Mind Fixers: Psychiatry's Troubled Search for the Biology of Mental Illness

by Anne Harrington

Overview

Mind Fixers tells the history of psychiatry’s quest to understand the biological basis of mental illness and asks where we need to go from here.

In Mind Fixers, Anne Harrington, author of The Cure Within, explores psychiatry’s repeatedly frustrated struggle to understand mental disorder in biomedical terms. She shows how the stalling of early twentieth century efforts in this direction allowed Freudians and social scientists to insist, with some justification, that they had better ways of analyzing and fixing minds.

But when the Freudians overreached, they drove psychiatry into a state of crisis that a new “biological revolution” was meant to alleviate. Harrington shows how little that biological revolution had to do with breakthroughs in science, and why the field has fallen into a state of crisis in our own time.

Mind Fixers makes clear that psychiatry’s waxing and waning biological enthusiasms have been shaped not just by developments in the clinic and lab, but also by a surprising range of social factors, including immigration, warfare, grassroots activism, and assumptions about race and gender. Government programs designed to empty the state mental hospitals, acrid rivalries between different factions in the field, industry profit mongering, consumerism, and an uncritical media have all contributed to the story as well.

In focusing particularly on the search for the biological roots of schizophrenia, depression, and bipolar disorder, Harrington underscores the high human stakes for the millions of people who have sought medical answers for their mental suffering. This is not just a story about doctors and scientists, but about countless ordinary people and their loved ones.

A clear-eyed, evenhanded, and yet passionate tour de force, Mind Fixers recounts the past and present struggle to make mental illness a biological problem in order to lay the groundwork for creating a better future, both for those who suffer and for those whose job it is to care for them.

Product Details

ISBN-13:	9780393071221
Publisher:	Norton, W. W. & Company, Inc.
Publication date:	04/16/2019
Pages:	384
Product dimensions:	6.10(w) x 9.30(h) x 1.50(d)

About the Author

Anne Harrington is the Franklin L. Ford Professor of the History of Science and faculty dean of Pforzheimer House at Harvard University. She is the author of four books, including Mind Fixers and The Cure Within. She lives in Cambridge, Massachusetts.

Table of Contents

Acknowledgments ix

Introduction: Our Biological Enthusiasms xi

Part I Doctors' Stories

Chapter 1 Betting on Anatomy 3

Chapter 2 Biology in Disarray 32

Chapter 3 A Fragile Freudian Triumph 74

Chapter 4 Crisis and Revolt 107

Part II Disease Stories

Chapter 5 Schizophrenia 139

Chapter 6 Depression 183

Chapter 7 Manic-Depression 217

Part III Unfinished Stories

Chapter 8 False Dawn 247

Afterthoughts 271

Notes 277

Guide to Further Reading 335

Index 345

Editorial Reviews

The story Harrington tells is one of push-and-pull, back-and-forth. She starts by presenting the myth she wants to dismantle—the heroic tale of biology's triumph in the 1980s over a half-century of vulgar Freudianism. The clean lines of that cartoonish tale are easy to delineate. The case Harrington makes to rebut it is more intricate and winding, though her prose remains clear and crisp.…Harrington doesn't romanticize the world of mental illness before drugs—drugs that many patients credit with offering relief and even a chance at survival. What psychiatry needs to do, she says, is narrow its focus to the most severe forms of mental illness and "make a virtue of modesty" rather than hubris. She knows it's a somewhat fanciful idea, but it's a measure of her own cleareyed approach that she appeals to psychiatric practitioners' self-interest by invoking that most valuable and (these days) elusive currency: trust.

The New York Times - Jennifer Szalai

01/14/2019

Harrington (Reenchanted Science), a Harvard science history professor, lucidly and accessibly chronicles the search for mental illness’s elusive causes. The book’s three parts make up a “deep dive into our long effort to understand the biological basis of mental illness.” Part one examines the historical figures in this effort, such as German psychiatrist Emil Kraepelin and Swiss neurologist Adolf Meyer; part two covers investigations into the possible biological basis of schizophrenia, depression, and bipolar disorder; and part three focuses on historic errors that led to the current stalemate between pharmaceutical proponents and supporters of nonmedical, nondrug practices. Along the way, Harrington delves into the drug industry’s murkier corners, including how pharmaceutical executives in the 1990s tried to maximize the profitability of antipsychotics by marketing them to people without schizophrenia, and fascinatingly explores historic and mostly discarded treatments such as lobotomy, once touted as “soul surgery” by a credulous media. She concludes by offering a way forward for psychiatry, declaring that the field must “resist self-serving declarations of imminent breakthroughs and revolutions,” “make a virtue of modesty,” and share more of its power over patient treatment—such as to determine prescriptions—with nonmedical mental health professionals. Anyone interested in mental health care’s history and future will appreciate this informative and rewarding survey. (Apr.)

