Read Of 2 Minds: The Growing Disorder in American Psychiatry by T.M. Luhrmann Online


Is the fight between cures worse than the disease? The fairly comfortable truce between psychotherapy and drug treatment for mental illness started eroding a few years ago, when the latter's bottom-line efficiency made it the preferred option for HMOs and many other health care providers. The often-sharp division between these two methods is highlighted in Of Two Minds, anIs the fight between cures worse than the disease? The fairly comfortable truce between psychotherapy and drug treatment for mental illness started eroding a few years ago, when the latter's bottom-line efficiency made it the preferred option for HMOs and many other health care providers. The often-sharp division between these two methods is highlighted in Of Two Minds, an insightful anthropological assessment of psychiatric training in America by University of California-San Diego's T.M. Luhrmann. She studied with psychiatrists in training, visited inpatient and outpatient facilities, and interviewed scores of doctors and patients to reveal the craft of a strange and misunderstood profession. Neither opponents nor defenders of the mental health establishment will find unqualified support from the author's careful evaluation. While she states from experience that she believes mental illness is real and in many cases of biological origin, she also despairs at the divide between research and treatment. Luhrmann is strongly sympathetic with her subjects, whether physicians, patients, or instructors. She paints a portrait of harrowing training for young doctors and hellish experiences before, during, and after treatment for those seeking relief. She does find much to recommend both drug and talk therapies, though current research suggests that combining them is more effective for more patients than either one alone. In closing, Luhrmann warns that we are in danger of dehumanizing the mentally ill by emphasizing cost-effective pharmaceutical management of symptoms over interpersonal relationships. Of Two Minds has the depth and complexity necessary to match its subject and the warmth to reach its readers. It's essential reading for anyone involved or interested in mental health. --Rob Lightner...

Title : Of 2 Minds: The Growing Disorder in American Psychiatry
Author :
Rating :
ISBN : 9780679421917
Format Type : Hardcover
Number of Pages : 337 Pages
Status : Available For Download
Last checked : 21 Minutes ago!

Of 2 Minds: The Growing Disorder in American Psychiatry Reviews

  • Ari
    2019-04-13 13:37

    T.M. Luhrmann has written an incisive and compelling study of contemporary American psychiatric theory and practice. Luhrmann describes a field in crisis: psychiatric training has long contained internal contradictions between psychodynamic and biomedical understandings of mental illness, but the rise of managed care in the 1990s served to heighten those contradictions and create a more pronounced divide between the two methods. The result, beginning in the 1990s and continuing into the present day, is the privileging of the biomedical model of treatment over the psychodynamic; that is, treating mental illness as an organic disease of the body rather than a complex, multifaceted issue rooted not only in the body, but also in personal history and cultural context. The effect of this shift is profound: psychiatric treatment for the mentally ill--and especially for underprivileged groups of people--has become primarily pharmacological, and psychoanalytic/therapeutic counseling has become an afterthought and is often not fully covered by private or public insurance. Using drugs to treat mental illness, Luhrmann convincingly argues, is at most half the battle. Despite the remarkable strides made in the second half of the twentieth century, psychopharmacological drugs are still not effective for a sizable portion of people suffering from mental illness. Even for those who do respond well to medications, counseling treatment is often an essential part of patients' disease management. But it has an increasingly diminished role in modern psychiatry; and the effects of this change are felt by patients, their families, the hospitals and clinics that treat them, and the communities in which they live.The most remarkable thing about Luhrmann's work is how eminently empathetic it is. Luhrmann describes the cultural landscape of psychiatric training and practice in vivid detail, including the contradictions, disagreements, and shortcomings of the field. She also acknowledges the many unknowns that still exist surrounding the causes, treatment, and meanings of mental illness. Yet her effort is less to assign blame or discredit, and more to explore how this situation came to be, and how psychiatric practitioners attempt to reconcile competing types of knowledge within the constraints of rigid bureaucratic institutions. If there is one area where this empathy is lacking, it is Luhrmann's somewhat dismissive treatment of the anti-psychiatry movement, and anti-psychiatric undercurrents in U.S. culture more broadly. "Madness is real," she argues in response to the writing of authors like Thomas Szasz, and "most people who end up in a psychiatric hospital are deeply unhappy and seriously disturbed" (12). Fair enough; but Luhrmann continues, "the fantasy that innocent victims are imprisoned in asylums where they go slowly mad under the weight of the psychiatrist's expectation and society's rejection is exactly that, a fantasy" (12). Luhrmann is responding here mostly to anti-psychiatric literature of the 1960s; but she would do well to consider the longer history of institutionalization in the United States. In the late nineteenth and twentieth centuries, mental institutions were in fact places where the state placed socially deviant "others," including people of color and poor whites who did not fit racist, sex- and gender-normative ideals, or who simply were unfairly or incorrectly deemed mentally deficient. More recently, debates have raged across the United States about the limits of involuntary civil commitment for street homeless people and others who make up a new class of social deviants. That many Americans are distrustful of psychiatry is at least in part a legacy of this institutional past, not superstition or willful ignorance. Surely acknowledging this complicated history would enrich Luhrmann's study, not diminish it.

