One-Minute Book Reviews

May 29, 2010

Psychiatrist Daniel Carlat Diagnoses His Profession’s Ills in ‘Unhinged: The Trouble With Psychiatry’


“Psychiatry has become a proving ground for outrageous manipulations of science in the service of profit.” Unhinged

Unhinged: The Trouble With Psychiatry. By Daniel Carlat. Free Press, 256 pp., $25.

By Janice Harayda

Has the profession of psychiatry lost its mind? You might think so after reading this relentless and mostly successful assault on current practices in the field.

Daniel Carlat focuses in Unhinged on the harm that he believes has resulted from the march of psychiatry away from psychotherapy and toward the better-paying practice of prescribing drugs. And he forges links between that shift and many ills in his field, including scandals at top-flight hospitals, one-sided articles in medical journals, and pharmaceutical-company payments to doctors who hawk questionable drugs to their peers.

Some of the statistics in Unhinged are chilling. In 2006, an estimated 10 percent of all 10-year-old boys in the U.S. were taking the stimulant Ritalin or an equivalent each day, and shabby medicine often accounts for its use or that of other psychotropic drugs. Psychiatrists routinely write prescriptions after 15- or 20-minute consultations. They know so little about the biology of most mental illnesses that they prescribe based on little or no science. And they mislead patients by presenting as fact theories formed by working backward from the discovery that a drug seemed to ease the symptoms of a disease. One of the most popular of those theories holds that depression results from a “chemical imbalance” in the brain:

“… the fact that many antidepressants increase levels of serotonin has led to a serotonin deficiency theory of depression, even though direct evidence of such a deficiency is lacking. By this same logic one could argue that the cause of all pain conditions is a deficiency of opiates, since narcotic pain medications activate opiate receptors in the brain.”

Carlat delivers his indictment in a crisp, journalistic style that serves him well, though he writes with less depth and elegance than his fellow physician Atul Gawande. But he doesn’t take his critique of the profession as far as it warrants. He clearly wants psychiatrists to do more psychotherapy but doesn’t make a strong case that patients would benefit from this – only that they would benefit from fewer bad drugs. He seems to take for granted that psychotherapy “works.”

This view clashes with that of respected critics of the profession such as the social scientist Robyn Dawes, who drew on decades of research for his brilliant House of Cards, which argues that psychotherapy itself is a con game: There is no evidence that psychiatrists or psychologists are better at counseling than minimally trained civilians, and both types of professionals have strayed so far from their roots in the study of human behavior that they offer little more than glorified intuition.

Unhinged may have the worthy effect of prompting patients to demand better explanations for why certain drugs are recommended for them — and it would be welcome for that reason alone — but it has little to say to people who remain unconvinced that psychotherapy would be better than the cavalier prescribing of Prozac or Wellbutrin. If psychiatrists are as willing as Carlat suggests to pimp for drug companies, why should Americans trust them with their deepest secrets?

Best line: “ … psychiatry has become a proving ground for outrageous manipulations of science in the service of profit.”

Worst line: Carlat says that an Ambien drug rep named Valerie once gave him a gift worth about $25, and later that day, he saw a patient and thought, “Why not prescribe Valerie’s drug for this patient?” That phrasing is too neat. Carlat also appears to be rationalizing in some of his comments on why he served briefly as a paid drug-company rep for the maker of Effexor.

Caveat lector: This review of Unhinged was based on an advance reading copy. Some material in the finished book may differ, and some people in it are composites.

Furthermore: Carlat is a psychiatrist in Newburyport, MA, specializing in psychopharmacology, and an associate clinical professor of psychiatry at Tufts University School of Medicine.You can follow him on Twitter at a @dcarlat (www.twitter.com/dcarlat). Carlat tells why he quit giving paid talks for drug companies in the New York Times article “Dr. Drug Rep.” Some of the material in Unhinged about brain scans appeared in different form in an article he wrote for Wired, “Brain Scans as Mind Readers?”

