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Ο μύθος της χημικής ίασης: Μια κριτική της ψυχιατρικής φαρμακοθεραπείας
Από τη δεκαετία του '60, ζούμε σε μια εποχή που χαρακτηρίζεται από την αντίληψη ότι τα φάρμακα μπορούν να θεραπεύσουν τα προβλήματα που στις μέρες μας αποκαλούνται "ψυχικές ασθένειες"· προβλήματα που στο παρελθόν ήταν γνωστά με όρους όπως παραφροσύνη, τρέλα, παράνοια και νεύρωση. Με τη λέξη "ίαση" εννοώ την αντίληψη ότι τα φάρμακα μπορούν να βελτιώσουν τα συμπτώματα βοηθώντας να διορθωθεί ο υποκείμενος παθολογικός μηχανισμός που εικάζεται ότι τα προκαλεί. Αυτός ο τρόπος σκέψης εξαπλώνεται, όλο και περισσότερο, και εκτός της ψυχιατρικής και τα φάρμακα έχουν φτάσει να θεωρούνται ότι έχουν θεραπευτικό ρόλο σε όλες τις καταστάσεις όπου οι άνθρωποι νιώθουν ότι δεν είναι αποδοτικοί ή δεν λειτουργούν τόσο καλά όσο θα έπρεπε. Τέτοιες καταστάσεις "διαγιγνώσκονται" ως κατάθλιψη, δυσθυμία, άγχος, κοινωνική φοβία, κατάχρηση ουσιών, ψυχαναγκαστική διαταραχή αγορών, προεμμηνορροϊκό σύνδρομο κ.τ.λ., και συνταγογραφούνται φάρμακα για την αντιμετώπισή τους. Η ιστορία για το πώς φτάσαμε να βλέπουμε τα φάρμακα με αυτόν τον τρόπο, δηλαδή ως ειδικές αγωγές για ειδικές ψυχικές διαταραχές (ή συλλογές συμπτωμάτων), και το ερώτημα του αν αυτός ο τρόπος σκέψης είναι σωστός ή δικαιολογημένος, αποτελεί το αντικείμενο αυτού του βιβλίου.
474 pages, Paperback
First published December 4, 2007
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Displaying 1 - 16 of 16 reviews
August 20, 2020
Antipsychotics for psychosis (plus a few other things), antidepressants for depression (plus a few other things), and mood-stabilisers for bipolar disorder. Neat, right?
According to psychiatrist Joanna Moncrieff, not only is there no sufficient evidence for the efficacy and specificity of each of these drug classes or their nomenclature, but their conception itself was, far from being scientific, a form of an ideology born out of interests held by psychiatric professionals, big pharma, and the state; the ideology of the disease-centred model of psychiatric drug action. Despite their being hailed as the liberators of asylums and specific treatments for psychiatric disorders, Moncrieff places them as chemical extensions of the now obsolete physical "treatments", including lobotomy, insulin coma therapy, and radical surgeries in terms of their evidential foundations.
The book's main proposition is that it's unwarranted, if not outright fraudulent, to view and publicize psychiatric drugs as acting in a disease-specific manner. Instead, drug actions should be viewed from a drug-centred model, meaning to view them as psychoactive substances which result in an abnormal/altered mental state which might be beneficial in the short-term in some cases, but long-term use is very rarely justifiable if ever.
In addition to providing the (at times disturbing) history of the psychiatric field and of each drug class, the book deconstructs the evidential basis of the main classes of psychiatric drugs published until 2007, illustrating what the author deems as fatal methodological flaws which, if were accounted for, would undermine the drugs' efficacy and specificity in the treatment of and prophylaxis against psychiatric disorders. Those flaws include the discontinuation effect of drugs, and the unblinding of both patients and experimenters in placebo-controlled trials (leading to enhanced placebo effect in the drug group and a corresponding reduced placebo effect in the placebo group). The author also briefly dips into philosophical discussions, such as Foucault's Power-Knowledge dynamic and its role in psychiatry, which I found interesting. It ends with a description of how psychiatric practice would look like if a drug-centred model was adopted instead of the current disease-centred practice.
This book was published 13 years ago, but it's hard to declare it as 'out-dated' since virtually all the drugs used currently were introduced in the 20th century. Nevertheless, I reserve judgement on how much progress has been made in the 'disease-centred model' of psychiatric drug action until I have a better look at today's literature. It's worth pointing out that at least one of the current main psychiatry text books (Kaplan and Sadock's Synopsis of Psychiatry) lists psychiatric drugs according to their mechanism of action instead of the psychiatric disorder they treat, which Moncrieff would be pleased to know.
