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42 of 43 people found the following review helpful
5.0 out of 5 stars Freud, Prozac, and managed care
This most recent book by T. M. Luhrmann distills the results of four years' observation, interviewing and experiencing the theory and practice of American psychiatry, in venues ranging from one of the last private psychoanalytic residential centers to neuroscience labs, psychiatric conferences, and elite biomedically oriented hospitals. Her previous books dealt with...
Published on June 5, 2000

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14 of 20 people found the following review helpful
1.0 out of 5 stars A great disappointment
I read this book on the basis of strong reviews from many different quarters. As a clinical psychologist with eclectic training, a fairly iconoclastic turn of mind and a research career in public health rather than mental health, I was hoping that at outsider to mental health practice could provide fresh insights. Instead, Luhrman has produced a work of lazy scholarship...
Published on July 5, 2002 by Richard A. Jenkins


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42 of 43 people found the following review helpful
5.0 out of 5 stars Freud, Prozac, and managed care, June 5, 2000
By A Customer
This review is from: Of Two Minds: The Growing Disorder in American Psychiatry (Hardcover)
This most recent book by T. M. Luhrmann distills the results of four years' observation, interviewing and experiencing the theory and practice of American psychiatry, in venues ranging from one of the last private psychoanalytic residential centers to neuroscience labs, psychiatric conferences, and elite biomedically oriented hospitals. Her previous books dealt with how people make sense of their worlds: Persuasions of the Witch's Craft showed how witches in modern England come to believe in astrology and magic; and _The Good Parsi_ examined the Parsis' reaction to their fall from grace as India's colonial elite. Now she turns her attentions to some of the great existential questions of modern society: what is mental health? how can we intervene in people's lives when we only have imperfect knowledge? and what does it mean to be a person?
Luhrmann began by following the training process of a group of new psychiatric residents, to see how medical students become psychiatrists, and how they negotiate between the two, often antagonistic, models of psychiatry: biomedical and psychodynamic. The book contains great descriptions of patients and residents, of the quirks of different kinds of programs, and of how neither the psychoanalysts nor the biomedical specialists really believe in most of the DSM categories per se, but use them empirically and pragmatically as a means to treating the problems they represent. Luhrmann is sympathetic to the position of psychiatrists, but fair. She makes the point quite strongly that both biomedicine and analysis have their down sides, that both have internal theoretical and practical problems, but that they're addressing an absolutely real need. The dichotomy between the two, according to Luhrmann, is a false one which grew out of historical differences (namely the near-monopoly of psychoanalysis in the 1950s and 1960s) and which has been prevented from a reconciliation by the perceptions and policies of managed care, probably to the detriment of both patients and of the financial bottom line.
The book is extremely readable, which is welcome in the field of medical writing, which is often either thinly disguised politics or thickly layered jargon. Luhrmann manages to range from William Styron's autobiography to budget cuts in a state psychiatric clinic to debates between Hume and Kant over the nature of personhood without once losing her readers. She also has written a book which would be almost impossible for one of the insiders to write, because most psychiatric professionals are thoroughly socialized into the assumptions and habits of medicine long before they come to psychiatry. And so she does what a good anthropologist is supposed to do -- to give us a new perspective on our own lives. I highly recommend this book to anyone interested in American psychiatry, the effects of managed care, or the profound challenges posed by the paradoxes of mental illness.
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20 of 21 people found the following review helpful
4.0 out of 5 stars Well done!, January 27, 2001
This review is from: Of Two Minds: The Growing Disorder in American Psychiatry (Hardcover)
I'm a practicing psychiatrist, with the requisite 10 years in to (in theory) know what I'm doing. I'm grateful to Dr. Luhrmann for the thoroughness of her experiential research and the humanity of her expression. The book evoked memories of powerful, sometimes painful experience for me as I read her descriptions of internship and psychiatric residency; her accounts are realistic and carefully written. Her description of the profession-threatening impact of market forces should be required reading for anyone interested in the future of mental healthcare.
My only real trouble with the book is in its mutually excluding premise of "either/or"; that one's perspective on human behavior and its tragedies must be viewed either objectively, in reductionistic biomolecular ("nature") terms, or intuitively, through the subjective lens of psychodynamics("nurture"). I, too, was weaned in a psychdynamic orientation, then later yanked by the both the shock of witnessing severe illness and the expediency of managed care psychiatry to a more medical model. I ultimately have been disappointed by the pure biologic orientation. It usually provides a mere pharmacologic "band-aid", insufficient for lasting change unless the patient's experience of the world is also addressed - something no pill can achieve but the "heavy lifting" of psychodynamic psychotherapy can.
