Prescriptions for the Mind

Book excerpt: The practice of psychiatry has undergone great changes in recent years. In this book, Joel Paris, MD, a veteran psychiatrist, provides a fluently written and accessible "state-of-the-field" assessment. Himself a clinician, researcher, and teacher, Paris focuses on the most striking change within the field - the diverging roles of psychopharmacology and psychotherapy in contemporary practice. Where once psychiatrists were trained in Freudian psychoanalysis - which involved, more than anything else, talking - current pressures in mental health practice, including those imposed by managed care, are leading psychiatrists to treat more and more of their patients exclusively with medication, which is cheaper and faster. At the same time, psychotherapy is increasingly not being taught to new psychiatrists-in-training, even though, as Paris reveals, there is scientific evidence that both talk therapies and medication can play an important role in the treatment of mental illness. These developments are occuring against a backdrop of exploding research in the genetics and neurobiology of mental illness that will continue to drive the field. Paris ends by contemplating how going forward psychiatry can best respond to all these forces and proposes a team-based approach to mental health care. The book will appeal both to specialists and nonspecialists, particularly psychiatric residents and fellows, medical students considering specialization in psychiatry, clinical psychologists, social workers, and general readers, especially consumers of mental health services.