|Basic InformationMore InformationLatest NewsQuestions and AnswersLinksBook Reviews|101 Healing Stories101 Things I Wish I'd Known When I Started Using HypnosisA Primer for Beginning PsychotherapyA Therapist's Guide to Understanding Common Medical ProblemsACT With LoveAssessment and Treatment of Childhood Problems, Second EditionBad TherapyBefore ForgivingBeing a Brain-Wise TherapistBiofeedback for the BrainBoundaries and Boundary Violations in PsychoanalysisBrain Change TherapyBreaking ApartBuffy the Vampire Slayer and PhilosophyBuilding on BionCare of the PsycheChoosing an Online TherapistClinical Handbook of Psychological DisordersClinical Intuition in PsychotherapyClinical Pearls of WisdomCompassion and Healing in Medicine and SocietyConfessions of a Former ChildConfidential RelationshipsConfidentiality and Mental HealthConfidingCouch FictionCounseling with Choice TheoryCritical Issues in PsychotherapyCrucial Choices, Crucial ChangesDecoding the Ethics CodeDepression 101Depression in ContextDo-It-Yourself Eye Movement Techniques for Emotional HealingDoing ItE-TherapyEncountering the Sacred in PsychotherapyEnergy Psychology InteractiveEssays on Philosophical CounselingEthics in Psychotherapy and CounselingEveryday Mind ReadingExpressing EmotionFacing Human SufferingFairbairn's Object Relations Theory in the Clinical SettingFamily TherapyFavorite Counseling and Therapy Homework AssignmentsFlourishingFlying ColorsHandbook of Clinical Psychopharmacology for TherapistsHandbook of Counseling and Psychotherapy with Lesbian, Gay, and Bisexual ClientsHealing the Soul in the Age of the BrainHeinz KohutHow to Give Her Absolute PleasureHow to Go to TherapyIf Only I Had KnownIn SessionIn Therapy We TrustIn Treatment: Season 1Incorporating Spirituality in Counseling and PsychotherapyIs Long-Term Therapy Unethical?Issues in Philosophical CounselingIt’s Your HourLearning from Our MistakesLetters to a Young TherapistLove's ExecutionerMan's Search for MeaningMetaphoria: Metaphor and Guided Metaphor for Psychotherapy and HealingMindfulness and AcceptanceMindfulness-Based Cognitive Therapy for DepressionMindworks: An Introduction to NLPMockingbird YearsMomma and the Meaning of LifeMotivational Interviewing: Preparing People For ChangeMulticulturalism and the Therapeutic ProcessOf Mice and MetaphorsOf Two MindsOn the CouchOne Nation Under TherapyOur Inner WorldOvercoming Destructive Beliefs, Feelings, and BehaviorsPhilosophical CounselingPhilosophical MidwiferyPhilosophical PracticePhilosophy and PsychotherapyPhilosophy for Counselling and PsychotherapyPhilosophy PracticePlato, Not Prozac!Psychologists Defying the CrowdPsychology, Psychotherapy, Psychoanalysis, and the Politics of Human RelationshipsPsychosis in the FamilyPsychotherapyPsychotherapyPsychotherapy As PraxisPsychotherapy for Children and AdolescentsPsychotherapy for Personality DisordersRational Emotive Behavior TherapyRational Emotive Behavior TherapyRationality and the Pursuit of HappinessRecovery OptionsRent Two Films and Let's Talk in the MorningSaving the Modern SoulSecond-order Change in PsychotherapySelf MattersSelf-Determination Theory in the ClinicSexual Orientation and Psychodynamic PsychotherapyStrangers to OurselvesTaking America Off DrugsTales of PsychotherapyThe Art of HypnosisThe Case Formulation Approach to Cognitive-Behavior TherapyThe Crucible of ExperienceThe Education of Mrs. BemisThe Fall Of An IconThe Gift of TherapyThe Husbands and Wives ClubThe Love CureThe Making of a TherapistThe Mummy at the Dining Room TableThe Neuroscience of PsychotherapyThe Neuroscience of Psychotherapy: Healing the Social BrainThe New PsychoanalysisThe Philosopher's Autobiography The Portable CoachThe Portable Ethicist for Mental Health Professionals The Present Moment in Psychotherapy and Everyday LifeThe Problem with Cognitive Behavioural TherapyThe Psychodynamics of Gender and Gender RoleThe Psychotherapy Documentation PrimerThe Real World Guide to Psychotherapy PracticeThe Schopenhauer CureThe Talking CureThe Therapist's Guide to Psychopharmacology, Revised EditionThe UnsayableThe Wing of MadnessTheory and Practice of Brief TherapyTherapyTheraScribe 4.0Toward a Psychology of AwakeningTracking Mental Health OutcomesTreating Attachment DisordersWhat the Buddha FeltWhat Works for Whom? Second EditionWhy Psychoanalysis?
