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Mind Fixers: Psychiatry's Troubled Search for the Biology of Mental Illness 1st Edition

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Mind Fixers tells the history of psychiatry’s quest to understand the biological basis of mental illness and asks where we need to go from here.

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.

ISBN-10

0393071227
ISBN-13

978-0393071221
Edition

1st
Publisher

W. W. Norton & Company
Publication date

April 16, 2019
Language

English
Dimensions

6.4 x 1.3 x 9.5 inches
Print length

384 pages
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Editorial Reviews

Review

"A compelling story of the ongoing mission to understand and treat our troubled minds."
― Nina MacLaughlin, Boston Globe

"A laudable venture, in which Harrington’s intellectual precision and exacting research cannot be faulted."
― Helen Thompson, New York Times Book Review

"Superb…nuanced…In Mind Fixers, Anne Harrington has written an excellent, engaging guide to what biological psychiatry has accomplished―and not accomplished―so far."
― Richard J. McNally, Wall Street Journal

"A tale of promising roads that turned out to be dead ends, of treatments that seemed miraculous in their day but barbaric in retrospect, of public-health policies that were born in hope but destined for disaster…Of value to historians of medicine."
― Gary Greenberg, Atlantic

"Harrington’s grasp of this story and the clarity with which, with limited moralism, she delivers a tale about the ‘big picture’ of psychiatry and neurology is emblematic of the historian’s craft."
― Stephen T. Casper, Science

"Masterful."
― Philip Alcabes, Los Angeles Review of Books

"[An] often shocking but admirably fair and level-headed history."
― Simon Ings, New Scientist

"In Mind Fixers, Anne Harrington offers a provocative and enthralling account of psychiatry’s quest for the holy grail of a biological explanation of mental illness. A well-written, effectively substantiated and devastating story of a research enterprise that has gotten nowhere at great expense, with nonending hype and, in so doing, has weakened a profession that is clinically still useful and, like its patients, deserves much better."
― Arthur Kleinman, author of Rethinking Psychiatry

"Anne Harrington masterfully chronicles the hopes―and the hype―surrounding psychiatry’s much-heralded ‘biological revolution’ in this penetrating, capacious, and immensely engaging account. Read Mind Fixers for an absorbing guided tour through psychiatry’s fractious history and current conflicts."
― Elizabeth Lunbeck, author of The Americanization of Narcissism

"Anne Harrington has written a lucid and compelling analysis of the travails of psychiatry as it has attempted to ground its understanding of mental illness in biology. She confronts the gaps between its aspirations and reality with fairness and even sympathy."
― Steven E. Hyman, director of the Stanley Center for Psychiatric Research

"A fascinating and wide-ranging unpacking of the field."
― Booklist

"A measured, insightful survey of the limits of contemporary treatment for mental illness."
― Kirkus Reviews

"A must-read that will interest general readers and medical professionals alike."
― Library Journal

"Anyone interested in mental health care’s history and future will appreciate this informative and rewarding survey."
― Publishers Weekly

About the Author

Anne Harrington is the Franklin L. Ford Professor of the History of Science and faculty dean of Pforzheimer House at Harvard University. She is the author of four books, including Mind Fixers and The Cure Within. She lives in Cambridge, Massachusetts.

Product details

Publisher ‏ : ‎ W. W. Norton & Company; 1st edition (April 16, 2019)
Language ‏ : ‎ English
Hardcover ‏ : ‎ 384 pages
ISBN-10 ‏ : ‎ 0393071227
ISBN-13 ‏ : ‎ 978-0393071221
Item Weight ‏ : ‎ 1.38 pounds
Dimensions ‏ : ‎ 6.4 x 1.3 x 9.5 inches

Best Sellers Rank: #534,924 in Books (See Top 100 in Books)
- #133 in Medical Psychology History
- #169 in Popular Psychology History
- #415 in Neuroscience (Books)

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Should be a required reading for each and every medical student...