My own conclusion is that neither model stands up fully on its own, either diagnostically or in treatment. I suspect the best path is in integrating the perspectives. And why not? We know, for instance, that the scarring of witnessing/experiencing trauma in early life commonly leads to the extreme suffering of PTSD - a syndrome that, though fully "situational" as opposed to genetic, appears, and is, "hard-wired" and responsive to medication intervention. Yet we also know that some who experience similar trauma don't become cursed with insomnia, night terrors and hypervigilence - suggesting a component of a biological nature. We trust so in the dogma of the double-blind study, but even that gets tarnished when recent studies show 80% or more of supposed blinded subjects can guess whether they are on active drug or placebo - potentially casting at least a little doubt on a generation of pharmacology research, not to mention an entire industry. Frankly, we really still know so little! That Dr. Lurmann preferentially interviewed either babes-in-the-woods(with an understandibly shaky perspectival foundation) or academic attendings (who are commonly where they are via a narcissistic confidence in the camp he or she cast his or her fate) - may account for the intellectual myopia inherent in insisting primacy of one of the two stances.
Only in attempting to integrate the two and understanding the field within a wider philosophical and spiritual perspective have I found an inhabitable worldview. My own study has reached outside the usual to philosophy, anthropology and spirituality (I recommend reading Hegel, Aurobindo and especially Ken Wilber in attempting to understand how to integrate this complex matter). Nevertheless, this book is a wonderful piece on how things are in the polarized climate of the psychiatric profession; I recommend it.
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14 of 16 people found the following review helpful
5.0 out of 5 stars psychiatry today, May 24, 2000
By A Customer
This review is from: Of Two Minds: The Growing Disorder in American Psychiatry (Hardcover)
Of Two Minds is destined to become a classic. Luhrmann writes with style and verve about more than three 3 years of participant observation of the modern world of psychiatry. Her book is rich in quotes and observations about the daily life of psychiatrists. The main thesis of Luhrmann's book is that the world of psychiatry is currently split between two different therapeutic models, the biological and the psychodynamic, and, at this point, the big battalions belong to the biological camp. Luhrmann succeeds in describing what this actually means with respect to human life - the lives of both patients and psychiatrists. Luhrmann's book takes on one of the major problems of modern society. The book is a good read, the illustrations are gripping, and the treatment is always balanced and far-sighted. She is sensitive to the moral dimension of human life and the great underlying American conflict between doing things the efficient way versus the moral way.
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17 of 22 people found the following review helpful
4.0 out of 5 stars An anthropologist studies the tribe, May 21, 2001
This review is from: Of Two Minds: The Growing Disorder in American Psychiatry (Hardcover)
What do anthropologists do these days as the number of unstudied tribes in the wild has dwindled to something like zero? They practice urban anthropology as they study various "cultures" within the larger society. Here ethnographer, T. M. Luhrmann of the University of California, San Diego, takes a long look at the psychiatric profession and finds it split into two mind sets as it tumbles toward disorder. On the left side we have the traditionalists who believe in the efficacy of psychodynamic psychotherapy (mainly Freudian psychoanalysis), and on the right, "psychiatric science," the biomedical approach, characterized by the use of various psychopharmacological agents such as Prozac, lithium, clozapine, etc. This bicameralization of psychiatry, Luhrmann argues, is in part the direct result of the rise of the managed care industry which is threatening to put psychodynamic psychotherapy (the "talk" cure) out of business because the insurance companies increasingly won't pay for lengthy psychoanalysis. She sees the "psychopharm" cure, even though it is of limited effectiveness (with unknown long-term side effects) as taking over. Thus we have the "disorder" in psychiatry. Her conclusion is that psychotherapy and psychopharmacology together are the most effective method of treating mental illness.
In the course of her work, Luhrmann visited various mental health facilities where she observed their practices while she interviewed the doctors, the nurses, the staff and the patients. She constructed composites of some of the personalities, gave them fictitious names, and quoted them. Her style is lucid, and balanced almost to a fault. For example, on page 269 where she is discussing patient advocacy groups, she refers to a magazine called Dendron which seeks alternatives to what it calls "forced psychiatric drugging." In the next paragraph she presents the alternative point of view of The National Alliance for the Mentally Ill which believes that "mental illness is not the result of poor socialization and inadequate parenting but rather a medical condition in need of medical attention." On page 278 she writes, "...in the years of psychoanalytic dominance, the vulgarized psychoanalytic model was used to humiliate and insult the parents whose children suffered." On page 286 she counters, "The real dilemma...faced by our society...is whether we will allow the seductions of the vulgarized biomedical model to overcome our own responsible commitment to a complex view of human life." Thus one can see that Luhrmann has become of two minds herself!
She is not, however, an entirely an unbiased observer. As she points out in the Introduction, she got the idea for this study because she joined "an anthropology department known for its long tradition of psychological anthropology," a discipline that "grew out a tradition of using psychoanalytic ideas to make sense of cultural practices." (The Freudian paradigm making sense of New Guinea tribesmen? I think I'll just pass on THAT.) Luhrmann's father is a psychiatrist, and although she maintains that her background "was more cognitive" her experience in writing this book included attending lectures designed to teach "a clinical perspective on Freud and psychoanalysis" (p. 3). Consequently it is understandable that she supports the Freudian psychoanalytical approach. Even so, Luhrmann does not shy away from quoting authorities to the effect that psychoanalytic theory is without a firm scientific basis.
