OK, it took me a while to get around to this 1990s bestseller. And one wonders how relevant portions of the text are, given the major changes over the past decade in the types of psychoactive medications available and especially in the way they're prescribed.
Certainly, the book's central question about the mutability of personality, particularly via chemical adjustment, no longer seems all that compelling or questionable. Of course the personality is malleable, though use of any number of tools. In the case of Phineas Gage, it was an iron rod through the skull that turned him into someone else. Nowadays, a prescription allows for more precision in personality-sculpting. Morality doesn't really seem like a valid concern as much as efficacy -- does it help the individual?
What was more interesting to me in this idea-dense tome was the notion -- and one that largely remains true through the present day, I think -- that psychiatric diagnosis is largely a matter of reverse engineering. You have a drug that relieves symptoms of a certain condition. If the patient responds to the drug, he probably has that condition. If not, look for something else.
Seems like a remarkably crude way to diagnose anything. Imagine if any other part of medicine worked that way. The opthamologist does a little slicing, you can see better afterward, so you must have had a cataract. A surgeon removes your appendix, your abdominal pain fails to subside, so he has to dig around for something else.
How long will it be before a doctor can take a blood draw, make a precise analysis of the person's neurochemical soup and prescribe accordingly?
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