Psychiatry's Troubled search for the Biology of Mental Illness
by Anne Harrington
Reviewed by Mira de Vries
This is the sanest history of psychiatry I've read since Robert Whitaker's 2002 Mad in America.
Harrington starts her story with Emil Kraepelin, touted by textbooks as founder of the science of biopsychiatry. But, she admonishes us, this is more a matter of hero worship than history. Kraepelin had no inkling of the chemical theories that dominate today's psychiatry. His ideas about the genetic origin of mental illness were based on racism, not genes. Moreover, he himself admitted that in spite of his extensive brain studies, he never found a biological cause. Kraepelin, supposed founder of biopsychiatry, concluded that Freud was on the right track, even though today we know that a fifth of Kraepelin's patients were suffering from late stage syphilis (and, not mentioned by her in connection with Kraepelin, encephalitis lethargica, possibly a residual effect of the Spanish flu).
Kraepelin was followed (and preceded, but she doesn't go any earlier) by many psychiatric trends. The author recounts phase after phase, fashion after fashion, hype after hype, building each episode up to a frenzied feeling of Eureka cheered on uncritically by the media, only to disintegrate into a sobering disappointment. Unlike many other historians of psychiatry, she does not shy away from the subject of eugenics. Today's drug dominated psychiatric paradigm, she relates at great length, is informed by commercial interests, not successes of medical research.
Throughout the book she uses words like psychosis, schizophrenia, and mental illness without defining them. She herself speaks of "diagnostic chaos." About the nature/nurture debate she states:
Which is which, and how they can be told apart, she doesn't know.... some are (almost certainly) suffering from a real illness, one that is understandable (in principle) like any other medical complaint. By the same token, others are (almost certainly) not.
She envisions a future psychiatry which would
That is probably her mealymouthed way of saying that none of the answers are medical. It is excellent advice but medical insurance won't pay for it.... step back from its current biological habits of mind and ask what might help most, even if all the answers do not necessarily feel medical.
Towards the end Harrington slips in a brief sentence incongruous with the rest of the book:
No reference or evidence is offered in support of this position. It looks like she halfheartedly inserted it to appease an editor or colleagues, or perhaps to deflect harassment from defenders of the pharmaceutical industry.The field's imperfect drugs continue not just to harm, but to save lives.
With the above exception, Harrington's history of biopsychiatry is thorough and honest. Yet it contains a major flaw, namely silence on the coercion that the supposed "biology of mental illness" justifies. Her only mention of coercion is about psychiatric labeling that, she adds in parentheses, is sometimes used coercively. She says nothing at all about legislation and courts which not only allow with impunity, but even mandate mental health workers to inflict on helpless, hapless citizens injustices that if committed by anyone else would be called kidnapping, assault, poisoning, torture, rape, and manslaughter.