  • Meghan
    2019-04-17 11:29

    Luhrmann's ethnography of the psychiatry profession is an engaging and a bit disturbing analysis of how mental illness is conceptualized and treated in the American health care system. Luhrmann's work is accessible to anthro and non-anthro folks alike.

  • Julie
    2019-03-31 18:40

    I read this book some years ago for a college course, and while informative, I felt it was almost more of a journalist's expose than the culmination of study for an anthropologist's essay. That's not to say it should be dry and disseminating; rather, it had the feel of pushing some hidden agenda than summing up what she had learned in her years of study (namely that 'crazy' people really are 'crazy' and much disdain for anti-psychotic medication versus talk therapy).

  • jo
    2019-04-19 11:42

    the parts about how psychiatrists learn to manage patients may be instructive, but the part about how they learn psychoanalysis -- no way. there *might* be training psychiatrists who routinely learn psychoanalysis and undergo analysis themselves, but you have to physically take me to see them for me to believe it.

  • Keith Wilson
    2019-04-08 18:42

    Having read Luhrmann's anthropological study of prayer, When God Talks Back, I couldn't wait to pick up this anthropologist's eye view of psychiatry. I could've gotten the same thing reading a good, long magazine article on the subject. I'm not sure anymore what the difference is between anthropology and journalism, maybe there was no difference, anyway.She contrasts the two minds of psychology, the biological medical model, with the Freudian. Doesn't she know that Freudianism died many years ago? Wouldn't narrative therapy, or client centered therapy, or any one of the many family approaches be a more worthy opponent to the medical model?She gets a lot of things right: the arrogance and the opacity of the Freudians, as well as the arrogance and reductionism of the medics. Let's face it, psychiatrist is just, well, arrogant. Anyone who is not intimately knowledgeable about psychiatry needs to know that. Anyone, like me, that is, needs to never forget it.

  • Andy Park
    2019-04-17 10:23

    Highly recommended book on modern psychiatry practices - medication vs. therapy - read this even if you don't know anything about psychology/psychiatry, and you'll gain a lot of respect and perspective about the issues that plague thousands of our fellow humans.I keep referring to this book when thinking/debating about modern psychiatry and American social issues.

  • Marcela
    2019-04-16 13:20

    One of my first exposures to medical anthropology, gets into detail about psychiatry residency training as well as the historical context to the anti-psychiatry movement.

  • Nuno Carrilho
    2019-03-22 10:41

    For the psychiatric interns you want to learn what they will go trough or have been trough. For the psychiatrist to remember how was their internship.Besides this enactment of the internship upon the intern, tells a interesting story about changes in handling psychiatric disorders - not only different medical/psychological models but also the interference of politics and insurance companies.Everyone that wants to learn how organizational changes aren't indifferent in the medical handling patients, should read this.

