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...
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...
May 17, 2019
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.
December 5, 2019
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
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
May 5, 2019
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.
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.
September 26, 2019
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.
July 11, 2019
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).
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).
December 29, 2021
Een genuanceerde geschiedenisles over de problematische aanvang van psychiatrie. Een meeslepend verhaal over hoe goede intenties onvoldoende waren. Facilis decensus Averno.
Had graag iets meer over hedendaagse problemen gelezen.
Had graag iets meer over hedendaagse problemen gelezen.
May 20, 2019
And we're still guessing.
December 28, 2021
Man, what an important book, especially for folks going into psychiatry but I think for all of us living in this mental health conscious age. Her essential premise is that psychiatry has for the past 150 + years tried to root mental Illness in biology through many different models, but has continually failed. She asserts that psychiatry’s current state, where it claims to have rooted much of mental illness in neurobiology clearly, is not much better and to claim victory or revolution is inaccurate. And like in the past, claiming this prideful untruth does and will likely continue to result in unnecessary suffering. She’d like to expand mental health treatments into diverse models, which I also agree with and enjoyed having a historical backing to. This is challenging to read as someone excited to step into psychiatry in one way or another.
One fun thing about this is I know some brilliant psychiatrists in the neuropsychiatry world who would strongly disagree. And I get their points too. I wish I could get them into a podcast conversation with this author. There would be much to learn there.
4 stars because I wish it was longer and engaged more with what I know has been going on with biological psychiatry in the last 10 years. She doesn’t even mention any of the promises of interventional psychiatry methods. She also doesn’t approach psychiatry’s role in addiction treatment, which is one place where a biological model is actually pretty attractive as it de-stigmatizes addicts, which is probably worth doing . Also she dumps on ect as a negative thing, which objectively it is not. I know that’s a lot of negatives for a 4 star, but I think this book’s perspective is so vital to me as I step into psychiatry, and I wish people would read it so we could chat about it.
Click this link below if you want to read a good article about it! Also I don’t think her take is entirely unbiased or practical. I just feel like this critique is needed to move forward, wherever that is.
https://www.theatlantic.com/magazine/...
One fun thing about this is I know some brilliant psychiatrists in the neuropsychiatry world who would strongly disagree. And I get their points too. I wish I could get them into a podcast conversation with this author. There would be much to learn there.
4 stars because I wish it was longer and engaged more with what I know has been going on with biological psychiatry in the last 10 years. She doesn’t even mention any of the promises of interventional psychiatry methods. She also doesn’t approach psychiatry’s role in addiction treatment, which is one place where a biological model is actually pretty attractive as it de-stigmatizes addicts, which is probably worth doing . Also she dumps on ect as a negative thing, which objectively it is not. I know that’s a lot of negatives for a 4 star, but I think this book’s perspective is so vital to me as I step into psychiatry, and I wish people would read it so we could chat about it.
Click this link below if you want to read a good article about it! Also I don’t think her take is entirely unbiased or practical. I just feel like this critique is needed to move forward, wherever that is.
https://www.theatlantic.com/magazine/...
July 22, 2019
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
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
August 15, 2019
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.
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.
August 6, 2019
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.
September 25, 2020
Great book — no complaints — purely historical account, no deep analysis.
April 13, 2023
This book taught me so many things about prescriptions and mental illness! Out of all the things I’ve read, I’ve never once read this side of the history of pharmaceuticals and mental illness. This side being the path of the scientists to come up with medicinal answers, using competing ideologies.
Very fascinating, if a bit unnerving about how much we don’t really know. The author’s hopefully that one day we’ll know, and we’ll be using words we don’t yet have, was a delightful projection!
Very fascinating, if a bit unnerving about how much we don’t really know. The author’s hopefully that one day we’ll know, and we’ll be using words we don’t yet have, was a delightful projection!
Read
July 3, 2023A great read, and an important one to for anyone who considers themself a psychologist without any proper certifications, licenses, or degrees, such as myself.
The history of psychology is messed up and it’s important to know why.
The history of psychology is messed up and it’s important to know why.