Reviewed in the United States 🇺🇸 on July 29, 2022

Verified Purchase

...and their mentors. In particular students of psychiatry. A great lesson in the dangers of hubris and dogmatic medicine.
I have practiced psychiatry for more than 30 years on 2 continents and many different settings and witnessed both the needs for support, compassion therapy, and, at times medications, but I also witnessed the corruption, arrogance and lack of compassion of a system, a profession that became the victim of the impossible concept of "for profit medicine"...it destroyed genuine research and genuine dedication, it is killing patients and burning out physicians who have one of the highest suicide rate among all professions...Medicine is now done on the cheap.... people suffer, and literally die in the streets in the richest country of the world...there are many ways to look at it and hopefully help to address some of this disaster...this book, like all well thought and documented history book, is a great tool to start Thank you. Bernadette Grosjean MD Retired Associate Professor of Psychiatry Harbor UCLA

5 people found this helpful

Helpful

Barbara N. Kuehner

The Search Goes On

Reviewed in the United States 🇺🇸 on July 2, 2019

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Review of Mind Fixers

In this history of psychiatry and the treatment if mental illness, the author covers an incredible amount of material illustrating the conflicting perspectives guiding care and treatment of the mentally ill. The book should be required reading for students of psychiatry and psychology as well as for those influencing decisions about what mental health services to offer. The author credits her Harvard students for helping with the content, and I think this has contributed to the breadth of the material as well as to the selection of engaging examples of various issues and treatments.

I have worked in nursing and health care for over 40 years and could relate on a personal level to many of the examples of treatment inconsistency, diagnostic confusion and misguided policy development. One example, referred to several times in the book, is the consequences of discharging the majority of patients from mental hospitals in the late 70’s. In 1983 as part of a clinical rotation in psychiatric nursing, I was assigned to a community based treatment center. I was carpooling with two other students, one of whom was doing her rotation in the jail and the other in the state mental hospital. During the term, we saw patients go from one place to another: a community patient would stop taking medications, act out and end up in jail. The same patient would be sent to the mental hospital, restarted on meds and then discharged to the community. The pattern repeated. It continues to this day.

We all know that many of the homeless are mentally ill. Jail populations include a large proportion of mentally ill. There are major issues with addiction, depression, and suicide. Children with severe behavior problems often disrupt an entire classroom. Mass shooters usually have a mental problem as the basis for their horrible actions. We keep identifying needs for better mental health care. Huge sums of money are being allocated for increased mental health services. With little consensus as to what actually works, this book may provide some insight as to where to look for support. Care and concern go a long way when there is no clear best path.

17 people found this helpful

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Jacob

Powerful Book! Absolute must-read if you're at all into modern medicine/psychology/research!

Reviewed in the United States 🇺🇸 on June 18, 2019

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This is an absolutely incredible book, and an absolute must read if you're at all interested in psychology; it should be MANDATORY if you're a researcher like me. There's a lot of information, but overall it reads like a fictional story: Anne elegantly discusses the history of psychiatry, of the neural anatomists' failures, of the Freudians taking over the psychiatric world, of dissent within the APA, and of a new psychological world order (the re-emergence of Kraepelin). As you can tell, the topics are complex and contain the drama of a sitcom, which ensures the reader will never lose interest.

More important, however, are the takeaways: Anne's storytelling illustrates, time and time again, how the whole world would trusts these psychological "experts", and how these psychological experts would underdeliver and abuse their power. The narrative teaches one to be skeptical and not blindly accept the latest findings from the "experts", whether it be about a miracle surgery that severs the "worry nerves" of the brain or a new drug that "cures" a mental illness. Overall, the narratives in this book will turn one into a more thoughtful scientific consumer who can more critically think about the latest claims within genetics/psychology, and for that, this book is a must-read.

8 people found this helpful

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Twyla Brown

Very helpful!

Reviewed in the United States 🇺🇸 on April 26, 2022

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Just what I needed to understand the current landscape of mental health care. Clear, fairly easy to read. Insightful and sources cited were also worth checking out.

