“Unhinged: the Trouble with Psychiatry”

"Unhinged: The Trouble with Psychiatry–A Doctor’s Revelations about a Profession in Crisis," is an important book, although it does not uncover new ground. The author,  psychiatrist, Daniel Carlat, MD, who trained at Harvard Medical School, is currently on the faculty of Tufts University, and has been a practicing psychiatrist for 15 years, edits the Carlat Psychiatry Report and maintains the Carlat Psychiatry blog.

The book is important because the author’s acknowledgment of psychiatry’s shortcomings is likely to be persuasive to a wide general audience:

"few laypeople realize how little we actually know about the underpinnings of [psychiatric] disorders….In virtually all of the psychiatric disorders–including depression, schizophrenia, bipolar disorder, and anxiety disorders–the shadow of our ignorance overwhelm the few dim lights of our knowledge."

  "Our diagnostic process is shallow and is based on an elaborate checklist of symptoms, leading us sometimes to overdiagnose patients with disorders of questionable validiy, or, conversely, to miss the underlying problems in our rush to come up with a discrete diagnostic label that will be reimbursed by the insurance company.  We tend to treat all psychological problems the same way–with a pill and a few words of encouragement. Because of this rote approach to treatment, patients are often misdiagnosed and medications are overprescribed.  In the end, we misserve our patients, failing to offer them psychotherapies that are sometimes more effective than drugs"

  "The resulting frenzy of psychiatric diagnoses has damaged the credibility of everyone in the field."

 "We like to see ourselves as neuroscientists, rationally manipulating levels of neurotransmitters like serotonin in order to get patients better.  But the fact is that we have no clear evidence that chemical imbalances are at the root of any mental disorder….we don’t know if changing levels of serotonin [by prescribing Zoloft or Celexa, or any other drug] is the actual curative mechanism. Nonetheless, we give patients elaborate explanations of how the drugs work chemically.  It makes us feel more scientific, and gives patients a feeling of confidence in us, but it’s little more than made up neurobable."

  "The fact is that psychopharmacology is primarily trial and error, a kind of muddling through different candidate medications…." depending upon which company’s sales rep or which academic "Hired Gun" recently made a pitch for one or another drug. Indeed, "when our most esteemed colleagues have essentially joined the marketing teams, it makes it that much harder for us to practice our craft responsibly."

Dr. Carlat is one of a small but growing number of mainstream psychiatrists in academia who are raising their voice against their profession for promoting profitable delusions about mental illness and its unsubstantiated chemical cures.

What’s missing in this, and most books authored by psychiatrists, is the acknowledgment of a body of evidence demonstrating serious harm to patients that  psychiatry’s industry-driven ministrations produce.

For an in-depth examination of  that evidence, readers must turn to another book: "Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America" by Robert Whitaker, which documents a drug-induced epidemic of chronic mental illness.  

Vera Hassner Sharav