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Unhinged: The Trouble with Psychiatry—A Doctor's Revelations about a Profession in Crisis

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IN THIS STIRRING AND BEAUTIFULLY WRITTEN WAKE-UP CALL, psychiatrist Daniel Carlat exposes deeply disturbing problems plaguing his profession, revealing the ways it has abandoned its essential purpose: to understand the mind, so that psychiatrists can heal mental illness and not just treat symptoms. As he did in his hard-hitting and widely read New York Times Magazine artic IN THIS STIRRING AND BEAUTIFULLY WRITTEN WAKE-UP CALL, psychiatrist Daniel Carlat exposes deeply disturbing problems plaguing his profession, revealing the ways it has abandoned its essential purpose: to understand the mind, so that psychiatrists can heal mental illness and not just treat symptoms. As he did in his hard-hitting and widely read New York Times Magazine article "Dr. Drug Rep," and as he continues to do in his popular watchdog newsletter, The Carlat Psychiatry Report, he writes with bracing honesty about how psychiatry has so largely forsaken the practice of talk therapy for the seductive—and more lucrative—practice of simply prescribing drugs, with a host of deeply troubling consequences. Psychiatrists have settled for treating symptoms rather than causes, embracing the apparent medical rigor of DSM diagnoses and prescription in place of learning the more challenging craft of therapeutic counseling, gaining only limited understanding of their patients’ lives. Talk therapy takes time, whereas the fifteen-minute "med check" allows for more patients and more insurance company reimbursement. Yet DSM diagnoses, he shows, are premised on a good deal less science than we would think. Writing from an insider’s perspective, with refreshing forthrightness about his own daily struggles as a practitioner, Dr. Carlat shares a wealth of stories from his own practice and those of others that demonstrate the glaring shortcomings of the standard fifteen-minute patient visit. He also reveals the dangers of rampant diagnoses of bipolar disorder, ADHD, and other "popular" psychiatric disorders, and exposes the risks of the cocktails of medications so many patients are put on. Especially disturbing are the terrible consequences of overprescription of drugs to children of ever younger ages. Taking us on a tour of the world of pharmaceutical marketing, he also reveals the inner workings of collusion between psychiatrists and drug companies. Concluding with a road map for exactly how the profession should be reformed, Unhinged is vital reading for all those in treatment or considering it, as well as a stirring call to action for the large community of psychiatrists themselves. As physicians and drug companies continue to work together in disquieting and harmful ways, and as diagnoses—and misdiagnoses—of mental disorders skyrocket, it’s essential that Dr. Carlat’s bold call for reform is heeded.


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IN THIS STIRRING AND BEAUTIFULLY WRITTEN WAKE-UP CALL, psychiatrist Daniel Carlat exposes deeply disturbing problems plaguing his profession, revealing the ways it has abandoned its essential purpose: to understand the mind, so that psychiatrists can heal mental illness and not just treat symptoms. As he did in his hard-hitting and widely read New York Times Magazine artic IN THIS STIRRING AND BEAUTIFULLY WRITTEN WAKE-UP CALL, psychiatrist Daniel Carlat exposes deeply disturbing problems plaguing his profession, revealing the ways it has abandoned its essential purpose: to understand the mind, so that psychiatrists can heal mental illness and not just treat symptoms. As he did in his hard-hitting and widely read New York Times Magazine article "Dr. Drug Rep," and as he continues to do in his popular watchdog newsletter, The Carlat Psychiatry Report, he writes with bracing honesty about how psychiatry has so largely forsaken the practice of talk therapy for the seductive—and more lucrative—practice of simply prescribing drugs, with a host of deeply troubling consequences. Psychiatrists have settled for treating symptoms rather than causes, embracing the apparent medical rigor of DSM diagnoses and prescription in place of learning the more challenging craft of therapeutic counseling, gaining only limited understanding of their patients’ lives. Talk therapy takes time, whereas the fifteen-minute "med check" allows for more patients and more insurance company reimbursement. Yet DSM diagnoses, he shows, are premised on a good deal less science than we would think. Writing from an insider’s perspective, with refreshing forthrightness about his own daily struggles as a practitioner, Dr. Carlat shares a wealth of stories from his own practice and those of others that demonstrate the glaring shortcomings of the standard fifteen-minute patient visit. He also reveals the dangers of rampant diagnoses of bipolar disorder, ADHD, and other "popular" psychiatric disorders, and exposes the risks of the cocktails of medications so many patients are put on. Especially disturbing are the terrible consequences of overprescription of drugs to children of ever younger ages. Taking us on a tour of the world of pharmaceutical marketing, he also reveals the inner workings of collusion between psychiatrists and drug companies. Concluding with a road map for exactly how the profession should be reformed, Unhinged is vital reading for all those in treatment or considering it, as well as a stirring call to action for the large community of psychiatrists themselves. As physicians and drug companies continue to work together in disquieting and harmful ways, and as diagnoses—and misdiagnoses—of mental disorders skyrocket, it’s essential that Dr. Carlat’s bold call for reform is heeded.

