I must begin this review with a confession of my biases. I have had bipolar disorder for 20 years and have learned through hard-fought experience how to control it. I also have progressed through medical school, but do not practice medicine due to side effects of medications for bipolar disorder. For a career, I build software infrastructure that supports the medical research system. I found Andrew Scull’s history of psychiatry enlightening. He clearly explains how certain strands of the psych system evolved historically.

For example, he explains how getting rid of psychiatric hospitals in favor of outpatient care seemed to be the result of legislators trying to save a buck rather than the beneficence of citizens. He describes this as changing one form “benign neglect” into another. He also describes more recent controversies about the efficacy of pharmacological treatments. He is rather cynical about the value of these drugs. He points out the problems and imperfection but has little understanding of why they are abundantly used. Even if they mask symptoms instead of curing, they work better than almost every alternative.

I found myself at odds with much of his strongly stated recommendations for its future. He simply does not admit his limitations as a man of letters without any experience with the clinical domain. Any answers for the future will surely come together from the consensus of diverse teams and communities, not from seemingly all-knowing academic individuals. He offers no way forward for psychiatric clinicians other than stating that they should be more attentive to the social domain. If drugs don’t work well, then why are they so widely used? (And why do they seem to help me?)

Thus, my review of this work is mixed. The history is outstanding and objective, but the analysis of recent controversies is driven more by Scull’s opinion and less by a restrained view of the facts. He becomes a hyperbolic social advocate (by training, he is a sociologist) and stays away from scientific study that looks for opportunities and learning.

Those involved in the American and British mental health systems can benefit from reading this work. There is no manual to the system, and whether professionals or patients, we all learn by trial and error how to make progress. This book can aid in that process, regardless of what we think of his recommendations. To be effective, the mental health system needs more attention, thought, funding, and study on many fronts. I think we can all agree on that. ( )

Lifechanging ( )

A worthwhile book to read, although if you've already read [Saving Normal], [Healing], [Unhinged], [Mind Fixers], [Mad in America], [The Loss of Sadness], [The Book of Woe], [Comfortably Numb], and even books about the personal level of fallout of deinstitutionalization such as [No One Cares About Crazy People] and [Crazy], you start to wonder if there's really room on your bookshelf for one more book about this topic, particularly one that doesn't really add much of anything new to the conversation.

Yes, there might be a bit more of a nuanced history here, including a bit more drama behind certain names and public figures, but over all, I did not learn anything new from this book. The book was also poorly edited, and at times the author wrote down incorrect names. (Are books just not edited any more? This seems like an increasingly bad problem lately.) ( )

Excellent history of American psychiatry, its failures, and the damage done.

Very tough to get through the first part, lots of details about early “therapies” such as lobotomy and shock treatment (and other awful early techniques I hadn’t heard about, such as extracting whole mouthfuls of teeth).

The latter part of the book was a little easier to read, the inanity of Freudian psychoanalysis, the awful antipsychotic drugs, de-institutionalization, the DSM battles - all still bad, but not quite as gruesome.

The book is quite thorough, with extensive footnotes, and I’m convinced the author knows his stuff. I’m sure a more sympathetic history of psychiatry could be written, but this one wasn’t entirely unsympathetic. The saddest thing is that there are so many profoundly disturbed people who really need help and support. ( )

At times this history can be hard to read; the persistence of brutal, cruel and unscientific psychiatric treatments is enough to drive one into depression. Yet the book is consistently fascinating. Scull's skeptical take on psychiatry, up through to the modern day, is refreshing.

> Most historians regard the trial of streptomycin in the treatment of tuberculosis, published in 1948, as the research that led to the establishment of the double-blind randomized trial as the gold standard in medical research. Even in medicine, the new approach was not adopted overnight, but psychiatry’s status as the poor relation of the profession allowed such unreliable research to pass muster for still longer. ( )