Books under review: fall 2021

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Frontier Struggles: Rollo May and the small group of psychologists who saved humanism through James Schlett (Akron University Press)

In the middle of the 20th century, an existential crisis took hold of psychology: what was it and who could practice it? Should therapy be the purview of psychiatry alone? Or should – more precisely, could—Are psychologists certified or even licensed by the State, receiving an official stamp distinct from psychiatry and medicine?

They could and they did. But battles over a licensing bill in New York State have been long and tense, marked by slow politics and behind-the-scenes machinations. In James Schlett’s full and straightforward account of this process, turf wars between psychiatrists and psychologists are a major part of the story. The same is true of the usual alliterative mixture that fuels all political history: propaganda, publicity, power, personality conflicts, dirty games, prestige. But beyond professional tensions and the sacred mess of law-making, the book also examines the yawning philosophical divide between the self-state of mind of humanistic psychologists and the more mechanistic, model-based approach. the illness of psychiatrists.

Rollo May himself, a prominent existential psychologist, author of Man’s search for himself, and, ultimately, head of the New York State Joint Council of Psychologists on Legislation – is less the protagonist of the book’s crusade than one of a rotating crowd of key figures. (Frankly, I wanted a list of Tolstoy-style characters to keep them all straight.) Step by step, Schlett follows the efforts of psychologists to define their work as a recognized profession and, simultaneously, the efforts of the medical establishment to establish itself as the only officially authorized to provide mental care. May, Schlett says, “called it” the narcissism of doctors “which has led to the belief that” no one can treat anyone for anything other than a doctor. “

After NYS finally passed its licensing act in 1956, other states followed suit with similar legislation. This wave “coincided with a significant divergence in the direction of psychology and psychiatry,” Schlett explains in the book’s conclusion. “For psychologists, there has been a shift away from the mechanical vision of people. . . . and towards a more humanistic psychology. For psychiatrists, there has been a shift from psychodynamics to the biological model.

As May himself said, “We have won our battle against all of WADA. . . We won it because the folks below realized we had something to give that wasn’t the usual tech prescription, but rather to hear from human beings.

*****

The Mike file through Stephen Trimble (Small hardcover books)

Cover of "The Mike file"

The Mike file is a small book, only 4 × 6 inches and 143 pages long. The story he tells is equally compact, focusing on a soul lost in the psychiatric system.

But intimate tales are windows to universal truths, and this one is as hot and powerful as it is small. Stephen Trimble’s subject is his late half-brother, Mike, who was diagnosed with paranoid schizophrenia at a Denver hospital in 1957 at the age of 14, “then shipped to Pueblo Public Hospital for this. which surely looked like punishment, incarceration. “

Stephen was then 6 years old. As a boy, he explains, he never focused much on his brother’s hospitalization, his discharge two years later at a Denver treatment center for mentally handicapped youth – his first diagnosis – or his ceaseless struggles until his solitary death. at 33 years old. But in the decades that followed, Mike’s absence was looming, ultimately setting Trimble on a quest to “look in my brother’s eyes” and deal with what happened with compassion. He interviewed family members and psychologists, scanned school reports, and reviewed the file holder of letters, medical records and other documents collected by their parents. “Everyone’s fine,” Mike wrote in one. “I’m just a worthless piece of junk.”

Unfolding his family history, Trimble also touches on the history of American psychiatric treatment, noting John F. Kennedy’s legislative retreat from “the cold pity of prison isolation” and his turn against long-term hospitalization. But he adds: “The hospitals have emptied. Without stable funding for alternative treatment in communities, deinstitutionalization has led to homelessness and epic incarceration. Our mental health treatment is still failing for our families today.

Trimble, an accomplished naturalist photographer and author of 25 books, is neither anti-psychiatry nor anti-drug. But he questions the existing system, seeing the horror in the way things are presented: the removal of not only rights but the agency, the community, even humanity, denying the clearest recognition. that Mike and those like him deserve a place in the world.

At the end, the author wonders about the possibilities. What would have happened, in another timeline, if her brother had found more compassionate and inclusive care? “Surely in this different world,” he wrote, “maybe Mike wasn’t so crippled – and rejected and sidelined – by his condition.” The parallel vision he exposes, in a raw and simple way, concludes this little book with epic nostalgia.

