This book suggests a diagnosis for the ailing condition of American psychiatry. In the early part of the 20th century, the author argues, psychoanalysis ruled the psychiatric world, but its reign was challenged by the rise of the neurosciences. There ensued a bitter conflict, in which the opposing camps eventually settled into what an American clinician has called a ‘happy pluralism’. However, with the recent emergence of ‘managed care’, insurance companies have been able to dictate the nature of the treatment given to patients. They have favoured pharmacology over psychotherapy, because it seems cheaper and more like the rest of medicine. As a result, the psycho-dynamic approach is being excluded and may become extinct. These trends have serious implications. Trainee psychiatrists no longer possess the skills to communicate with patients. Those with mental illnesses feel that they are not being understood, and the imperatives of managed care mean that patients are being discharged from hospital long before they have recovered. Clinicians are being forced to confront the moral dilemma of whether to prescribe treatment they consider inappropriate. Finally, the adoption by the general public of a vulgarised neurobiological model of mind has led to a simplistic view of humanity which ignores meaning and complexity.

T. M. Luhrmann is an anthropologist and, in reaching her diagnosis, she has spent several years observing and inter-viewing psychiatrists in a variety of clinical settings. She has paid particular attention to psychiatrists in training, and records their attempts to master the often confusing and contradictory nature of clinical practice. We learn that trainees who take their work too seriously are considered a liability and that young clinicians read little in the way of psychiatric theory. We also learn that research is seen as superior to mere clinical work and that psychotherapy is considered an unsuitable job for a man.

Luhrmann views with alarm the disappearance of the art of listening, and repeatedly advocates the nostrum that it takes both pills and talk to make a patient better. Like many millennial commentators, she calls for a reconciliation between the opposing forces of neuroscience and psychotherapy — between what Eisenberg (Reference Eisenberg2000) has called ‘mindless’ and ‘brainless’ psychiatry. There have, of course, been other perspectives on contemporary American psychiatry. A bleak account is provided by Samuel Shem's (Reference Shem1999) satirical novel,Mount Misery, which trainees in Luhrmann's book recommend as a true picture of their experience. A more upbeat assessment is given by Nancy Andreasen (Reference Andreasen2001) in a recent editorial, although she too worries that the ability to talk to the patient is diminishing as the emphasis on symptom checklists increases.

Rather curiously, given that the writer is not a psychiatrist, the book lacks critical distance and frequently takes psychiatry at its own estimation. Perhaps this is to be expected, because the author is not only the daughter of a psychiatrist but has also been in therapy. A much more searching anthropological account of psychiatry is to be found in Barrett's (Reference Barrett1996) The Psychiatric Team, in which he questions the ‘taken-for-granted’ assumptions of clinicians. Luhrmann is hindered by a verbose and repetitive prose style, and readers who do not share her enthusiasm for Freud or Christianity may have reservations about her conclusions. Despite this, and despite its concentration on the American experience, many of the concerns of the book are of fundamental importance to British psychiatry. It is, therefore, well worth reading.