Hippocrates Cried: The Decline of American Psychiatry

by Michael A Taylor

Overview

Hippocrates Cried offers an eye-witness account of the decline of American psychiatry by an experienced psychiatrist and researcher. Arguing that patients with mental disorders are no longer receiving the care they need, Dr. Taylor suggest that modern psychiatrists in the U.S. rely too heavily on the DSM, a diagnostic tool that fails to properly diagnose many cases of mental disorder and often neglects important conditions or symptoms. American psychiatry has come to reflect simplistic algorithms forged by pharmaceutical companies, rather than true scientific methodology. Few professionals have a working knowledge of psychopathology outside of what is outlined in the DSM, and more mental health patients are being treated by primary care physicians than ever before.

Dr. Taylor creates a passionate yet scholarly account of this issue. For psychiatrists and researchers, this book is a plea for help. Combining personal vignettes and informative data, it creates a powerful illustration of a medical field in turmoil. For the general reader, Hippocrates Cried will provide a fresh perspective on an issue that rarely receives the attention it requires. This book strips American psychiatry of its modern misconceptions and seeks to save a form of medicine no longer rooted in science.

Product Details

ISBN-13:	9780199948062
Publisher:	Oxford University Press
Publication date:	04/29/2013
Edition description:	New Edition
Pages:	296
Product dimensions:	6.30(w) x 9.30(h) x 1.20(d)

About the Author

Michael A. Taylor, MD, lives in Ann Arbor, Michigan, where he works as an adjunct clinical professor of psychiatry at the University of Michigan Medical School. He previously worked as professor emeritus at Rosalind Franklin University of Medicine and Science in Illinois. He was founding editor of the peer-reviewed journal, "Cognitive and Behavioral Neurology," and also worked as professor, chairman, and director at the Department of Psychiatry and Behavioral Sciences at the Chicago Medical School. He established and directed the psychiatry residency-training program at the State University of New York at Stony Brook. He earned a bachelor's degree from Cornell University and earned his medical degree from New York Medical College.

Table of Contents

Introduction
Hippocrates
The Hippocratic Oaths
The Patient Vignettes
Acknowledgements
Chapter 1: The Origins of Indignation
Lesions learned in a teaching hospital
Dogma derails data
The US navy as a model for neuropsychiatry
Decision
Chapter 2: First do no Harm
The deadly mind-body dichotomy
Conversion disorder, a classic psychiatric pejorative
The decline of psychiatric care in the USA
Chapter 3: Free of Injustice and Mischief
Models of psychiatric disorder
Mischief emerges
The injustice of a corrupting influence
Shell games
Chapter 4: For the benefit of the Sick
Beneficence: the fundamental imperative of medicine
Clinical diagnosis requires disciplined curiosity
Electroconvulsive therapy and beneficence
The most dangerous of doctors

Chapter 5: Peeves
Moral short-comings
Community psychiatry's overreach
Child psychiatrists
Anti-psychiatry groups and state legislatures
The rapacious health insurance industry and their minions
Academic psychiatrists
Myths
Chapter 6: Survival of the Fit
A rudderless ship
A specialty offering nothing special
Reduced habitat
Little advantage at a higher cost
The Process of extinction
Chapter 7: Back to the Future: The Once and Future King
A brainless diagnostic system
An alternative diagnostic approach
A neuropsychiatrist defined
The principles of neuropsychiatry
The biopsychosocial regression
Neuropsychiatry marginalized
Back to the future
Chapter End Notes
Reference List

Editorial Reviews

A neuropsychiatric clinician and professor with 45 years of experience, Taylor finds that the contemporary theory and practice of psychiatry has lost its way. He launches a full-throated attack on the still influential Freudian view of the psychodynamic basis of psychopathology, insisting instead that the brain must be “treated as a body organ and not a metaphysical mind.” Among Taylor’s targets are faddish and vague diagnoses: the number of people classed as bipolar is up 40-fold in the past 30 years, while “borderline personality disorder” has become the “somewhat polite term” psychiatrists use when “they think the patient is unpleasant.” He also criticizes psychopharmacology’s reliance on “trial and error,” the underutilization of electroconvulsive therapy in treating severe depression versus the use of less effective antidepressants, and the reality that many psychiatrists, by refusing Medicaid payments, avoid treating the poor. Occasionally, Taylor delivers harsh rhetorical broadsides—“Most brands of psychotherapy... don’t work”—or digresses from his main topic, as in a discussion of early signs of Alzheimer’s in Ronald Reagan during his first debate with Jimmy Carter in 1980. Whether Taylor is correct that biologically based neuropsychiatry will someday subsume psychiatry, his provocative book will give many clinicians and trainees considerable pause. (May)

