Psychiatry--Study and teaching, Psychiatry 

In this groundbreaking book, Tanya Luhrmann -- among the most admired of young American anthropologists -- brings her acute intelligence and her sophisticated powers of observation to bear on the world of psychiatry. On the basis of extensive interviews with patients and doctors, as well as day-to-day investigative fieldwork in residency programs, private psychiatric hospitals, and state hospitals, Luhrmann shows us how psychiatrists are trained, how they develop their particular way of seeing and listening to their patients, what makes a psychiatrist successful, and how the enormous ambiguities in the field affect its practitioners and patients. How do psychiatrists learn to do what they do? What is it like for psychiatrists to deal with people who are in emotional extremity? How does the choice between drug therapy and talk therapy, each of which requires very different skills, affect the way psychiatrists understand their patients? Boldly and with sharp insight, Luhrmann takes the reader into the world of young doctors in training. At a time when mood-altering drugs have revolutionized the treatment of the mentally ill and HMOs are forcing caregivers to take the pharmacological route, Luhrmann places us at the heart of the struggle -- do we treat people's brains or their minds? -- and allows us to see exactly what is at stake. Editorial Reviews Amazon.com Review Is the fight between cures worse than the disease? The fairly comfortable truce between psychotherapy and drug treatment for mental illness started eroding a few years ago, when the latter's bottom-line efficiency made it the preferred option for HMOs and many other health care providers. The often-sharp division between these two methods is highlighted in Of Two Minds, an insightful anthropological assessment of psychiatric training in America by University of California-San Diego's T.M. Luhrmann. She studied with psychiatrists in training, visited inpatient and outpatient facilities, and interviewed scores of doctors and patients to reveal the craft of a strange and misunderstood profession. Neither opponents nor defenders of the mental health establishment will find unqualified support from the author's careful evaluation. While she states from experience that she believes mental illness is real and in many cases of biological origin, she also despairs at the divide between research and treatment. Luhrmann is strongly sympathetic with her subjects, whether physicians, patients, or instructors. She paints a portrait of harrowing training for young doctors and hellish experiences before, during, and after treatment for those seeking relief. She does find much to recommend both drug and talk therapies, though current research suggests that combining them is more effective for more patients than either one alone. In closing, Luhrmann warns that we are in danger of dehumanizing the mentally ill by emphasizing cost-effective pharmaceutical management of symptoms over interpersonal relationships. Of Two Minds has the depth and complexity necessary to match its subject and the warmth to reach its readers. It's essential reading for anyone involved or interested in mental health. --Rob Lightner From Publishers Weekly Cultural anthropologist Luhrmann puts the psychiatric profession on the couch, with devastating results. Psychopharmacology has become "the great, silent dominatrix of contemporary psychiatry," she reports, as a combination of ideology and socioeconomic forces favors treatment via prescription drugs and drives talk therapies out of the marketplace. In the new climate of managed care, doctors have very little time to evaluate patients, psychotherapy is not deemed cost-effective and psychiatrists in hospitals and clinics are pushed into management roles. A professor at the UC-San Diego, Luhrmann spent more than four years in psychiatric hospitals, attending classes and interviewing psychiatrists and administrators. Though she writes in a rather academic style, her valuable report offers an uncensored look at the new biological psychiatry. Luhrmann found that medications often do not work, that most patients are on more than one medicine and that unwanted interactions between drugs are common. In the classroom, discussion of Freud or of the scientific literature on emotion and human development is extremely cursory. Moreover, biomedically oriented doctors are trained to see psychiatric illness as a medical disease, which tends to eliminate ambiguity and nuance in diagnosis. Luhrmann's own view is that the evidence indicates a combination of talk therapy and psychopharmacology works best for most patients. She concludes with a look inside the mental health patient advocacy movement, which, like the profession itself, is sharply divided between lobbies for biomedicine and groups opposed to mandated psychiatric medication. Agent: Jill Kneerim, Palmer and Dodge Agency. (Apr.) Copyright 2000 Reed Business Information, Inc.