Book Review Misses Evolution of Psychiatry

Leon Eisenberg, who was the founder of the Social Medicine program at Harvard, is a purported source of inspiration for Marcia Angell's recent two-part "review" of three books in the New York Review of Books. As a psychiatry resident under Eisenberg at Massachusetts General Hospital (MGH) and a friend and colleague until his death, it pained me greatly to compare the encyclopedic and nuanced knowledge of Eisenberg with the superficial treatment of psychiatry provided by Angell's attempted review of three disparate books, all of which have an antipsychiatry message....

The three books chosen by Angell, however, could in no way reflect the complex evolutionary development of psychiatry over the past 40 years that was reflected in Eisenberg's comment about the limitations of either brainless or mindless psychiatry (theories of psychiatry that either discount the role of the brain or neglect the concept of mind). Rather than providing a true book review in which the strengths, weaknesses, and context of each book are articulated, as has been done in other trenchant critiques, Angell merely uses them as convenient echoes of her own book: The Truth About the Drug Companies. Adding to her indictment of the pharmaceutical industry is her wholesale indictment of "the way psychiatry is now practiced" and a questioning of whether mental disorders are serious enough to risk treatment with medications that can have significant side effects. Although there are a few doubts raised about Robert Whitaker's (author of Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America) contention that mental disorders are better left untreated and a grudging acceptance that "many people suffer grievously from mental disorders," there is no appreciation of the scientific advances that have been made in the understanding of mental disorders in recent decades and the care with which those findings are being reviewed by international scientists involved in the revision of the Diagnostic and Statistical Manual of Mental Disorders.... This is a story worth telling and a lost opportunity for informing the public about advances in psychiatry from the vantage point once occupied by Leon Eisenberg.

For physicians who have only an "indictment hammer" in their tool kit, every developmental flaw in a medical field looks like a nail. Pontification is much easier than identifying the underlying mechanisms of complex mental disorders like schizophrenia or neurological disorders like Parkinson's disease. Developing effective medications and psychosocial treatments, personalized treatments based on genetic subtypes, and even effective service delivery and health insurance systems take sustained hard work, with many blind alleys to contend with.