However I don't think she goes far enough. What really needs to be said is that the old Freudian psychoanalytic model in which the patient is psychoanalyzed for several years is no longer tenable. It's not just that the insurance companies won't pay for it. There have been many studies from Eysenck in 1952 to the present demonstrating the dubious effectiveness of psychotherapy, particularly in treating the heavyweights like schizophrenia and psychosis. Luhrmann cites studies both for and against this conclusion. She recalls the old "mantra" (p. 208) that "both psychotherapy and psychopharmacology have the same crude success rate: a third of the time they work well; a third of the time, they have some impact; a third of the time they don't work at all." She also makes the point that no one form of psychotherapy is superior to another, that it is the caring and the time spent with the therapist that helps, not the mode of therapy. This last point is really the crux of the matter. Luhrmann writes on page 202: "If the moral authority of the scientist derives from the knowledge he acquires, the moral authority of the analyst derives from the love he gives." On page 201 she quotes Elvin Semrad: "The most important thing, the thing that makes the difference, the thing that we as psychiatrists are dealing in, is love and humanity." It is NOT the Freudian mumble-jumble that helps patients (to the extent that they are helped), but it is the loving concern and care of the therapist.
If this is so, it raises the question, why do therapists need to go to medical school, need to study the now largely discredited Freudian mythology, need to spend years in psychoanalysis to be no more effective than a counselor from the local church? The answer is they don't. And this is part of the reason for the split and the crisis in psychiatry. What needs to be gotten rid of, and I don't think Luhrmann really sees this, is the Freudian baggage. Psychodynamic psychiatry really needs a framework and model more nearly consistent with the advances in knowledge about human beings that have occurred since the days of Freud. Those old ideas of "penis envy" and Oedipus complex, etc., as significant factors in mental illness must be scrapped. The revelations and the paradigms from cognitive psychology and evolutionary psychology need to replace the Freudian construct.
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2 of 2 people found the following review helpful
4.0 out of 5 stars Well done!, January 27, 2001
This review is from: Of Two Minds: The Growing Disorder in American Psychiatry (Hardcover)
I'm a practicing psychiatrist, with the requisite 10 years in to (in theory) know what I'm doing. I'm grateful to Dr. Luhrmann for the thoroughness of her experiential research and the humanity of her expression. The book evoked memories of powerful, sometimes painful experience for me as I read her descriptions of internship and psychiatric residency; her accounts are realistic and carefully written. Her description of the profession-threatening impact of market forces should be required reading for anyone interested in the future of mental healthcare.
My only real trouble with the book is in its mutually excluding premise of "either/or"; that one's perspective on human behavior and its tragedies must be viewed either objectively, in reductionistic biomolecular ("nature") terms, or intuitively, through the subjective lens of psychodynamics("nurture"). I, too, was weaned in a psychdynamic orientation, then later yanked by the both the shock of witnessing severe illness and the expediency of managed care psychiatry to a more medical model. I ultimately have been disappointed by the pure biologic orientation. It usually provides a mere pharmacologic "band-aid", insufficient for lasting change unless the patient's experience of the world is also addressed - something no pill can achieve but the "heavy lifting" of psychodynamic psychotherapy can.
My own conclusion is that neither model stands up fully on its own, either diagnostically or in treatment. I suspect the best path is in integrating the perspectives. And why not? We know, for instance, that the scarring of witnessing/experiencing trauma in early life commonly leads to the extreme suffering of PTSD - a syndrome that, though fully "situational" as opposed to genetic, appears, and is, "hard-wired" and responsive to medication intervention. Yet we also know that some who experience similar trauma don't become cursed with insomnia, night terrors and hypervigilence - suggesting a component of a biological nature. We trust so in the dogma of the double-blind study, but even that gets tarnished when recent studies show 80% or more of supposed blinded subjects can guess whether they are on active drug or placebo - potentially casting at least a little doubt on a generation of pharmacology research, not to mention an entire industry. Frankly, we really still know so little! That Dr. Lurmann preferentially interviewed either babes-in-the-woods(with an understandibly shaky perspectival foundation) or academic attendings (who are commonly where they are via a narcissistic confidence in the camp he or she cast his or her fate) - may account for the intellectual myopia inherent in insisting primacy of one of the two stances.
Only in attempting to integrate the two and understanding the field within a wider philosophical and spiritual perspective have I found an inhabitable worldview. My own study has reached outside the usual to philosophy, anthropology and spirituality (I recommend reading Hegel, Aurobindo and especially Ken Wilber in attempting to understand how to integrate this complex matter). Nevertheless, this book is a wonderful piece on how things are in the polarized climate of the psychiatric profession; I recommend it.
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14 of 20 people found the following review helpful
1.0 out of 5 stars A great disappointment, July 5, 2002
