Daniel Carlat, a Massachusetts psychiatrist, is the author of the excellent blog The Carlat Psychiatry Blog. He also wrote an excellent article in the New York Times Magazine about working on the side as a drug rep: He told other psychiatrists about new drugs. He quit (or was fired) because telling the truth wasn’t compatible with the job.
Unhinged, his new book (sent to me by the publisher after I asked for it twice — that’s how much I wanted to read it), covers the same ground. Its subtitle (or two subtitles) is/are The Trouble With Psychiatry — A Doctor’s Revelations about a Profession in Crisis. The contents were well-written, but none of it was new to me: the “chemical imbalance” theory of depression is a convenient myth, how drug reps work, how drug companies influence doctors, diagnosis difficulties, the cases of Charles Nemeroff and the like. (I did learn that Nemeroff was called “the boss of bosses” because of his prominence and power.) If any of his criticisms are new to you, this book is a great introduction. He uses many stories of patients to make his points.
Overall, I found the book too calm. What Nemeroff and others like him did I find outrageous but Carlat doesn’t sound outraged. Maybe he is, I have no idea, but his book is more reasonable-sounding than scornful and I would have preferred scornful. At one point he says he wrote an “angry” op-ed for the New York Times about something and I thought: good, some emotion!Â
The crisis of the subtitle (“A profession in crisis”) is enticing but is not borne out by the contents. Carlat dislikes aspects X, Y, and Z of his profession, but one person’s dissatisfaction does not equal crisis. I saw no signs he is part of a growing movement. My take on the trouble with psychiatry is that psychiatrists don’t understand what is wrong in almost every case they see and, due to lack of understanding, do a poor job of fixing the problem. Lack of understanding by doctors is nothing new and, until someone has a better understanding, doesn’t pose a professional problem. This basic truth goes unmentioned in Unhinged.
I haven’t read the book, but I’m not a big fan of Daniel Carlat. He seems to specialize in mild, relatively uncontroversial criticism of psychiatry, as in this disappointing NY Times article:
https://www.nytimes.com/2010/04/25/magazine/25Memoir-t.html
Seth writes that psychiatrists “…do a poor job of fixing the problem.” I agree, but I would go further and say that psychiatrists often create long-term harm to the very patients they are ostensibly helping. (Psychiatry has a long history of this sort of thing: lobotomies, insulin comas, unnecessary tooth extractions, etc.)
Louis Menand has an interesting piece in the New Yorker a few weeks back on psychiatry, and is interviewed about it on Econ Talk. A lot of it has to do with whether perfectly reasonable people are down in the dumps and whether they have a disease. In many respects, it confirms what most people probably suspect already in terms of diagnosing it. This is sort of the first-order problem before, what this post seems to address, which is the problems of attempting to treat it given extant market incentives.
Here’s the interview link if anyone’s interested:
https://www.econtalk.org/archives/2010/05/menand_on_psych.html
Alex, yeah, the article you link to is a good example of the problem with Carlat. In that article he writes:
That there might be something deeply wrong with therapy doesn’t occur to him.
https://www.thelastpsychiatrist.com is not always coherent, but if “calm” is what you don’t want, he’s worth a shot. And he’s usually pretty entertaining.
I with trepidation would love to send you my memoir to comment on as
a child psychiatrist who is trying to humanize the psychiatric profession by showing how patients/therapists share the same kind of sorrow and often that the work to heal can be life saving.
Dr. Carlat even if you think is less militant, has taken many steps to bring
psychiatrists into being self reflective about how we practice.
Sincerely, Nancy
Thanks for the offer, Nancy, but no.
As for Carlat, I think his influence has been wonderful, as I tried to say at the beginning of my post. But, for this particular reader, his book was not wonderful.
How interesting that I only recently connected to your blog and now I find another common interest: psychiatry. I just heard him on NPR. My interest goes back to my work in psychiatry as a psychiatric nurse practitioner. Though I continued my love of health care through my writing, I quit medicine when MD’s decided to be bought off and nurses were powerless to do anything. In hospitals, money speaks the loudest. If you wonder why health care is in the shape it’s in, look in the garages of Docs practicing during the heyday of moneyed medicine-80′s, 90′s and 2000s until the collapse. They love pretty cars…. They also don’t-or can’t- speak out too loudly about each other because most of them were in collusion actively or passively. Money’s a hard drug to refuse. Most MD’s I know didn’t include this MD whose blog I will now check out.
Best
Marla Miller, RN, MSN