Dr. Daniel Carlat’s book, “Unhinged: The Trouble With Psychiatry; A Doctor’s Revelation about a Profession in Crisis” is a gutsy introspection – the kind that may not make Carlat many friends in his profession but should win him the admiration of readers, consumers and patients.
I first became aware of Carlat when he published the tell-all “Dr. Drug Rep” piece in the New York Times about his experiences going on the road for a drug company talking about its antidepressant.
His Carlat Psychiatry Blog has become a clearinghouse of criticism of psychiatry with a goal of, as his tagline states, “promoting honesty in medical education.”
So Unhinged was the frosting. It’s well written – truly a hard-to-put-down book.
It ‘s painfully honest:
“I have no idea how Lexapro works to relieve depression, nor does any other psychiatrist…while Lexapro increases levels of serotonin in the nerve synapses, there is no direct evidence that depression is a disorder of reduced serotonin. The term ‘chemical imbalance’ is commonly used by laypeople as a shorthand explanation for mental illness. It is a convenient myth because it destigmatizes their condition – I the problem is a chemical imbalance, it is not their fault. Psychiatrists go along with this shorthand, because it gives us something to say when patients ask us questions about pathophysiology, After all, no doctor wants to admit ignorance about the very problems he or she is trained to manage.”
“Because diagnosis in psychiatry is more art than science, the field is vulnerable to ‘disease mongering,’ the expansion of disease definitions in order to pump the market for medication treatment.
…newer drugs for schizophrenia, depression and bipolar disorder are generally no more effective than the older drugs they have largely replaced.”
Its insights are revealing:
Carlat asks, “How did you decide, for example, on five criteria as being your minimum threshold for depression?”
Dr.Robert Spitzer, one-time editor of the Diagnostic & Statistical Manual – the “bible of psychiatry” answers: “Because four just seemed like not enough. And six seemed like too much.”
If I go on much longer, I’ll excerpt the entire book. Read it yourself. And/or listen to Carlat on a recent NPR Fresh Air.