The Mind Has Mountains: Reflections on Society and Psychiatry
http://www.100md.com
《新英格兰医药杂志》
In the preface to this collection of well-written, sometimes elegant essays for medical journals and for magazines such as Commentary, First Things, and The Weekly Standard, Paul McHugh writes, "To avoid an unrelenting stance of criticism against psychiatry that provides no solutions to its problems . . ., book concludes with essays that describe the systematic ways of thinking about psychiatric disorders taught at the Johns Hopkins University School of Medicine." McHugh, director of the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins University from 1975 to 2001, begins his book with criticism of those who fail to understand that disorders such as schizophrenia and manic–depressive psychosis are diseases, not social discomforts or emotional problems (although there often are such consequences), and their sufferers are sick. He is responding to the misplaced understanding of psychiatric disease in the 1970s that led to de-institutionalization and to exaggerated critiques by commentators such as Thomas Szasz and R.D. Laing that cast psychiatry as the creator of schizophrenia.
To provide a conceptual basis for psychiatry that is as substantial as his own beliefs about the specialty, McHugh turns toward the rest of medicine, which he views as solidly rooted in empiricism. Medicine is based on evidence available to all, and McHugh wants a similar method for psychiatry. (He understands that as exciting as brain research has become, it is not the answer.) He includes his own foreword to the recent edition of Karl Jaspers's important book, General Psychopathology (Baltimore: Johns Hopkins University Press, 1997). Jaspers wrote this two-volume work, first published in 1913, before he was 31 years old. McHugh says that Jaspers's "phenomenological method hinges on the human capacity for self-expression — a means of communicating one's experiences to another. This capacity makes it possible for patients to describe the content of their minds and for psychiatrists listening to these descriptions to enter the mental life of such patients." Jaspers's method could also apply to the way internists come to understand their patients' experience of their sicknesses. McHugh's erudite commentary sent me back to Jaspers's great work, which is conceptually strong and wonderfully rich in its description of human nature and of psychic and personal life.
A subtext throughout The Mind Has Mountains is spelled out explicitly in several chapters; for example, "The Death of Freud and the Rebirth of Psychiatry" suggests that McHugh is on a crusade to "rescue" psychiatry from Freud (and Adler and Jung) and psychoanalysis. Unfortunately, crusaders often find it important to caricature the enemy (e.g., calling psychoanalysts "romanticists," as compared with empiricists). Readers might infer that psychoanalysis stands only for ideas that have not changed since Freud's death in 1939; that many of the ideas of Freud and others in the field have not, for good reason, become a part of the everyday ideas and beliefs of Western culture; or that 75 years of Western intellectual history about mental life are wrong and for the first time the truth is dawning.
McHugh's attitude toward Freud is but one example of his extreme stance. Is he intolerant of complexity, does he not brook disagreement, or is he merely using a technique of argument commonly called reductio ad absurdum? For example, in the section on assisted suicide, he describes the excesses of Jack Kevorkian, who "motors around Michigan carrying cylinders of carbon dioxide or bottles of potassium chloride to dispatch the sick," and he dismisses the problem of suffering by saying that its elimination "is a veterinary rather than medical goal," thus reducing a disturbing and difficult problem to the absurd. Similarly, the chapter on the Schiavo case is entitled, "Annihilating Terri Schiavo." Jaspers is explicit that value judgment must be separated from observation. I do not doubt that with patients, McHugh follows Jaspers's wise dictum, but in this book it is seldom in evidence. Perhaps because most of the chapters are written for nonprofessionals, the method he uses best makes his points with no pretense of being evenhanded.
Near the end of the book, a wonderful chapter entitled "Another Psychiatrist's Shakespeare" shows McHugh's wit, insight, and skill as a writer. I wish there had been more like it.
Eric J. Cassell, M.D.
Weill Medical College of Cornell University
New York, NY 10021
eric@ericcassell.com(By Paul R. McHugh. 249 pp)
To provide a conceptual basis for psychiatry that is as substantial as his own beliefs about the specialty, McHugh turns toward the rest of medicine, which he views as solidly rooted in empiricism. Medicine is based on evidence available to all, and McHugh wants a similar method for psychiatry. (He understands that as exciting as brain research has become, it is not the answer.) He includes his own foreword to the recent edition of Karl Jaspers's important book, General Psychopathology (Baltimore: Johns Hopkins University Press, 1997). Jaspers wrote this two-volume work, first published in 1913, before he was 31 years old. McHugh says that Jaspers's "phenomenological method hinges on the human capacity for self-expression — a means of communicating one's experiences to another. This capacity makes it possible for patients to describe the content of their minds and for psychiatrists listening to these descriptions to enter the mental life of such patients." Jaspers's method could also apply to the way internists come to understand their patients' experience of their sicknesses. McHugh's erudite commentary sent me back to Jaspers's great work, which is conceptually strong and wonderfully rich in its description of human nature and of psychic and personal life.
A subtext throughout The Mind Has Mountains is spelled out explicitly in several chapters; for example, "The Death of Freud and the Rebirth of Psychiatry" suggests that McHugh is on a crusade to "rescue" psychiatry from Freud (and Adler and Jung) and psychoanalysis. Unfortunately, crusaders often find it important to caricature the enemy (e.g., calling psychoanalysts "romanticists," as compared with empiricists). Readers might infer that psychoanalysis stands only for ideas that have not changed since Freud's death in 1939; that many of the ideas of Freud and others in the field have not, for good reason, become a part of the everyday ideas and beliefs of Western culture; or that 75 years of Western intellectual history about mental life are wrong and for the first time the truth is dawning.
McHugh's attitude toward Freud is but one example of his extreme stance. Is he intolerant of complexity, does he not brook disagreement, or is he merely using a technique of argument commonly called reductio ad absurdum? For example, in the section on assisted suicide, he describes the excesses of Jack Kevorkian, who "motors around Michigan carrying cylinders of carbon dioxide or bottles of potassium chloride to dispatch the sick," and he dismisses the problem of suffering by saying that its elimination "is a veterinary rather than medical goal," thus reducing a disturbing and difficult problem to the absurd. Similarly, the chapter on the Schiavo case is entitled, "Annihilating Terri Schiavo." Jaspers is explicit that value judgment must be separated from observation. I do not doubt that with patients, McHugh follows Jaspers's wise dictum, but in this book it is seldom in evidence. Perhaps because most of the chapters are written for nonprofessionals, the method he uses best makes his points with no pretense of being evenhanded.
Near the end of the book, a wonderful chapter entitled "Another Psychiatrist's Shakespeare" shows McHugh's wit, insight, and skill as a writer. I wish there had been more like it.
Eric J. Cassell, M.D.
Weill Medical College of Cornell University
New York, NY 10021
eric@ericcassell.com(By Paul R. McHugh. 249 pp)