Posted by dj on August 7, 2000, at 19:57:26
Of Two Minds: The Growing Disorder in American Psychiatry
by T. M. Luhrmann
Is the fight between cures worse than the disease? The fairly comfortable truce between psychotherapy and drug treatment for mental illness started eroding a few years ago, when the latter's bottom-line efficiency made it the preferred option for HMOs and many other health care providers. The often-sharp division between these two methods is highlighted in Of Two Minds, an insightful anthropological assessment of psychiatric training in America by University of California-San Diego's T.M. Luhrmann.
She studied with psychiatrists in training, visited inpatient and outpatient facilities, and interviewed scores of doctors and patients to reveal the craft of a strange and misunderstood profession. Neither opponents nor defenders of the mental health establishment will find unqualified support from the author's careful evaluation.
While she states from experience that she believes mental illness is real and in many cases of biological origin, she also despairs at the divide between research and treatment.
Luhrmann is strongly sympathetic with her subjects, whether physicians, patients, or instructors. She paints a portrait of harrowing training for young doctors and hellish experiences before, during, and after treatment for those seeking relief. She does find much to recommend both drug and talk therapies, though current research suggests that combining them is more effective for more patients than either one alone.
In closing, Luhrmann warns that we are in danger of dehumanizing the mentally ill by emphasizing cost-effective pharmaceutical management of symptoms over interpersonal relationships. Of Two Minds has the depth and complexity necessary to match its subject and the warmth to reach its readers. It's essential reading for anyone involved or interested in mental health. --Rob Lightner
From Booklist
Anthropologist Luhrmann examines how psychiatrists are trained and how they interact with patients in this thoughtful study of the "two minds" of psychiatry: the biomedical approach that sees mental illness as a disease best treated with drugs; and the psychodynamic approach, seeing mental illness in the mind and emotions and treating it through therapy.The students Luhrmann followed learned both, and many practicing psychiatrists find both valuable for most patients. But managed-care plans prefer the speed and (relative) low cost of psychopharmacology, forcing many therapists to narrow their focus. Luhrmann examines the consequences of this narrowing--for patients, doctors, and society. Valuable as drug treatment is for many mental illnesses, it cannot help every patient. Even when it works, the medical model leaves many patients feeling powerless.
Luhrmann makes an eloquent case for the psychodynamic approach's moral and cultural context, recognizing that, with all its limitations, the Freudian method serves individual patients' needs and strengthens society's grasp of what it means to be human. Mary Carroll
From Kirkus Reviews
A probing, nuanced look at the culture of psychiatry, with particular emphasis on the dichotomy between the drug cure and the talking cure. Anthropologist Luhrmann (Persuasions of the Witchs Craft, 1989) spent some time exploring an aspect of psychological anthropology that required her to examine various cultures with the psychoanalytic theories of Freud in mind.
As a result, she found herself drawn to the world of psychiatrists, psychoanalysts, and their patients. What she found after years of observation and immersion (she served briefly as a psychotherapist herself) were two ways of looking at mental illness.
One approaches mental disorders as disturbances of the brain, biological anomalies, treatable with psychopharmaceuticalsProzac, lithium, and the like. The other focuses on what Luhrmann calls disturbances of the mind, distortions of the personality that respond to the many, varying forms of guided exploration of the conscious and unconscious categorized as psychodynamic therapy.
Psychiatrists are usually trained in both, but they are often forced to choose one approach or the other, committing themselves as brain doctors or mind doctors. Recently the two camps began to collaborate, agreeing in essence that a combination of medication and psychodynamics is most effective, but managed care put a severe cramp in that prognosis, forcing many hospitals and doctors into the drug McCure, eliminating or curtailing the now 45-minute hour.
In chapters that include empathetic exploration of the stresses of medical training, careful examinations of the difficulties of diagnosis, the split between the scientist and the psychoanalyst, and the crisis of managed care, Luhrmann lays out clearly, with anecdote and case history, the ethnography that shapes a psychotherapist.