This review is from: Of Two Minds: The Growing Disorder in American Psychiatry (Hardcover)
I read this book on the basis of strong reviews from many different quarters. As a clinical psychologist with eclectic training, a fairly iconoclastic turn of mind and a research career in public health rather than mental health, I was hoping that at outsider to mental health practice could provide fresh insights. Instead, Luhrman has produced a work of lazy scholarship and self-serving pretense. The book proports to be balanced, but it is clear, throughout, that Luhrmann spends most of her time defending psychoanalytic therapy against biological approaches. Nonetheless, she never really defines what she means by psychoanalytic therapy and, in the process, rules out large chunks of that field, including contemporary variants like interpersonal psychotherapy. She reduces much serious work on psychopharamacology to being only about rhetoric and one wonders whether she ever tried to understand the what happens in the neurotransmitter systems (a topic that is more accessible than it sounds). Indeed, it appears that she developed rather little depth in either the biological or psychoanalytic perspective and she does grave injustice to both. Similarly, her insights about human interactions in her stint as a therapist-in-training suggest that qualitative interviewing is not her strength, either. Instead, we get a postmodern-lite analysis of what happens in clinical interviews and therapy. Indeed, the turgid prose and not-so subtle self-aggrandizing pose make this an altogether unsatisfying read.
Compared with past non-fiction accounts of mental health practice, the book lacks depth and the author's voice gets in the way rather than providing real insight. The book lacks the rigorous depth that has made for gripping, thought-provoking jounalistic accounts like Susan Sheehan's "Is There No Place For Me". It also lacks the depth of historical reviews of the field like Murray Levine's work. There is a need for a contemporary, close-to-the-front-line story of current mental health practice. Perhaps, someone will be inspired by the shortcomings of this pretentious effort to write such a book.
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3 of 4 people found the following review helpful
5.0 out of 5 stars Thoughtful and thought-provoking, October 11, 2000
By 
This review is from: Of Two Minds: The Growing Disorder in American Psychiatry (Hardcover)
Am I my mind? Am I my illness? In a fascinating new book, T.M. Luhrmann makes a clear, concise argument that we cannot look upon the diseases of the mind in the same way that we look upon diseases of the body. This view is too simplistic, and allows healthcare companies to undertreat mental illness by paying for medication treatment, but discouraging talk therapy.
Luhrmann used her experience as an anthropologist and four years of field work to observe first-hand the training of mental health professionals. This part of the book is of interest to any patient who is affected by how their doctor's attitude toward patients was developed.
Lurhmann observes the situation and treatment of the mentally ill with a clear vision. The concerns she raises about the emphasis of the biomedical (chemical) model of mental illness over the psychodynamic (talk therapy) model are on target and worth serious consideration.
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3 of 4 people found the following review helpful
4.0 out of 5 stars The Great Debate, March 28, 2001
By 
Heather C. Liston (Santa Fe, NM United States) - See all my reviews
This review is from: Of Two Minds: The Growing Disorder in American Psychiatry (Hardcover)
Of Two Minds: The Growing Disorder in American Psychiatry By T. M. Luhrman
Managed care is drastically shortening the time in which the mentally ill can afford to be hospitalized, and making it harder for most people to afford outpatient psychotherapy. Drugs are cheaper and faster. But do they solve the underlying problems in people's lives, or merely mask symptoms? The growing distance between those who believe in medication and those who put their primary faith in therapy is one of the burning issues Luhrman explores in this excellent work. The author is an anthropologist who decided to study the training of American psychiatrists, and the result is a dense but not difficult book Anyone with an interest in mental health can find much that is useful, elucidating, and even intriguing here.
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9 of 13 people found the following review helpful
4.0 out of 5 stars Disability model is missing, July 4, 2000
By 
Sylvia (Santa Cruz, CA) - See all my reviews
This review is from: Of Two Minds: The Growing Disorder in American Psychiatry (Hardcover)
Luhrmann compares and contrasts the biomedical and the psychodynamic in psychiatric training. The focus is compelling. The author starts from the assumption of medicine that these are illnesses. Service user diagnoses -- schizophrenics, borderlines -- replace the person; a family organizataion is described as a patient lobby, she notes that is clear to her that these are diseases and the medical model works. The last chapter tries to redress, and she has interviewed and quotes California clients John Hood, Vernon, and Howie, but she uses professional distancing jargon -- high-functioning and dysfunctional, .... I felt they were diminished. Missing is the model of managing and accommodating disability. Missing is the fuller context - where these psycho-science approaches fit when the spiritual and social dimension are included.
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5.0 out of 5 stars Brains and Minds as Two Cultures, May 16, 2013
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This review is from: Of Two Minds: The Growing Disorder in American Psychiatry (Hardcover)
Tanya Marie Luhrmann, a University of California--San Diego (now Stanford University) psychological anthropologist, has written an enlightening ethnographic study of the training of American psychiatrists, and the conflict of psychodynamic and biomedical models of psychiatry, in "Of Two Minds: The Growing Disorder in American Psychiatry."

