Robert Taylor has lots of skepticism about modern psychiatry and he has many well-argued views about how modern psychiatry should be practiced. It is no surprise that there is a prominent blurb from Daniel Carlat (author of Unhinged: The Trouble with Psychiatry - A Doctor's Revelations about a Profession in Crisis) on the front cover. While he is not completely against the prescription of medication, he argues that psychiatrists should be cautious in prescribing, remaining open to other treatments. He is critical of the way that medications have been overprescribed and of the idea that chemical imbalances are corrected by psychiatric medication. He recommends trying exercise, various nutritional supplements, and some kinds of psychotherapy. He devotes a chapter to psychiatric politics, in which he discusses mental health law, the insanity defense, and the criminalization of the mentally disabled. So it sounds like one should be choosing a psychiatrist on the basis of their political views. In the next chapter, Taylor recommends that one should not should not trust a psychiatrist who says that psychiatry is a brain science. The best advice in the book is that one should find a psychiatrist who listens.
Most of Taylor's views of psychiatry make sense, and his advice is not bad. However, for anyone who has gone in search of a therapist or a psychiatrist, it will be immediately obvious that it is mostly useless advice. Most therapists and doctors are evasive when you ask them detailed questions about their methods and ideology. If you say you want to interview them before starting therapy or treatment, they are quite likely to not return your messages. In discussing this with therapists I know, it is likely that they may suspect that you are going to be a difficult patient if you start out with lots of questions about their practices ahead of time. They are not going to welcome having their credentials and their overall views of psychiatry inspected. Most people with health insurance will have a limited number of psychiatrists they can select from in the first place, and a limited number of sessions covered, which will make them reluctant to spend one of them on interviewing the clinician, especially when faced with evasion and vague answers. If there are ways of getting psychiatrists to answer the kinds of questions that Taylor recommends, a separate book would need to be written on how to find them without wasting a lot of time and money.
A useful book about finding the right psychiatrist would need to be much more practical. What kinds of questions should one leave with the psychiatrist's voice mail, what ways there are to find out information about psychiatrists by doing internet searches, whether to trust online reviews or criticisms of psychiatrists, how to get referral to a good psychiatrist from a general practitioner or a psychotherapist, or from friends. One of the most important skills patients need to learn is assessing whether treatment is going well and whether it could be going better. Life is always complicated with many things changing at the same time, so it is always very difficult to work out whether one is improving or deteriorating because of treatment or because of other factors. Such a book would need to be written by people with experience of actually finding psychiatrists -- Taylor never says he has any experience of doing so -- maybe in collaboration with psychiatrists.
This book should be retitled "Being the Right Psychiatrist." Its advice is much more suitable for psychiatrists working out how to treat patients than it is for patients looking for psychiatrists.
© 2014 Christian Perring
Christian Perring, Professor of Philosophy, Dowling College, New York
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