30 review for Unhinged: The Trouble with Psychiatry—A Doctor's Revelations about a Profession in Crisis

  1. 4 out of 5

    Eva

    I think that if I were not myself a psychiatrist, and privy to much of the information Dr. Carlat is, as well as having had similar experiences, I might have found this book more engaging. As it was, it felt like reading a guidebook to your hometown written by a another townie who is equally aware of the terrain, the locals, and the pros and cons of the place. There was little in this book I hadn't already contemplated myself. I do take issue with the idea that all psychiatrists are on the same I think that if I were not myself a psychiatrist, and privy to much of the information Dr. Carlat is, as well as having had similar experiences, I might have found this book more engaging. As it was, it felt like reading a guidebook to your hometown written by a another townie who is equally aware of the terrain, the locals, and the pros and cons of the place. There was little in this book I hadn't already contemplated myself. I do take issue with the idea that all psychiatrists are on the same page, or should be, regarding attending medical school. I specifically choose to work with very medically ill/fragile patients, and collaborate with other physicians closely in their care. I am frequently ruling out medical contributors to diagnoses, performing neurological exams on patients, and check for drug-drug interactions. I am also interested in palliative care, and might consider working as a medical director of a hospice (which is a role a psychiatrist can take). Given all that, my view of what the role of a psychiatrist is and how to best train for that is decidedly different than Dr. Carlat's. Also, perhaps because he trained earlier than I did, he is more pessimistic than I am about the profession. I know physicians in my town who earn a reasonable living doing medication management and psychotherapy with one hour long visits, and I think residents at my training institution are trained to be highly skeptical of medical literature, as well as leery of linking themselves to Big Pharma (commonly regarded as selling your soul to industry). Many challenges await all fields of medicine at this juncture in our society, not just psychiatry. Anyway, an easy read and good food for thought.

  2. 4 out of 5

    Sandy

    Quick and informative read leaving me with a dilemma - how can I recommend to my son that he follow a career in psychiatry when the training lasts 12 years, 6 of which seem unnecessary and wasteful? And when the training is complete, psychotherapy is not a major part of the day because prescription writing is the only way to make a profitable living and pay for college loans! A conundrum. Really enjoyed Carlat's simple explanation of transference and its usage in therapy, "The patient eventually Quick and informative read leaving me with a dilemma - how can I recommend to my son that he follow a career in psychiatry when the training lasts 12 years, 6 of which seem unnecessary and wasteful? And when the training is complete, psychotherapy is not a major part of the day because prescription writing is the only way to make a profitable living and pay for college loans! A conundrum. Really enjoyed Carlat's simple explanation of transference and its usage in therapy, "The patient eventually brings his whole world into my office. It's not what he tells me that's so important-that's the least accurate information I have. It's how he treats me, and how he feels I'm treating him. I know how he acts with his girlfriend because he acts that way with me some of the time. And I know what goes on with his boss or his kids the same way...The well-known term for this is "transference" from the fact that the patient transfers habitual ways of perceiving people onto the person of the therapist. The height of the psychoanalyst's art is to be able to perceive transference, and then point it out to the patient in a nonthreatening and productive way. (p. 191). A psychiatrist with simple, coherent sentences - wonderful! Now, the solution is to have psychiatrists spend less time being trained as surgeons and obs, etc. and have them learn more psychotherapeutic skills so they can offer medication and psychotherapy to their patients. An Excellent idea, but its coming is decades in the future.

  3. 5 out of 5

    Eric_W

    Excellent review of this and three other books dealing with the crisis in psychiatry in the NYRB Part 1: http://www.nybooks.com/articles/archi... Part 2: http://www.nybooks.com/articles/archi... Excellent review of this and three other books dealing with the crisis in psychiatry in the NYRB Part 1: http://www.nybooks.com/articles/archi... Part 2: http://www.nybooks.com/articles/archi...

