This book is the next in an influential line of thinking from Johns Hopkins University. Headed by Paul McHugh for many years, and influenced by Peter Slavney as residency director, the Hopkins department has been a proponent of a way of thinking about psychiatry that has been, and remains, outside of the mainstream. The mainstream is the biopsychosocial model, in all its eclecticism, an anarchy of anyone doing whatever one wants.
Prior alternatives were psychoanalytic orthodoxy and biological reductionism, each of which are obviously flawed in their extremism. The Hopkins group has been trying to come up with something different: something that is not dogmatic and not eclectic. The classic statement is in McHugh and Slavney's Perspectives in Psychiatry. This approach, which has its own roots in the tradition of the German psychiatrist Karl Jaspers, has had some impact. At Harvard, it was heard sympathetically by Leston Havens, whose Approaches to the Mind was another attempt to make sense of psychiatry without being eclectic or dogmatic. As a student of Havens, I have added my own thoughts. But most of the thinking and writing has come from Hopkins, and here we have the newest installation. MacKinnon has worked with McHugh and Slavney for decades; he is a close disciple. As the founders have retired, it is now time for the next generation to step up; and, with this book, MacKinnon has stepped up.
He provides his teaching not as a conceptual book aimed at the upper reaches of the professions, but rather as an introductory text aimed at new students. This makes sense. No professor above the age of 40 has ever changed his mind about anything important. (This is what William Osler believed). We probably waste time and paper in writing for the leaders of the profession; a career of beliefs and activities is a terrible thing to waste. And people refuse to waste such careers by refusing to change their minds. But young people have no past to defend (as Cajal once said). They come to a field clean, naïve, honest. It is to them we must speak. And MacKinnon speaks.
How well he speaks is something for readers to judge. Most of the book is about normal psychology and neurobiology. Only the last chapter, about 20 pages long, gets into psychopathology, i.e., psychiatry per se. For me, that last section was the most interesting, and yet it came across as marginalia, as if the writer was really not interested enough in it to plunge profoundly into the material; I wanted more. But the book wasn't written for me; I'm already too old. It was written for the medical student and the psychiatric resident and the psychology and social work intern. For those readers, it is a masterly summary of what we know about the normal brain, and how it goes awry.
If you haven't made up your mind about psychiatry, but your mind is open, read this book. If you've already made up your mind, it doesn't matter what you read.
© 2011 Nassir Ghaemi
Nassir Ghaemi, MD MPH, Professor of Psychiatry and Pharmacology; Director, Mood Disorders Program, Tufts Medical Center
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