<html>
<head>
<meta http-equiv="content-type" content="text/html; charset=UTF-8">
</head>
<body>
<address><a class="moz-txt-link-freetext" href="https://www.nybooks.com/articles/2021/01/14/changing-psychiatrys-mind/">https://www.nybooks.com/articles/2021/01/14/changing-psychiatrys-mind/</a></address>
<p><br>
</p>
<header class="article-header pt-xs-6 pt-lg-8 pb-xs-3 pb-lg-4
mb-xs-6 mb-lg-12 mb-xs-6 bg-green"
data-keen-page-type="article-paywalled">
<div class="container">
<div class="row">
<div class="col-12 col-md-10 offset-md-1">
<h1 class="text-center mb-xs-2 color-white">Changing
Psychiatry’s Mind</h1>
<div class="author text-center dek color-light-blue
font-giza"> <a
href="https://www.nybooks.com/contributors/gavin-francis/"
class="dek color-light-blue font-giza
hover-border-light-blue hover-text-light-blue
text-decoration-none"><span class="dek color-light-blue
font-giza hover-border-light-blue
hover-text-light-blue text-decoration-none">Gavin
Francis</span></a> </div>
</div>
<div class="col-12 col-md-10 offset-md-1 col-lg-6 offset-lg-3
color-white">
<div class="dek mt-xs-3 mt-lg-6 mb-xs-3 text-center"> Two
books investigate the science and pseudoscience of
diagnosing mental illness. </div>
<div class="text-center"> <time>
<p class="color-white text-label mb-0"> <a
class="color-white hover-text-white hover-underline"
href="https://www.nybooks.com/issues/2021/01/14/"><span>January
14, 2021 issue</span></a> </p>
</time> </div>
</div>
</div>
</div>
</header>
<section class="article-body">
<article class="article" data-post-id="1005165">
<div class="container">
<div class="row position-relative">
<div class="social-desktop d-none d-lg-block">
<div class="article-social">
<div class="d-flex flex-lg-column justify-content-center
align-items-lg-end"> <a
href="https://www.facebook.com/sharer/sharer.php?u=https%3A%2F%2Fwww.nybooks.com%2Farticles%2F2021%2F01%2F14%2Fchanging-psychiatrys-mind%2F"
data-share="facebook" class="social-icon d-flex
bg-light-blue justify-content-center
align-items-center mb-lg-4 fill-green">
<svg width="8" height="16" viewBox="0 0 8 16"
fill="none" xmlns="http://www.w3.org/2000/svg">
</svg></a></div>
</div>
</div>
</div>
</div>
</article>
</section>
<a
href="https://www.facebook.com/sharer/sharer.php?u=https%3A%2F%2Fwww.nybooks.com%2Farticles%2F2021%2F01%2F14%2Fchanging-psychiatrys-mind%2F"
data-share="facebook" class="social-icon d-flex bg-light-blue
justify-content-center align-items-center mb-lg-4 fill-green"><svg
width="8" height="16" viewBox="0 0 8 16" fill="none"
xmlns="http://www.w3.org/2000/svg">
</svg> </a> <a
href="https://twitter.com/share?text=Changing%20Psychiatry%E2%80%99s%20Mind&url=https%3A%2F%2Fwww.nybooks.com%2Farticles%2F2021%2F01%2F14%2Fchanging-psychiatrys-mind%2F&via=nybooks"
data-share="twitter" class="social-icon d-flex ml-xs-3 mr-xs-3
mr-lg-0 bg-light-blue justify-content-center align-items-center
mb-lg-4 fill-green">
<svg fill="none" height="13" viewBox="0 0 17 13" width="17"
xmlns="http://www.w3.org/2000/svg"></svg> </a><a
href="mailto:?subject=Changing Psychiatry’s Mind by Gavin
Francis&body=From The New York Review of
Books%0D%0A%0D%0AChanging Psychiatry’s Mind%0D%0ATwo books
investigate the science and pseudoscience of diagnosing mental
illness.%0D%0A%0D%0Ahttps://www.nybooks.com/articles/2021/01/14/changing-psychiatrys-mind/%3Futm_source%3Dnybooks%26utm_medium%3Demail%26utm_campaign%3Demail-share"
class="social-icon copy-link d-flex bg-light-blue
justify-content-center align-items-center position-relative
fill-green"
data-copy="https://www.nybooks.com/articles/2021/01/14/changing-psychiatrys-mind/">
<svg xmlns="http://www.w3.org/2000/svg" width="34" height="34"
viewBox="0 0 34 34">
</svg></a><a href="mailto:?subject=Changing Psychiatry’s Mind by
Gavin Francis&body=From The New York Review of
Books%0D%0A%0D%0AChanging Psychiatry’s Mind%0D%0ATwo books
investigate the science and pseudoscience of diagnosing mental
illness.%0D%0A%0D%0Ahttps://www.nybooks.com/articles/2021/01/14/changing-psychiatrys-mind/%3Futm_source%3Dnybooks%26utm_medium%3Demail%26utm_campaign%3Demail-share"