August 2, 2023
I struggled with this book a lot, primarily because it deals with a field I’m considering joining. I really liked the historical aspect of the book, it did a really good job putting together the different thought trends. I kind of already knew the main point of the book, that it has been really difficult to find the biological basis for mental health disorders and that a lot is left to be done in the realm of finding new drugs. I found more issue with some of the finer points the author makes. There’s a sense I get of a flashiness to the book that attempts to conclude neatly that things are really messed up. And they are, but there was little nuance to the successes of psychiatry thus far and the way in which people can be helped tremendously as well. The author’s suggestions at the end aren’t very inspiring. One of the points made was that many underserved people would fare much better with decent housing rather than medication. Yeah obviously. But what can be done in the meantime, what can be done to alleviate people’s suffering and give them some sort of baseline to move forward? Of course I agree that our society should change fundamentally and that those things should be a given, but that’s not the reality right now. It’s a question I’ve been thinking about a lot, that of the role of psychiatry in underserved settings as a way to support rather than just to put on a band aid on structural issues. And we can’t forget the role of other therapeutic practices that are teachable,such as CBT to help people tackle the day to day. The other thing she mentions is broadening prescribing power to social workers and psychologists. I get what she’s saying, we need more people to also deal with the more run of the mill depression and anxiety. I agree. And again, hard to not be defensive about this point, but many of these medications can have serious side effects. Many have to be monitored closely and have to consider the potential for metabolic side effects, neurological side effects, among others. So it’s tough. I don’t have answers and I hope to learn a lot more in the coming years. I just kind of refuse to treat this as a story of failure even with so many shortcomings when many people can benefit and will benefit in the future. I just don’t know, ah!
November 16, 2019
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.
June 22, 2025
The past 100 years has been a medical revolution, most notably in our ability to create great drugs for cancer and cardiovascular diseases. Contradistinctively, the medicines for neuropsychiatric disorders - namely schizophrenia, bipolar disorder and depression have substantially lagged.
A common explanation for this is that psychiatric medicine had been held back by Freudian type psychoanalysis. Harrington very convincingly shows that this is not true, but instead points to the fact that psychiatry he’s grappling with hard questions and embraced many distinct ways of treating mental illness - lobotomy, electroconvulsive therapy, asylums, insulin coma therapy and yes, psychoanalysis. If anything, psychiatrists like Bleuler embraced the patristic style Freudian analysis because they felt it would enhance their understanding of their patients.
A common explanation for this is that psychiatric medicine had been held back by Freudian type psychoanalysis. Harrington very convincingly shows that this is not true, but instead points to the fact that psychiatry he’s grappling with hard questions and embraced many distinct ways of treating mental illness - lobotomy, electroconvulsive therapy, asylums, insulin coma therapy and yes, psychoanalysis. If anything, psychiatrists like Bleuler embraced the patristic style Freudian analysis because they felt it would enhance their understanding of their patients.
January 20, 2021
Good book with a great message generally speaking. But has a slight bias, is a simplified, presents things as a black and white binary, ignores lots of research that doesn’t fit her agenda and goal, and can mislead people who aren’t more thoroughly educated on the topic. Oh and some of the sources she cited has since been debunked.
April 6, 2024
In Mind Fixers, Anne Harrington wraps her diatribe against the advancements (and failures) of pharmaceuticals for mental health by noting some telling data on the placebo effect that came to widespread recognition in the early 2000s. Basically, most psychiatric meds don't outperform a placebo, and those that do have a marginal improvement that wouldn't be borne out by changes in symptoms (something like 18%). By sharing this, she invites you to question the diagnoses that millions of people possess and the multi-billion industry that's sprouted around them — "Do these pills really work?"
By preceding this placebo figure with hundreds of pages of tales of medicine gone wrong from the 1800s and 1900s, Harrington invites you to doubt the system as a whole. Is it scientific advancement that we are now seeing, or is it all a fraud? Are modern pharmaceuticals any different than the lobotomy? Are the "so-called" psychiatrists and "so-called" neurologists just agents of the profiteering Big Health — and are they even legit? She shares stories of pills gone wrong, failed efforts to find a biological origin of mental illnesses, and the fracture between all of the types of mental health practitioners who (she implies) are just angling for insurance money. She sets the stage with the worst of modern medicine (and the worst of science) and hopes you believe that it's all broken.
Yet Harrington is careful not to lean too far in one direction. She hates Freud (easy), hates lobotomies and asylums (easy), is an agnostic on the pros and cons of modern mental health care (easy!). She cites people who find psychotherapy financially wasteful and medically dubious, skewers psychiatry with the "so-called" label, and vaguely alludes to social work being somehow more noble. She is for sure against the preponderance of labels DSM-5 has left us with, and invites you to share in her ridicule of things like "social anxiety" which have to be made up.