I look forward to seeing the results of Moncrieff's ongoing RADAR study examining the benefit of long-term antipsychotics use.
According to psychiatrist Joanna Moncrieff, not only is there no sufficient evidence for the efficacy and specificity of each of these drug classes or their nomenclature, but their conception itself was, far from being scientific, a form of an ideology born out of interests held by psychiatric professionals, big pharma, and the state; the ideology of the disease-centred model of psychiatric drug action. Despite their being hailed as the liberators of asylums and specific treatments for psychiatric disorders, Moncrieff places them as chemical extensions of the now obsolete physical "treatments", including lobotomy, insulin coma therapy, and radical surgeries in terms of their evidential foundations.
The book's main proposition is that it's unwarranted, if not outright fraudulent, to view and publicize psychiatric drugs as acting in a disease-specific manner. Instead, drug actions should be viewed from a drug-centred model, meaning to view them as psychoactive substances which result in an abnormal/altered mental state which might be beneficial in the short-term in some cases, but long-term use is very rarely justifiable if ever.
In addition to providing the (at times disturbing) history of the psychiatric field and of each drug class, the book deconstructs the evidential basis of the main classes of psychiatric drugs published until 2007, illustrating what the author deems as fatal methodological flaws which, if were accounted for, would undermine the drugs' efficacy and specificity in the treatment of and prophylaxis against psychiatric disorders. Those flaws include the discontinuation effect of drugs, and the unblinding of both patients and experimenters in placebo-controlled trials (leading to enhanced placebo effect in the drug group and a corresponding reduced placebo effect in the placebo group). The author also briefly dips into philosophical discussions, such as Foucault's Power-Knowledge dynamic and its role in psychiatry, which I found interesting. It ends with a description of how psychiatric practice would look like if a drug-centred model was adopted instead of the current disease-centred practice.
This book was published 13 years ago, but it's hard to declare it as 'out-dated' since virtually all the drugs used currently were introduced in the 20th century. Nevertheless, I reserve judgement on how much progress has been made in the 'disease-centred model' of psychiatric drug action until I have a better look at today's literature. It's worth pointing out that at least one of the current main psychiatry text books (Kaplan and Sadock's Synopsis of Psychiatry) lists psychiatric drugs according to their mechanism of action instead of the psychiatric disorder they treat, which Moncrieff would be pleased to know.
I look forward to seeing the results of Moncrieff's ongoing RADAR study examining the benefit of long-term antipsychotics use.
August 5, 2024
This book is a convincing de-bunking of psychiatric drugs in the tradition of Foucault, Szasz, Laing, and others from the old “anti-psychiatry movement.” While Moncrieff does not doubt that severe mental disorders exist and people really suffer from them, she very seriously doubts that “anti-psychotic” or “neuroleptic” drugs treat those disorders.
The best that anti-psychotic drugs do is sedate the patient so severely that the person is less of a problem to the community. While that may be useful to the patient and their society, it comes at heavy cost, including weight gain, cognitive impairment, muscle spasms, reduced functioning, and permanent brain damage. All these findings are well-documented and referenced by Moncrieff.
Modern (and even the older) psychiatric drugs are essentially chemical strait-jackets. They do not act on specific “diseases” of the brain. There are no such diseases, she says. Big Pharma and Big Psychiatry have implicitly colluded to sell the idea of “brain disorders” and “chemical imbalances." But there’s no clear evidence that they exist.
If all psychiatric drugs do is sedate the person, why not use a plain sedative and skip the extremely dangerous or totally ineffective anti-psychotics? It’s a very good question, and leads to her proposed way forward. Let patients (and their representatives) be fully informed of the effects of various drugs and let them “choose their poison.”
A sedative might be enough if you’re extremely agitated. If you’re mainly depressed, a simple stimulant might help. Then look to psychotherapy –not as a “cure” because you don’t have a “disease” –but as a way to understand what is happening to you.
A fine sentiment, though wholly impractical, especially in America, where pursuit of money triumphs over all other considerations. This is one of the better, more concise, and well-documented books of this nature I’ve read, but I can’t say it contains much “new news.” The sad fact is, we don’t have much of a clue about the causes of mental illness and even less so about treatment.