by T. M. Luhrmann
Review by Heather C. Liston on Mar 31st 2001
Managed care is drastically shortening the time in which the mentally ill can afford to be hospitalized, and making it harder for most people to afford outpatient psychotherapy. Drugs are cheaper and faster. But do they solve the underlying problems in people's lives, or merely mask symptoms? The growing distance between those who believe in medication and those who put their primary faith in therapy is one of the burning issues Tanya Luhrmann explores in this excellent work.
On the question of whether or not mental illness is biological, she writes, "A recent survey on world mental health observed that in all different age, gender, and cultural categories everywhere, the most important risk factor for mental health is social disruption . . . Poverty, war, and dislocation are bad for people-an obvious point, but important if you are tempted to think of psychiatric illness as purely hereditary." Although she considers many different points of view on the question, here is one of her own conclusions: "I believe both the biomedical and psychodynamic approaches to psychiatric illness to be substantially correct and equally effective, although not always for the same person." Not everyone agrees with her, of course.
Of the current trend in psychiatry she says, "Psychiatric science is now configured, at least for many of the more senior scientists, as a rejection of the psychodynamic approach to mental illness. This rebellious aspect of psychiatric science might well vanish in two decades. But now it is very real." The author is an anthropologist who decided to study the training of American psychiatrists, and the result is a dense but not difficult book. Her research is very thorough: over the course of more than four years, she immersed herself in psychiatry classes and hospital rounds; she shadowed young doctors and interviewed numerous patients. She observed those in psychotherapy and those on medication. Luhrmann reports on the courseload, the workload, the strengths, weaknesses, fears, and successes of the psychiatrists-in-training. What are they trying to do? Are they making a difference? Truly helping patients? Is their training adequate to equip them for the real-life situations they encounter? Are they too constrained by the limits of health insurance to offer proper care? Too quick to offer drugs when human interaction is called for? Or too hung up on Freudian theories to recognize when a problem is simply chemical? The human stories here are well-written, moving, and insightful, and the conclusions are well-documented and clearly explained.
Among other topics, Luhrmann looks at some of the causes of depression, a very important question in this modern "Prozac Nation" in which it sometimes seems that everyone is taking drugs for something. If we're all depressed, then what's normal? Here's one of her answers to that: "Depression, and mood disorders in general, may be more common in the twentieth century than every before, because in no other time of human history have so many people been so isolated." "More people," she says, "live alone in America than ever before-a quarter of all Americans, compared to less than 10 percent in 1940 and probably almost none in our ancestral past. . . From a human evolutionary perspective, this is bizarre." Anyone with a serious interest in mental health can find much that is useful, elucidating, and even intriguing here.
© 2001 Heather C. Liston Heather Liston studied Religion at Princeton University and earned a Masters degree from the NYU Graduate School of Business Administration. She is the Managing Director of the National Dance Institute of New Mexico, and writes extensively on a variety of topics. Her book reviews and other work have appeared in Self, Women Outside, The Princeton Alumni Weekly, Appalachia, Your Health and elsewhere.