In reading all of these stories, it's easy to step into Harrington's world and believe that modern healthcare has failed the brain, for the reason that suicide still persists and homelessness is unfortunately abundant. Because many modern antidepressants repurpose developments of the 50s and 60s, how do they command the price they do? Is pharmaceutical research even that useful? This was the first nonfiction book where I was genuinely curious to read the conclusion, hopeful for solutions. When I got there, she concluded with a call to action to transform psychiatry into something less self-serving and more patient-focused, eschewing oversimplified diagnostic measures in favor of better care. Cool! Thanks for nothing!
There's a lot to be said about how broken psychiatry is, and Anne Harrington certainly says most of it. Every body reacts to pills differently, and the success rate is stunningly low — so perhaps patients have been overpromised a better life by authority figures who aren't even authoritative. There is no reason to think that today's diagnoses of "depression" and "bipolar disorder" won't go the same way as their predecessors "melancholy" and "manic depression". And why are we searching for a biological origin of all 300-something illnesses, when we have mostly come up short so far? She leans far in the direction of "AGH!" and not at all in the direction of "Ahh. Let's see what we can do about this," instead throwing her hands up in the air and saying that it is all broken and probably not all real anyway (though she is sure to state that she is sympathetic to all who are mentally ill in some form).
Though not a double-blind study, what I know is my own life. When I first seriously sought mental health care after a traumatic brain injury I suffered two years ago, I wasn't thrust into an asylum and given a lobotomy. I wasn't institutionalized and given ECT. My life did not stop — precisely because of advancements in how we diagnose and treat mental illness. I worked with a neurosurgeon, neuropsychologist, two therapists, two general practitioners, and a psychiatrist in the year immediately following my TBI; I can safely say that none of them had all the answers. Two of them tried failed pharmaceutical approaches (sorry to Lexapro and Wellbutrin and Concerta and Ritalin), which I suppose is what Harrington wants me to find distaste for. Although I could linger on diagnoses and questions of efficacy (Am I still depressed? Is my anxiety purely social or is it more generalized? Do SSRIs flatten the best parts of me in favor of balance?), I am grateful to be alive and know that I am better for the treatment I received.
I have been on Prozac for a year and find that I am better for it. My scaredy-cat Moo has been on Prozac, too, and has transformed into a less anxious and not self-harming version of herself. I know that Prozac works for both of us — and I don't think the placebo effect has any bearing on cats. I am grateful for this system, even with its flaws. I wish Harrington didn't see our success as a throwaway sentence, and instead as a central thesis of the book: that medicine works in treating symptoms of mental illness.
By preceding this placebo figure with hundreds of pages of tales of medicine gone wrong from the 1800s and 1900s, Harrington invites you to doubt the system as a whole. Is it scientific advancement that we are now seeing, or is it all a fraud? Are modern pharmaceuticals any different than the lobotomy? Are the "so-called" psychiatrists and "so-called" neurologists just agents of the profiteering Big Health — and are they even legit? She shares stories of pills gone wrong, failed efforts to find a biological origin of mental illnesses, and the fracture between all of the types of mental health practitioners who (she implies) are just angling for insurance money. She sets the stage with the worst of modern medicine (and the worst of science) and hopes you believe that it's all broken.
Yet Harrington is careful not to lean too far in one direction. She hates Freud (easy), hates lobotomies and asylums (easy), is an agnostic on the pros and cons of modern mental health care (easy!). She cites people who find psychotherapy financially wasteful and medically dubious, skewers psychiatry with the "so-called" label, and vaguely alludes to social work being somehow more noble. She is for sure against the preponderance of labels DSM-5 has left us with, and invites you to share in her ridicule of things like "social anxiety" which have to be made up.
In reading all of these stories, it's easy to step into Harrington's world and believe that modern healthcare has failed the brain, for the reason that suicide still persists and homelessness is unfortunately abundant. Because many modern antidepressants repurpose developments of the 50s and 60s, how do they command the price they do? Is pharmaceutical research even that useful? This was the first nonfiction book where I was genuinely curious to read the conclusion, hopeful for solutions. When I got there, she concluded with a call to action to transform psychiatry into something less self-serving and more patient-focused, eschewing oversimplified diagnostic measures in favor of better care. Cool! Thanks for nothing!
