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Bursztajn, H.J. Haque, O.S. (2017). The Trouble with Modern Psychiatry: A Basis in Science for the Subjective Mind, by Ron Abramson, Lap Lambert Academic Publishing, 2017, 116 pp. Can Pragmatic Philosophy Restore Psychiatry's Humanity in the Age of Neuroscience?. Psychodyn. Psych., 45(4):623-625.

(2017). Psychodynamic Psychiatry, 45(4):623-625

The Trouble with Modern Psychiatry: A Basis in Science for the Subjective Mind, by Ron Abramson, Lap Lambert Academic Publishing, 2017, 116 pp. Can Pragmatic Philosophy Restore Psychiatry's Humanity in the Age of Neuroscience?

Review by:
Harold J. Bursztajn, M.D.

Omar Sultan Haque, M.D., Ph.D.

Ron Abramson, M.D., former Associate Professor of Psychiatry at Tufts University School of Medicine, in his book, The Trouble with Modern Psychiatry: A Basis in Science for the Subjective Mind, attempts to characterize the nature and causes of the problems that have emerged in contemporary psychiatry, and suggest ways out of the present impasse.

In medicine and mental health, the term “philosophical” is all too often used in a dismissive manner and as a euphemism for “doesn't matter.” Disagreement in professions, even those less splintered than contemporary psychiatry, begins with a food fight over what questions are worthy of consideration in the first instance, and a question which is characterized as “philosophical” is all too often well on its way to being judged as being trivial and of no practical significance. Abramson courageously considers philosophical questions as vital and practical. Connecting with realities on the ground and in the lives of patients and practicing psychiatrists, Abramson characterizes the territory of professional disorder by asking why people “hate” psychiatrists, why top medical students tend not to select psychiatry as a specialty, why psychiatrists increasingly don't enjoy their work, and why patients often don't feel listened to by their psychiatrist. Abramson, then, is interested in asking the taboo questions in psychiatry and pushes past the Panglossian denial about these problems among most leaders in psychiatric organizations.

There are no easy answers in Abramson's diagnosis, but a few recurring themes emerge, including the increasingly normalized gremlin of biological reductionism. Psychiatry has literally “lost its mind.” The bio-psycho-social formulation has become the bio-bio-bio formulation. Because of this shift, patients don't feel their psychiatrists are as interested in their subjective experiences and illness narratives, psychiatrists find their jobs have been circumscribed to medication management of the most efficient and reimbursable sort, and students find the field dehumanizing, fractured, and uninteresting. Thus, the most talented minds increasingly stay away from the field.

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