class="social-icon copy-link d-flex bg-light-blue
justify-content-center align-items-center position-relative
fill-green"
data-copy="https://www.nybooks.com/articles/2021/01/14/changing-psychiatrys-mind/"><svg
xmlns="http://www.w3.org/2000/svg" width="34" height="34"
viewBox="0 0 34 34">
</svg> </a> <a
href="https://www.nybooks.com/articles/2021/01/14/changing-psychiatrys-mind/?printpage=true"
class="social-icon d-flex ml-xs-3 mr-xs-3 mr-lg-0 bg-light-blue
justify-content-center align-items-center mt-lg-4 hover-text-green
color-green fill-green" target="_blank">
<svg width="34" height="34" viewBox="0 0 34 34" fill="none"
xmlns="http://www.w3.org/2000/svg">
</svg></a><a
href="https://www.nybooks.com/articles/2021/01/14/changing-psychiatrys-mind/?printpage=true"
class="social-icon d-flex ml-xs-3 mr-xs-3 mr-lg-0 bg-light-blue
justify-content-center align-items-center mt-lg-4 hover-text-green
color-green fill-green" target="_blank">
</a><a
href="https://www.nybooks.com/articles/2021/01/14/changing-psychiatrys-mind/?printpage=true"
class="social-icon d-flex ml-xs-3 mr-xs-3 mr-lg-0 bg-light-blue
justify-content-center align-items-center mt-lg-4 hover-text-green
color-green fill-green" target="_blank">
</a>
<div class="social-desktop d-none d-lg-block">
<div class="article-social">
<div class="d-flex flex-lg-column justify-content-center
align-items-lg-end"><a
href="https://www.nybooks.com/articles/2021/01/14/changing-psychiatrys-mind/?printpage=true"
class="social-icon d-flex ml-xs-3 mr-xs-3 mr-lg-0
bg-light-blue justify-content-center align-items-center
mt-lg-4 hover-text-green color-green fill-green"
target="_blank"><svg width="34" height="34" viewBox="0 0 34
34" fill="none" xmlns="http://www.w3.org/2000/svg">
</svg> </a> </div>
</div>
</div>
<div class="submit-letter sidebar-item text-xs left-border-lg
mr-auto d-none d-lg-block hide-on-paywall">
<div class="pl-xs-2">
<p class="mb-xs-2">Submit a letter:</p>
<p class="mb-0">Email us <a href="mailto:letters@nybooks.com">letters@nybooks.com</a></p>
</div>
</div>
<div class="col-12">
<div class="sidebar-item article-sidebar">
<div class="review-items mb-xs-12">
<p class="mb-xs-3 text-xs-16 font-giza color-ny-red">Reviewed:</p>
<article class="mb-xs-3">
<p class="text-xs semi-bold mb-0"> <a
href="https://www.bookshop.org/a/312/9780393358063"
target="_blank" class="color-black hover-text-ny-red">
Mind Fixers: Psychiatry’s Troubled Search for the
Biology of Mental Illness</a> </p>
<div class="attribution text-xs mb-0">by Anne Harrington</div>
<div class="details text-label mb-0 color-gray">Norton, 366
pp., $27.95; $17.95 (paper)</div>
</article>
<article class="mb-xs-3">
<p class="text-xs semi-bold mb-0"> <a
href="https://www.bookshop.org/a/312/9780571345977"
target="_blank" class="color-black hover-text-ny-red">
This Book Will Change Your Mind About Mental Health: A
Journey into the Heartland of Psychiatry</a> </p>
<div class="attribution text-xs mb-0">by Nathan Filer</div>
<div class="details text-label mb-0 color-gray">London:
Faber and Faber, 248 pp., £9.99 (paper)</div>
</article>
</div>
</div>
<div class="article-col article-main-content paywall-article
has-tombstone" style="display: block;">
<figure class="article-img alignright mw-100">
<div class="image-caption-wrapper"> <a
href="https://cdn.nybooks.com/wp-content/uploads/2020/12/francis_1-011421.jpg"
class="d-block " target="_blank" rel="noopener noreferrer">
<img
src="https://cdn.nybooks.com/wp-content/uploads/2020/12/francis_1-011421.jpg"
class="" alt="Diagram of the cerebellum by Santiago
Ramón y Cajal, 1894" width="760" height="862"> </a> <figcaption
class="img-caption pt-xs-1">
<p class="text-label-sm mb-xs-1 color-gray text-center">Instituto
de Neurobiología Ramón y Cajal, Madrid</p>
<p class="text-xs color-gray text-center mb-0">Diagram of
the cerebellum by Santiago Ramón y Cajal, 1894. Cajal’s
drawings are collected in <i>The Beautiful Brain</i>,
edited by Eric A. Newman, Alfonso Araque, and Janet M.
