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Unhinged: The Trouble with Psychiatry - A Doctor's Revelations about a Profession in Crisis

3.86  ·  Rating details ·  363 Ratings  ·  53 Reviews
IN THIS STIRRING AND BEAUTIFULLY WRITTEN WAKE-UP CALL, psychiatrist Daniel Carlat exposes deeply disturbing problems plaguing his profession, revealing the ways it has abandoned its essential purpose: to understand the mind, so that psychiatrists can heal mental illness and not just treat symptoms. As he did in his hard-hitting and widely read New York Times Magazine artic ...more
ebook, 272 pages
Published May 18th 2010 by Free Press (first published April 28th 2010)
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Jul 30, 2013 rated it liked it  ·  review of another edition
I think that if I were not myself a psychiatrist, and privy to much of the information Dr. Carlat is, as well as having had similar experiences, I might have found this book more engaging. As it was, it felt like reading a guidebook to your hometown written by a another townie who is equally aware of the terrain, the locals, and the pros and cons of the place. There was little in this book I hadn't already contemplated myself. I do take issue with the idea that all psychiatrists are on the same ...more
Jul 01, 2011 marked it as to-read  ·  review of another edition
Excellent review of this and three other books dealing with the crisis in psychiatry in the NYRB

Part 1:

Part 2:
Doreen Petersen
Aug 04, 2017 rated it it was amazing  ·  review of another edition
Shelves: medical
To me this was by far one of the better books written on mental health from a psychiatrist's perspective. It helped you understand what is good as well as what is lacking in the mental health field. Well worth checking out!
Jul 13, 2010 rated it liked it  ·  review of another edition
Recommends it for: anyone recommending or using psychotropic medications
Recommended to Sandy by: Bill Lucht
Quick and informative read leaving me with a dilemma - how can I recommend to my son that he follow a career in psychiatry when the training lasts 12 years, 6 of which seem unnecessary and wasteful? And when the training is complete, psychotherapy is not a major part of the day because prescription writing is the only way to make a profitable living and pay for college loans! A conundrum.
Really enjoyed Carlat's simple explanation of transference and its usage in therapy, "The patient eventually
Terry Lynch
As books written by mainstream psychiatrists go, this is one one of the best and most honest that I have read. Daniel Carlat has had the courage to express his major concerns about psychiatry. He has also discussed what he sees as his own inadequacies, that arise as a consequence of psychiatry's limited training. He acknowledges that he does not practice psychotherapy because he "cannot", ie, he doesnt really know how. He admits telling patients that antidepressants correct chemical imbalances n ...more
Mar 29, 2014 rated it really liked it  ·  review of another edition
In the U.S., there is growing concern that doctors are overprescribing medicine as the answer for patients with mental health and behavior problems. Feelings of sadness, behaviors like restlessness, which were once seen as normal aspects of being a human being, are now diagnosed as health problems like depression or attention deficit hyperactivity disorder, the argument goes, and treated away with prescription drugs.

Psychiatrist Daniel Carlat does not necessarily endorse this, but he does offer
A mainstream psychiatrist, Carlat gives an inside view of the many problems and pitfalls in current psychiatry. He emphasizes that the causes of psychiatric conditions are not understood, that the "chemical imbalance" theory is unconfirmed, that no one understands why psychological drugs work at all or why they work for one patient and not another, and admits that the choice of which drug to prescribe is largely arbitrary. He also makes plain the tremendous and unwholesome influence of drug comp ...more
Jul 23, 2010 rated it really liked it  ·  review of another edition