  • Paige
    2019-03-20 11:39

    Fabulous; anyone interested in psychiatry should read this insightful, interesting, and well-written analysis of psychiatrists themselves and the way they interact with patients. Luhrmann--who recently published a fabulous ethnography of evangelical Christians (When God Talks Back: Understanding the American Evangelical Relationship with God)--is even-handed, reserving outright judgment of the field while showing great respect and deference for the people who practice it. She is also very fair to the issue of mental illness itself, dispelling romantic notions of the "mad" (à la Foucault The Birth of the Clinic: An Archaeology of Medical Perception and Camus ) and legitimizing the field of psychiatry without looking at it through an unrealistically rosy lens.

  • Yi
    2019-03-29 14:25

    As an Anthropology major who has read plenty of works dealing with abstract concepts, I would have to say that "Of Two Minds" is probably one of the most accessible ethnographies that I have read. Tanya Luhrmann's writing is very clear and her arguments are sophisticated yet easy to understand. If you aren't a psychiatrist (or a psychiatrist-in-training), you will probably be fascinated, unsettled and maybe even slightly repulsed by the culture of psychiatry that Luhrmann describes through her top-notch participant observation and interviews. Although her work focuses on the training of young psychiatrists, it's easy to see how the process by which they are socialized into the culture of psychiatry could affect their future practice. "Of Two Minds" is light on the theory, the conclusions (especially those regarding managed care) that she draws from her solid ethnographic research are informative, and I daresay relevant to the current health care debate. Read this book if you want to learn more about the field of psychiatry or if you simply want to read an exemplary ethnography.

  • Molly
    2019-03-22 18:39

    I'm sorry to miss the book club discussion on this because I'd be curious to hear what other people thought. I found the discussion on the economies of mental health care more interesting than the philosophies of the different branches, so I'm glad I stuck it out through the end of the book. There really does need to be a change in how Americans deal with long-term chronic conditions (hospitalizations are getting shorter, but alternative care situations are not covered, etc.), and mental health is one of those fields where it's almost all chronic conditions. It's one thing to be cured from a one-time infection, it's quite another thing to be on medication for the rest of your life. I also found it interesting that there is not good data on the long-term effects of psychiatric medications. At least for my life time, there has pretty much always been Prozac, Ritalin, etc., so I hadn't really considered that those drugs have not been around that long. I guess NIMH has their work cut out for them.

  • Chuck O'Connor
    2019-03-27 18:23

    This is a fascinating study on how psychiatric treatment divided between the therapeutic and bio-chemical models upon the discovery of anti-psychotic medicine and the rise of managed care organizations. At the heart of this book is the question of person-hood. Is the mind the essence of a person, and therefore the foundation of medical ethics or, is the mind what the brain does and something to be treated with medicine? There are deep consequences in terms of personal responsibility, and the definition of "human being", when one considers the debate about the source of mental illness. Is psychiatric pain a disease of the brain, and therefore a bio-medical concern where the person suffering is a passive medical respondent, or is it a consequence of social circumstance and something that demands an integration of trauma driven by individual empowerment. The debate continues and new discoveries in brain science and mind-body realities seem to be deepening it.

