Of Two Minds: The Growing Disorder in American Psychiatry
By T.M. Luhrmann
Knopf, 352 pp.

Prozac Backlash: Overcoming the Dangers of Prozac, Zoloft, Paxil, and Other Antidepressants with Safe, Effective Alternatives
By Joseph Glenmullen
Simon and Schuster, 320 pp.

Since the 19th century, when psychology and psychiatry emerged as modern "sciences," there has been tension between theirspiritual and scientific roots. Early psychologists had to convinceskeptical patients that they could fill the spiritual vacuum in theirlives, while also fighting to maintain their authority by the newstandards of real science--chemistry, biology, and especially medicine.

Asthe millennium turns, that tension continues. Anthropologist TanyaLuhrmann suggests in her disturbing new book on psychiatry that thescientific roots have been artificially stimulated and are in danger ofstrangling the spiritual roots altogether.

Unlike other doctors, who deal with what Martin Luther called "inessentialsuffering," which is separable from who we are, psychiatrists deal with"essential suffering," which is tied up with what makes us human. AsLuhrmann puts it, essential suffering involves the "wants, fears,aspirations that are knitted into the person that [a] patient has become."Psychiatrists cannot deal with all of that fully: "That is why there arepriests, ministers, and rabbis attached to hospitals." Religion, saysLuhrman, can make us come to terms with essential suffering. "We learn tounderstand pain as part of life... as a spiritual lesson."

Luhrmann believes that the tension between the two "minds" ofpsychiatry--the biomedical, which treats psychological suffering asinessential, and the psychodynamic, which seeks to grapple with both kindsof suffering--has been a source of its strength. Chemists' discoverieshave been as important as the insights of doctors who talk and listen totheir patients. Drugs have a good record in recent years in treating whatare now understood to be largely organic malfunctions, such asschizophrenia.

But chemistry has not done so well with other kinds of suffering,particularly with the currently fashionable "depression." The vogue of Prozac and other so-called serotonin re-uptake inhibitors has obscured thetruth that Luhrmann patiently sets out: in study after study, the newdrugs perform no better than old-fashioned "talk therapy" in alleviatingthe symptoms of depression.

Yet the mania for cost-cutting--i.e., for rofits--in the new managed-caresystem is squeezing out old-fashioned methods, along witha whole way of thinking about our mental (what used to be called ourspiritual) condition.

Luhrmann is remarkably calm about how psychiatry, particularly hospitaltraining, is being hypermedicalized--how the spirit is being taken out ofthe study and treatment of the psyche. Much of what she reports about thepressures on the young residents she spent years observing is so alarming,and the pharmaceutical and managed care industries are so full ofPollyannas, that a harsher tone would have been warranted, if only to balance the hype put out by drug companies and "researchers" who advocate the new drugs. Perhaps Luhrmann, as an outsider without scientific credentials, felt compelled to be overly polite.

Joseph Glenmullen, clinical instructor at Harvard Medical School and anM.D. fluent in neurochemistry and microbiology, has no such reservations.He indicts the health industry for dangerous malfeasance, presentingevidence that talk therapy is actually more effective than themuch-touted new drugs.

Glenmullen criticizes influential "studies" of the new serotoninboosters--often tainted by the researchers' conflicts of interest("consulting" fees and the like from the companies whose products theyaresupposedly evaluating). He concludes that the Prozac-type drugs do nobetter than older, cheaper drugs, or even cocaine, nicotine, and caffeine.The research published in top journals is often so shoddy, and thereporting so selective, that doctors are often as ill-informed as theirpatients about new drugs.

Meanwhile, the diminishing number of doctors who are informed are shunted aside. Managed-care companies have shifted decision-making away from psychiatrists (to a far greater extent than they have done with other specialists) toward primary-care physicians. These overworked "gatekeepers" of the managed-care inferno cannot hope to keep up with independent research. They can hardly be blamed when they rely on the pseudoscience that pharmaceutical companies bombard them with.

The most disturbing example Glenmullen describes is the l994 Webseckercase, in which Eli Lilly bought off the survivors of a mass homicideapparently committed under the influence of its wonder drug, Prozac.

Thesurvivors had sued Eli Lilly, but in an unprecedented breach of legalethics, the parties to the case made a deal behind the judge's back tosuppress evidence and to keep the survivors silent. Then Lilly boasted to the press that the product had been certified safe by the legalsystem. The truth only came out years later, when one plaintiff's payofffrom Lilly became part of the public record in his divorce case. Theoriginal trial judge ordered the verdict changed, but there was hardly any publicity about that (it took place when the nation's attention was focused on the O. J. Simpson trial).