Just-so Therapy

The Mind Has Mountains

Reflections on Society and Psychiatry

Paul R. McHugh

The Johns Hopkins University Press, $25, 272 pp.

The Mind Has Mountains is a long and uneven feast of a book made up of seventeen essay-length courses. The author, Paul R. McHugh, is former director of psychiatry at the medical school of the Johns Hopkins University. As an appetizer, McHugh offers stories of psychiatric misadventure and therapy gone awry. The main course consists of essays related to the cultures of life and death, particularly as revealed in the cases of Dr. Jack Kevorkian and Terri Schiavo. Dessert includes reflections on the happy demise of Freudianism and other psychiatric mistakes, followed by a digressive but bracing aperitif on terrorism. Laced through these essays is McHugh’s mistrust of metaphor; and so, to conclude my own metaphor, I would say that while the fare McHugh offers is sometimes quite good indeed, the real appeal of the meal is its presentation: the author knows how to tell a story.

McHugh portrays contemporary psychiatry as dangerously enamored of metaphor and narrative at the expense of reason and empirical research. The results of this “cultural antinomianism” have hurt patients most of all: schizophrenics are considered to be living an “alternative lifestyle” and are released from the institutions that sought to help them; patients confused about their gender identity are not helped to understand and accept reality but are rather “mutilated” through sex-reassignment surgery. In McHugh’s opinion, all of these mistakes...

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About the Author

Mathew N. Schmalz is associate professor of religious studies at the College of the Holy Cross in Worcester, Massachusetts.