  4. 5 out of 5

    Canadian Reader

    The book’s subtitle basically says it all. Carlat writes in clear, accessible prose about a number of problems within the field of psychiatry. First of all, there is the slightly troublesome “procedure” for diagnosing mental illness. Based on an interview with a patient, a psychiatrist (fairly subjectively, using his observational skills and experience) matches up what he sees in the patient with a description—essentially, a list of symptoms—of one of the psychiatric conditions that appear in the The book’s subtitle basically says it all. Carlat writes in clear, accessible prose about a number of problems within the field of psychiatry. First of all, there is the slightly troublesome “procedure” for diagnosing mental illness. Based on an interview with a patient, a psychiatrist (fairly subjectively, using his observational skills and experience) matches up what he sees in the patient with a description—essentially, a list of symptoms—of one of the psychiatric conditions that appear in the Diagnostic and Statistical Manual of the American Psychiatric Association. No laboratory or diagnostic imaging tests exist to diagnose mental illnesses. For many conditions, symptoms overlap. This means a patient could potentially visit three different psychiatrists and end up with three different diagnoses.. Once a diagnosis is made, there’s the problem of what to prescribe. No one is quite clear on how psychoactive medications even work. Since there are large numbers of “me-too” drugs modelled on the initial big sellers like Prozac, choosing one medication over another is tricky. The drugs intended to be used for a particular psychiatric disorder can be chemically very similar. Ultimately, the decision might be based on a psychiatrist’s own preferences or on the patient’s trial and error. A related problem is that the pharmaceutical industry currently doesn’t find developing new psychiatric drugs a financially rewarding pursuit. Scientists are not clear on the causes of mental illness. If you don’t know enough about the actual biological condition causing the problem, how do you treat it? For now, it’s more about symptom reduction than real understanding—in spite of all the fancy talk you’ve heard about “chemical imbalances” in the brain or insufficient serotonin. Carlat also discusses psychiatrists’ lucrative and highly problematic relationship with the pharmaceutical industry. He presents a number of prominent cases in which big-name psychiatrist-researchers were less than forthcoming about their work with major drug companies. These psychiatrists withheld information about pharmaceutical affiliations from the university and hospital research facilities that employed them, conveniently receiving federal grant money to investigate the very drugs that companies wanted them to push. Studies were not uncommonly conducted (or, more precisely, manipulated) in such a way as to prove the efficacy of those psychoactive drugs—or even to expand their use to new patient populations. Powerful antipsychotics were, for example, increasingly being dispensed to young children who’d been given the controversial diagnosis of bipolar disorder. Most psychiatrists nowadays are “psychopharmacologists” or pill-pushers, writes Carlat. They practice no psychotherapy; rather, they refer patients to psychologists and other mental-health counsellors. Psychotherapy is time-consuming, and it simply doesn’t pay well enough to make it worth a psychiatrist’s while. In referring patients to other professionals, however, psychiatrists can miss out on critical information about patients’ daily lives, relationships, and thought processes. Carlat believes that psychiatric education needs to be reconfigured. Traditional medical education, with student rotations through a variety of specialties from surgery to obstetrics, he says, is simply not useful to a person who wants to pursue a career in psychiatry. Carlat also believes that the training of clinical psychologists could be expanded so that these mental-health professionals could prescribe psychoactive medications. Carlat’s book is now a decade old, but, based on some of the recent mental-health memoirs I’ve read, not a great deal has changed within psychiatry. Some of the material is a bit dated, but the facts seem to basically stand.

  5. 5 out of 5

    Doreen Petersen

    To me this was by far one of the better books written on mental health from a psychiatrist's perspective. It helped you understand what is good as well as what is lacking in the mental health field. Well worth checking out!

  6. 4 out of 5

    Terry Lynch

    As books written by mainstream psychiatrists go, this is one one of the best and most honest that I have read. Daniel Carlat has had the courage to express his major concerns about psychiatry. He has also discussed what he sees as his own inadequacies, that arise as a consequence of psychiatry's limited training. He acknowledges that he does not practice psychotherapy because he "cannot", ie, he doesnt really know how. He admits telling patients that antidepressants correct chemical imbalances n As books written by mainstream psychiatrists go, this is one one of the best and most honest that I have read. Daniel Carlat has had the courage to express his major concerns about psychiatry. He has also discussed what he sees as his own inadequacies, that arise as a consequence of psychiatry's limited training. He acknowledges that he does not practice psychotherapy because he "cannot", ie, he doesnt really know how. He admits telling patients that antidepressants correct chemical imbalances not because he believes it, but because patients want to think their doctors know what they are doing. It seemed to me that Carlat really does this for his own benefit, not wanting to admit to his patients that, as he wrote, he really has no idea how these substances act in the brain. The limited thinking characteristic of mainstream psychiatry surfaces frequently in the text. For example, he wonders, what else other that biology could cause psychiatric "illnesses". The very real possibility that a biologically-dominated understanding might not actually be necessary does not appear to strike him; all psychiatric diagnoses can be deeply understood - far deeper than through the medical lens - under the themes, trauma/woundedness; distress its many forms; defence mechanisms; and choice-making, which is influenced by the previous three. Nevertheless, this is a worthwhile book, written by a psychiatrist courageous enough to speak his mind.

