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50 Signs of Mental IllnessA Beautiful MindA Beautiful MindA Bright Red ScreamA Casebook of Ethical Challenges in NeuropsychologyA Corner Of The UniverseA Lethal InheritanceA Mood ApartA Research Agenda for DSM-VA Slant of SunA War of NervesAbnormal Psychology in ContextADD-Friendly Ways to Organize Your LifeAddiction Recovery ToolsAdvance Directives in Mental HealthAggression and Antisocial Behavior in Children and AdolescentsAl-JununAlmost a PsychopathAlterations of ConsciousnessAm I Okay?American ManiaAmerican Psychiatric Publishing Textbook of Neuropsychiatry and Clinical NeurosciencesAn American ObsessionAngelheadAnger, Madness, and the DaimonicAnthology of a Crazy LadyApproaching NeverlandAs Nature Made HimAsylumAttention-Deficit Hyperactivity DisorderAttention-Deficit/Hyperactivity DisorderBeing Mentally Ill: A Sociological Theory Betrayal TraumaBetrayed as BoysBetter Than ProzacBetter Than WellBeyond AppearanceBeyond ReasonBinge No MoreBiological UnhappinessBipolar 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ChildrenEmotions and LifeEmpowering People with Severe Mental IllnessEssential PsychopharmacologyEssentials of Cas AssessmentEssentials of Wais-III AssessmentEthics and Values in PsychotherapyEthics in Mental Health ResearchEthics in Psychiatric ResearchEthics, Culture, and PsychiatryEverything In Its PlaceFamily Experiences With Mental IllnessFatigue as a Window to the BrainFear of IntimacyFinding Iris ChangFinding Meaning in the Experience of DementiaFlorid StatesFolie a DeuxFor the Love of ItForensic Nursing and Multidisciplinary Care of the Mentally Disordered OffenderFountain HouseFrom Madness to Mental HealthFrom Trauma to TransformationGandhi's WayGender and Its Effects on PsychopathologyGender and Mental HealthGenes, Environment, and PsychopathologyGetting Your Life BackGracefully InsaneGrieving Mental IllnessHandbook of AttachmentHandbook of DepressionHandbook of Self and IdentityHealing the SplitHerbs for the MindHidden SelvesHigh RiskHope and DespairHow Clients Make Therapy WorkHow People ChangeHow to Become a SchizophrenicHow We Think About DementiaHughes' Outline of Modern PsychiatryHumanizing MadnessHysterical MenHystoriesI Hate You-Don't Leave MeI Never Promised You a Rose GardenI Thought I Could FlyI'm CrazyImagining RobertImpulse Control DisordersIn Others' EyesIn Two MindsInsanityIntegrated Behavioral Health CareIntegrative MedicineIntegrative Mental Health CareIntuitionJust CheckingKarl JaspersKissing DoorknobsKundalini Yoga Meditation for Complex Psychiatric DisordersLaw and the BrainLaw, Liberty, and PsychiatryLegal and Ethical Aspects of HealthcareLiberatory PsychiatryLife at the BottomLife at the Texas State Lunatic Asylum, 1857-1997Life Is Not a Game of PerfectLithium for MedeaLiving Outside Mental IllnessLiving with AnxietyLiving With SchizophreniaLiving with SchizophreniaLiving Without Depression and Manic DepressionLost in the MirrorLove's ExecutionerLoving Someone With Bipolar DisorderMad in AmericaMad TravelersMad, Bad and 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Managed care is drastically shortening the time in which the mentally ill can afford to be hospitalized, and making it harder for most people to afford outpatient psychotherapy. Drugs are cheaper and faster. But do they solve the underlying problems in people's lives, or merely mask symptoms? The growing distance between those who believe in medication and those who put their primary faith in therapy is one of the burning issues Tanya Luhrmann explores in this excellent work.
On the question of whether or not mental illness is biological, she writes, "A recent survey on world mental health observed that in all different age, gender, and cultural categories everywhere, the most important risk factor for mental health is social disruption . . . Poverty, war, and dislocation are bad for people-an obvious point, but important if you are tempted to think of psychiatric illness as purely hereditary." Although she considers many different points of view on the question, here is one of her own conclusions: "I believe both the biomedical and psychodynamic approaches to psychiatric illness to be substantially correct and equally effective, although not always for the same person." Not everyone agrees with her, of course.
Of the current trend in psychiatry she says, "Psychiatric science is now configured, at least for many of the more senior scientists, as a rejection of the psychodynamic approach to mental illness. This rebellious aspect of psychiatric science might well vanish in two decades. But now it is very real." The author is an anthropologist who decided to study the training of American psychiatrists, and the result is a dense but not difficult book. Her research is very thorough: over the course of more than four years, she immersed herself in psychiatry classes and hospital rounds; she shadowed young doctors and interviewed numerous patients. She observed those in psychotherapy and those on medication. Luhrmann reports on the courseload, the workload, the strengths, weaknesses, fears, and successes of the psychiatrists-in-training. What are they trying to do? Are they making a difference? Truly helping patients? Is their training adequate to equip them for the real-life situations they encounter? Are they too constrained by the limits of health insurance to offer proper care? Too quick to offer drugs when human interaction is called for? Or too hung up on Freudian theories to recognize when a problem is simply chemical? The human stories here are well-written, moving, and insightful, and the conclusions are well-documented and clearly explained.
Among other topics, Luhrmann looks at some of the causes of depression, a very important question in this modern "Prozac Nation" in which it sometimes seems that everyone is taking drugs for something. If we're all depressed, then what's normal? Here's one of her answers to that: "Depression, and mood disorders in general, may be more common in the twentieth century than every before, because in no other time of human history have so many people been so isolated." "More people," she says, "live alone in America than ever before-a quarter of all Americans, compared to less than 10 percent in 1940 and probably almost none in our ancestral past. . . From a human evolutionary perspective, this is bizarre." Anyone with a serious interest in mental health can find much that is useful, elucidating, and even intriguing here.
© 2001 Heather C. Liston Heather Liston studied Religion at Princeton University and earned a Masters degree from the NYU Graduate School of Business Administration. She is the Managing Director of the National Dance Institute of New Mexico, and writes extensively on a variety of topics. Her book reviews and other work have appeared in Self, Women Outside, The Princeton Alumni Weekly, Appalachia, Your Health and elsewhere.
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