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The European Journal of Psychiatry

versión impresa ISSN 0213-6163

Eur. J. Psychiat. vol.21 no.2 Zaragoza abr./jun. 2007




The mind has mountains. Edited by Paul R McHugh, Johns Hopkins University Press, 249 pages, 2006

Antonio Campayo M.D.

Instituto Aragonés de Ciencias de la Salud. Hospital Clínico Universitario



It is a honour to write a comment on this book from one of our most distinguished Editorial Committee members in the European Journal of Psychiatry. The book assembles in five chapters a collection of 23 essays eloquently written by Professor McHugh for different psychiatric and medical journals, but also for publications such as The American Scholar or The Weekly Standard. He demonstrates again why he is one of the most thought-provoking figures in the international, psychiatric world. It is fascinating to read interesting stories accumulated from years of clinical and teaching experience, and to see his courage and compromise to bring to public light critical experience, and to see his courage and compromise to bring to public light critical views in controversial issues such as the "recovered memory syndrome", sexual reassignment, multiple personality disorder or "Vietnam-specific post traumatic stress syndrome". As some reviewer has commented, "the pleasure provided by these essays is heightened by the brilliant light they cast on the true nature of psychiatry and on those mountains of the mind... he never stops struggling to fathom and to climb".

Essays such as Psychiatric Misadventures, Psychotherapy Awry, How Psychiatry Lost Its Way or Dissociative Identity Disorder is a Socially Constructed Artifact will be classical in the field. And the views of a relevant psychiatrist in heated issues approached in essays such as Annihilating Terry Schiavo or A Psychiatris Looks at Terrorism will no doubt stimulate professional and popular discussion about the goals and methods of current psychiatric practice. The essays "...were in one way or another prompted by disbelief in many claims and opinions expressed by psychiatrists and psychologist of my generation"... "Each of these essays tried to challenge or amend some egregious thought or practice in psychiatry"... "Psychiatrists made claims that were not true, pressed for attitudes and behaviours that were destructive, and held beliefs about human mental life that were incredible. All these ideas were both transmitted to and reciprocally evoked by a civilization already confused about matters of truth and morals..." These comments from the author himself are self explanatory. His opinions are strong and often controversial, and no one who reads this book will remain unaffected by the clarity and depth of his thinking. As R. Michaels has expressed, Professor McHugh: "has one of the finest minds, and sharpest tongues, in American psychiatry"... "I have never had so much fun while being educated, or so much education while having fun".

Dr. McHugh argues in the preface that two themes are implicit in all of the essays in the book. First, his "instinctive antipathy" toward the "Gnostic" presumptions or assumptions that psychiatrists know deep secrets of the mind. This is the antipathy of somebody who for this reason rebelled very early against some teachers he found, as a medical student at Harvard; who sent those early years to the Maudsley Hospital in London, to get some classical, European training with sir Aubrey Lewis; who, in relation to this, introduced to a great extent the jasperian thinking in his country, as it is apparent in his Foreword to Jasper's General Psychopathology, incorporated to the book; and who has been a pioneer of "empirical psychiatry" in the USA, or of what is now called "evidence based psychiatry".

The second theme implicit in the essays relates to "another element of contemporary psychiatry giving root support to misdirections": the psychotherapists' "natural tendency to give themselves over to the softer virtues of kindness, and soothing support ("often saluted as non-judgemental") at the expense of the sterner virtues of truth, responsibility, and justice". Dr. McHugh argues that eventually this "may lead to the detriment of the patient and the public' attitude toward the discipline itself".

These views are connected with his position in the already influential book "The Perspective of Psychiatry"(*), written with Phillip Slavney and summarized in the essay A Structure for Psychiatry at the Century's turn: the View from Johns Hopkins. The "Perspective", a blueprint for his teaching and research, try to be "both a means of circumventing the mind-brain problem in making sense of mental disorder and a means of transcending-indeed resolving-the long standing factionalism disrupting the discipline..." He argues for a realistic appraisal of just what psychiatrists know and how they know it. The aim now is to indicate how such knowledge "can be best used not only for better patient care but also to reflect on and influence public issues and social movements".

Dr. McHugh has been described as iconoclastic, but he is both idealistic and deeply informed. His students have considered him a psychiatrist with clear and incisive thinking; intense compromise with the highest clinical standards; and extraordinary ability as a teacher. He has been one of the most important influences on generations of psychiatric researchers and clinicians. The essays collected in this book, as well as the "Perspectives", give credit to these opinions, and will no doubt be part of his legacy. But we should also expect new, crucial contributions from his expertise, his energy and his compromise with both, science and society.

*PR McHugh and PR Slavney: The Perspectives of Psychiatry, second edition. Johns Hopkins University Press: Baltimore, 1998.

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