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Susan Braider

An important contribution to the American health care debate

Reviewed in the United States 🇺🇸 on June 20, 2019

Verified Purchase

Harrington’s Mix Fixers is a long-needed and much-needed contribution to history of (American) psychiatry. Missing from Harrington’s work however, is the pernicious role of health insurers and economists that cause psychiatry to be a triple crown of unholy alliances between psychiatry and big Pharma and insurers. This misalliance renders psychiatry and ever-increasing failure at a time when success is possible for more and more patients. As long as insurers are allowed to undervalue the functioning brain in a way that would be unacceptable if the organ was the heart, lung, kidney, or liver, psychiatry will continue to fail. As long as insurers carry none of the blame for psychiatry’s failures the changes the patient community needs and deserves will not happen. Few Americans know how effective quality psychiatric care can be because it is denied to all except the very rich.

15 people found this helpful

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Nerd with no life

great read

Reviewed in the United States 🇺🇸 on April 28, 2022

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This is a great read for people who are in mental health or are interested in it. Well written and detailed history.

Helpful

BL

A great dive into the history of psychiatry

Reviewed in the United States 🇺🇸 on May 31, 2021

Verified Purchase

Wonderfully detailed. It really helps you understand how the regime changes/differences in the schools of thought of psychiatry have changed over the centuries. It can be a little dense/obtuse at times, but it really does give you an in depth look into the history and the people behind the field. Would definitely recommend to those interested in the history of psychiatry!

Helpful

Top reviews from other countries

Topher

should be read by everyone in the industry and the general public

Reviewed in the United Kingdom 🇬🇧 on October 23, 2021

Verified Purchase

This is an excellent book that is well written and for a book about the history of psychiatry its a real page turner and reads like a novel.

I’ve worked in the mental (ill) health system so I was familiar with some of the content but a lot of it was new to me.

The entire mental (ill) health system, not just psychiatry needs to be fundamentally changed. How it has been allowed to continue on doing way more harm than it can ever do good is shocking and must be investigated and changed.

The industry has set about labelling anything that walks as disordered or ill and billions are being made through the massive and growing over prescribing of what are essentially neurotoxins falsely advertised as ‘anti depressant’s and ‘anti psychotics’ see the work of Dr Peter Breggin in the USA and Dr David Healy in the UK - the latter is also mentioned in this book.

These drugs have been approved time and again by corrupt regulatory authorities that are often wholly of significantly funded by drug companies and often headed up by ex industry CEO’s. This is true in the US and the UK. Not to mention ghost writing, manipulating data, mis categorisation in studies, employ of thought leaders, the setting up of advocacy and ‘user’ groups also funded by industry, massive advertising and bombarding prescribers and the general public with drug company propaganda. In addition to a huge history of out of court settlements of billions and billions for harm caused yet it's just allowed to continue.

To approve drugs that impact on such an unfathomably complex organ as the brain after little more than 8 week trials is dangerously criminal.

The industry has embedded itself so completely in the culture and tied itself to insurance, benefits, reasonable adjustments etc that today people are seeking out diagnosis and drugs for themselves and more worryingly their children.

The big lie that these are real diseases with real treatments is a disgusting and dangerous gang bang of hubris, self interest and greed.

It is interesting to read in the final thoughts near the end a call for psychiatry to be honest about its utter failure and share power and build bridges with other players in the system.

This would be all well and good if the other players in the system were any better but they are just as self deluding with castles made of sand as psychiatry.

Social Work, Psychotherapy etc are equally filled with hubris, self interest and what seems like wilful ignorance at the lack of robust evidence for their effectiveness.

The author does point out the dearth of social science that tells us that rather than people being given drugs or talk therapy they need resources. Good homes, safety, security, meaning and purpose, good safe neighbourhoods, good education and equal opportunity, good food, exercise, access to nature etc in short access to the ingredients of wellbeing.

Will it happen? Perhaps if enough people fight for it but it's hard to fight something when you are surrounded by and think of as normal and need it to get some crumbs of anti help.

2 people found this helpful

docread

The endless struggle to understand the biology of the disturbed mind.

