J. David Kinzie

The Truth about Depression: Choices for Healing

CHARLES L. WHITFIELD, M.D.: The Truth about Depression: Choices for Healing. Deerfield Beach, FL: Health Communications, Inc, 2003, 324 pp.,

Understanding and Preventing Violence: The Psychology of Human Destructiveness

12.95, ISBN 0-7573-0037-5. Charles Whitfield, MD, whose major medical specialty is substance abuse, has written a book geared for potential patients about treatment approaches to depression. His book can be reviewed on two levels; first, in terms of its utility to patients, and second, as a scientific discussion of depression and its causes. From the latter point of view, Whitfield presents over 800 references, the biggest group relating to child abuse and its effect on adult disorders. The authors major thesis is that child abuse is a severe problem and often leads to major mental illness including depression. This point is made over and over again through references. One must agree that the author has made his point: child abuse is bad, and the degree of its prevalence is probably under-recognized. Of course, this doesnt prove that all depression is caused by child abuse, or that it is the only or major factor for depression in a single individual-a point he concedes in his flow chart of the treatment of depression if no trauma is found. He provides up-to-date information on brain studies of depressed and traumatized individuals which is fairly accurate. He takes on several issues including the effectiveness of antidepressants and the toxicity of ETC. Admittedly, pharmaceutical companies have pushed SSRIs and other newer antidepressants, but it doesnt mean that they are only slightly better than placebos. Long term studies have shown that antidepressants, especially for major depressive disorders, have an improvement rate of 65%, compared to the 30% improvement rate of placebos. Other data indicate the inverse relationship between antidepressant use and suicides in adolescents. Equally disturbing is his blanket condemnation of ECT using Peter Breggin as his source. More objective evidence indicates no evidence of neurological damage from ECT. Whitfield seems to have limited understanding of the seriousness of severe depression and its 15% lifetime mortality. Often major interventions are required to save the life of a depressed individual, sometimes including hospitalization, aggressive medication, and even ETC. The treatment approaches offered imply criticism of some psychiatrists who fail to take a trauma history or to ask about abuse. There is the implication that one only needs to ask and this information will be forthcoming. The author either ignores or doesnt understand the effects of avoidance, guilt, repression, conscious ambivalence, let alone the complex relationship between a therapist and patient involved in a complicated discussion of child abuse. …

Book Reviews -- Cruel Compassion: Psychiatric Control of Society's Unwanted by Thomas Szasz

LEIGHTON C. WHITAKER: Understanding and Preventing Violence: The Psychology of Human Destructiveness. CRC Press, Boca Raton, FL, 2000, 227 pp., ISBN 0-8493-2265-0. I was reading Understanding and Preventing Violence, when the TV images of the terrible destruction of the World Trade Center and The Pentagon filled my mind. What could help our understanding of suicidal fanatics who would kill over 6,000 innocent civilians? I reread Leighton Whitakers sections on antigovernment extremists, terrorists, and deadly cults. The background of deadly groups like Aryan Nation and Aum in Japan with their techniques, authoritarian leadership, and distance from the victim was helpful. However, these activities seem to pale in comparison with the massive destruction requiring huge expenses, planning, secret organization, and utter disregard for life as was inflicted on New York and Washington, D.C. How is one to understand such religious fanaticism mixed with murderous hatred? It is not Whitakers fault that he does not answer these questions. None of us anticipated this type and amount of violence. It is for future authors to take up these issues when and if the nation can heal and look at the events with some distance and rationality. That said, the author tries to cover a great deal of material in a small book; from dehumanizing effects of ordinary social interaction to explaining Hitler. Whitakers approach is to emphasize the indirect causative factors or influences that provide and facilitate lethal behavior, not just immediate apparent cause. The second chapter covers a series of observations on social factors and violence. The primary premise is that some solutions to violence-more prisons, more death penalties, more police, and more guns-have actually exacerbated the situation. Portrayal of violence in the media is particularly described and its relationship to self-reinforcing violence in society is pointed out. This chapter, as do the others, attempts to offer constructive suggestions, including improving parenting, teaching, critical thinking, countering racism, reforming education, and filling the spiritual void. This is not an easy agenda to meet. Chapter three covers institutionalized aggression and violence, ranging from the legal and journalistic professions to extremist and doomsday cults. There is specific information on inhibiting the institutional violence and suggestions for inhibiting antigovernment activities. But more generally, what is needed is early education in relationships and democratic living. Chapter four details a long list of the CIAs institutional aggression over the past fifty years, which involves human rights violations, and outright deaths. Of special note is the case of psychiatrist, Dr. Ewen Cameron, funded by the CIA, who subjected his patients to aggressive treatment in attempts at depatterning. …

Psychotherapy for massively traumatized refugees: the therapist variable.

THOMAS SZASZ: Cruel Compassion: Psychiatric Control of Societys Unwanted. John Wiley and Sons, New York, 1994, 264 pp.,

Psychotherapy with African-American Women: Innovations in Psychodynamic Perspective and Practice

19.95. Thomas Szasz maintains in Cruel Compassion his antipsychiatric stance but has moved on to deal with an issue he calls adult dependency and the societys unwanted. In the first part of the book, he makes the case that modern psychiatric treatment is similar to segregating paupers in workhouses, incarcerating default debtors in prisons, and exiling epileptics to colonies. His argument is almost entirely based on analogy. In the past paupers, debtors, epileptics, et al. were coerced and controlled because they were unwanted by society. He asserts that the same thing is happening today with the so-called mental patients housed in mental hospitals. His argument lacks one thing: proof. Later in the book, he turns his attention to the de-institutionalized people on the street who he admits can be disruptive and dangerous. De-institutionalization seems o be what he has always advocated, i.e., a liquidation of psychiatric hospitals. However, now he blames psychiatry for homeless people. In this approach, his style is to attack psychiatry and disabled patients, and his technique is provocative. The primary target of his anger is the general psychiatrist, but he speaks ill of a wide range of people and organizations: the American psychiatric Association, the National Institute of Mental Health, parents of the mentally ill, the National Alliance of the Mentally Ill, Hobbes, John Stuart Mill, John F. Kennedy, the Joint Commission on Mental Illness and Health, Philippe Pinel, Eugene Bleuler, Henry Maudsley, Sigmund Freud, Anna Freud, Carl Menninger, Nathan Kline, E. Fuller Torrey, Paul Applebaum, Richard Lamb, Bruno Bettleheim, and Lewis Thomas among others. He does have heroes and quotes approvingly from Shakespeare, Adam Smith, and himself. One might think his attacks on psychiatry are some form of professional autogenocide, however this is not quite the case. He never speaks of himself as a member of the profession. He gives no personal case material to indicate how he would actually take care of patients. Nor can one really imagine Szasz conducting his own receptive, nondirective interview with patients. He is so certain he knows what is wrong, how could he possibly listen to ill patients describe bizarre delusions, auditory hallucinations, poor concentration, threatening thoughts, and marked ambivalence in speech and action. …