There's a lot to be said about how broken psychiatry is, and Anne Harrington certainly says most of it. Every body reacts to pills differently, and the success rate is stunningly low — so perhaps patients have been overpromised a better life by authority figures who aren't even authoritative. There is no reason to think that today's diagnoses of "depression" and "bipolar disorder" won't go the same way as their predecessors "melancholy" and "manic depression". And why are we searching for a biological origin of all 300-something illnesses, when we have mostly come up short so far? She leans far in the direction of "AGH!" and not at all in the direction of "Ahh. Let's see what we can do about this," instead throwing her hands up in the air and saying that it is all broken and probably not all real anyway (though she is sure to state that she is sympathetic to all who are mentally ill in some form).
Though not a double-blind study, what I know is my own life. When I first seriously sought mental health care after a traumatic brain injury I suffered two years ago, I wasn't thrust into an asylum and given a lobotomy. I wasn't institutionalized and given ECT. My life did not stop — precisely because of advancements in how we diagnose and treat mental illness. I worked with a neurosurgeon, neuropsychologist, two therapists, two general practitioners, and a psychiatrist in the year immediately following my TBI; I can safely say that none of them had all the answers. Two of them tried failed pharmaceutical approaches (sorry to Lexapro and Wellbutrin and Concerta and Ritalin), which I suppose is what Harrington wants me to find distaste for. Although I could linger on diagnoses and questions of efficacy (Am I still depressed? Is my anxiety purely social or is it more generalized? Do SSRIs flatten the best parts of me in favor of balance?), I am grateful to be alive and know that I am better for the treatment I received.
I have been on Prozac for a year and find that I am better for it. My scaredy-cat Moo has been on Prozac, too, and has transformed into a less anxious and not self-harming version of herself. I know that Prozac works for both of us — and I don't think the placebo effect has any bearing on cats. I am grateful for this system, even with its flaws. I wish Harrington didn't see our success as a throwaway sentence, and instead as a central thesis of the book: that medicine works in treating symptoms of mental illness.
September 19, 2024
I was a bit peeved that certain aspects were not highlighted. (Bleuler's repentance on schizophrenia and the treatment of schizophrenics, as well as criticism of the psychiatric profession as a whole in "Autistic Undisciplined Thinking in Medicine and How to Overcome It" as well as no expansion on the nature of the so called epileptic colonies)
However, as a comprehensive work, cramming the maximum amount of facts into the shortest book possible, I think the author excelled and crafted a very fine work.
I blasted through this in essentially three days and enjoyed every minute of it.
However, as a comprehensive work, cramming the maximum amount of facts into the shortest book possible, I think the author excelled and crafted a very fine work.
I blasted through this in essentially three days and enjoyed every minute of it.
October 12, 2025
Cannot recommend this book enough as a comprehensive but concise and well-written history of modern psychiatry. I wish I had read it sooner because it gives much-needed context for understanding all the major developments in theory&treatment of mental illness and places it all within a continuous narrative so that now I really feel like I have a birds eye understanding psychiatry as a field and all the major controversies/debates... Also has really detailed and helpful endnotes. Just great scholarship 💯
April 23, 2019
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.
January 11, 2021
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).
April 9, 2020
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
September 6, 2020
A scathing indictment of psychiatry and pharmaceutical companies. A must read for basically everyone.
August 4, 2019
“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.
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.
July 24, 2024
An important book.
It takes aim at psychiatric shibboleths, seeking to dismantle them with historical detail, so that new, truer stories may be told. For me, it succeeds completely.
For starters, consider the story of Freud. It is fairly common to view the psychoanalytic era as an aberration, best forgotten as we march into the glorious era of "biological" psychiatry. Freud has been falsified, and while the sway of his personality held for a while somehow, we've thankfully moved on to a more scientific time. That's certainly the story I would have told if you'd put a gun to my head. Anne Harrington would chip away at that nonsense with a thousand hammers of historical fact.
The turn of reasoning brought on by Freudian psychoanalysis is not gone - it survives as psychotherapy. It wasn't just Freud - focussing on the personality of one figure makes it easy to topple, but psychoanalytic treatment really picked up in America post-War, after Freud, and it was definitely not just one person. Psychotherapy was an improvement - it was kinder, more humane, more effective than what came before - the likes of shock therapy and lobotomies and inhumane institutionalisation. Biological psychiatry has not outperformed psychotherapy when it comes to things like depression. Indeed, biological psychiatry has barely outperformed placebo. (More on the placebo problem later.)