I feel that I learned a great deal about psychiatry from reading this book. Why do psychiatrists only spend 20 minutes with each patient? Insurance reimbursement answers that question. More importantly, the book describes how psychiatry differs from other medical fields insofar as the biological causes of mental illness are not well understood. The author notes that finding the right prescription "cocktail" for any individual patient is really a trial and error process that is unfortunately infl
Emily Crow
Written by a practicing psychiatrist, Unhinged discusses many of the problems in that field, such as rampant marketing and deceptive information from drug companies, the limitations (and benefits) of the DSM, that few psychiatrists actually practice any form to talk therapy, etc. The book was well-written and engaging, and I liked the fact that the author isn't anti-medication (from his discussion, it sounds like he reaches for his prescription pad quite often), even when discussing what is prob ...more
Ok, so to be honest, I did not finish this book. I read a few chapters and it was written interestingly but I've heard these complaints about psychiatry before. I should have skipped ahead to the Solutions chapter before I returned it to the library but I hope it had some realistic ones. I get kind of annoyed when people point out the flaws in psychiatry without offering real solutions. It is a complicated field, trying to help people when we still have little knowledge of the source of mental i ...more
Jul 26, 2017 rated it liked it  ·  review of another edition
This book is one psychiatrist's perspective on the industry, how it developed, where it is now, and how to proceed. Apparently there is a huge emphasis by most psychiatrists on prescribing medication as opposed to any form of real psychotherapy. No surprise there, since there's a lot of financial incentive for them to do so.

The main takeaway I got from this book is that the therapy industry is a business, like any other. And people love money. Another takeaway is that most people who go to thera
David Teachout
Nov 24, 2016 rated it really liked it  ·  review of another edition
Shelves: kindle, psychology
I'm not a psychiatrist, but I am a therapist and involved in integrated care so psychotropics are rather common. I wasn't so much surprised by the information here as I was impressed with the honesty and lack of alarmist language. Rather than calling out the doom of an industry, there was thoughtful critique and recognition of layers being involved including a desire to help, personalities, politics and other social influences. The result is certainly not a resounding chorus of hallelujah, but a ...more
Author reviews fairly familiar critiques of psychiatry today (i.e. overuse of antidepressants, little research basis for same, etc). He ends with the conclusion that psychotherapy is underutilized which is a point I very much agree with.
Mar 25, 2011 marked it as abandoned  ·  review of another edition
I don't want or need to read a book about the wonders of talk therapy. In my considered opinion, the idea that listening to what people say will tell you anything about how their brain is working is just as strange as checking the color of someone's blood to see how their heart is working.
Aug 28, 2011 rated it it was amazing  ·  review of another edition
This book poked holes in everything I thought I knew about psychiatry and mental health medication. Everyone should read it.
Nov 14, 2017 rated it really liked it  ·  review of another edition
Reading this book has made me even more antagonistic toward legal prescription drugs than I already was!
Feb 06, 2012 rated it really liked it  ·  review of another edition
While short, this book gave a well thought out argument for changing the practice of psychiatry in America. Dr Carlat presents his opinions with research to back them and seems to strive to give the reader a balanced perspective when they are done with the book. There is very little demonizing of anyone in this, even the drug companies are given a fair shake and apportioned no more then what they are due.
This book contains a few ideas woven together. There are stories about his own practice and
At first, I found this book rather uneventful. I felt it could benefit from more voyeuristic drama and less rationality. Normally, I wouldn't say this about a book. It is appropriate for a nonfiction book to be rational. Voyeuristic drama can be misleading. Yet this information was redundant to me in the beginning. We all know that psychiatrists have begun to lean too heavily on psychopharmacology without paying enough attention anymore to therapy and other modalities. Also, in the beginning of ...more
Feb 24, 2013 rated it liked it  ·  review of another edition
Dr. Carlat is a brave man. He makes some bold calls in this book and offers suggestions for improving the troubled field of psychiatry that are sure to get blood boiling in some circles.

