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James Davies's top 10 psychiatry critiques

Written By Unknown on Wednesday, June 19, 2013 | 7:17 AM


The author of Cracked selects a battery of books that challenge received wisdom about mental illness and how to treat it


I wrote Cracked: Why Psychiatry Is Doing More Harm Than Good because of the huge gulf between what most people believe about psychiatric diagnoses and medications and what the evidence actually reveals.


When I started working in the NHS I pretty much accepted the mainstream view – that psychiatric drugs work, that the categories of mental disorder have been established via solid scientific research, and that we are now on the cusp of understanding the biology of mental illness. It took many years of practice and research to learn that such assertions do not stand up to serious scientific scrutiny.


My choice of 10 books here reflects the writings of diverse commentators – patients, academics, novelists, psychologists and critical psychiatrists – who have at different times challenged our understanding of mental illnesses and how best to treat them.


1. Crazy Like Us by Ethan Watters


Written by one of North America's foremost investigative journalists, this exceptional book tells the story of the globalisation of western psychiatry. Watters lays bare the strategies through which the pharmaceutical industry has converted new populations to our way of understanding and treating mental disorder, making billions in the process.


2. Anatomy of an Epidemic by Robert Whitaker


Whitaker's now-classic book on critical psychiatry tackles one of the great dogmas of psychiatric lore: that antipsychotic medications work. While agreeing that short-term use of these drugs can help stabilise patients, Whitaker documents the mounting evidence showing how their long-term deployment has counter-therapeutic effects. The evidence leads to a startling conclusion: that the "chronic" nature of many severe mental disorders may be partly or entirely caused by the antipsychotic drugs patients are encouraged to consume.


3. The Emperor's New Drugs by Irving Kirsch


While Whitaker's book tackles antipsychotics, the Harvard psychologist Irving Kirsch explodes the antidepressant myth. By tabulating the results of all the clinical trials conducted on antidepressants (including those buried by the pharmaceutical industry), he reveals that antidepressants actually work no better than placebos for 85% of patients. Even though his results have withstood sustained criticism and have also been replicated, antidepressant use has continued to soar. In 2011 there were 46.7m prescriptions dispensed to the English public alone. The lesson here is: don't judge the excellence of a book by its impact on policy.


4. The Undiscovered Self by Carl Gustav Jung


After witnessing the atrocities of the second world war, Jung implored future generations to become more aware of the human capacity for destructiveness. The message of this book: cease projecting your destructiveness on to others and become conscious of the destructive side of yourself. This message is crucial for certain care workers who, by self-identifying as altruistic, are prone to allow their unacknowledged destructiveness to corrupt their well-meaning intentions.


5. Shoot the Damn Dog by Sally Brampton


In this harrowing and illuminating book, Sally Brampton, a former editor of Elle magazine, leads us into the vortex of her devastating breakdown. She graphically teaches how awful emotional suffering can be, how patients can so often be misguided by professionals, but ultimately how suffering can not only pass in time, but sometimes also impart essential lessons for the art of living.


6. The Bell Jar by Sylvia Plath


This book tells the story of how a bright and sane young woman ends up in a psychiatric asylum. There she is given electroconvulsive and insulin therapy but not a drop of the feminism she obviously needs. Plath shows how healthy ambition can easily transmute into misery in the face of limited options and the devilish innocence of uncomprehending authorities. The message is still a pertinent one: suffering is not always sickness but often the sanest response to an imperfect world.


7. Outliers by Malcolm Gladwell


Gladwell has become a guru of the "smart thinking" set. There is a simple reason: he knows how to tell a story. And this book is rich with compelling stories about men and women who, as he puts it, "are so accomplished and so extraordinary and so outside of ordinary experience that they are as puzzling to the rest of us". What is gripping – and sometimes tragic – about outliers is that they are so regularly misunderstood. We are too prone to recast their difference as pathology. Gladwell deploys insightful psychological research to challenge our most basic assumptions about normality.


8. Civilisation and Its Discontents by Sigmund Freud


Here Freud locates our emotional problems in the conditions of modern civilisation. While its rules lead us to repress our instinctual needs (creating frustration), we know that gratifying these needs will be penalised (creating guilt and anxiety). Given this catch-22, it is no surprise Freud argues that the pursuit of happiness is ultimately futile. Better to dedicate ourselves to learning how to love and work productively.


9. The Sorrows of Young Werther by Johann Wolfgang von Goethe


This book tells the tale of how young Werther, having fallen for a betrothed woman, takes his own life to flee the awful love triangle. It became a sensation throughout Europe and led to a spate of copycat suicides among young men. These consequences are tragic yet fascinating. We know that once a clinical "disorder" or "trait" wins strong cultural recognition an epidemic can follow. This happened with anorexia and self-harm. Does psychiatry merely respond to or actually help create the epidemics it purports to cure?


10. DSM-III (The Diagnostic and Statistical Manual of Mental Disorders)


The DSM-III, although not recommended reading, surely deserves its status as the most influential book in psychiatric history. It established the diagnoses still broadly used today. Later editions (including the recent DSM-5) are mere footnotes to this vast bible of mental illness. And yet, perhaps no single book in medicine has caused so much controversy. Has it medicalised too much normality? Has it become a moneymaking tool for the American Psychiatric Association and the pharmaceutical industry? Has it really improved patients' lives? These important debates rage on …





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