The victory of biological psychiatry in the public mind has been so complete that I had no idea that the commonly held distinction between psychotherapy (no drugs, not medical practitioners) and psychiatry (can prescribe drugs) did not exist sixty years ago. They were all psychiatrists, and the changes that have happened since are arguably more of a turn in ideology than scientific progress.
What is that turn in ideology and how did it take hold? As with major changes in society a lot of factors need to separately aim at different goals to cause it. Consider, for instance, the notion of "biological" psychiatry. A phrasing like that is already a PR win in the secular West. (How can psychiatry not be biological? Surely you're not thinking of invoking some supernatural explanation, are you?) There's nuance here. Firstly, one of the greatest mysteries of philosophy and one of the simplest phenomena in the world poses a challenge: the subjective experience of mind and consciousness. How does that arise from biological matter? Let's leave that simmering for a bit. Even if we accept (as I generally do) that ultimately everything we care about - our loves, our hates, our desires, our wishes, our emotions - derive from biological processes, there is a question of scale. Psychotherapy and psychiatry are looking at the same system from different scales.
One of my favourite analogies to illustrate the scale problem is this: imagine you are an alien trying to understand the rules of basketball. Would you poke around inside the brains of players trying to work out which bits produce the rules? Or would you watch the game itself? Maybe talk to the players? Clearly, doing the latter is not denying that the players are biological creatures, but just that studying the system at this level is the most effective way of getting the answer.
How then did a reductionist focus on "brain stuff" become the sole domain of psychiatry, when clearly there's more to it? Mental illness is often described as bio-psycho-social, but that label seems more aspirational than descriptive when it comes to psychiatry. Why wasn't a more holistic approach the norm? Part of the answer to that is this non-answer: the distinction between "bio" and "psycho" mattered, because it mattered to the people in power - the leaders of the APA. Anne Harrington's careful historical tale of the twists and turns of ideology brings this out. Why did DSM-III set itself a biological agenda? Because it explictly sought to reject the psychological focus of DSM-II. Why not both, why not both, your idealistic self asks? Because people.
People care about different things, and form beliefs in the context of their time and place. Why did the 19th century psychiatrist Theodor Meynert forcefully dismiss any interest in the mind at all, and only focus on the "brain machine"? At least partly because he associated an interest in the mind with the newly outdated theological view of the world, and his inspiration drew from the secular, mechanistic view of the world. That's just an example. Anne Harrington portrays all the major players over two centuries.
A different question may be coming into being in your mind now. OK, people are people, but why did that matter? Surely, empirical evidence would be the gold standard, and regardless of the personal beliefs of the experimenters, the facts would gently direct us to a truer picture of the world. It does matter what leading psychiatrists thought because the diagnosis of mental illness was - and continues to be - a top-down, committee-driven exercise by the American Psychiatric Association. It is more a consensus of experts, than an upswelling of facts from the ground.
Therein lies another problem. Amidst the battle between the "bio" and "psycho" factions, is lost a third thing. What happened to "social"? Surely different times and places and cultures would cause less or more clinical distress in people, perhaps so much as to even make make a difference between "normal" and "ill". The APA is - well - American. At best, this produces an unintended bias. In the absence of other diagnostic tools, everyone uses what's the available (the DSM), until something more "socially" aware is invented. At worst, it reflects an ignorance of culture, and a too-soon adoption of "bio" explanations for particularly American phenomena. I suspect it's the latter even if the book only hints at it.
The story of homosexuality is an illustrative one. Until DSM-III, it was classified as a mental illness by the APA. It took years of social activism, both within and without the APA, and the rising tide of social momentum for the members of the APA to approve declassifying it after a vote. What other ossifications of conventional social beliefs are masquerading as "mental illness" classifications? In today's times, neurodiversity offers a crucial counterpoint to the "bio" bias of the DSM. It posits (as I understand it) that the mental distress people suffer varies based on the social context, even if the biological makeup of the person is the same. It is worthwhile, and necessary, it says, to invest in social change to amend our institutions, our habits, our culture, our public places and so on, so that the distress suffered by a person who's "different" is alleviated, perhaps so much so that they would not even need help. With homosexuality, the distress suffered by gay people was not because of homosexuality (as DSM would have it), therefore making it a mental illness, but because society stigmatised homosexuality to such an extent that it caused mental distress. This attitude is the focus of many social justice movements today.