As an assistant professor of anthropology at UC--San Diego, she did "more than four years of fieldwork" in the early 1990's studying psychiatrists and psychiatric hospitals, in "more than sixteen months of full-time, intensive immersion." She attended classes, interviewed scores of doctors and patients, visited inpatient and outpatient facilities, and observed psychiatrists in training. She grew painfully aware of the conflict of two distinct models of psychiatry competing for the commitment of young psychiatrists--the psychodynamic or psychoanalytical and the biomedical or psychopharmacological--her "two minds."

Citing her extensive interviews of patients and doctors, and her investigative fieldwork in residency programs, private psychiatric hospitals, and state hospitals, Dr. Luhrmann depicted how psychiatrists developed their characteristic way of seeing and listening to their patients, and how the conflicting therapeutic ideologies in the field affected both practitioners and patients. She tried to convey what it was like for psychiatrists and interns to deal with people in extreme emotional distress. She showed how the choice of drug therapy and talk therapy, each requiring different skills and based on a different understanding of the nature and causes of mental illness, affected the way psychiatrists understood their patients. As mood-altering drugs like Prozac revolutionized the treatment of the mentally ill while HMO's and managed care were forcing care-givers to take the pharmacological route as cheaper and faster than the talk therapy indicated by the psychodynamic model, Dr. Luhrmann saw the struggle in contemporary American psychiatry as basically an ethical and philosophical one over treating people's brains or their minds, of attending mainly to their brain chemistry or to their life stories, to their hopes and fears, joys and sorrows.

