geekery · reviews

Book Review – Unhinged:The Trouble with Psychiatry – A Doctor’s Revelations about a Profession in Crisis

Unhinged: The Trouble with Psychiatry - A Doctor's Revelations about a Profession in CrisisUnhinged: The Trouble with Psychiatry – A Doctor’s Revelations about a Profession in Crisis by Daniel Carlat
My rating: 4 of 5 stars

While short, this book gave a well thought out argument for changing the practice of psychiatry in America. Dr Carlat presents his opinions with research to back them and seems to strive to give the reader a balanced perspective when they are done with the book. There is very little demonizing of anyone in this, even the drug companies are given a fair shake and apportioned no more then what they are due.

This book contains a few ideas woven together. There are stories about his own practice and how he has developed as a psychiatrist, a brief history of how the current methods of psychiatric treatment came to be, and the actual use of those treatments, as well as some ideas as to how psychiatric patients could be better served by the mental health industry.

Dr Carlat first points the finger of blame at himself, he was one of those doctors that shilled for the drug companies and relays the story of his thought processes during that time, why he excepted the offer to do it, and the inner turmoil about whether or not it was ethical that eventually led to him ceasing to do so. The best part of the book was learning how he made his decisions in what medications were chosen to treat patients and just how arbitrary it can be, due to the complete lack of evidence that some medications perform better then others. Trial and error is sadly the best and really only way to choose a medication for an individual.

The information regarding psychotropic drugs and how they work is fainrly disturbing as well as refreshingly honest. Disturbing in that how they work is not really known, and yet somehow they do work. Refreshing because in my opinion it is much better to know that how these drugs affect the brain hasn’t been worked out yet, but these studies show they do work for these mental illnesses.

The last portion of the book is devoted to ideas on how to make the practice of psychiatry better. Over the past 20 years psychiatry has become more and more about prescribing medications rather then therapy which is how it started out and Dr Carlat feels that this is not necessarily the best practice. Although it is far more lucrative to only see a patient for 15 minutes he argues that with a better understanding of a patients life and the issues that are causing/exacerbating their condition, a psychiatrist is better able to prescribe the right medication and in some cases (many more then people realize), therapy is better then medications and has a longer impact.

The book is well written for the most part, it can be a bit repetitive at some points with information being repeated in various chapters. I found myself wanting to know more about the history of these medications, the current medical research being done and how the government is working to regulate both the use and marketing of these powerful and sometimes dangerous drugs. It was an easy read that provided me with an interesting perspective and I found myself better informed for the next time I go to see a mental health professional. I would recommend it to anyone who is interested in finding out more about the current state of the psychiatric field and especially to those who see a psychiatrist.

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