  7. 5 out of 5

    Elaine

    In the U.S., there is growing concern that doctors are overprescribing medicine as the answer for patients with mental health and behavior problems. Feelings of sadness, behaviors like restlessness, which were once seen as normal aspects of being a human being, are now diagnosed as health problems like depression or attention deficit hyperactivity disorder, the argument goes, and treated away with prescription drugs. Psychiatrist Daniel Carlat does not necessarily endorse this, but he does offer In the U.S., there is growing concern that doctors are overprescribing medicine as the answer for patients with mental health and behavior problems. Feelings of sadness, behaviors like restlessness, which were once seen as normal aspects of being a human being, are now diagnosed as health problems like depression or attention deficit hyperactivity disorder, the argument goes, and treated away with prescription drugs. Psychiatrist Daniel Carlat does not necessarily endorse this, but he does offer reasons from his own personal experience as a psychiatrist--as to why medications are so commonly prescribed and advances a compelling argument for a more holistic approach that emphasizes talk therapy equally if not more than medicine. Medication does work, Dr. Carlat says, but it should not be the only answer, and part of the reason why medication is so often prescribed is because of the commercial power of pharmaceutical companies and the reimbursement practices of insurance companies. Dr. Carlat says he and his colleagues are reimbursed better if they see patients for 15-minute medication management programs than 45-minute talk therapy programs--even though therapy works as well if not better than med management for treating depression. Dr. Carlat gives us a firsthand account of his own experiences as a paid shill for a drug company, as well as a review of the evidence on what research says about the efficacy of psychiatric medication. He offers some very constructive suggestions for how to balance the system so that there is not an over-reliance on prescribing. He argues that psychiatrists should re-integrate talk therapy in their practices and talks about his own experiences struggling to help patients who he can only see for 15-minute medication sessions. This focus on his experience gives the reader a very tangible picture of what the problem is and what the solution could look like. To his credit, he does not dismiss psychologists, licensed social workers, and nurse practitioners but rather encourages psychiatrists to extend an olive branch to them. What might surprise some people is how little is actually known about behavioral and psychiatric disorders compared to just about any other kind of health problem, like cardiovascular disease, cancer, asthma, etc. There is no clear scientific explanation for WHY antidepressants work either, which people might find hard to believe. This doesn't mean we shouldn't do anything if we do suffer from mental health problems or that they aren't real, it just means that we shouldn't trust anyone who promises a silver bullet for these complex issues. Really recommend this book for anyone who is wondering how to deal with a mental health issue--their own or family and friends.

  8. 5 out of 5

    lark benobi

    As someone who has written a good bit of health journalism in my career I'm aware of how easy it is for a health story to be influenced by bias, whether it be a well written PR piece that comes across your desk when you have a deadline looming (you may or may not be surprised to learn how many stories in newspapers and magazines are printed with huge chunks of text lifted verbatim from a given company's press release), or a study that promises an exciting health breakthrough and will make for a As someone who has written a good bit of health journalism in my career I'm aware of how easy it is for a health story to be influenced by bias, whether it be a well written PR piece that comes across your desk when you have a deadline looming (you may or may not be surprised to learn how many stories in newspapers and magazines are printed with huge chunks of text lifted verbatim from a given company's press release), or a study that promises an exciting health breakthrough and will make for a great cover story people will want to read (never mind that the study is funded by a drug company, or authored by a doctor on that company's payroll). So what delighted me about this book is that not only did it expose the many systemic weaknesses in how psychiatric medicine is being practiced today, but it also gives a very detailed analysis of how misinformation about psychiatric drugs becomes FACT, however false. Not only pharmaceutical companies but also doctors and journalists and even patients have strong incentive to believe in their treatments, however lacking the science might be, and however bad the side effects, and however little real improvement is seen. There aren't any bad guys here...well, not so many of them...Carlat describes instead how simple human nature--a combination of vulnerability, hope, and a little greed--has led to a runaway industry. Great journalism.