Publishers Weekly

"Dr. Taylor's Hippocrates Cried is an amazing read. Michael brings a wealth of history and clinical insights to bear on the evolution of psychiatry and the emergence of neuropsychiatry. Although billed as a book on the decline of American psychiatry, I found it to be an uplifting account of the emergence of neuropsychiatry and the benefits of marrying neuroscience with psychiatry and behavioral health. It is a provocative forward-looking history that entertains, teaches, and provokes thought."
— Jeffrey L. Cummings, MD, ScD, Director, Lou Ruvo Center for Brain Health, Camille and Larry Ruvo Chair for Brain Health, Cleveland Clinic , Las Vegas, NV

"I found myself breaking into involuntary laugher at points in reading this manuscript, not because the stories are really funny - they are horrifying - but because they illustrate the failure of American psychiatry in the last third of the twentieth century... Doctor Taylor gives us a view from the trenches. He is actually a psychiatrist of great international distinction, and he says that the changes in psychiatry he describes here have been even more worrying than we thought. One might have imagined that after the destruction of Freud's psychoanalysis, things would have gone well. Not a bit of it! The field's unhappy lurch towards cookbook diagnosis and psychopharm simplehood have had a very unhappy influence on patient care. Taylor has experienced all this ringside over the last 45 years, and he is forceful, well-spoken, and amusing."
— Dr. Edward Shorter, Professor of the History of Medicine, Professor of Psychiatry, Faculty of Medicine, University of Toronto, Ontario, Canada

"According to Michael Taylor, American psychiatry is on life support and fading fast. In this thoughtful and well-written book, Taylor details the grievous wounds inflicted on the profession first by Freudian theory and then by the pharmaceutical industry, but psychiatrists also have themselves to blame. Taylor champions neuropsychiatry and decries the deterioration of his profession over the past half century. Given his analysis, the ultimate integration of psychiatry and neurology is inevitable and should be most welcome. This is a very useful book for anyone using psychiatrists, or wondering why they did."
— Fuller Torrey, MD, Executive Director, Stanley Medical Research Institute, Chevy Chase, MD

"Dr. Taylor's stories may be emotionally charged and somewhat one-sided, but when he moves away from his own experiences and surveys the present state of psychiatry, he offers a sound critique of the pillars of American Psychiatry... His larger argument is convincing because it marshals evidence, not simply his own opinion. ... So read his anecdotes with an understanding of his frustration, and wait for Dr. Taylor's cooler analyses. The content of his arguments are well worth consideration." —New York Journal of Books

"Whether Taylor is correct that biologically based neuropsychiatry will someday subsume psychiatry, his provocative book will give many clinicians and trainees considerable pause." —Publishers Weekly

"The book is written as if you are sitting with Dr. Taylor on his back porch, as he recounts his life. It is well written, frank, and clear. ... If it receives the attention it deserves, his laudable effort here would benefit humanity multiple times more than all the other pseudo-critiques of psychiatry combined." —Acta Psychiatrica Scandinavica

From the Publisher

Taylor (psychiatry, Univ. of Michigan) writes with verve and compassion about patients, doctors, and the training of young psychiatrists. He criticizes pharmaceutical companies for their role as profiteers, and the American Psychiatric Association for what he calls its pseudo-scientific Diagnostic and Statistical Manual. He narrows his perspective greatly, however, defining psychiatric illness as a brain disease and removing psychology as an element of diagnosis and treatment. For decades, psychoanalysis, which the author claims is a flawed theory and practice, dominated the field of psychiatry. Taylor would delegate the study of it to nonphysicians while training neuropsychiatrists who diagnose and treat syndromes traceable to the brain. VERDICT Taylor's argument is laced with technical terms and his ideas stretch beyond the reach of the lay reader, but his text will be highly valued by the medical community despite its narrow focus. More accessible critiques of psychiatry that respect both psychology and neuroscience include Hobson and Leonard's Out of Its Mind (2001) and Joel Paris's Prescriptions for the Mind (2008).—E. James Lieberman, George Washington Univ. Sch. of Medicine, Washington, DC

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