Psychiatry’s Troubled Search for the Biology of Mental Illness

Reviewing the book ‘Mind Fixers’ by Anne Harrington

The book gives a very in-depth history of psychiatry, especially as it is relevant for a biological account of mental illness. It has roughly 3 parts. The beginning of American psychiatry and its roots, the post-Freudian biological search for mental illness (focused mostly on schizophrenia, depression, and bipolar), and ends with more recent developments in the 21st century and some thoughts on contemporary psychiatry and how it can improve from its current state.

It starts in the 19th century with the obsession with brain anatomy, then moves into psychoanalysis, the first shock treatments, lobotomies, and obsessions with mothers and parenting. More recently, it goes into the first anti-anxiety medication, the hypothesizing of neurotransmitters as biological causes (dopamine, neuro epinephrine, and serotonin), the popularization of anti-depressants and the impact and development of the DSM.

Some of it is a typical account of psychiatry. However, it gave a good emphasis on some topics that are usually barely talked about or completely skipped, such as the anti-psychiatry movement with figures like Lang, Szasz, and Foucault, the controversies of the DSM, and also the role of psychedelics in psychiatry in the 50s and 60s. And while it has a biological perspective, it covers very well the field as a whole and how the profession progressed.

What I really enjoyed about the topic is that I felt I gave a fair narrative of how psychiatry developed without being pretentious at the views it is describing based on its posthoc knowledge. It is easy to mock why early shock treatments were implemented, the theories of psychoanalysis, or the serotonin hypothesis of depression. However, at the time, they were relatively reasonable positions. They were products of their time and the evidence available to them.

This book is also a great reminder of how science can be wrong and how it can overstep in our lives. While I was already familiar with much of it, nevertheless just re-reading the history is incredibly depressing. The amount of suffering it caused, despite the best intentions, is hard to fathom. Mothers that had their autistic children taken away because they were supposedly bad mothers, mothers that were told their schizophrenic children were better not to have been born, or even forced euthanasia of the mentally ill.

What I didn’t like about the book is that it heavily focused on its early history until the mid-20th century or so. Anything more recent, especially after the 80s and 90s, is mentioned at the very end feeling very rushed and without much substance. It does cover recent controversies of the pharmaceutical industry but without much depth. And recent developments in genetics and neuroscience in regards to mental illness, despite often being overvalued or misinterpreted, deserved some attention, and they were completely skipped.

Despite the more modern shortcomings, it is nevertheless a book about the history of psychiatry. So I can’t put a lot of blame that it focused more on its roots and how we got here. I was already familiar with the topic, and I still learned tons of new things and looked at many subjects with a fresh and more insightful perspective.

The scale of this complexity is not something about which psychiatry needs to feel in any way embarrassed. After all, current brain science still has little understanding of the biological foundations of many — indeed, most — everyday mental activities.

This being the case, how could current psychiatry possibly expect to have a mature understanding of how such activities become disordered — and may possibly be reordered? In the early years of neurophysiology, Sir Charles Scott Sherrington predicted that when all was said and done, the effort to understand how different brain systems related to mental activity would likely “resolve into components for which at present we have no names.”

If we think Sherrington was right, we may well anticipate that the psychiatry of the future will have little use for diagnostic categories like “schizophrenia,” “bipolar disorder,” and “depression.” The fact that we don’t know what terms it will use instead is just one measure of how far we still are from the promised land of real medical understanding of real mental illness.

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