From jails to hospitals to the analyst's couch, the venues of psychiatry have shifted amid debate over the nature of mental illness: is it psychosocial or biological? Andrew Scull follows the path from the asylum to the street, from shock therapies to talk therapy, and on to psychiatry's dependence on drugs, whose side effects are often ignored.
... grim but fascinating ... This is an angry history, as, say, histories of slavery or genocide will tend to be. Although Scull doesn’t spend much time on this aspect, psychiatrists and those caring for the severely mentally ill will often have done their duties as they saw them and according to the state of knowledge at the time, acting with compassion for their patients. But the ones who made the weather in American psychiatry seem to have shared a dangerous self-confidence in their theories and an obstinate zeal in acting on them ... Scull ends this absolutely essential, deeply felt and horribly absorbing book more with a plea than with enlightenment. He begs that we should, despite everything (including Big Pharma’s withdrawal from psychiatric-based research), keep looking to help our suffering fellows, and consider while doing so whether social and environmental causes of mental illness are not as significant as physical ones. Somewhere in the amazingly plastic human brain lies the solution to our most intractable problem.
... dominated by extremes and hopes. It is meticulously researched and beautifully written, and even funny at times, despite the harrowing content ... in this context, the patients who were lost to 'cutting-edge' treatments, or simply to appalling care, hardly seem like people – something of which Scull is painfully and compassionately aware ... Scull, as a sociologist, is not entirely sympathetic to psychiatry and psychiatrists. It’s right that he doesn’t spare them, and as the book draws to a close, he writes passionately of the need for a broader approach, embracing more than the currently dominant biological paradigm. His analysis of prevailing diagnoses and their links with pharmacological treatments is sceptical, but he also acknowledges the vital relief of symptoms that can be provided by some medicines and modified ECT. He asks for caution, honesty, humility, and, above all, for understanding.
This is a chilling book ... fascinating and enraging ... Scull has written some eloquent books on the history of psychiatry, though they have previously had a tighter focus. Here, it is as though taking a panoramic view of the whole subject has brought home to him, finally and with considerable emotion, what a pitiful racket it has been. He struggles sometimes to keep an academic tone. And in the light of the evidence, who can blame him?
