This situation can cause confusion and misdiagnosis, but Harrington’s argument is not even nearly as clear as she thinks: pain, fatigue, nausea and so on frequently present in doctors’ consulting rooms, are not confirmed by radiology or blood tests, but are nevertheless treated, as they should be. Psychiatrists are totally dependent on what the patient and/or the family have to tell. Harrington mentions an objection frequently raised against psychiatry, namely that there are no radiological or blood investigations confirming a diagnosis. Also, the various psychiatric ailments should have been described in more detail. Naturally, the harm done to patients must always be kept in mind.Ĭognitive behavioral therapy is unfortunately mentioned only in passing, it merits at least a short description, if not more. Errors of judgement and inapplicable paradigms are inevitable. The author maintains an even, objective tone throughout, although a little bit more sympathy towards psychiatrists would not be amiss – after all, they are mostly trying their best to help. The book is well written and interesting. I am not sure that I entirely agree with all Harrington’s thoughts on this matter, but they certainly deserve consideration. Part 3, “Unfinished Stories” has only one chapter, titled “False Dawn.” This chapter essentially deals with what one may call the walking wounded of psychiatric or psychological ailments. Part 2, “Disease Stories,” deals with the history of schizophrenia, depression and manic depression (Harrinton’s term), better known as bipolar disease. That the inventor of this method was honored by a Nobel prize certainly isn’t something the Nobel Committee should be proud of. Other treatments were also developed, such as electroconvulsive therapy (also known as shock therapy, a nonsurgical intervention) and prefrontal lobotomy, where nerve tracts from the brain’s prefrontal cortex to the rest of the brain were cut, usually with catastrophic results for the patient – undoubtedly one of the most barbaric episodes in the history of medicine. The marketing methods of pharmaceutical companies are also discussed, and it is not a good story. Harrington describes the development of some of these agents, the claims made, the hopes it fostered in patients and families, as well as the inevitable disappointment when the realization dawned that they don’t work for everybody and that some side-effects were intolerable. The discovery of psycho-active drugs after WW 2 opened new doors and quickly gained popularity, despite opposition by psychoanalysts. Unfortunately, neither prevention, cure, or psychoanalysis were successful. The effects (now known as PTSD) of two world wars on soldiers’ psyches, together with efforts to prevent and/or treat it, had a profound influence on psychiatry and Harrinton’s description, although brief, is accurate. This treatment modality, however, wasn’t exactly a roaring success, to put it mildly. The efforts of these psychiatrists, such as Emil Kraepelin, Theodor Meynert and others, while often insightful, were nevertheless in vain and the supporters of nonbiological psychiatry, eg Freudian psychoanalysis, used this opportunity to occupy center stage. The first part, “Doctors’ Stories,” deals largely but not exclusively with the founders of biological psychiatry, those researchers (often neurologists or neuropathologists) who wanted to find an organic, anatomical locus for psychiatric illness as well as to establish a scientific system for behavioral pathology. There are numerous cross-references to this between the two parts of the book – unavoidable given the nature of the subject – but it in fact enriches the flow of the narrative. The conflict between biological and nonbiological paradigms in the description, classifying and treatment of psychiatric conditions is a very interesting tale with no end in sight. All branches of medicine have had high and low points aplenty (with more on the way), psychiatry probably more than most.
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