  9. 4 out of 5

    Sally

    A mainstream psychiatrist, Carlat gives an inside view of the many problems and pitfalls in current psychiatry. He emphasizes that the causes of psychiatric conditions are not understood, that the "chemical imbalance" theory is unconfirmed, that no one understands why psychological drugs work at all or why they work for one patient and not another, and admits that the choice of which drug to prescribe is largely arbitrary. He also makes plain the tremendous and unwholesome influence of drug comp A mainstream psychiatrist, Carlat gives an inside view of the many problems and pitfalls in current psychiatry. He emphasizes that the causes of psychiatric conditions are not understood, that the "chemical imbalance" theory is unconfirmed, that no one understands why psychological drugs work at all or why they work for one patient and not another, and admits that the choice of which drug to prescribe is largely arbitrary. He also makes plain the tremendous and unwholesome influence of drug companies on drug testing, doctors' prescription choices, overprescription, and the material published about treatments in the professional journals and newsletters, as well as the harm of the common practice of direct payments to psychiatrists to help promote a company's products to other doctors. He also comments on the role of insurance company reimbursement policies and psychiatrists' economic self-interest in promoting drug-oriented treatment that discourage other types of therapy or getting to know patients as people, and suggests how psychiatrists might deal with this situation constructively.

  10. 5 out of 5

    Qwerty

    I feel that I learned a great deal about psychiatry from reading this book. Why do psychiatrists only spend 20 minutes with each patient? Insurance reimbursement answers that question. More importantly, the book describes how psychiatry differs from other medical fields insofar as the biological causes of mental illness are not well understood. The author notes that finding the right prescription "cocktail" for any individual patient is really a trial and error process that is unfortunately infl I feel that I learned a great deal about psychiatry from reading this book. Why do psychiatrists only spend 20 minutes with each patient? Insurance reimbursement answers that question. More importantly, the book describes how psychiatry differs from other medical fields insofar as the biological causes of mental illness are not well understood. The author notes that finding the right prescription "cocktail" for any individual patient is really a trial and error process that is unfortunately influenced by drug reps and hired gun doctors payed to push certain drugs over others. This isn't a jeremiad against psychiatry or even the role of prescription drugs in treating mental illness, but rather a thoughtful and reasoned critique of the modern day practice of psychiatry. The author suggests that psychiatrists should incorporate traditional psychotherapies into their practices and also questions whether psychiatrists really need to be trained as medical doctors. I would especially recommend this book to anyone undergoing treatment or with family members in treatment.

  11. 4 out of 5

    Bookworm007

    Ok, so to be honest, I did not finish this book. I read a few chapters and it was written interestingly but I've heard these complaints about psychiatry before. I should have skipped ahead to the Solutions chapter before I returned it to the library but I hope it had some realistic ones. I get kind of annoyed when people point out the flaws in psychiatry without offering real solutions. It is a complicated field, trying to help people when we still have little knowledge of the source of mental i Ok, so to be honest, I did not finish this book. I read a few chapters and it was written interestingly but I've heard these complaints about psychiatry before. I should have skipped ahead to the Solutions chapter before I returned it to the library but I hope it had some realistic ones. I get kind of annoyed when people point out the flaws in psychiatry without offering real solutions. It is a complicated field, trying to help people when we still have little knowledge of the source of mental illness. If there were no Solutions chapter I would have thought it was just a cheap way to make money while also instilling distrust in psychiatrists, which helps no one. So hopefully the Solutions chapter redeemed this book, otherwise, if you have studied psychology/ psychiatry to any sort of length, you already know what this book is going to say.

  12. 4 out of 5

    Emily Crow

    Written by a practicing psychiatrist, Unhinged discusses many of the problems in that field, such as rampant marketing and deceptive information from drug companies, the limitations (and benefits) of the DSM, that few psychiatrists actually practice any form to talk therapy, etc. The book was well-written and engaging, and I liked the fact that the author isn't anti-medication (from his discussion, it sounds like he reaches for his prescription pad quite often), even when discussing what is prob Written by a practicing psychiatrist, Unhinged discusses many of the problems in that field, such as rampant marketing and deceptive information from drug companies, the limitations (and benefits) of the DSM, that few psychiatrists actually practice any form to talk therapy, etc. The book was well-written and engaging, and I liked the fact that the author isn't anti-medication (from his discussion, it sounds like he reaches for his prescription pad quite often), even when discussing what is problematic about psychiatric medications--namely, that we don't even know what causes mental health problems or the actual mechanisms by which these drugs work, if/when they do. I found that refreshing, as a lot of books on the topic take such an all-or-nothing stance that it's hard to take them seriously.