Reviewed in the United Kingdom 🇬🇧 on August 22, 2019

Verified Purchase

Is mental illness a disease of the brain, or is it a malfunction of the mind ? Is it a disorder of neuro chemicals and their brain receptors or is it an emotional/ cognitive maladjustment as a consequence of disturbed childhood or stress related life events? In fact how do you define the causes of a mental disorder, let alone characterise the features of a mental illness and distinguish it from a slightly exaggerated emotional reaction? These are not flippant or rhetorical questions. These are questions that have bedevilled the Psychiatric profession for at least a century and half, to which no definitive answers have been found. In spite of its extraordinary efforts to model itself on the medical “ somatic” specialties, the profession appears to stagger from one crisis to the next. Each time uprooting its foundations and cherished dogmas, inventing a new language and launching itself into the next promising revolution which turns out to be another mirage. The latest being the biological revolution probing the brain chemistry and genetic markers of mental illness.

The author convincingly deludes us about the achievements of the biology of mental illness. She provides a lucid and engaging account of the history of the numerous trials and failures the profession has faced, in its attempt to delineate its field of knowledge and anchor its practices on scientific grounds. Some of its more iconoclastic practitioners in the 20th C denied even the existence of mental illness, a fiction manufactured in order to control transgression and social dissent.

Recently meticulous meta analysis of the double blind clinical trials using pharmaceutical agents, showed that placebo effect accounted for more than 75% of the effectiveness of treatment, in fact there was no statistical difference for suicide risk in depressed patients between those taking active ingredients or placebo. Pharmaceutical companies that were resolutely driving the medicalisation of the mundane emotional or cognitive maladjustments of life in order to expand their markets, are withdrawing from research into new pharmacological agents.

Following the closure of the asylums, and the fruitless anatomical research for brain abnormalities, the end of shock therapy and psychosurgery, the demise of Freudian psychoanalysis, the failed hunt for mood genes and the loss of faith in the bible of psychiatry (the DSM) we appear to have reached another dead end by questioning the effectiveness of psycho pharmacology. Unlike somatic disease, no biological markers for the commonest mental illnesses have been elucidated, which can only stunt research into effective therapies. In fact the limitation of our knowledge of the abnormal, is a consequence of the limited hard facts generated in modern neurosciences. This in spite of the mind boggling new technologies at our disposal. What a sorry state of affairs for psychiatrists but more so for their patients. We need to explore holistic approaches , psychiatry will have to be more modest as the author suggests.

7 people found this helpful

Le Legume

Brilliantly and forensically lays out how psychiatry has failed time and again.

Reviewed in the United Kingdom 🇬🇧 on April 23, 2019

Verified Purchase

This book is the necessary corrective to anyone who backs up psychiatric consensus on autism, ADHD, schizophrenia, depression or whatever, by asking "can an entire profession really be wrong?". Because, as this book lays out with brutal clarity, it has been, very often, in the past.

It is quite terrifying to see how the profession's leadership has so often completely changed it most core beliefs about the nature of mental illness and how to treat it without ever gaining the humility you would expect, learning caution, or issuing any sort of apology to their long-suffering patients.

This book is a fascinating depiction of what happens when a group of experts is set up to oversee an area -- the brain --- over which there simply isn't enough known yet for any real expertise to be possible.

As becomes terrifyingly clear, the scientific-sounding concepts and diagnoses we all generally believe in, don't really have any validity. Psychiatry presents itself as a branch of medicine like any other, when it isn't. Not yet.

Harrington isn't anti-psychiatry. She lays out the view of critics who see psychiatry as a sort of apparatus of social control, like RD Laing, or Michel Foucault, in such a way that they seem pretty unconvincing.

She ends the book with a wise and totally convincing essay about where psychiatry could go from here, and how it could rebuild itself on firmer foundations, concentrating on the severely mentally ill who clearly do have a medical condition, and leaving the rest of their patients to psychologists, social workers, and others.

After I reading it, I feel what psychiatry needs is more humility and more honesty: the humility to accept the limits of current understanding and ability to cure, and the honesty to communicate those limits to the wider world.

10 people found this helpful

Edward Gallagher

Great book!

Reviewed in the United Kingdom 🇬🇧 on July 28, 2020

Verified Purchase

I've read quite a few histories of psychiatry. This is the best and covers issues such as parent-blaming, that are missing from most accounts.

One person found this helpful

Lekhansh Shukla

Good

Reviewed in India 🇮🇳 on August 25, 2019

Verified Purchase

Nice

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