. On the basis of extensive interviews with patients and doctors, as well as day-to-day investigative fieldwork in residency programs, private psychiatric hospitals, and state hospitals, Luhrmann shows us how psychiatrists are trained, how they develop their particular way of seeing and listening to their patients, what makes a psychiatrist successful, and how the enormous ambiguities in the field affect its practitioners and patients

. How do psychiatrists learn to do what they do? What is it like for psychiatrists to deal with people who are in emotional extremity? How does the choice between drug therapy and talk therapy, each of which requires very different skills, affect the way psychiatrists understand their patients? Boldly and with sharp insight, Luhrmann takes the reader into the world of young doctors in training. At a time when mood-altering drugs have revolutionized the treatment of the mentally ill and HMOs are forcing caregivers to take the pharmacological route, Luhrmann places us at the heart of the struggle - do we treat people's brains or their minds? - and allows us to see exactly what is at stake.

Publishers Weekly Cultural anthropologist Luhrmann puts the psychiatric profession on the couch, with devastating results. Psychopharmacology has become "the great, silent dominatrix of contemporary psychiatry," she reports, as a combination of ideology and socioeconomic forces favors treatment via prescription drugs and drives talk therapies out of the marketplace. In the new climate of managed care, doctors have very little time to evaluate patients, psychotherapy is not deemed cost-effective and psychiatrists in hospitals and clinics are pushed into management roles. A professor at the UC-San Diego, Luhrmann spent more than four years in psychiatric hospitals, attending classes and interviewing psychiatrists and administrators. Though she writes in a rather academic style, her valuable report offers an uncensored look at the new biological psychiatry. Luhrmann found that medications often do not work, that most patients are on more than one medicine and that unwanted interactions between drugs are common. In the classroom, discussion of Freud or of the scientific literature on emotion and human development is extremely cursory. Moreover, biomedically oriented doctors are trained to see psychiatric illness as a medical disease, which tends to eliminate ambiguity and nuance in diagnosis. Luhrmann's own view is that the evidence indicates a combination of talk therapy and psychopharmacology works best for most patients. She concludes with a look inside the mental health patient advocacy movement, which, like the profession itself, is sharply divided between lobbies for biomedicine and groups opposed to mandated psychiatric medication. Agent: Jill Kneerim, Palmer and Dodge Agency. (Apr.) Copyright 2000 Cahners Business Information. | Library Journal Luhrmann (anthropology, Univ. of California, San Diego) has written "an ethnography of psychiatry" that focuses on the ways new psychiatric residents learn to think about their patients. She follows residents through medical school and internship, when they learn to distance themselves from patients; through the first year of residency, when they serve within the hospital and become solely responsible for patient care with only a few hours of training; and to the second year, when they must become deeply involved with patients and learn to empathize. The title's "two minds" refers to the split in the profession between those who see themselves as drug-treatment specialists and those who regard themselves as therapists. The latter group, argues Luhrmann, is an endangered species owing to managed healthcare's preference for quick, cheap solutions. She also cites studies to show that patients do best with a combination of drugs and... Knopf Publishing Group 0-679-42191-2 / 9780679421917
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