*****

DSM: A Bible History of Psychiatry through Allan V. Horwitz (John Hopkins University Press)

Cover of "DSM: A Bible History of Psychiatry"

The Diagnostic and Statistical Manual of Mental Disorders is not, according to Allan V Horwitz, set in stone. It is not a sacred act from above. Except for one thing: it’s treated that way.

“Its undisputed position in the United States and, increasingly, the world has led the DSM to be called the bible of psychiatry. In fact, it’s anything but foolproof writing, ”he wrote at the start of DSM.

As he explains in the following pages, the American Psychiatric Association’s guide to the classification and coding of diagnostic labels has shaped not only the profession – and the emphasis on drugs – but the general population as well. , increasingly important sections of society reporting anxiety and mood disorders. “Using DSM diagnostics thus gives the impression,” he writes, “that mental disorders are rampant.

Horwitz, emeritus professor of sociology at Rutgers, is also the author of Create mental illness and a history of anxiety and PTSD. His close examination of the DSM is a scrutiny, following its evolution against the backdrop of the evolution of psychiatric care, the expansion of disease taxonomy, growing pharmaceutical influence, emerging social movements and a wide range of personalities and identities (trans, queer) classified as disorders. From the first edition in 1952 to the last, DSM-5, in 2013, it follows the textbook’s growth in scope and sprawling impact as it has grown “from a minor and infrequently used volume to an authoritative classification with enormous influence both within and outside of psychiatry ”.

Throughout, Horwitz questions the mental institution’s fixation on symptoms and disregard for the human context (circumstances, experiences); it also recognizes the wrongs suffered by many people in treatment. At the same time, it sends a sinister omen to those who criticize the medical paradigm and call for change. “These reviews are unlikely to succeed,” he said. “Regardless of their validity, these arguments are likely to carry little weight in the face of the substantial benefits that DSM diagnostics reap for many groups. “

Towards the end, he adds, “Patients need his diagnoses to get treatment, clinicians to get reimbursement, insurance companies to make payments, schools to provide services, government programs to decide on. eligibility and pharmaceutical companies to market products. Perhaps more importantly, the current DSM responds to psychiatry’s need for professional legitimacy.

It’s their bible, and they’re pushing it around.

*****

Open Dialogue for Psychosis: Organizing Mental Health Services to Prioritize Dialogue, Relationship and Meaning through Nick Putman and Brian Martindale (Routledge)

Cover of "Open dialogue for psychosis"

It’s not just a book. As befitting the topic, this is a conversation – a polyphony of voices about the history, principles, training, practice, challenges, experiences and global applications of the psychosocial approach based on the Mental health care dialogue first developed in Western Lapland Finland in the 1980s. While editors Nick Putman (founder of Open Dialogue UK) and Brian Martindale (former president of the International Society for Psychosocial and Social Approaches to Psychosis) are named on the cover and contribute multiple chapters, it’s as much a delivered incorporating Open dialogue in book form In regards to her, his various essays highlighting the power of the colloquium itself.

In OD we learn, community and open communication form the basis of its response to those who suffer from psychosis (and, in Finland, other mental health crises). At the heart of the action are network meetings involving the “person of concern” as well as family members, health workers and others. Perspectives matter; relationships are important; transparency is essential; and no one is silenced because they are in pain. Also, hallucinations or other psychotic episodes are not seen as an excuse to drug someone, but as a reason to ask what happened to them, possibly trauma.

“In OD, psychotic behavior is not seen as a separate set of categorical phenomena, as in illness,” writes Jaakko Seikkula, one of its founders. Instead, it is a way for the mind “to deal with experiences so ‘heavy’ that it has been impossible to construct a rational oral narrative. “

The main themes are in the foreground: openness, flexibility, mobility, tolerance to uncertainty and other fundamental principles. Sometimes, with the contribution of people with lived experience, Open dialogue reads like an oral history; at other times, with essays from researchers and practitioners around the world, it is a more studied analysis of the successes, practical implementation and logistical challenges of DO in countries with healthcare systems (eg, the United States) are limited by insurance companies and the medical model.

All this gives a sense of mission, passionate but pragmatic, to the entire volume. As Martindale writes in his epilogue: “We both hope that the book will play an important role in transforming the image of OD as being largely related to, and therefore a feature of a small part of the Finland to that of OD being of great importance. to the wider international field of mental health.


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