We hear it all the time: Americans need to have a conversation about race. But as far as Anthony M. D’Agostino, M.D., can tell, these conversations usually just reinforce our existing attitudes and prejudices. Is it actually possible for white people to have fruitful conversations with each other about prejudice and race? His answer: a definite maybe.

In Prejudice, Racism, Tribalism: A Primer for White People, he offers a discussion of these beliefs and attitudes from the point of view of a prejudice-prone white person. He writes how these terms are similar and how they are different. Consider questions such as:

• Who are victims of racism and why should we care?
• Who benefits from tribal prejudices and why are they so enduring?
• How do our prejudices influence our social and political opinions?
• Just what is “white privilege” and why would I want to lose it?

The author also examines topics such as attitudes about immigration, language, and other prejudices of white people about religion, women, Hispanics, and politics.


(And Other Controversies in Psychiatry)

This book is a history of medicine and psychiatry over the last two centuries but with particular emphasis on economic changes in medicine in general and psychiatry in particular over the past 40 years.  The Alexian Brothers health systems and its 700 year history is used as a point of focus and illustration for changes which have occurred in all hospitals, medical and psychiatric, in the age of Managed Care. It is a history of the scientific and economic issues driving these changes.

I wrote this book for laymen interested in a concise history of medicine and psychiatry as well as for healthcare professionals generally.  My other motive is to raise the issue of “free market” incentives in medicine and stimulate concerns (I hope) about who has control when it comes to quality and cost. If the free market in medicine is best, why do Americans pay more for pharmaceuticals, for example, than any other nation on planet Earth? Isn’t the competition implied by a “free” market supposed to keep prices low?  Why don’t we see price competition in prescription drugs?

And what is the primary purpose of any health system or plan? One might reasonably assume that caring for the sick would be job one. If so, then why do health plans and politicians lobby ceaselessly to exclude sick people ( eg.,pre-existing conditions) from access to health insurance?

This book also examines psychiatry’s place as a medical specialty and the legitimacy of insurance coverage for psychiatric conditions.  This is less of an issue today than it was 40 or 50 years ago. “Obamacare” laws have mandated parity in coverage for psychiatric illnesses and addictive conditions with “medical” illnesses. This seems fair enough, so why then do so many Americans seem to want these laws repealed?

As the subtitle implies, The Alexian Brothers Behavioral Health Hospital’s existence itself is just one of many controversies in psychiatry. Is what we do legitimate medical treatment? I believe so and have practiced psychiatry most of my life under that assumption. But there are controversial practices and I try to address several of these in a way that makes sense for the general reader who has an interest in the mental health field. The word “curious” in the title refers to the dramatic rise of this single location community psychiatric hospital to the nation’s 7th largest psychiatric corporation at a time when most not-for-profit, as well as for-profit,  psychiatric hospitals were dramatically contracting or going out of business.

Although there is considerable overlap, the first six chapters are about medicine and psychiatry before the advent of health insurance. They trace the history of hospitals from their function as places where the poor went to die, to their evolution into repositories of high tech medical (and initially surgical) practice.  Chapters seven through fifteen are primarily about medicine and psychiatry after the rather dramatic expansion of employer based health insurance during the 1930’s, and during and after World War ll.  Chapter ten describes the major influence of psychoanalysis in American psychiatry and its effect in diminishing interest in brain function among American psychiatrists while increasing interest in the practice of psychotherapy by psychiatrists and other mental health professionals.

Chapters nine, eleven, and thirteen discuss why so much medical, surgical, and psychiatric care today is managed. Do doctors and hospitals have conflicts of interest? Do insurance companies have conflicts of interest? And what is all this talk about “Medicare For All?”

Anthony M. D’Agostino, MD


US Review

The Curious Case of the Alexian Brothers Behavioral Health Hospital: And Other Controversies in Psychiatry

by Anthony M. D’Agostino, MD

book review by Carol Anderson, D.Min., ACSW, LMSW

“The problem is that patients keep coming—all the more since there are now fewer options out there for them, public or private.”

An in-depth treatise regarding the history of psychiatry, the book traces the beginning of treatment starting with the history of religious influence. This includes the forward-thinking Alexian Brothers, which was a Catholic religious order that began 700-800 years ago in Europe. The work then takes us through the history of early hospitals, medical schools, surgery, medicine, psychiatric wards, the use of ECT (electroconvulsive therapy), and lobotomies as well as Freudian theory and psychoanalysis. Also explored are the value of psychiatric medicines, behavioral treatment, and the positives and negatives of health care, including managed care. This thorough analysis of 228 pages is then followed by an extensive list of references which adds to the professional depth of this work.

With his long-term work in psychiatry including work at the Alexian Brothers behavioral health hospitals, the author expertly delivers an important work regarding the history and current practices of psychiatry. The book is steeped in insight with its analytical focus and depth of information. While it switches back and forth regarding history, it flows in the presentation and is a fascinating read, especially for those in the field of mental health services, not just psychiatry.

The exploration of the negatives (including such horrors as lobotomies and the problems of managed care) and the positives (including the advancement of psychiatric medicines) is a balanced look at how medical practices including psychiatry have developed. Showing how the Alexian Brothers’ treatment model has kept them in business might be a business model for others. Finally, this book shows how things need to change in the future—something everyone must understand for psychiatry to continue to help those in need.

RECOMMENDED by the US Review

Title: IPS member publishes a book: “The Curious Case of the Alexian Brothers Behavioral Health Hospital and Other Controversies in Psychiatry”
Author: Lala Park, MD.

“The Curious Case of the Alexian Brothers Behavioral Health Hospital” is more than tales within the walls of the Alexian Brothers Hospital, where Dr. D’Agostino has practiced for 40 years. Rather, the Alexian Brothers Hospital, or how it survived the “power of managed care to influence all aspects of psychiatric care,” is used as a backdrop for a broader discussion about our broken healthcare delivery system.

Dr. D’Agostino challenges the idea of free market healthcare and advocates for a single payer system. He builds his arguments carefully yet unapologetically. He first shows that psychiatry is “definitely not a recent trend or a fad” by taking us through the history of psychiatry. We have been taking care of the mentally ill for hundreds of years. He demonstrates that the successes and failures in our field are legitimate attempts to understand and treat mental illnesses, by drawing similarities to the way advancements were made in cancer treatments or surgical knowledge. Then, we get an insider’s views on “the most interesting decades in the history of American psychiatry,” or the last 40 years, during which managed care has greatly affected and altered the way we practice psychiatry. It is important to note the various roles Dr. D’Agostino served during this time. Locally, he served as President of IPS and also on Insurance and Ethics committees. He was a hospital surveyor for the Hospital Licensing Division of IDPH. Nationally, he served as an Illinois delegate to the Assembly of the APA and also as Vice Chair of Managed Care Committee.

This book will motivate members to take a stand on our healthcare system — and, of course, it will be an interesting read for anyone with love for our profession and our patients.