Luhrmann studied the two current branches in psychiatry and psychiatric training, the biomedical model and the psychodynamic model. She believes the split occurred in the late 1970s and early 1980s. The rise of managed health care in the 1990s began pushing talk therapy out of the picture and replacing it with a growing number of increasingly successful medications. After all, prescribing medications is easier and faster and cheaper than talk therapy. This shift, Luhrmann maintains, comes at considerable cost to consumers and their families.
Many psychiatrists use both medication and forms of talk therapy.
The latter is practiced widely by clinical psychologists, social workers, and counselors. But her book raises serious and worrisome questions about the separateness of the two approaches and the different methods of training, with little crossover, and the philosophical and ideological dispute that underlies the separateness. Neither talk therapy nor medication alone is the answer for most ill persons, and reduced services under managed care are threatening access to both. Luhrmann's final chapter addresses society's moral responsibility for providing suitable care for people with mental illnesses. NAMI members and friends should heed this advice.