All of this might have been forgiven if "bio" psychiatry worked. Its rhetorical victory and rise to scientific truth, and the demotion of social workers and the like to ideological fashion, might have been OK to swallow if it just worked. Here's the most startling fact of all: it's not clear that it has. Anti-depressants barely beat placebo. On average, even when they do, it's not clinically significant.
Then there's the question of the big pharmaceuticals. Who would have thought profit-motivated businesses would do everything in their power to make money? Things like convincing people that no they're not actually fine via advertising, forming relationships with psychiatrists, the government regulators, hiding or downplaying the poor efficacy of their drugs. It's downright terrifying.
Let me take twenty steps back before I end this ramble. I'm approaching this topic from a deeply personal place. Mental illness has affected me, my family and people close to me. It is undeniable that mental suffering is real. In the clamour of the APA turf wars, this must not be forgotten. Mental suffering cannot be measured with a thermometer - an institution that fosters recognition that suffering can be crippling is valuable. The DSM's flawed classifications are not only the difference between your boss saying "everybody is depressed - shut up and get back to work" and "sorry to hear - take all the time you need"; but also between access to life-saving medical interventions and without.
With those stakes, isn't it all the more important that the strange elitism of "bio" psychiatry is dissolved, and a holistic approach towards treatment that acknowledges psychological and social work as equals developed? Ultimately, this is what Anne Harrington hopes for. If this book seems to weaken your trust in psychiatry as an institution (it did mine), then she would say it is historically merited. But tearing down that edifice means - hopefully - that a stronger one is built in its place, one that's less biased, less self-serving, and more focussed on treating the suffering.
It takes aim at psychiatric shibboleths, seeking to dismantle them with historical detail, so that new, truer stories may be told. For me, it succeeds completely.
For starters, consider the story of Freud. It is fairly common to view the psychoanalytic era as an aberration, best forgotten as we march into the glorious era of "biological" psychiatry. Freud has been falsified, and while the sway of his personality held for a while somehow, we've thankfully moved on to a more scientific time. That's certainly the story I would have told if you'd put a gun to my head. Anne Harrington would chip away at that nonsense with a thousand hammers of historical fact.
The turn of reasoning brought on by Freudian psychoanalysis is not gone - it survives as psychotherapy. It wasn't just Freud - focussing on the personality of one figure makes it easy to topple, but psychoanalytic treatment really picked up in America post-War, after Freud, and it was definitely not just one person. Psychotherapy was an improvement - it was kinder, more humane, more effective than what came before - the likes of shock therapy and lobotomies and inhumane institutionalisation. Biological psychiatry has not outperformed psychotherapy when it comes to things like depression. Indeed, biological psychiatry has barely outperformed placebo. (More on the placebo problem later.)
The victory of biological psychiatry in the public mind has been so complete that I had no idea that the commonly held distinction between psychotherapy (no drugs, not medical practitioners) and psychiatry (can prescribe drugs) did not exist sixty years ago. They were all psychiatrists, and the changes that have happened since are arguably more of a turn in ideology than scientific progress.
What is that turn in ideology and how did it take hold? As with major changes in society a lot of factors need to separately aim at different goals to cause it. Consider, for instance, the notion of "biological" psychiatry. A phrasing like that is already a PR win in the secular West. (How can psychiatry not be biological? Surely you're not thinking of invoking some supernatural explanation, are you?) There's nuance here. Firstly, one of the greatest mysteries of philosophy and one of the simplest phenomena in the world poses a challenge: the subjective experience of mind and consciousness. How does that arise from biological matter? Let's leave that simmering for a bit. Even if we accept (as I generally do) that ultimately everything we care about - our loves, our hates, our desires, our wishes, our emotions - derive from biological processes, there is a question of scale. Psychotherapy and psychiatry are looking at the same system from different scales.
One of my favourite analogies to illustrate the scale problem is this: imagine you are an alien trying to understand the rules of basketball. Would you poke around inside the brains of players trying to work out which bits produce the rules? Or would you watch the game itself? Maybe talk to the players? Clearly, doing the latter is not denying that the players are biological creatures, but just that studying the system at this level is the most effective way of getting the answer.
