Prescriptions For The Mind

Prescriptions for the Mind

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Prescriptions for the Mind
A Critical View of Contemporary Psychiatry

JOEL PARIS, MD

1
2008

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Oxford University Press, Inc., publishes works that further Oxford University’s objective of excellence in research, scholarship, and education. Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi KualaLumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam

Copyright # 2008 by Oxford University Press, Inc.
Published by Oxford University Press, Inc. 198 Madison Avenue, New York, New York10016 www.oup.com Oxford is a registered trademark of Oxford University Press All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Oxford University Press. Library of Congress Cataloging-in-Publication Data Paris,Joel, 1940– Prescriptions for the mind : a critical view of contemporary psychiatry / Joel Paris. p. ; cm. Includes bibliographical references and index. ISBN 978-0-19-531383-3 1. Psychiatry—Philosophy. 2. Psychotherapy—Methodology. [DNLM: 1. Psychiatry—methods. 2. Mental Disorders. WM 100 P231p 2008] I. Title. RC437.5.P37 2008 616.89001—dc22 2008006681

1 3 5 7 9 8 6 4 2 Printed in the UnitedStates of America on acid-free paper

This book is dedicated to Leon Eisenberg.

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Contents

Acknowledgments Introduction xi

ix

part i—MODELS
1. Neuroscience and Psychiatry 3 2. Psychotherapy and Psychiatry 21

part ii—DIAGNOSIS
3. 4. 5. 6. Diagnosis in Psychiatry 37 The Boundaries of Mental Disorders Mood and Mental Illness 65 Psychiatry’sProblem Children 83 55

part iii—TREATMENT
7. Evidence-Based Psychiatry 101 8. Psychiatric Drugs: Miracles and Limitations 111

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Contents

9. Talk Therapies: The Need for a Unified Method 10. Psychiatry in Practice 149

133

part iv—OUTLOOK
11. Training Psychiatrists 171 12. Psychiatry and Society 183 13. The Future of Psychiatry 197 Endnotes 209 References 213 Index 235Acknowledgments

I sions of this book and made many useful suggestions for improvement,

would like to thank Roz Paris and Ned Shorter, who read earlier ver-

and also Leon Eisenberg, Maurice Dongier, Richard U’ren, and Hallie Zweig-Frank, who offered helpful comments on early drafts of several chapters. A special thanks to my editor at Oxford, Marion Osmun, who believed in this book and tookthe time to work with me on its shape and contents.

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Introduction

Two Visions of Psychiatry
Psychiatrists are experts on the mind and its maladies. But no one is quite sure anymore what it is they do. It is not surprising that the public has difficulty understanding the field. Psychiatrists themselves are confused about how they should practice.The discipline remains divided between two visions, and there is a continuing struggle within psychiatry about its future role. Should psychiatrists be more like neurologists—examining patients, making diagnoses, and prescribing drugs? Or should they be more like psychologists—probing the inner workings of the mind and providing expert psychotherapy? These contrasting visions are not new. In a bookpublished fifty years ago, a sociologist, August Hollingshead, and a psychiatrist, Fritz Redlich, described two types of psychiatrists (Hollingshead and Redlich, 1958). One wore white coats and treated patients in hospitals; the other wore sports jackets and treated patients with psychotherapy in offices. Twenty
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Introduction

years later, when I studied psychiatry, my teachers...