  13. 4 out of 5

    Eve Lyons

    This book should be required reading for any mental health professional - therapists, nurses, psychologists, psychiatrists. I discovered Dr. Carlat via his blog, and the book gives a thorough analysis of the mental halth field and how it has "gone astray" in his words. It has become corrupted by pharm companies and the medical world, and gotten away from its roots, which is about healing people. I appreciate Dr. Carlat's frank and honest account, including of his own experience being a "hired gu This book should be required reading for any mental health professional - therapists, nurses, psychologists, psychiatrists. I discovered Dr. Carlat via his blog, and the book gives a thorough analysis of the mental halth field and how it has "gone astray" in his words. It has become corrupted by pharm companies and the medical world, and gotten away from its roots, which is about healing people. I appreciate Dr. Carlat's frank and honest account, including of his own experience being a "hired gun" for the company that makes Effexor, until he started being too even-handed about his experiences with antidepressants (they all work about the same as each other and placebos, and we don't really know why they work when they do work)

  14. 5 out of 5

    Noer

    This book is one psychiatrist's perspective on the industry, how it developed, where it is now, and how to proceed. Apparently there is a huge emphasis by most psychiatrists on prescribing medication as opposed to any form of real psychotherapy. No surprise there, since there's a lot of financial incentive for them to do so. The main takeaway I got from this book is that the therapy industry is a business, like any other. And people love money. Another takeaway is that most people who go to thera This book is one psychiatrist's perspective on the industry, how it developed, where it is now, and how to proceed. Apparently there is a huge emphasis by most psychiatrists on prescribing medication as opposed to any form of real psychotherapy. No surprise there, since there's a lot of financial incentive for them to do so. The main takeaway I got from this book is that the therapy industry is a business, like any other. And people love money. Another takeaway is that most people who go to therapy don't need any psychoactive drugs in order to get mentally healthy. They just need to learn about their mind and learn useful strategies to deal with pain and suffering.

  15. 5 out of 5

    David Teachout

    I'm not a psychiatrist, but I am a therapist and involved in integrated care so psychotropics are rather common. I wasn't so much surprised by the information here as I was impressed with the honesty and lack of alarmist language. Rather than calling out the doom of an industry, there was thoughtful critique and recognition of layers being involved including a desire to help, personalities, politics and other social influences. The result is certainly not a resounding chorus of hallelujah, but a I'm not a psychiatrist, but I am a therapist and involved in integrated care so psychotropics are rather common. I wasn't so much surprised by the information here as I was impressed with the honesty and lack of alarmist language. Rather than calling out the doom of an industry, there was thoughtful critique and recognition of layers being involved including a desire to help, personalities, politics and other social influences. The result is certainly not a resounding chorus of hallelujah, but as a starting point for reflection it's excellent.

  16. 5 out of 5

    jen8998

    Author reviews fairly familiar critiques of psychiatry today (i.e. overuse of antidepressants, little research basis for same, etc). He ends with the conclusion that psychotherapy is underutilized which is a point I very much agree with.

  17. 4 out of 5

    Kaethe Douglas

    I don't want or need to read a book about the wonders of talk therapy. In my considered opinion, the idea that listening to what people say will tell you anything about how their brain is working is just as strange as checking the color of someone's blood to see how their heart is working.

  18. 5 out of 5

    Molly

    This book poked holes in everything I thought I knew about psychiatry and mental health medication. Everyone should read it.