Contrary to the date you see under the headline, this review was posted on May 31, 2010. WordPress appears to be having technical problems that have led to scrambled dates. For this reason, I’ve removed a May 30 post about my forthcoming review of the young-adult novel The Things a Brother Knows.

You can follow Jan Harayda (@janharayda) on Twitter at www.twitter.com/janiceharayda.

© 2010 Janice Harayda. All rights reserved.
www.janiceharayda.com

May 24, 2010

Has Psychiatry Lost Its Mind? A Review of Daniel Carlat’s ‘Unhinged’ Coming Soon

Filed under: Nonfiction — 1minutebookreviewswordpresscom @ 9:36 am
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In late 2007 the psychiatrist Dan Carlat wrote a provocative article about why he quit giving paid talks for drug companies, many about Effexor, an anti-depressant that causes high blood pressure. Now he’s back with Unhinged: The Trouble With Psychiatry (Free Press, 256 pp., $256), a book that indicts his profession for shunning therapy for the more lucrative practice of prescribing medications. A review of the book will appear soon on One-Minute Book Reviews.

July 10, 2008

Gunning for Love — ‘Twisted Triangle: A Famous Crime Writer, a Lesbian Love Affair, and the FBI Husband’s Violent Revenge’

Love didn’t go by the book for two FBI agents, one of them a specialist in undercover work

Twisted Triangle: A Famous Crime Writer, a Lesbian Love Affair, and the FBI Husband’s Violent Revenge. By Caitlin Rother with John Hess. Wiley/Jossey-Bass, 281 pp., $26.95.

By Janice Harayda

You know the old Woody Allen joke about how the great thing about being bisexual is that it doubles your chances of getting a Saturday-night date? This book reminds us that it can also halve your chances of getting out of it alive.

Twisted Triangle grew out of a macabre story about two married FBI agents that got splashy coverage in Vanity Fair and elsewhere in the 1990s. Gene Bennett had taken part in two successful undercover operations before he tried to kill his wife, Margo, in the apparent belief that she had become infatuated with the novelist Patricia Cornwell. His past raises interesting questions touched on in the book: Does undercover work – which requires agents to assume a false identity – foster personality disintegration? Can it lead to disassociative disorder, commonly known as multiple personality disorder, to which Gene’s lawyers attributed his violent behavior? Might undercover work attract people predisposed to the condition?

These questions have a relevance that may extend beyond the Bennett case to those involved in covert operations in places like Afghanistan. So you wish Caitlin Rother and John Hess had gotten better material from Margo, whose story they tell.

The essential problem surfaces in the subtitle, A Famous Crime Writer, a Lesbian Love Affair, and the FBI Husband’s Violent Revenge. Margo Bennett says repeatedly that she and Cornwell had two intimate “encounters” — or what sounds like a two-night stand — and Cornwell has confirmed it in interviews. On the witness stand, Margo corrected a lawyer who said she’d had “an adulterous lesbian affair” with Patricia Cornwell: “I said I had two encounters with Ms. Cornwell.”

So why is Twisted Triangle billed as the story of “a lesbian love affair”? The publisher may have imposed that subtitle on the authors. But Margo comes across as such an unreliable source that the unreliable subtitle, in a sense, represents a book driven by what sound like rationalizations instead of explanations. Margo signed phony documents in a home-relocation scam because, she says, Gene threatened to leave her if she didn’t. She lied on the witness stand when he was tried for the fraud because, she says, she was afraid he would hurt their children if she didn’t. To explain other unflattering actions, she invokes the Stockholm syndrome and — you guessed it — her “fragile self-esteem.” But if Margo lied under oath to protect her children, how do we know she didn’t try to protect them again by distorting the facts when she was interviewed for this book?

Rother and Hess confirmed some of what Margo told them through court documents and other sources. But much of this book has a “he said, she said” quality. Margo complains that a 1996 Washington Post story made her seem “very careless, uncaring, and crazy on my own.” Twisted Triangle does little to correct that impression and, in some ways, deepens it. In the Post story, Karl Vick expressed the theme of the Bennett case in seven words. Those words also sum up the moral of this book: “Sometimes, homo sapiens behave very, very badly.”

