OUT OF ITS MIND: Psychiatry in Crisis: A Call for Reform

It isn't quite true that the lunatics have taken over the asylum, but that might be preferable to the current state of psychiatry, at least according to this provocative and alarming study by noted Harvard Medical School faculty member Hobson and science writer Leonard. Not only is psychiatry underfinanced, but due to HMOs' disregard for patients' basic mental health needs and the profession's increasing tendency to treat mental problems with pharmaceuticals rather then look at deeper causes, as well as a lack of community services, two million Americans suffer from "severe but untreated mental ills." Many of these individuals are warehoused in nursing homes or prisons, while "the plight of the severely disordered homeless on our streets has become a socially indefensible disgrace." Several concise chapters examine how psychiatry wound up in such a sorry state, and include an informed and incisive discussion of the profession's evolution from the rise of asylums and the invention of psychoanalysis to the emergence of the more radical psychoanalytic theories of R. D. Laing, the birth of the HMO and the impact of brain science. Hobson and Leonard offer concrete remedies for what ails mental health care today, such as a complete overhaul of psychiatric training, better working relationships between mental hospitals and other social service agencies and the bringing of key elements of mental hospital treatment to prisons. While some of the proposals are practical, others are more utopian. Yet this powerful book is convincing in its call for reform. (June)