  19. 5 out of 5

    Judith

    A good, easy-to-read analysis of the psychiatric profession today, along with recommendations for improvement. Dr. Carlat was disturbed that he spent his days prescribing drugs. Although financially rewarding, this activity was not what brought him into psychiatry in the first place. His practice consisted of interviewing patients, and, when warranted, prescribing medications and referring them to therapists. The therapists were psychologists, family therapists, and other professionals trained in A good, easy-to-read analysis of the psychiatric profession today, along with recommendations for improvement. Dr. Carlat was disturbed that he spent his days prescribing drugs. Although financially rewarding, this activity was not what brought him into psychiatry in the first place. His practice consisted of interviewing patients, and, when warranted, prescribing medications and referring them to therapists. The therapists were psychologists, family therapists, and other professionals trained in "talk therapy". From there, he would see his patients for short appointments to adjust drugs every few months or so. One reason psychiatrists lean toward prescribing is that they like to consider themselves biologically oriented, more science than woo. But in fact there has yet to be established a medical basis for the syndromes they treat most. We are told that there may be a "chemical imbalance", that the patient was born with it, but in fact this has never been proven and there is good reason to believe it never will be. Carlat acknowledges this fact, but he doesn't part ways with drugs altogether. Dr. Carlat believes that psychiatric drugs work, on the whole. But they aren't magic bullets and they often cover over underlying issues the patient fails to address. He further found that drug companies deliberately misguide the doctors who prescribe, by attributing qualities to their drugs that they don't have, or that are actually no different from other similar drugs. Carlat became a "hired gun" himself for a time. He was drawn into this lucrative field when offered good pay for little work. Mostly, he would speak to other doctors at educational meetings, describing his experience with various drugs. It wasn't long before he discovered that, while he was never told to lie or to promote a manufacturer's drug over others, he was given signals when he took a more evenhanded approach by telling the truth. He realized that he was subject to influence, because when he continued to speak honestly about his experiences his speaking engagements started to fall off. By tailoring his talks to promote his employer's (drug company's) drugs, he received better and more frequent requests to speak. He and others also received many gifts. Interestingly, he points out that even a small gift like a memo pad or a book can make a person feel a sense of obligation. Carlat felt his patients weren't getting all that he could give them. They needed prescriptions that were the best for them and they needed a more acute listener. He found at times that when he spent a little more time listening he sometimes found other issues that required different treatment. He also found that he was rusty and not expert in actual talk therapy. He felt like a fraud (although he doesn't use that word here). The profession of psychiatry has become eroded over time. Now certain other professions can prescribe psychiatric medications. He can't find fault in how well these others are doing their jobs. Where does the psychiatrist actually fit today? There are newer types of talk therapy that yield remarkable results. Even exercise can relieve many symptoms, as well as or better than drugs. Carlat believes psychiatrists should become proficient in these techniques so that they can choose the proper course of action for each patient. Carlat explores various different paths psychiatrist and psychiatric schools might take to energize the profession and make it more useful. He falls on the side of finding a way to combine talk therapy and prescribing that doesn't eat away greatly at the doctor's income. I appreciated the simplicity of the book, the clear descriptions and examples of his positions. I had to question his belief about the efficacy of psychiatric drugs. He says they work, yet in many patients there is no improvement. Further, many conditions, like depression, resolve on their own. How do you determine that the effects are better than placebo? Some studies have been made in this area and they find that drugs usually do not do better than talk therapy, and certainly not better than talk therapy and exercise combined. It also concerns me that many patients are on these drugs for a lifetime when their underlying issues could be resolved and the drugs eliminated. Carlat himself experienced a panic attack and, not having drugs available, he turned to cognitive behavioral therapy techniques. They worked. This is partly why he recommends that doctors learn the different therapies available so they can choose what works best for their patients. I felt more emphasis could have been placed on these alternatives that do not involve drugs. And that have no side effects.

  20. 5 out of 5

    Sarah Aubert

    I don't often read books related to work; reading for pleasure is my escape *from* work, and I spend so much of my time buried in medical textbooks as it is. Still, I saw this sitting on the shelf of one of my Staff Physicians, and the subtitle drew me in. As someone halfway through her Psychiatry residency, it would be untrue to say that I don't sometimes have my own fears and suspicions about my chosen profession; as a more abstract branch of medicine with a relatively small pool of scientific I don't often read books related to work; reading for pleasure is my escape *from* work, and I spend so much of my time buried in medical textbooks as it is. Still, I saw this sitting on the shelf of one of my Staff Physicians, and the subtitle drew me in. As someone halfway through her Psychiatry residency, it would be untrue to say that I don't sometimes have my own fears and suspicions about my chosen profession; as a more abstract branch of medicine with a relatively small pool of scientific research from which to pull answers, Psychiatry can be as frustrating as it is interesting. Unfortunately, the "revelations" promised within the pages of this book, were, well, anything but. I don't know if this is because the book was published 10 years ago or because I practice in a Canadian setting rather than in the USA, but many of the revealed "dangers" of the profession (drug-sponsored papers, accepting funding, the relative lack of convincing research) are more or less commonly accepted facts. If anything, the writing of this book seemed more a kind of penance for Carlat's past transgressions. What's more, Carlat's argument that Psychiatrists have no need of medical school is a surprisingly narrow-minded view of an outpatient psychiatrist who must have forgotten the medical knowledge required on inpatient and Consult Liaison services. Compounding the dubious subject matter is the fact that Carlat's writing is just bad. It's cliche-ridden, with hokey anecdotes and cringe-worthy proclamations. The chapters could have used some tighter editing and the entire thing felt more like a collection of blog-posts rather than a cohesive work of nonfiction. Entirely skippable, unfortunately.

