A prominent psychiatrist and a lucid science writer argue for a new psychology grounded in neuroscience. Should psychiatrists treat the mind or the brain? Battles about this have plagued psychiatry at least since the end of the nineteenth century, when Sigmund Freud rejected science in favor of psychoanalysis. But now, 100 years later, we find the pendulum has swung the other way-toward over-dependence on psychoactive drugs and depersonalized psychiatry. In this important book, Harvard psychiatrist J. Allan Hobson and science journalist Jonathan Leonard explore the roots of this trend and propose the development of a more balanced "humanistic" psychiatry that-while remaining wary of "pill-pushing"-embraces rather than shuns neuroscience. For as Hobson and Leonard demonstrate, neuroscience has revolutionized our understanding of the mind, has shed a bright light on mental ills, and now stands ready to bridge the gap between biomedicine and psychotherapy. This is a vital step, they assert, if we are to revive today's flagging over-drugged psychiatry, provide sound care for millions of the neglected mentally ill, and realize humanity's ancient dream of treating not just the mind or brain alone, but both together.

Review

Prozac and all of its cousins haven't helped psychiatry as much as their manufacturers claim. In Out of Its Mind, Harvard psychiatrist J Allan Hobson and science writer Jonathan Leonard argue that the field is reaching a crisis point in the struggle between biological treatments and psychoanalytic methods and that a synthesis is badly needed. Calling his approach "neurodynamic," Hobson advocates a broad understanding of each patients' unique situation, including genetic and physiological factors as well as social qualities like family history. Hardly revolutionary, but given the resistance of HMO culture to any treatment that's not simple and cheap, the paradigm will require aggressive, concerted efforts to implement.

The book is half history of psychiatry, half utopian plan of action. The authors first examine the strengths and weaknesses of both treatment modes and unsurprisingly find problems with uncritical acceptance of one over the other. The current mess, including a 90 per cent reduction in hospital beds and a wild emphasis on pill-pushing, is a direct result of the successful pharmaceutical treatments devised in recent decades. Hobson and Leonard ask for broader education for psychiatrists and other professionals, to include what might be called holistic methods--wrapping up nature and nurture to better treat ill people. Out of Its Mind will appeal to both non-technical readers and those directly involved in mental health and guide them toward the emerging synthesis. --Rob Lightner

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