Changing minds

Scholar Andrew Scull lays bare the often misguided and cruel history of psychiatry. But with cures for many mental illnesses still elusive, he argues that the profession remains vitally important.

- ELEANOR DE JONG

DESPERATE REMEDIES, by Andrew Scull (Allen Lane, hb $65) Among medical specialists practising today, psychiatrists continue to rank among the least trusted by patients and their medical peers - an unenviable situation for professionals who spend more than a decade studying.

The most charitable assessments express concern at the lack of diagnostic testing available in the field - all major mental illnesses are diagnosed by a symptom checklist and close interviewing - and the heavy reliance on psychoactive drugs that often have dubious rates of success: no one knows how or why lithium helps stabilise mood; Prozac is fully effective in treating only about a third of patients prescribed it.

The least charitable continue to regard psychiatry and those who practise it as little more than quacks, and point to the barbaric history of the profession, rising rates of illness globally, and the continued debate over what qualifies as a mental illness in the psychiatric bible, the Diagnostic and Statistical Manual of Mental Disorders - Asperger's has recently been scrapped, but disruptive mood dysregulation disorder added.