Out of Its Mind: Psychiatry in Crisis: A Call for Reform

Prozac and all its cousins haven't helped psychiatry as much as their manufacturers claim. In Out of Its Mind, Harvard psychiatrist J. Allan Hobson and science writer Jonathan Leonard argue that the field is reaching a crisis in the struggle between biological treatments and psychoanalytic methods and that a synthesis is badly needed. Calling his approach "neurodynamic," Hobson advocates a broad understanding of each patient's unique situation, including genetic and physiological factors, as well as social qualities like family history. Hardly revolutionary, but given the resistance of HMO culture to any treatment that's not simple and cheap, the paradigm will require aggressive, concerted efforts to implement.

The book is half history of psychiatry, half utopian plan of action. The authors first examine the strengths and weaknesses of both treatment modes and, unsurprisingly, find problems with uncritical acceptance of one over the other. The current mess, including a 90 percent reduction in hospital beds and a wild emphasis on pill-pushing, is a direct result of the successful pharmaceutical treatments devised in recent decades. Hobson and Leonard ask for broader education for psychiatrists and other professionals, to include what might be called holistic methods--wrapping up nature and nurture to better treat ill people. Out of Its Mind will appeal to both nontechnical readers and those directly involved in mental health and guide them toward the emerging synthesis. --Rob Lightner