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Preface to the Paperback Edition
- Johns Hopkins University Press
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Preface to the Paperback Edition The debates and dilemmas discussed in this book have been a century in the making. The issues raised are real today and will remain so for years to come. Unfortunately, it is still the case that psychiatry is murkily eclectic, uncertain of what it stands for, unable to clearly explain its basic views to outsiders, and engaged in tense conflict within itself as well as with a skeptical public. Hence persons with mental illness have to navigate a world in which those who are trained to treat them have conflicting views and little ability to explain what is right. Confusion, disorder, disarray, and anarchy are the rule of the day. At the same time, we have learned much about neurobiology, have developed new medications, and continue to advance in scientific methods of research . Yet this is for naught if we do not have an idea what to do with all this knowledge. As Frank Ayd, a prominent founder of psychopharmacology, put it (pers. comm., 2005), the future may lead to the discovery of many new medications or treatments, but such discoveries will not translate into practical progress unless we better understand when and how to use our different treatments . It is as if we were given the gift of a powerful Lamborghini, without having a license to drive. William James once said that new ideas become popular if they respond to a human need. Sometimes people feel they need simple answers to complex problems. The problem is that simple answers are often wrong, and they often end up as nothing but dogmas, blindly followed. In medical practice, such dogmatic mistakes can do real harm to real people. This book offers no simple answers ; in fact, it seeks to show how all our simple answers are wrong, including the biopsychosocial view that all theories are potentially valid. That eclectic approach is “kitchen-sink” psychiatry: we throw in all kinds of methods, hoping that something works. Here you will find an alternative: a pluralist model of the mind and mental illness — broad but selective, systematically identifying when to use which methods to the exclusion of others in the understand- ing and treatment of mental illness. (Thanks to my colleague Ronald Pies for this analogy.) I hope that this new paperback edition makes the book more accessible to those who may be most interested in such new ideas and that the book will provide some needed criticism, while also stimulating further critiques and acting as a sign post to a better future. Perhaps then we can meet those other human needs, so desirable yet so elusive — to know and to be free. xvi Preface to the Paperback Edition ...