Of Two Minds: An Anthropologist Looks at American Psychiatry
|T.M. Luhrmann, Of Two Minds: An Anthropologist Looks at American Psychiatry, Vintage Books, 2000
Commentary by Anneliese Butler. a Bryn Mawr alum
The title "Of Two Minds" refers to a contradiction at the heart of American psychiatry, that is, the co-existence of two very different ways of thinking about and treating mental illness: bioscience and pharmacotherapy, on the one hand, and psychodynamics and psychotherapy, on the other. Anthropologist Tanya Luhrmann presents these as two different lenses through which psychiatrists learn to view reality. She is not interested in evaluating which lens creates a clearer picture; rather, her aim is to understand how each of these lenses changes one's perception of reality, and with what consequences.
To this end, Luhrmann conducted more than four years of ethnographic research as a participant-observer in psychiatric training programs, hospital wards, residential treatment programs, individual and group therapy sessions, and various professional conferences. In "Of Two Minds," she brings us a remarkably comprehensive and deeply compassionate critique of American psychiatry. In addition to the depth of her research, another major strength is her refusal to take sides. In her own words: "I believe both the biomedical and psychodynamic approaches to psychiatric illness to be substantially correct and equally effective, although not always for the same person. ... I don't think that either approach mirrors the reality of mental illness, but then I don't think that any domain of knowledge "mirrors" the world as it is. The real issue for me is how one learns to look at mental illness through different lenses and the consequences of those ways of seeing." (p. 10)
Instead of pitting one approach against the other, she focuses on their common enemy: a health care system that limits access to psychodynamic therapies while promoting drug therapy as a quicker and more cost-effective "fix." Most psychiatrists agree, and research shows, that a combination of drug and talk therapies is more effective in treating mental illness than either one on its own. Eliminating psychotherapy from the picture would thus be a collective loss to both psychiatrists and their patients. "Of Two Minds" makes me think of the statement that science is about "getting it less wrong." When it comes to understanding mental illness, no one has any definite answers, and (to paraphrase the old saying) two minds are better than one.
Beyond the issue of uncertainty regarding biologic versus psychosocial causes of mental distress, the dichotomy between mind and body is flawed. Illness of any kind ("physical" or "mental") is disruptive and creates stress in people's lives. I doubt, therefore, that psychotherapy will ever become unnecessary or obsolete.
"Of Two Minds" is as fascinating as it is informative. It is eloquent, sophisticated, and extremely timely. With the recent proliferation of emotional and behavioral "disorders" and the aggressive marketing of drugs to treat them, mental illness has become increasingly inclusive. Furthermore, psychiatry exerts a profound influence on the broader culture, shaping how we understand ourselves and others. I would thus not limit my recommendation of this book to any audience in particular; to me, it is a matter of public interest.