Publishers Weekly

"[An] often shocking but admirably fair and level-headed history."

New Scientist - Simon Ings

"A laudable venture, in which Harrington’s intellectual precision and exacting research cannot be faulted."

New York Times Book Review - Helen Thompson

"In Mind Fixers, Anne Harrington offers a provocative and enthralling account of psychiatry’s quest for the holy grail of a biological explanation of mental illness. A well-written, effectively substantiated and devastating story of a research enterprise that has gotten nowhere at great expense, with nonending hype and, in so doing, has weakened a profession that is clinically still useful and, like its patients, deserves much better."

Arthur Kleinman

"Masterful."

Los Angeles Review of Books - Philip Alcabes

"A fascinating and wide-ranging unpacking of the field."

Booklist

"Superb…nuanced…In Mind Fixers, Anne Harrington has written an excellent, engaging guide to what biological psychiatry has accomplished—and not accomplished—so far."

Wall Street Journal - Richard J. McNally

"Anne Harrington has written a lucid and compelling analysis of the travails of psychiatry as it has attempted to ground its understanding of mental illness in biology. She confronts the gaps between its aspirations and reality with fairness and even sympathy."

Steven E. Hyman

"Harrington’s grasp of this story and the clarity with which, with limited moralism, she delivers a tale about the ‘big picture’ of psychiatry and neurology is emblematic of the historian’s craft."

Science - Stephen T. Casper

"A tale of promising roads that turned out to be dead ends, of treatments that seemed miraculous in their day but barbaric in retrospect, of public-health policies that were born in hope but destined for disaster…Of value to historians of medicine."

Atlantic - Gary Greenberg

"Anne Harrington masterfully chronicles the hopes—and the hype—surrounding psychiatry’s much-heralded ‘biological revolution’ in this penetrating, capacious, and immensely engaging account. Read Mind Fixers for an absorbing guided tour through psychiatry’s fractious history and current conflicts."

Elizabeth Lunbeck

2019-02-28

A thorough and well-researched account of the ongoing attempts to find biological bases for mental illness.

In a surprisingly suspenseful narrative, Harrington (History of Science/Harvard Univ.; The Cure Within: A History of Mind-Body Medicine, 2008, etc.) traces the conflict between those who believed it would be possible to find biological causes and cures for mental illness and those who suspected that the current scientific tools were too crude to do so and that such illness could only be treated with a series of dialogues between patient and physician. In the late 19th and early 20th centuries, the author suggests, the biologists had a few victories, such as making the connection between the physical effects of syphilis and its effect on the mind, but they focused primarily on unproductive autopsies of the brains of patients. Meanwhile, the newly popular Freudians won the approval of patients with less severe mental illnesses as well as those attempting to ameliorate their symptoms. Later in the 20th century, as new drugs and techniques such as electroconvulsive therapy were discovered and heavily marketed, the balance swung temporarily toward the biologists—at least until it became clear that these drugs and techniques didn't produce the miracles their proponents initially claimed. After considering this struggle as a whole, Harrington moves on to examining it in the context of several specific forms of mental illness, including schizophrenia, depression, and manic depression. Beneath the author's firm, stately prose, which never becomes alarmist or provocative, lies a bleak assessment of the mental health profession. Its practitioners come across as hampered by the current, insufficient state of understanding of how the mind functions and malfunctions as well as prompted by jealousy, fear, greed, and a desire to one-up those they see as their competitors. Can psychiatry, Harrington asks, "acknowledge and firmly turn away from its ethical lapses—and especially the willingness of so many of its practitioners in recent decades to follow the money instead of the suffering?"

A measured, insightful survey of the limits of contemporary treatment for mental illness.

Kirkus Reviews

"By charting our fluctuating beliefs about our own minds, [Anne] Harrington effectively tells a story about the twentieth century itself."

The New Yorker - Jerome Groopman

"A compelling story of the ongoing mission to understand and treat our troubled minds."

Boston Globe - Nina MacLaughlin

"The story Harrington tells is one of push-and-pull, back-and-forth.… Intricate and winding, though her prose remains clear and crisp."

New York Times - Jennifer Szalai

"Enthralling.… Harrington takes us on a fascinating tour of the up-and-down history of pharmaceutical treatments for psychiatric disorders."

Nature - Alison Abbott

"When it comes to doctoring the body, you have to go back to the 19th century to find a time when the theories were baseless… and the treatments often harmful.… For doctoring the mind, as Anne Harrington’s fine history of psychiatry shows, that point is much more recent."

Economist

"When it comes to doctoring the body, you have to go back to the 19th century to find a time when the theories were baseless… and the treatments often harmful.… For doctoring the mind, as Anne Harrington’s fine history of psychiatry shows, that point is much more recent."

Economist