  • Adrienne
    2019-04-06 15:20

    i had mixed feelings overall. she makes some really good points about the split between biomedical psychiatry and psychoanalysis, but although it was published in 2000 a lot of her work was in the 90s and is now outdated... there are also sections that basically explain how to become a psychiatrist, which obviously was a little boring for me.on the other hand, her prose is just excellent -- she has a surefooted clarity that makes one feel that things one inherently knows are more firmly true now that they are phrased so well. and there are glimmers of brilliant commentary about what its like to train and work in psych -- in the end it was really worth the 45 pages of boring to hit the ingenious moments of resonance. i definitely want to read her other work that is NOT about my work :)

  • Kevin Hilke
    2019-04-06 16:26

    "Managed care is a moral crisis for doctors, particularly for psychiatrists whose primary identity is psychotherapeutic. The despair of psychiatrists who see the medical world changing around them comes from a sense of moral violation, from the horror that they cannot care for people in the way that good doctors do, that they have been forced to break trust with their patients, that they can no longer respond empathetically. They feel like bad people. The feel that they have been trained to understand a grotesque misery, yet all they are allowed to do is hand out a biomedical lollipop to its prisoners and then turn their backs. They feel as if they have been eating lunch on a park bench while the man across from them died, and they watched and did nothing."

  • Sal
    2019-04-02 17:22

    For those interested in psychiatry or mental health, and certainly for future practitioners, this is a book worth reading. It's useful for those who have wondered where mental illnesses come from. One of the reasons this might puzzle you is that psychiatry has two very distinct answers: the brain and the mind. Unfortunately, the moral of this story seems to be that the insurance industry (less on big pharma) has hijacked the way psychiatrists practice, essentially forcing the psychotherapy/mind-origin contingent out of business. This development, according to Luhrmann and many empirical studies, is bad news for patients.

  • Ashley Hamilton
    2019-03-27 12:28

    I almost put this book down after the first 20 pages because I didn't think I was likely to get much out of it, but I'm glad I stuck with it. It is true that much of the information is old, given that the research Luhrmann wrote on was conducted at least 15 years ago. However the book provides a valuable perspective on the history of the field and a offers a useful account of how the flaws of the past have paved the way for the current dilemmas and weaknesses of psychiatric care and mental health care in general.

  • Bobby
    2019-04-07 18:49

    I found this a very interesting read and agree with most of Ms Luhrmann's analysis on psychiatry today. For an "outsider" (she's an anthropologist by training I believe so not in the mental health field per se), I think she did a great job of recognizing and articulating the problems faced by psychiatry. Though I do think that at times she gets a bit too pessimistic and fails to give adequate recognition to certain contexts/settings in which psychiatry has overcome some of the challenges she outlines in her book.

  • Beth
    2019-04-15 13:37

    Interesting look at how psychiatrists are trained, with emphasis placed on the "divide" between psychopharmacological and psychoanalytical approaches to treatment, as well as the role of managed care.

  • Olivia
    2019-03-31 15:20

    Skimmed the end, some very interesting parts, but also some very repetitive themes. Can't imagine this would be terribly interesting to people outside of the mental health world, or maybe even just psychiatrists

  • John
    2019-04-20 12:48

    A remarkably fine ordering of the period of my training as a psychiatrist and e subsequent years. Even handed tracing of the miserable state of psychiatric practice in the USA today. Since being published in 2000 things have gotten only worse and more so as described. Terrific book.

  • Catherine Woodman
    2019-03-21 13:43

    great book on modern psychiatry's hx

  • Emily Bufford
    2019-03-23 13:48

    A great look at the current ebb and flow of psychiatry. Depressing too, as the state of insurance claims yet another victim.

  • Tasha
    2019-04-05 16:25

    It was alright. I am apparently not as interested in how an anthropologist examines psychiatrists/psychologists/etc as I thought I was

  • Rebecca Emily
    2019-04-18 11:49

    Dense at times but overall a fascinating topic to read about

  • Chuck
    2019-04-13 14:31

    Fascinating read about the culture and training of psychiatrists from an anthropologist. Great insight into the impact of the biomedical model on modern psychiatry.

  • Gregry
    2019-03-31 14:34

    read for Psych Anthro at UCB

  • Patrick Nylen
    2019-03-27 13:32

    Really enjoyable - a diverse and interesting look into the science and business of American mental health treatment.

  • Kelli
    2019-03-24 14:28

    couldn't finish it.