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Hippocrates CriedReview - Hippocrates Cried
The Decline of American Psychiatry
by Michael A Taylor
Oxford University Press, 2013
Review by Duncan Double
Sep 3rd 2013 (Volume 17, Issue 36)

The author of this book, Michael A. Taylor, was chairman of the Department of Psychiatry and Behavioral Sciences at the Chicago Medical School and is still on the faculty of the University of Michigan. He believes that psychiatry has declined over his 45 years practice to the point where it may be doing more harm than good. Despite hopes for a better psychiatric classification, Taylor argues that the diagnostic process in the American Psychiatric Association's DSM manual is more political and administrative than scientific. In his view, psychopharmacological practice has lost its therapeutic flexibility through cookbook adherence to guidelines.  He recognizes the corrupting influence of the pharmaceutical industry and sees the fundamental problem with US psychiatry as being unethical psychiatrists.

Although we have moved on from psychoanalytic dominance of US academic psychiatry, Taylor thinks psychiatry is not offering anything special and could be extinct by 2100. His solution is to develop neuropsychiatry, which he has always practiced since his early training. As far as he is concerned, biopsychosocial formulation merely diverts attention from focusing on the patient's brain. With Max Fink, he has been a strong advocate of ECT over the years. He would dispense with psychodynamic psychotherapy in psychiatric training.

Although consistent, Taylor's position is not particularly well argued. He admits he can be "presumptious and opinionated" (p. xi). Still, despite the general superficial and idiosyncratic nature of his thinking, I found it interesting to note that one of the most biomedical of psychiatrists can still have concerns about the ethics of modern psychiatry. As he says, "While making money is the American way, when treatments are equated to widgets, profits will trump efficacy and safety" (p. 110). The endorsement of various treatments by psychiatrists is well paid for by the pharmaceutical industry, including financial support to academic departments and the carrying out of multisite clinical trials. Taylor proposes that no academic responsible for training should accept any industry money.

This book is something of a romp through modern psychiatry. Dr Taylor has particular individual views, although his promotion of neuropsychiatry as the solution to what is seen as the modern crisis in psychiatry is not unusual. He is right that the integrity of psychiatry is important. However, my problem is with his belief system. His fundamental idea is that "there is no mind, only brain" (p. 184). The future of psychiatry, despite what Taylor says, depends on the acceptance and understanding of people's thoughts, feelings and behavior. There's no need to retreat into neuropsychiatry.

 

© 2013 Duncan Double

 

Duncan Double is a Consultant Psychiatrist and Honorary Senior Lecturer, Norfolk & Suffolk NHS Foundation Trust and University of East Anglia, UK; blogs at critical psychiatry.


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