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Book Review

This book exposes the philosophies that lay behind modern psychiatry.

Feb 21, 2017

In Unhinged: The Trouble with Psychiatry- A Doctor’s Revelations about a Profession in Crisis, Dr. Daniel J. Carlat seeks to help readers understand modern psychiatry. He specifically helps readers to understand what modern psychiatrists know about the mind and what they do not know about the mind (page 16). He describes the process physiatrists undergo to become licensed to prescribe psychological medication, he discusses the Diagnostic and Statistical Manual of Mental Disorders (DSM), and he analyzes some of the medications that are supposed to treat the disorders in the DSM. Dr. Carlat also discusses pharmaceutical companies and the strategies they employ to sell their medications.

A particularly interesting point that Dr. Carlat makes is how little psychiatrists know about the biology of mental illness and the effects of medicine on mental illness (pages 74-75). Another interesting point in the book is his discussion of psychopharmacology, and the lengths that pharmaceutical companies go to in order to sell their products (page 111). He writes, not as an outsider analyzing psychiatry, but as someone who is deeply involved in psychiatry and has experienced the situations he writes about.

Dr. Carlat is not a Christian or a biblical counselor and yet he sees significant and overarching problems with modern psychiatry. This book is not a resource to help Christians grow in counseling skills or better understand the Bible. It is written by a secular psychiatrist about his experience and observations from his years providing psychiatry. It is shockingly honest and helps to pull the curtain back from a movement that has largely passed unchallenged in society.

Helpful Quotes

  1. “The shocking truth is that psychiatry has yet to develop a convincing explanation for the pathophysiology of any illness at all” (page 7).
  2. “Our diagnostic process is shallow and is based on an elaborate checklist of symptoms, leading us sometimes to over diagnose patients with disorders of questionable validity, or, conversely, to miss the underlying problems in our rush to come up with a discrete diagnostic label that will be reimbursed by the insurance company” (page 15).
  3. “The idea that depression is a ‘chemical imbalance’ derives from how the drugs seem to work…. But the problem is that there is no direct evidence that a serotonin or norepinephrine deficiency is involved, despite thousands of studies that have attempted to demonstrate such a deficiency” (pages 76-77).
  4. “To a remarkable degree, our choice of medications is subjective, even random” (page 83).
  5. “Guided purely by symptoms, we try different drugs, with no real conception of what we are trying to fix, or of how the drugs are working” (page 86).
  6. “Patients like to think that we prescribe based on a careful review of the medical science, not because a likable rep just visited our office and handed us a book. But this is how salesmanship in the pharmaceutical industry works” (page 111).
  7. “While ECT works, we have no idea how or why” (page 167).
  8. “Psychiatrists need to reacquaint themselves with the missing skill of psychotherapy” (page 188).
  9. “Part of what makes mental illness so painful is its terrible mystery” (page 201).
  10. “In psychiatry, we do not know the pathophysiology of mental illnesses, and therefore we do not use physical exams or laboratory data to diagnose” (page 217).