It's a well-written book full of interesting information and illuminating insights. My main problem was figuring out who it is addressed to. It is written with a journalist as co-author, so I assume the writers did not want to limit readership to other psychiatrists. It is certainly not a self-help book. It might be useful to some-one with a mentally ill family member, but such a person would be better off going to the NAMI web site.
The first part is an excellent history of the decline and fall of psychoanalysis and of the last 50 years of American psychiatry. Then comes a short account of neurophysiology in some technical depth. The object seems to be to show that psychiatrists are real doctors and real scientists. The authors tread on philosophical ground with their theories of consciousness. It's "for every twisted thought a twisted molecule" stuff.
Part three consists of cases vignettes of panic disorders, of bipolar disorder and of schizophrenia.
Finally come recommendations, but who are the recommendations being made to? They seem to be talking about things "we" should change. Who is this "we"? Sometimes it's as if they were talking to a group of state legislators, the Secretary of HHS, the United States Congress or the American Council on Graduate Medical Education. I suspect it is largely directed at a readership of psychiatrists. A problem (if you can call it a problem) that they discuss is the fact that the new anti-depressant and anti-psychotic drugs have become so free of side-effects and so easy to use that there is not as much for psychiatrists to do. Primary care doctors and RN's and (in New Mexico) psychologists can prescribe them. That leaves psychotherapy, but why would psychiatrists be any better at that than somebody without an MD? It's an interesting question but a full answer would need need hard evidence. As it is, many of the assertions are subjective.
Coming back to some particular points, I wondered why,in the description of management of a patient with auditory hallucinations and delusions, no mention was made of the evidence-based techniques other that drugs. The strictures about foreign psychiatrists are not supported by valid evidence. Anti-psychotic drugs were invented in France, the use of lithium in Australia, and anti-depressants in Switzerland. How good is the evidence that specific brands of psychotherapy such as cognitive-behavioral or interpersonal are really different?
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