Answers the question for professionals and patients alike: who is the person playing with your mind? Or is it your soul?
-- Copyright (c)2000, Kirkus Associates, LP. All rights reserved.
From the Publisher
"An astute and fascinating account of American psychiatry at the intersection of centuries. Of Two Minds vividly portrays the fierce and often unnecessary wars between those representing the interests of the mind and the brain."
-- Kay Redfield Jamison, Professor of Psychiatry, Johns Hopkins School of Medicine and author of Night Falls Fast and An Unquiet Mind
"That rarest of achievements--a brilliant contribution to scholarship, an important document for policy, a compulsive read."-- Howard Gardner, author of The Disciplined Mind and Intelligence Reframed
"A spirited, clear-eyed visit to the land of American psychiatry, where the insurance industry drones and the drug-cowboys of psychopharmacology are taking over. This terrific book urges us to preserve what truly heals: a shared journey of mutual, compassionate connection."-- Samuel Shem, M.D., Ph.D., psychiatrist at Harvard Medical School, author of The House of God and Mount Misery
"Extraordinarily perceptive...Luhrmann has not only described to outsiders how the culture of mental health looks from within, but also made a highly revealing external analysis of that culture. By looking at the split in how we understand insanity, she tells us how we define sanity; and that, in turn, makes us rethink what it is to be human. If we are lucky, this work will lead to a reconciliation of the ideological positions that, even as they claim to cure, drive us mad."-- Andrew Solomon
"Of Two Minds needs to be read by every psychiatrist, and every psychiatric resident, and by psychologists, social workers, nurses, and laypeople who possess an interest in psychiatry, because it is the single best account of what is happening to psychiatry. And because Luhrmann convincingly shows what psychiatry's travails may tell us about what is happening to the soul in a dismaying time. Beautifully written and tellingly evocative ethnography. A triumph!"
-- Arthur Kleinman, M.D., Professor of Anthropology and Psychiatry, Harvard University
"This is both wonderful and amazing. It's a read that carries you through the trauma of medical school, to the life and death decisions physicians have to make. But it also is fixed right on one of the main lines of conflict in modern mental science: between the person's life experience and her biology. The difference in approaching a patient in terms of chemical or life imbalances has so rarely been so well dramatized. A great book!"--Robert Ornstein, author of The Life of the Mind
"We psychiatrists are seldom pleased with commentaries from 'outsiders' about the complexity of what we do in our daily practice. But Tanya Luhrmann is that rare observer who immerses herself so deeply in her field of observation that she emerges with a profound emphatic understanding of what it's like to be a psychiatrist in the new millennium. She has her fingers on the pulse of the profession and perfectly captures the mind/brain conflict and its impact on the clinical, economic and educational dilemmas that haunt psychiatry."-- Glen O. Gabbard, M.D., Callaway Distinguished Professor of Psychoanalysis, The Menninger Clinic
"An important book, shedding light on the world of psychotherapy as only a caring outsider could do."-- Harold Kushner, author of When Bad Things Happen to Good People
"This is an important book for several reasons. The author argues forcefully that mental illnesses are real illnesses, serving an important role in decreasing stigma toward patients with psychiatric problems.More important, though, Luhrmann points out the critically important need to preserve within psychiatric care a complex and multilayered understanding of the people with the illnesses psychiatrists treat. This is an essential point of view, especially in an era in which economic forces and the abuses of the managed care approach tempt some to follow a biological reductionist approach.
No treatment can succeed optimally, she asserts, and I agree, unless we recognize and address the richness and complexity of biological, developmental, emotional, psychological, interpersonal, and social factors influencing mental life in our approaches to training and clinical care."
--Allan Tasman, M.D., President, American Psychiatric Association; Professor and Chairman, Dept. of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine
Bravo!!!
dj
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