The Mind Has Mountains: Reflections on Society and Psychiatry

This is a fantastic book that explores the depths that modern psychiatry has only recently rebounded from, and is in danger of relapsing into. McHugh is a fairly balanced thinker, and pretty well-informed. The article on sex reassignment surgery is an absolute gem that challenges psychiatry to look its dogma in the face. Occasionally, there is a tendency to be extremely conservative. The Terry Schiavo comparison to the Nazi's extermination is a bit hyperbolic, although his point that there was no fMRI, PET, or even conventional MRI to _scientifically_ enlighten the debate is a very good one. The slippery slope argument is valid, but I think focusing of the right to keep alive by tube-feeding is going to distract from more clear-cut issues. Finally, McHugh outlines where the future of psychiatry might lead and how we have to make crucial decisions at this point in history to keep the art in accordance with truly Hippocratic principles. In short, every psychiatrist should read it, but I am sad to say there are many who won't because they lack the capacity to be self-critical.

In 1909, during a lecture at Clark University, Dr. Sigmund Freud, the founder of psychoanalysis, who was educated to be a neurologist, told his audience in Massachusetts that he was pleased and satisfied that psychoanalysis would only accompany medical doctors for a short distance but then "take leave of them." Just how far this distance would grow and how unfortunate the consequences of the separation between psychoanalysis and scientific medicine would be for our culture, and indeed all of society, is one of the topics in this new, five-part book, "The Mind Has Mountains." The author, Dr. Paul McHugh, former chair of the department of psychiatry at Johns Hopkins Medical School, has put together a collection of his scholarly articles. Harold Bloom in his column, "Why Freud Matters," (Wall Street Journal, May 5, 2006) advised us that despite the fact that no one today believes that psychoanalysis is a science, it cannot be gainsaid that "Freud ... was the equal of the other major writers of his era, James Joyce, Marcel Proust and Franz Kafka." Freudianism, along with its creative and imaginative platonic-like constructs (id, ego, libido, etc.) continues to impact society. A reader of "The Mind Has Mountains" will have a balanced, erudite critique of Freud's continuing influence. Unlike the work of Freud and his progeny, Dr. McHugh's "Reflections" are based not on personal opinions or unproven theses, but are the fruit of years of painstaking, empirically verified research coupled with the vast clinical experience of the author and his colleagues at Johns Hopkins and other major university hospitals. The book is not narrowly limited to psychoanalysis, but treats the whole range of issues which psychiatry faces today. From Part I, "Beginnings," until the last chapters in Part V, "The Ethical Use of Embryonic Stem Cells" and "A Psychiatrist Looks at Terrorism," the book covers a breadth of subject matter in engaging language that is accessible to the layman.

This book should be required reading in all the "helping professions." Dr. McHugh takes on the "acceptable thought" of psychiatry and, in my opinion, gives it a beating. His moral beliefs are strong, and he outlines and defends them well on difficult topics like Jack Kevorkian and Terri Schiavo. I thought very differently until I read him; he has managed to cause me to have second thoughts, which is not an easy thing to do. His concern for the patient shines through everything he writes, and he writes brilliantly. He can be overbearing and arrogant in spots, but it is actually refreshing to hear someone in this field with the courage to put his clear convictions out there for the rest of us.

There is so little written regarding psychiatry for the lay audience that makes much sense or is of serious value. While I am not necessarily one to toe the line with regard to Dr. McHugh's hard-line Catholicism, I will say that he is spot-on in lambasting the bad and standing up for the good within psychiatry and our very society, all in this compact little book. This is as indispensable as Strunk and White for all psychiatrists, psychologists, teachers, social workers, parents, singles, and patients. If you've ever wanted to drug children for being children or go to therapy over being dumped by a perpetual adolescent or alter oathes that have lasted millenia simply to please administrators, then there is an essay in here for you. Whether one agrees with him or not, Dr. McHugh's voice is too clarion to ignore.

This book comprises of a selection of powerful essays that address comtempory controversies in psychiatry. Paul McHugh's ideas and understanding make for facinating and thought provoking reading. I have seldom seen such brave and independent thinking in this field of study. In an age where reality offends and professors are dulling themselves to the university "group think", this work will be an intellectual milestone within the neglected field of psychiatric ethics. Richard Howlin, Ph.D. Clinical Developmental Psychologist