Summary Of Of Two Minds By T. M. Luhrman

T.M. Luhrmann wrote “Of Two Minds: The Growing Disorder in American Psychiatry” as an anthropological study focusing on the psychiatric world of the United States. In it, she argues that the psychiatric field has split into “two minds” – biological and psychodynamic. Luhrmann compares two models of mental disorders, describing diagnosis and psychopharmacology psychiatry against a psychodynamic psychotherapy specialization. Matthew Ratcliffe’s article “Understanding Existential Changes in Psychiatric Illness” details the theory of existential phenomenology and how that idea contributes to the field of psychiatry. As a result, Luhrmann provides a comparison of the psychodynamic model and biomedical models of psychiatry, which are similar
to how Ratcliffe presents his views about phenomenology. According to Luhrmann, biomedical psychiatry treats mental illness as a bodily illness, one that could be comparable to other physical illnesses. On the contrary, psychodynamic psychoanalysis considers mental illness to be in the mind, analyzing emotional responses and reactions to stimuli and other people to consider its causes. Both of these approaches have their roots in the enduring Western belief in a division between the mind and the body. These psychiatrists are taught this division (though this is a false belief) and that both of these approaches exist for separate purposes although using them in combination works best. Luhrmann presents a differentiation between the terms “disease” and “illness,” insisting that a disease results from problems in the person’s body and illness refers to a person’s subjective experience. Once these words have been defined, she describes mental illness as “thing” that underlies and therefore generates the mental symptoms. Luhrmann presents both a medical model and a psychotherapy model, and describes how empathy and subjective experience are cultivated and defined in different ways as a result. In a biological model, psychiatrists treat mental illness with psychopharmacological drugs and the psychiatrist’s goal is not to entirely understand how these drugs work but rather just to know how to use them. These psychiatric medications treat symptoms rather than diseases and do not reach underlying mechanisms of mental illness. Luhrmann discusses how neurotransmitter systems are involved in psychiatric illness, especially the serotonin, dopamine, and norepinephrine systems, but there is no longer an agreement amongst psychiatrists about which systems affect what illnesses or that these pathways are the major cause of distress. In a biological model, diagnosis and medicine work together to treat a patient in an objective, inpatient environment and since diagnosis is subjective due to there being no real, objective criteria and also because a patient being admitted may be unorganized and unwilling to give details about his illness, the psychiatrist needs to develop a sense of intuition about these situations. In an outpatient situation, dealing with psychodynamic psychotherapy involves a patient attending counseling sessions anywhere between five times a week to once a month, and these sessions are guided by psychoanalytic thinking.
The psychotherapist does not give advice or counsel their patient, instead having them talk about their problems to infer what is troubling the patient. The psychiatrist learns how to become more conscious of the way they empathize and interact with their patients better as a result. The center of psychotherapy is emotion, and to access a patient’s emotion one must talk to them and get to know their behaviors and
desires. For both of these approaches, what one learns to do affects the way they see their patients. For the biomedically minded psychiatrists the focus is put on learning to memorize patterns and how to use them by thinking in terms of the disease and how to see these patterns quickly. For the psychodynamically minded psychiatrists focus is on emotions and there is no clear difference between health and illness and a good psychiatrist will understand why their life has become difficult. Each psychiatrist constructs a person out of the patient. Matthew Ratcliffe on the other hand, argues that phenomenology provides the background for what makes up psychological and personal realities and therefore is the backbone of mental disorders.
Phenomenology focuses on the structures of conscious experience and how the subjective experience of reality informs the psychological and personal understanding of a given person’s daily life. Ratcliffe’s “Understanding Existential Changes in Psychiatric Illness” informs the reader about phenomenology and why it is indispensible as a form of mental interpretation. Phenomenology does not try to provide casual information about existence, but does try to characterize existence by intentional directedness within the world. This theory, in line with most humans, is more concerned with existential
meaning. Ratcliffe focuses on existential changes in depression as a way of backing his theory about the importance of phenomenology. He rationalizes this by describing depression as a series of existential changes that when compared against a presupposed and preconditioned reality one cannot understand. Because depression alters a person’s sense of being in the world, this indicates the kinds of experiential changes that underlie the theory of phenomenology. For the purpose of his argument, depression involves existential changes that are closely associated or even inseparable. The article goes on to discuss phenomenology in relation to neuroscience. Ratcliffe describes at least some of neuroscience as being phenomenological in nature and therefore one cannot understand neurobiology without understanding phenomenology. Based on phenomenology, one can show that a changed biological bodily feeling is the result of an altered experience, showing that