Dubinsky and published by Abrams in 2017. For more on
Cajal, see Gavin Francis’s essay ‘In the Flower Garden
of the Brain’ at nybooks.com/cajal.</p>
</figcaption> </div>
</figure>
<p>Twenty-five years ago, at the end of my two-month rotation in
psychiatry, Edinburgh Medical School delivered the results of
our student assessments by posting three lists of names on a
departmental notice board. It was a nerve-racking experience
for all of us, who would learn of having passed or failed in
full view of our peers.</p>
<p>A crowd gathered around the board, and one by one my
classmates found their names on the pass list—or, even better,
on the shorter list of those who passed “with
distinction”—then cheered and went off to celebrate at the
bar. But as I strained toward the lists I felt a ball of
tension in my gut; I was a good student, had excelled in a few
specialties so far, but couldn’t see my name. Then, <i>there
it was—</i>unmistakably, on the dreaded third list of those
who had failed. I felt a tap on my shoulder, someone pointed
up at the distinguished students: <i>there it was again.</i>
The test had combined a written exam and an appraisal of
clinical competence; it seemed one of my assessing
psychiatrists had deemed me a star student, the other, a
failure. I reported upstairs for what turned out to be an
awkward interview, the outcome of which was that both
assessments had been wrong: I was an average student after
all, neither struggling nor distinguished. I was left
wondering if I’d make a good psychiatrist, an abysmal one, or
both.</p>
<p>That experience was unique in my medical training: in no
other specialty was there such confusion over what separates
success from failure. If the psychiatrists couldn’t agree on
the assessment of student performance, I wondered how much
they’d agree on their assessments of patients. A thorny
subject, perennially controversial, because mental health
diagnoses have such power—to save lives, or ruin them. It’s a
difficulty that Anne Harrington, a professor of the history of
science at Harvard, tackles masterfully in <i>Mind Fixers:
Psychiatry’s Troubled Search for the Biology of Mental
Illness</i>,<i> </i>which she divides into a history of how
psychiatry has approached, characterized, treated, and
maltreated mental illness since the 1850s (“Doctors’
Stories”); a section on depression, schizophrenia, and manic
depression as the three most illustrative disorders (“Disease
Stories”); and finally suggestions for the future of
psychiatry, with an argument that a fundamental reappraisal is
needed (“Unfinished Stories”).</p>
<p>I work now as a primary care physician in Edinburgh;
approximately a third of my consultations concern mental
health, and every day brings first-hand examples of just how
variable the manifestations of mental illness can be, and how
mutable its diagnostic labels. There are patients of mine
who’ve had four or five different diagnoses since their career
in the care of psychiatric services began, even though their
core symptoms (and distress) have hardly changed. Most people
who have lived a few decades with severe mental illness have
seen their own label evolve, simply because the way their
symptoms are characterized by psychiatrists has evolved. This
is true as much for “major” psychiatric conditions, such as
paranoid psychosis and psychotic depression, as it is for
conditions habitually thought of as existing along a spectrum
that reaches normality (whatever that is), such as autism or
attention-deficit disorder.</p>
<div class="leaky_paywall_message_wrap">
<div id="leaky_paywall_message">
<div class="paywall" id="paywall-a">
<div class="paywall-content text-center pb-xs-14"> <img
src="https://www.nybooks.com/wp-content/uploads/2021/01/Toast-2021-PrintDigital.png"
alt="" class="paywall-img mb-xs-3">
<p class="text-xs-20 text-lg-30 mb-xs-1 color-ny-red
font-giza">Continue reading<br>
for just $1 an issue.</p>
<p class="text-xs-16 mb-xs-2">Choose a Digital
subscription or our best deal—All Access—that includes
print and digital issues, full archive access, and the
NYR App!</p>
<a
href="https://subscribe.nybooks.info/ecom/nyb/app/live/subscriptions?org=NYB&publ=NY&key_code=EPGXM01&type=S¤t_page=https://www.nybooks.com/articles/2021/01/14/changing-psychiatrys-mind/"
class="button font-giza bg-ny-red color-white
hover-text-white hover-expand sign-in-subscribe
text-xs-16 mb-xs-3" id="paywall-offer"><span></span></a></div>
</div>
</div>
</div>
</div>
</div>
</body>
</html>