Psychiatrists should not have to weigh what's best for the patient against what's best for their own bottom line, he argues. But the reality is that they have to make this choice every day. Simply put, prescribing pills pays better than taking the time to really understand a patient's troubles. And from direct-t
Sep 05, 2015 rated it it was amazing
As someone who has written a good bit of health journalism in my career I'm aware of how easy it is for a health story to be influenced by bias, whether it be a well written PR piece that comes across your desk when you have a deadline looming (you may or may not be surprised to learn how many stories in newspapers and magazines are printed with huge chunks of text lifted verbatim from a given company's press release), or a study that promises an exciting health breakthrough and will make for a ...more
Bill Gray
Jun 16, 2014 rated it really liked it  ·  review of another edition
It may not be much of a reveal at this time, but this book spells out, in detail, the transition of psychiatry from the state in which psychiatrists were primarily therapists, the concept most of us have of psychiatrists, to its current state, in which psychiatrists see a huge number of patients, each of them very quickly, and each of them leaving the office with a prescription, and likely one from a company that just had a representative in the office,and who left the office a clock. This was n ...more
Nov 26, 2011 rated it it was ok  ·  review of another edition
Shelves: 2010-reads
Unhinged is the psychiatric version of Perkins' Confessions of an Economic Hitman, and reads just as smarmily self-congratulatory. Carlat's "exposé" of the industry will come as a surprise only to those currently being treated for a persistent belief in Santa Claus and the Easter Bunny - anyone else who's ever visited a doctor has already made the connection between the sight of an exiting drug rep and their physician's sudden insistence that there's a new "miracle cure" for what ails you. So, ...more
Real Supergirl
Feb 06, 2011 rated it it was amazing  ·  review of another edition
Recommends it for: Mental health professionals
This book should be required reading for any mental health professional - therapists, nurses, psychologists, psychiatrists. I discovered Dr. Carlat via his blog, and the book gives a thorough analysis of the mental halth field and how it has "gone astray" in his words. It has become corrupted by pharm companies and the medical world, and gotten away from its roots, which is about healing people. I appreciate Dr. Carlat's frank and honest account, including of his own experience being a "hired gu ...more
Jun 15, 2011 rated it it was amazing  ·  review of another edition
This is a book probably more geared towards people working in or interested in the mental health/social service/psychiatry field.

Overall I thought this was an extremely well written and insightful book. I must admit it did align with beliefs I already held but what I liked most about this book is Dr. Carlat wrote an honest account of the problems with psychiatry but also offered practical suggestions on ways to improve upon a broken system.

I would highly recommend this book but it may be borin
Mar 29, 2015 rated it really liked it  ·  review of another edition
This book is excellent if you want a behind-the-scenes approach to psychiatry and drug companies. By the end, you'll be trying your damndest to cut back or stop taking all your meds, thanks to the research or lack thereof of effective unbiased research that shows meds even work. Made me question my pills, my doctors, my pharmacist, my profession. Just the kind of book I like. Dr. Carlat is a genius and brave soul for speaking out against these billionaire companies to enlighten us with the dark ...more
Apr 27, 2010 marked it as to-read  ·  review of another edition
just want to note that this is about PSYCHIATRY, and not PSYCHOLOGY, which just emphasizes more and more why i want nothing to do with drugs in my professional career. (in that i don't want to prescribe them, i just want to do talk-behavior-therapy stuff.)

still interested to see, especially to see if i agree with anything (well, i already agree about the DSM), but stigmatizing medications is not a solution . . . and i hardly think bi-polar is being over-diagnosed. ADD/ADHD, sure, even autism, bu
Oct 14, 2010 rated it it was amazing  ·  review of another edition
This was an insightful and knowing book about some of the major problems with psychiatry as a profession. What I enjoyed about this book was not just reading what was wrong with the profession, though, but also anecdotes and scientific studies illustrating Carlat's points, as well as possible solutions to the problems laid out. This may not appeal to everyone, but as someone interested in medicine broadly and mental health in particular, I found this book informative and interesting.
Jun 09, 2012 rated it really liked it  ·  review of another edition
It had interesting points, fascinating bits of information, and useful anecdotes. While he clearly had an agenda, he wasn't heavy-handed about it... or if he was, his agenda was new to me and thus I didn't notice his heavy-handedness so much. An interesting companion piece to Crazy Like Us: The Globalization of the American Psyche.
James Hansen
Sep 04, 2014 rated it it was amazing  ·  review of another edition
Bold, unflinchingly honest appraisal of the current state of the psychiatric profession from a practicing psychiatrist. Although I did not agree with all of his conclusions, I greatly admired the author's willingness to write about the problems in the field, his professional mistakes, and his visions for the future of psychiatry. I highly recommend this book as a fascinating, critical insider's perspective on a profession in crisis.
Carol Peters
Makes me despair of corporations of anything. Such corruption. Such lies. Perhaps the ethical choice would be to ban marketing in all forms.

After reading this book, I wouldn't want to take any psychiatric drug for longer than a few days or weeks. Anything longer seems like committing one's brain to random gunshot wounds.
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