How then did a reductionist focus on "brain stuff" become the sole domain of psychiatry, when clearly there's more to it? Mental illness is often described as bio-psycho-social, but that label seems more aspirational than descriptive when it comes to psychiatry. Why wasn't a more holistic approach the norm? Part of the answer to that is this non-answer: the distinction between "bio" and "psycho" mattered, because it mattered to the people in power - the leaders of the APA. Anne Harrington's careful historical tale of the twists and turns of ideology brings this out. Why did DSM-III set itself a biological agenda? Because it explictly sought to reject the psychological focus of DSM-II. Why not both, why not both, your idealistic self asks? Because people.
People care about different things, and form beliefs in the context of their time and place. Why did the 19th century psychiatrist Theodor Meynert forcefully dismiss any interest in the mind at all, and only focus on the "brain machine"? At least partly because he associated an interest in the mind with the newly outdated theological view of the world, and his inspiration drew from the secular, mechanistic view of the world. That's just an example. Anne Harrington portrays all the major players over two centuries.
A different question may be coming into being in your mind now. OK, people are people, but why did that matter? Surely, empirical evidence would be the gold standard, and regardless of the personal beliefs of the experimenters, the facts would gently direct us to a truer picture of the world. It does matter what leading psychiatrists thought because the diagnosis of mental illness was - and continues to be - a top-down, committee-driven exercise by the American Psychiatric Association. It is more a consensus of experts, than an upswelling of facts from the ground.
Therein lies another problem. Amidst the battle between the "bio" and "psycho" factions, is lost a third thing. What happened to "social"? Surely different times and places and cultures would cause less or more clinical distress in people, perhaps so much as to even make make a difference between "normal" and "ill". The APA is - well - American. At best, this produces an unintended bias. In the absence of other diagnostic tools, everyone uses what's the available (the DSM), until something more "socially" aware is invented. At worst, it reflects an ignorance of culture, and a too-soon adoption of "bio" explanations for particularly American phenomena. I suspect it's the latter even if the book only hints at it.
The story of homosexuality is an illustrative one. Until DSM-III, it was classified as a mental illness by the APA. It took years of social activism, both within and without the APA, and the rising tide of social momentum for the members of the APA to approve declassifying it after a vote. What other ossifications of conventional social beliefs are masquerading as "mental illness" classifications? In today's times, neurodiversity offers a crucial counterpoint to the "bio" bias of the DSM. It posits (as I understand it) that the mental distress people suffer varies based on the social context, even if the biological makeup of the person is the same. It is worthwhile, and necessary, it says, to invest in social change to amend our institutions, our habits, our culture, our public places and so on, so that the distress suffered by a person who's "different" is alleviated, perhaps so much so that they would not even need help. With homosexuality, the distress suffered by gay people was not because of homosexuality (as DSM would have it), therefore making it a mental illness, but because society stigmatised homosexuality to such an extent that it caused mental distress. This attitude is the focus of many social justice movements today.
All of this might have been forgiven if "bio" psychiatry worked. Its rhetorical victory and rise to scientific truth, and the demotion of social workers and the like to ideological fashion, might have been OK to swallow if it just worked. Here's the most startling fact of all: it's not clear that it has. Anti-depressants barely beat placebo. On average, even when they do, it's not clinically significant.
Then there's the question of the big pharmaceuticals. Who would have thought profit-motivated businesses would do everything in their power to make money? Things like convincing people that no they're not actually fine via advertising, forming relationships with psychiatrists, the government regulators, hiding or downplaying the poor efficacy of their drugs. It's downright terrifying.
Let me take twenty steps back before I end this ramble. I'm approaching this topic from a deeply personal place. Mental illness has affected me, my family and people close to me. It is undeniable that mental suffering is real. In the clamour of the APA turf wars, this must not be forgotten. Mental suffering cannot be measured with a thermometer - an institution that fosters recognition that suffering can be crippling is valuable. The DSM's flawed classifications are not only the difference between your boss saying "everybody is depressed - shut up and get back to work" and "sorry to hear - take all the time you need"; but also between access to life-saving medical interventions and without.
With those stakes, isn't it all the more important that the strange elitism of "bio" psychiatry is dissolved, and a holistic approach towards treatment that acknowledges psychological and social work as equals developed? Ultimately, this is what Anne Harrington hopes for. If this book seems to weaken your trust in psychiatry as an institution (it did mine), then she would say it is historically merited. But tearing down that edifice means - hopefully - that a stronger one is built in its place, one that's less biased, less self-serving, and more focussed on treating the suffering.
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