In the 1950's and early 1960's, she noted, the psychodynamic or psychoanalytic approach strongly dominated American psychiatry, often in its classic Freudian version. From the late 1960's on, however, the biomedical model became more and more dominant, and psychiatry became virtually synonymous with neurology, biochemistry, and drug therapy. This was driven partly by the development of various popular new psychiatric "wonder drugs," but mainly by growing economic pressures toward speedy, cost-effective, quick-fix managed care. It was much quicker and cheaper to medicate psychiatric patients than to spend vast amounts of time and money on lengthy, expensive, time-consuming psychotherapy!

However, Dr. Luhrmann also noted, by the early 1990's a partial reaction was beginning to set in, a reaction with which she herself strongly sympathized. More and more psychiatrists began to see the inadequacy of either a one-sidedly biomedical or an exclusively psychoanalytical approach, and instead advocated a combination of both approaches. Some mental patients, it was found, responded well to a reliance on "talking cures," some to a pharmaceutical approach, but many did best with a combination of both. "However we understand the possible causes of mental illness," she argued, the "available evidence" suggested that "for most patients and for most disorders, psychopharmacology and psychotherapy were best in combination."

Dr. Luhrmann thus sided wholly neither with defenders nor with opponents of the mental health "establishment" and its largely biomedical approach, though her own personal orientation and temperament were very much those of a "humanist" rather than a "technocrat." On the one hand, she believed that mental illness is real and in many cases of biological origin, but she also despaired at what she saw as the divide between research and treatment. Likewise, she emphasized the vital importance of sensitive, humane personal concern for patients, and feared that we run a grave risk of dehumanizing the mentally ill by emphasizing cost-effective pharmaceutical symptom management over interpersonal relationships. Dr. Luhrmann was strongly sympathetic with doctors, patients, and instructors alike. She empathetically followed psychiatric residents through medical school and internship, when they learned to distance themselves from patients; through their first year of residency, when they served within the hospital and became solely responsible for patient care with only a few hours of training; and to their second year, when they had to become deeply involved with patients and learn to empathize.
Dr. Luhrmann stressed economic factors in the medicalization of psychiatry. Psychopharmacology, she observed, had become "the great, silent dominatrix of contemporary psychiatry" as "a combination of socio-economic forces and ideology" was "driving psychotherapy out of psychiatry," favoring treatment via prescription drugs and driving talk therapies out of the marketplace. In the new climate of managed care, she noted, doctors had very little time to evaluate patients, psychotherapy was not deemed cost-effective and psychiatrists in hospitals and clinics were pushed into management roles. She noted that pharmacologic treatments proved highly popular and fairly effective in the 1950's and 1960's, at first with seriously ill inpatients and then with outpatients. Meprobamate (Miltown), diazepam (Valium), and fluoxetine (Prozac) became part of American popular culture and the biomedical and psychoanalytic paradigms began to compete in the larger American society as well as in clinical and academic arenas.
Dr. Luhrmann, however, did not explore the earlier, pre-1960 history of psychiatry very much in her book, beyond reiterating the predominance of a Freudian or at least generically psychoanalytic approach in psychiatry in the 1950's and 1960's. She did not examine the social and cultural roots of this predominantly psychodynamic as opposed to biological approach. Unlike many other writers (e.g., Carl Degler, "In Search of Human Nature" [1991], Peter Kramer, "Listening to Prozac" [1993], or Susan Cain, "Quiet" [2012]), she did not mention the post-1930's and post-World War II liberal intellectual as well as political revulsion against racism, eugenics, and hereditarian modes of thinking as leading to anti-immigrant bigotry and forcible sterilization of the "unfit" in America, and to Nazism and Auschwitz in Germany.

However, Dr. Luhrmann did describe the new biological psychiatry as reviving the views of the German psychiatrist Emil Kraepelin (1856-1926). Kraepelin, born the same year as Freud (1856), was a principal founder of modern scientific psychiatry, as well as of psychopharmacology and psychiatric genetics. He believed the chief origin of psychiatric disease to be biological and genetic malfunction. Kraepelin's theories dominated psychiatry in the early 20th century, but were later largely displaced by Freud's psychodynamic influence. Luhrmann believed the school of "remedicalized" psychiatry emerging in the 1970's owed its allegiance not to Freud but to Kraepelin. The "new psychiatric scientists argued, in effect," she noted, that "psychiatry had made a wrong turn by following Freud instead of Kraepelin."

