... 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?
Ours is a time of historical reckoning for many fields, and psychiatry is no exception. An indisputable masterpiece among a flurry of reappraisals is Andrew Scull’s Desperate Remedies—a comprehensive, fascinating and persuasive narrative of the past 200 years of psychiatry in America ... he is unsparing in his critiques when motives of money, power and fame have tempted psychiatrists to disregard the welfare of those under their care.
[Scull's] lucid prose and urgent narrative style take the reader through psychiatry’s dubious characters, its shifting conceptions of mental illness and fluctuating diagnostic categories, the often gruesome treatments visited upon patients and their families, and the ultimate demise of public mental hospitals for 'community care,' which, as he explains, meant no community and no care ... What Scull misses is that recent research makes it clear that the immune system is highly sensitive to psychological stress and that a lowered immune response creates vulnerability to a host of illnesses, including those caused by bacteria ... By skirting the philosophical mind-body problem, Scull avoids psychiatry’s crucial dilemma. The medical discipline has never known and still does not know what it is treating. Can the mental be reduced to the physical? Are mind and brain identical, or is the reduction of feelings and thoughts to genes, brain regions and neurochemicals a mechanistic fantasy that has haunted science since the 17th century? If human development and its dynamic biological processes (including brain development) are at once genetically constrained and experience-dependent, then a new understanding of 'the mental' in psychiatry and in popular culture is vital to negotiating the future ... As a sociologist, Scull is attuned to the broad upheavals that transform societies. He is also sensitive to cultural repetitions. He quotes William Laurence, a science reporter for the New York Times, who, in 1937, celebrated lobotomy as a procedure that 'cuts away the sick parts of the human personality.' For readers who believe that such crude thinking belongs to a bygone era before neurobiology and genetics came along with answers, I recommend Desperate Remedies as a tonic for your optimism.
... comprehensive, sober, and compulsively readable ... Scull, a sociologist, provides a lucid and, in his own words, 'skeptical' overview of the field, describing a complex and densely detailed series of developments with skill and little mercy. His empathy, which is considerable, is saved for the stigmatized and frequently dehumanized patients who are too often the victims of psychiatric arrogance as well as of the profit-fixated marketplace ... Scull’s book is an effort to provide a sight line through the often turbulent currents of the field, touching on its strengths and (mostly) its shortfalls, from the start of the psychiatric endeavor to the present moment. His hope, I would suggest, is to provide readers with a way of thinking about people with mental illness as part of us rather than as alien or weird presences, best drugged into compliance or shuttled off to an institution. Understanding the long, sordid history of how these diseases of the mind have been treated is a necessary first step toward bringing people with even the most debilitating disorders into the fold and finding the solutions that might aid in their healing or, at the least, alleviate their suffering ... If Scull’s turbulent history were merely an indictment, it would be a far less powerful document than it is. It’s also a plea for less internecine fighting between the nature and nurture proponents and a greater acceptance of the large gray area that encompasses our inability to fully discern where the influence of biology stops and the influence of environment begins. Scull has joined his wide-ranging reporting and research with a humane perspective on matters that many of us continue to look away from. And understanding these 'desperate remedies” helps to elucidate the psychiatric pathologies to which they were responding.
A leading figure in the history of psychiatry, Scull is obviously passionate about the unhelpful directions psychiatry has taken ... nods toward green shoots of progress in neuroscience and genetics, but there’s no doubt, as Scull makes clear, that psychiatry in the US and the UK needs to up its game in response to increasing levels of psychiatric illness. He doesn’t mention other new and promising frontiers, such as research by Skip Rizzo on alleviating post-traumatic stress disorder with Virtual Reality, or Professor Celia Morgan’s research on the use of ketamine to help alcohol relapse, or the work of the Multidisciplinary Association of Psychedelic Studies. Even so, Scull’s history remains a vital rallying cry.
... a depressing book ... The story told by Scull in Desperate Remedies does in fact have three acts, or rather three parts, but it has no unity of action, nor a clear narrative arc. Not only do the three parts overlap chronologically, presenting an almost cubist narrative of interpenetrating temporalities, but each one tells the same story: how a new theory or remedy stirred wild hopes, only for its proponents to face disappointment and patients outright harm ... None of this makes for a good story, obviously, but it does make for sobering history. All too often, the history of psychiatry has been written from some happy endpoint in theorization, as if the definitive truth of mental illness had been discovered in 1895 by Sigmund Freud, or in the early 1950s with the advent of the psychopharmacological revolution. No such thing with Scull. Being methodically skeptical of psychiatrists’ theoretical and therapeutic claims, he relates not 'what may happen,' but 'what has happened' without necessarily trying to make sense of the events he narrates. The result is a messy, haphazard, and, yes, utterly depressing tale of ambition, incompetence, and callousness ... One senses that Scull struggled to write the conclusion to his relentless exposé of the psychiatric enterprise.
Scull’s sober, precise, and sometimes wry history of efforts to diagnose and cure mental illness is also, unavoidably, a catalog of abuse and torture. Scull, who has written landmark studies of hysteria and the asylum system, is interested in the grisly particulars of treatment, and also more broadly in the construction over time of a profession, psychiatry, that has never quite functioned independently: always borrowing, always distancing itself, from other branches of medicine. Desperate Remedies is unconsoling about this history and what it suggests for the future ... narrates all of this with admirable clarity and care. While some of the more vicious cures, and their cruel, opportunist, or merely deluded inventors, are singled out for retrospective fury and reproach, Scull is mostly laconic when it comes to judgment, letting dismal facts speak for themselves.
... authoritative and sobering ... Characteristically critical but nevertheless decently evenhanded ... . Scull, who pulls no punches in his often muckraking account, can be accused of excessive harshness toward only a small number of his cast of characters; few deserve to emerge intact from his evidence-based lashings. Yet he also lays out the obstacles that all practitioners in the field have faced as successive methods of treatments—Freudian analysis, talk therapy, and medication—have come into vogue and then retreated. Most importantly, the author omits nothing related to his subject: Medicare and Medicaid, insurance companies, psychopharmacology, big pharma, financial and economic considerations, and, in a particularly brilliant section, the battle over diagnostic precision. Because Scull’s crisis-to-crisis history is so impeccable, it’s also deeply troubling ... A magisterial tale of the always frustrating yet sometimes well-intentioned efforts to aid desperate people.
