BOOK REVIEW / SCIENCE : An Insider's Look at Flaws of Psychiatry : THE MIND'S FATE: A Psychiatrist Looks at His Profession--Thirty Years of Writings by Robert Coles ; Little, Brown, & Co. $24.95, 448 pages


In his long and distinguished career, Robert Coles, the Harvard child psychiatrist, has written several well-regarded books and a prolific stream of scholarly papers and articles.

This book is a collection of his popular articles--book reviews, memoirs, essays and musings from publications like the New Yorker, the New England Journal of Medicine, the New Republic, Commonweal and the New York Review of Books, among others (some of which are not so easily accessible).

Coles is wise, thoughtful and soft-spoken. He has a keen eye for the many shortcomings and pitfalls of psychiatry and a great appreciation for the complexities and nuances of life.

All of this comes through in this collection of essays, but, like all collections, the presentation is not orderly or systematic. It's up to the reader to put it all together.

What we have here is a collection of snapshots of Coles' thinking on this and that, which is valuable to have as Coles has a lot to say.

He also has a lot of experience to draw on. For example, he hears a medical student extolling Prozac, this year's wonder drug, and observes, "She speaks of it the way, well, some of us 40 years ago spoke of psychoanalysis: as an answer to anyone's problem with anything."

Coles no longer thinks that about psychoanalysis and he has never thought that about Prozac.

In another essay he writes, "No drug will obliterate the vicissitudes of ordinary human relatedness--the ups and downs we all have with one another as we try to navigate our way from one shore (the early years of life) to another shore (the final moments of our particular spell of time on this planet)."

Face it, he acknowledges: Nothing much can be done.

Or, as Freud wrote, "We consider that we have succeeded when hysterical misery turns into ordinary unhappiness."

Coles speaks of psychiatry as "an exceedingly elusive mix of science and art." Not surprisingly, this is a recurring idea in these essays. It comes up in several different contexts across the spectrum of Coles' work.

But the format keeps it from being developed sufficiently in its own right. Here again, the reader must make the connections.

One of Coles' defining characteristics throughout his life has been his professional involvement in social and political issues. He has not retreated to the ivory tower but has brought child psychiatry to race and poverty.

These matters, too, are encompassed in this book. In a provocative essay written in 1990 for the Journal of Child and Adolescent Psychopharmacology, Coles draws conclusions from his long work with poor children.

Despite their material deprivation, he writes, they are no more unhappy than rich kids. "The pathology of childhood depression--and indeed other pathologies we physicians try to treat--are by no means epidemic among the poor, and may be just as common and conspicuous among the well-to-do who have so much and who want so much."

Coles has little use for many of his colleagues, whom he sees as narrow-minded and condescending, too quick to apply textbook labels and pseudo-diagnoses. In one book review, he extols R.D. Laing, the contrarian and controversial British psychiatrist who is something of a pariah for challenging the distinction between sanity and madness:

"Freud called himself a conquistador, and if the bookkeepers and bureaucrats have now descended upon the psychoanalytic 'movement' in droves to claim his mantle, all the more reason for a man like Laing to stand fast as the psychoanalyst he is," Coles writes.

"I am overpowered by the challenges he issues to what has become a rather conventional profession, very much the property of (and source of solace to) the upper-middle-class American, this century's civis Romanus . To Laing, we psychiatrists are something else, too: willing custodians, who for good pay agree to do the bidding of society by keeping tabs on various 'deviants,' and in the clutch 'taking care' of them--the double meaning of the verb being exactly to the point."

Coles calls Laing "a doctor, a writer, a human being trying to live enthusiastically and suffer honorably."

Let's hear it for Laing. And for Coles.

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