The 1950's and 1960's were the high point both of the vogue of Freudianism in intellectual and popular circles alike, and of the liberal intellectual revulsion against racism, eugenics, and hereditarian modes of thinking. Intellectuals saw in Freud's theories a major key to literature, art, religion, and history, Sigmund Freud's and Ludwig Wittgenstein's Vienna was an intellectual and cultural capital of the 20th century West alongside Sartre's and Picasso's Paris, and W.H. Auden described Freud in 1940 as "no more a person now but a whole climate of opinion." On a more popular level, ids, egoes, super-egoes, Oedipus complexes and penis envies were a staple of cocktail-party chitchat, and it was de rigueur in literary, artistic, and showbiz circles to talk about one's "analyst" and being "in analysis."

At the same time, there was a general enlightened consensus in the 1950's and 1960's that hereditarian thinking had led to horrible crimes and abuses in recent history--to massive sterilization of the allegedly "unfit" and "feeble-minded," to anti-immigrant bigotry, to glib "eugenic" prejudice against whole ethnic groups, nationalities, and social classes, and ultimately to Dachau and Auschwitz. Humanity, decency, and modern democracy all seemed to demand that we abandon hereditarian modes of thinking, and make an earnest concerted effort to think in terms of "nurture" rather than of "nature." Anthropologists like Franz Boas, Margaret Mead, and Ruth Benedict, with their strong emphasis on culture over biology, "nurture" over "nature," reinforced the anti-hereditarian backlash setting in after the 1920's and 1930's.

Such cultural and political attitudes helped bring the predominant 19th and early 20th century Kraepelinian "medical materialism" of psychiatry into widespread disrepute in the 1950's and 1960's. If "medical materialism" had reduced human behavioral, emotional, or cognitive idiosyncrasies to malfunctions of brain physiology or chemistry, it was instead now emphasized that people have experiences and stories, making us who and what we are, and shaping our personalities, our characters, our attitudes to life, and our hopes, fears, and obsessions. If "medical materialism" echoed eugenics and Social Darwinism in describing the psychiatrically disturbed as resembling criminals, the working classes, the poor, and non-WASP or non-Nordic ethnic groups as made of a different, inferior flesh from the respectable, successful, mentally healthy bourgeoisie, the psychoanalytically oriented psychotherapy of the 1950's and 1960's saw the insane, the neurotic, and the psychologically disturbed instead as people just like ourselves who've had a few too many bad breaks in life, who've had to contend with too raw a deal from their families or society--no longer as "bad seed" or "biological mistakes," as the older approach was now felt to imply. Luhrmann insisted that the simple "disease" model of mental illness diminishes all of us. The ideals of psychodynamic psychiatry are based on the belief that "the mastery of bad circumstances is inherent to what a person is ... the sense of a person is of someone who has overcome suffering in a particular way and forged a specific path through life."

Starting in the late 1960's, however, and continuing apace through the 1970's, 1980's, and 1990's, a number of social and cultural trends in American society converged to reverse 1950's and 1960's anti-hereditarian, "nurture" over "nature," pro-"talk therapy" consensus. As noted by Dr. Luhrmann, there were the seeming spectacular therapeutic efficacy of new psychiatric drugs and the increasing managed-care economic pressures for cost-effective quick-fix pharmacological therapies. There was also the growing Rightward trend of American politics, with its disgruntled middle-class populist resentment of liberal egalitarianism as "political correctness," making the warm-hearted "Let all the world's children dance together as one happy family!" subtext of 1950's and 1960's "nurture" over "nature" discourse seem unfashionable and embarrassingly sentimental.

We might perhaps also add the paradoxical influence of the 1960's "counter-culture" with its fondness for mind-altering drugs as the youthful rebels' own version of "better living through chemistry." Even those disdaining Timothy Leary's "drop out, turn on, tune in" gospel were all too aware of brain chemistry's powerful ability to alter our thoughts, perceptions, and feelings. Interestingly enough, though, Dr. Luhrmann also observed that a 1980's survey of biological psychiatrists versus psychotherapists had found that "more of the psychodynamically oriented psychiatrists had experimented with illicit drugs." Even though "LSD may have sent some psychiatrists into research on the brain and buttressed their beliefs in organic causes," others "seem to have been drawn to the drugs for other reasons and no doubt explained their use as a symptom of their early dependency or rebellious needs." In a sense, we might say, biologically oriented psychiatrists often tend to be cultural "Republicans" while their psychodynamically oriented colleagues just as often tend to be cultural "Democrats"!
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Of Two Minds: The Growing Disorder in American Psychiatry
Of Two Minds: The Growing Disorder in American Psychiatry by T. M. Luhrmann (Hardcover - April 4, 2000)
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