Best line: “Louis Freeh, who had just been appointed director [of the FBI], had instituted a zero-tolerance approach and was taking a hard line on disciplinary issues. Some agents described him as Hoover without the compassion.”

Worst line: Margo says that after working as an FBI agent for a few years, she learned that her husband had $60,000 in cash that he insisted was a gift from his dead father: “Gene claimed that his father had given him $60,000 in cash, which he’d kept in a suitcase in his mother’s attic. He said that his father had told him not to put it in the bank, so Margo figured his father had never reported it to the IRS, and this was his way of protecting Gene, who said he would take the old bills to the bank and exchange them for new ones so that no one would question any transaction or track the income.

“At the time, Margo took Gene at his word.”
This passage shows one of the many hard-to-believe rationalizations that Margo Bennett gives for why she accepted her husband’s shady behavior.

Published: April 2008 www.catilinrother.com

If you like true crime, consider reading instead: Stanley Alpert’s The Birthday Party (Putnam, 2007) www.stanleyalpert.com, a memoir by a former federal prosecutor abducted on a Manhattan street and held for 25 hours by captors who showed a gang-that-couldn’t-shoot-straight ineptitude. A review appeared on this site on Jan. 30, 2007 www.oneminutebookreviews.wordpress.com/2007/01/30/ and a reading group guide on Feb. 4, 2007 www.oneminutebookreviews.wordpress.com/2007/02/04/.

Furthermore: The Bennetts met while working in the Atlanta office of the FBI. Margo is a campus police captain at the University of California at Berkeley. Gene is serving a 23-year sentence in a Virginia prison. Patricia Cornwell has responded to Twisted Triangle in an Advocate article www.advocate.com/issue_story_ektid54596.asp.

Janice Harayda is an award-winning journalist who has been the book columnist for Glamour, book editor of the Plain Dealer and a vice-president of the National Book Critics Circle. She does not accept books, catalogs, advance reading copies, press releases or other promotional materials from editors, publishers, authors or agents.

© 2008 Janice Harayda. All rights reserved.
www.janiceharayda.com

November 13, 2007

The ‘Tyranny of Positive Thinking’ and Cancer Patients — A Physician-Author Says That It’s Not Always Best to Tell People to ‘Be Optimistic’

Can you give too much encouragement to people who are ill?

By Janice Harayda

Not long ago, I reviewed Betty Rollin’s Here’s the Bright Side and objected to its theme that all human suffering holds “a hidden prize waiting to be found.” I argued that some losses are so sad — the death of a child, say — that urging people to find their “bright side” is cruel.

Later I read some interesting, related comments by Jimmie Holland, chair of Department of Psychiatry and Behavioral Sciences at the Memorial Sloan-Kettering Cancer Center. They appeared in an article Leslie Brody wrote about caring for her husband, who has pancreatic cancer, for the New Jersey daily, The Record, on May 20, 2007.

“Think twice before telling the patient to ‘be positive,’” Brody wrote. She added:

“Dr. Jimmie C. Holland, author of The Human Side of Cancer and a pioneer in the psychological aspects of the illness, has written about the ‘tyranny of positive thinking.’ When people insist patients should ‘be optimistic,’ they imply that those who get sicker may be to blame for not trying hard enough to stay upbeat and conquer the disease.

“Holland says a patient’s mind-set might help him stick to a grueling chemo regimen, but it’s less clear whether attitudes and emotions in themselves can affect tumor growth or the body’s response. Patients — and their families — should feel free to vent depressing and anxious thoughts without being judged.

“Instead of saying ‘Chin up,’ or, ‘You’ll be fine,’ it’s better to say, ‘Hang in there,’ or ‘We’re thinking of you,’ or ‘We’re hoping for the best.’”

Links: To read the original review of Here’s the Bright Side, click here www.oneminutebookreviews.wordpress.com/2007/08/21/. To read about The Human Side of Cancer, click here www.humansideofcancer.com.

© 2007 Janice Harayda. All rights reserved.

www.janiceharayda.com

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