Abstract
Perhaps the internal battles of one’s own historical subfield always loom larger than they should, but it does seem to me that the history of psychiatry has uncommon amounts of vitriol and feuding. Anne Harrington’s book Mind Fixers stands out against this background as an engaging, lucid survey of some key parts of the history of psychiatry, animated by two things in particular. The book shows a willingness to be reasonably generous to, as well as fulsomely critical of, some of the traditional villains of the piece (including lobotomy enthusiasts and huge pharmaceutical companies). It is also held together analytically and conceptually by focusing upon the desire to understand mental illness or mental disorder as a biological phenomenon.
This latter characteristic – a clear argumentative position – is particularly welcome for a survey text: it enables readers to keep themselves oriented as the story ranges across large temporal and slightly more constrained geographical distances. On this point, the book is quite significantly US-centric. This is not in itself a problem, but the tight geographical focus is sustained enough that part of the way through I did check whether the subtitle mentioned American psychiatry specifically (it does not). Adolf Meyer’s particular brand of psychobiology comes out of Harrington’s account with much credit, but many of even the big names in British psychiatry (Aubrey Lewis, for example, or perhaps Meyer’s chief British disciple, David Kennedy Henderson) are omitted. However, it is tedious when reviewers harp on about the book that the author should perhaps have written, or the subjects that the book should have included, rather than appraising the text in front of them. Harrington’s book works extremely well as an introductory and analytical text on North American psychiatry, and contains a useful thematic bibliography to guide further reading. The book itself is structured into ‘Doctor’s Stories’ (Chapters 1–4), ‘Disease Stories’ (Chapters 5–7) and ‘Unfinished Stories’ (Chapter 8); this works well, but it does leave the final part a little short.
One of the highlights was the ‘Disease Story’ of schizophrenia (Chapter 5) which pulls together a number of different but related historical and current diagnoses, without ever collapsing them into one another. It artfully treads a difficult line between clarity and complexity, and ended leaving this reader feeling enriched in understanding without having to try very hard at all, such was the quality and sensitivity of the scholarship. On the other hand, the disease story of depression did get slightly bogged down in the different drugs, and patents, and the story of Big Pharma. To be fair, this is a big part of the quest for the ‘biology of mental illness’, and I cannot on the one hand praise the analytical engine that moves this story on, and then complain on the other that this focus leaves too much out. There are many good – and many horrifying – anecdotes and examples scattered throughout. The story about lithium and the soft drink 7 Up (p. 224) is characteristic of the tone in these stories: irreverent, gently humorous, but still part of a serious story. The material on the placebo effect, and the efforts of drug companies to manage and contain this phenomenon is extremely insightful engaging – and no wonder, as Harrington has previously edited a collection on this topic.
Despite all the heat and disagreement in the history of psychiatry, there are precious few moments in Harrington’s book where I winced at something that caused me serious disagreement. One of the few times I did deserves mention. In the final (‘Afterthoughts’) section, Harrington describes it as ‘good news’ that the ‘restless ex-patient and psychiatric survivor movements … have morphed into consumer advocacy groups that have won for patients a voice in their own care and – in the current preferred lingo – “recovery”’ (p. 272). I am not sure why ‘restless’ is used as an adjective here, and even less sure that describing the recovery model in such glowing terms – with apparently no sense of the opposition to this term – is appropriate when talking of patient advocacy.
It would be unfair and misleading to end on any kind of negative note, given how much I like this book. It is a fine synthesis of a complicated and fractious story, with a clear and unapologetic argumentative position that gives it clarity without undercutting its complexity or sensitivity. There is not a huge amount that is surprising here, because I don’t think it is supposed to be the kind of book for people already ensconced in the history of psychiatry. It has the lucidity and power to reach beyond the already interested and to provide people new to this field with an extremely good way in to some of the debates. With appropriate caveats about geographical range, it should really be required reading for all who seek to get into the history of psychiatry as an academic discipline; it should also be read by all those who want a fair-minded and analytical account of a turbulent and fractious twentieth century for all concerned with medical approaches to the mind.