  21. 4 out of 5

    Jake Burlaga

    Carlat gave a fair assessment of how psychiatry has been working in recent history. For example, He was unbiased in his approach and seemed to be disturbed on things such as the DSM and how content is documented on this manual by means of voting. He zoned in specifically on marketing tactics that pharmaceutical companies use in order to generate business. Of course, it isn't a bad thing to do marketing by all means; but what is bad, is elevating business over the health of the patient. Carlat wa Carlat gave a fair assessment of how psychiatry has been working in recent history. For example, He was unbiased in his approach and seemed to be disturbed on things such as the DSM and how content is documented on this manual by means of voting. He zoned in specifically on marketing tactics that pharmaceutical companies use in order to generate business. Of course, it isn't a bad thing to do marketing by all means; but what is bad, is elevating business over the health of the patient. Carlat was specifically helpful in the area of how psychiatrists are treated with royalty in order to prescribe a patient with a product by that pharmaceutical company. Overall, I thought this book was so intriguing because of his honesty as one being in the practice of psychiatry.

  22. 5 out of 5

    Ioannaky

    Is psychiatry a science? I always thought that the answer was maybe yes but after having read this book I must admit that it is not. I became fascinated by psychiatry some years ago and then after reading this book and some similar ones including some articles I quickly became disillusioned by it. No it is not a science and no, psychiatric meds perform no miracles after all and it is true that most of the time psychiatrists do not even know why or what they are doing. Still, it works for many pe Is psychiatry a science? I always thought that the answer was maybe yes but after having read this book I must admit that it is not. I became fascinated by psychiatry some years ago and then after reading this book and some similar ones including some articles I quickly became disillusioned by it. No it is not a science and no, psychiatric meds perform no miracles after all and it is true that most of the time psychiatrists do not even know why or what they are doing. Still, it works for many people and it is the author's hope and wish that one day psychiatry is going to be a real science like the others. An intriguing book that should be read by mental health professionals.

  23. 4 out of 5

    Colin

    The author had a style that read like cutting through smooth butter. Surprisingly, Unhinged gives insight to how corruption can seep into fields even outside of psychiatry. A lot of the pros and cons are common knowledge if you have an interest in mental health, and a more subtle criticism is the cover design, which makes this book difficult to read in public. Additionally, I usually dread writer's inclusion of anecdotes in informational books like these, but Carlat had a way of making these sho The author had a style that read like cutting through smooth butter. Surprisingly, Unhinged gives insight to how corruption can seep into fields even outside of psychiatry. A lot of the pros and cons are common knowledge if you have an interest in mental health, and a more subtle criticism is the cover design, which makes this book difficult to read in public. Additionally, I usually dread writer's inclusion of anecdotes in informational books like these, but Carlat had a way of making these short quips engaging.

  24. 4 out of 5

    Randy E.

    Thoughtful book that made me rethink what I thought I knew about how about the process of drug approvals and reinforced my support for "talk therapy" as a necessary treatment even when pharmaceuticals are useful. Casts a harsh light on the influence of pharma on clinical psychiatry, but from the viewpoint of an insider who has experienced it and also understands the benefits of prescription meds. This is not a conspiracy theory-ridden book from an anti-science POV.

  25. 4 out of 5

    Upasna

    This was one of the many books I read during the lockdown which were critical of Psychiatry. I enjoyed reading about his views, agreed with most of them. I particularly liked the chapter where he talks about his ties with the Pharma Industry and how he gradually realised he was actually being used by them.

  26. 4 out of 5

    Psettinger

    Reading this book has made me even more antagonistic toward legal prescription drugs than I already was!

  27. 5 out of 5

    Jessie

    For anyone interested in psychiatry I enjoyed this book for its honesty about what the flaws are of psychiatry and for the hope it provides for the future of the field.

  28. 4 out of 5

    Th

    Asa psychiatrist, was familiar with much of the information. Addresses issues of loose diagnoses and over-reliance on medications and technology in current psychiatry. Respect Dr Carlat's courage.

  29. 5 out of 5

    Gabrielle Paul

    Enjoyed the parts on ethics 3.5 stars. Great book, but I’m not sure if I agree with the last chapter’s proposed solutions. The chapters on ethics were eye opening though

  30. 4 out of 5

    Sam Diener

    meh --- interesting book, but still stuck in the medical model and doesn't really speak about the failures of the model and research on medication...

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