Andrew Scull’s new book is an important plea for psychiatrists not to be seduced into offering a cure that is worse than the disease. When speaking to psychiatrists, I frequently encounter the sentiment that we must do something to ‘treat’ people suffering from mental distress (indeed that it is quite immoral not to do so), no matter if our interventions show little evidence of being helpful. This sort of thinking is driving the current craze for psychedelic drug therapies, for example, which are often aimed at those who have ‘failed’ standard treatments and are thus particularly vulnerable to the enticements of novel remedies.
Scull never minimises the suffering that people with severe mental disorder experience and the burden this can place on families and society. He is highly critical of successive US governments, which have basically defunded public mental-health care since the large-scale closure of asylums, leaving many of the long-term mentally ill to live on the streets or in cheap boarding houses. Yet the book also suggests that overenthusiastic intervention is no better or worse than neglect, and that modern psychiatric treatments are little different from their precursors, bringing partial relief to only a few and inflicting discomfort and disablement on many.
Scull’s engaging account of the development of psychiatry and psychiatric treatments since the 19th century shows history repeating itself many times over. One hoped-for cure for mental distress follows another, resembling more the ups and downs of fashion than the conventional processes of science. In the early 19th