I'm a bit skeptical of Moncrieff's one-sided review of the literature. She does present research contrary to her thesis but always with the note that it was funded by the pharmaceutical industry. That's a very fair caution, but still, we can associate certain brain structures and functions with certain mental effects, and certain drugs with certain brain areas and processes. She paints over those details with too broad a brush.
At a high level of abstraction for "disease" and "cure," Moncrieff is surely correct and her cautions are fully warranted. But I would not be so quick to repudiate all so-called psychiatric drugs just because they are marketed for a non-existent "disease." Her suggestion to look instead at what the drugs biologically accomplish seems more fruitful but she spends 95% of this book attacking the "disease model" and very little on alternatives.
Moncrieff, Joanna (2008). The Myth of the Chemical Cure. New York. Palgrave/Macmillan, 272 pp.
The best that anti-psychotic drugs do is sedate the patient so severely that the person is less of a problem to the community. While that may be useful to the patient and their society, it comes at heavy cost, including weight gain, cognitive impairment, muscle spasms, reduced functioning, and permanent brain damage. All these findings are well-documented and referenced by Moncrieff.
Modern (and even the older) psychiatric drugs are essentially chemical strait-jackets. They do not act on specific “diseases” of the brain. There are no such diseases, she says. Big Pharma and Big Psychiatry have implicitly colluded to sell the idea of “brain disorders” and “chemical imbalances." But there’s no clear evidence that they exist.
If all psychiatric drugs do is sedate the person, why not use a plain sedative and skip the extremely dangerous or totally ineffective anti-psychotics? It’s a very good question, and leads to her proposed way forward. Let patients (and their representatives) be fully informed of the effects of various drugs and let them “choose their poison.”
A sedative might be enough if you’re extremely agitated. If you’re mainly depressed, a simple stimulant might help. Then look to psychotherapy –not as a “cure” because you don’t have a “disease” –but as a way to understand what is happening to you.
A fine sentiment, though wholly impractical, especially in America, where pursuit of money triumphs over all other considerations. This is one of the better, more concise, and well-documented books of this nature I’ve read, but I can’t say it contains much “new news.” The sad fact is, we don’t have much of a clue about the causes of mental illness and even less so about treatment.
I'm a bit skeptical of Moncrieff's one-sided review of the literature. She does present research contrary to her thesis but always with the note that it was funded by the pharmaceutical industry. That's a very fair caution, but still, we can associate certain brain structures and functions with certain mental effects, and certain drugs with certain brain areas and processes. She paints over those details with too broad a brush.
At a high level of abstraction for "disease" and "cure," Moncrieff is surely correct and her cautions are fully warranted. But I would not be so quick to repudiate all so-called psychiatric drugs just because they are marketed for a non-existent "disease." Her suggestion to look instead at what the drugs biologically accomplish seems more fruitful but she spends 95% of this book attacking the "disease model" and very little on alternatives.
Moncrieff, Joanna (2008). The Myth of the Chemical Cure. New York. Palgrave/Macmillan, 272 pp.
February 14, 2014
An incredible read. Moncrieff's premise (reminiscent of Thomas Szasz) is that a disease-centered model of drug action has been adopted and widely publicized, not because the evidence for it is compelling, but because it helps to promote the interests of certain powerful social groups, namely the psychiatric profession, the pharmaceutical industry and the modern state.
As a consequence, we have become a society of "neurochemical selves", where millions of people worldwide are convinced they need to take psychiatric drugs to be normal.
She systematically presents research data to support this claim for the three major types of psychoactive drugs: neuroleptics (anti-psychotics), antidepressants and mood stabilizers. In her concluding chapter, she sums up the conclusions of her efforts tellingly:
The data surveyed in this book suggest that psychiatric drug treatment is currently administered on the basis of a huge collective myth; the myth that psychiatric drugs act by correcting the biological basis of psychiatric symptoms or diseases. We have seen that for the three main classes of drugs used in psychiatry there is no evidence to substantiate this view. Instead, the evidence suggests that these drugs induce characteristic abnormal states that can account for their so-called therapeutic effects. (217)
As a consequence, we have become a society of "neurochemical selves", where millions of people worldwide are convinced they need to take psychiatric drugs to be normal.
April 25, 2012
This book concerns the creation of a myth, the myth of the disease-centered model of drug action (the current standard view of psychotropic drug action, in other words it is the idea in psychiatry that drugs are thought to act on the underlying physical disease process.), and how that myth could be accepted as a real description of the world. It therefore involves questions about the nature of knowledge and the relation between knowledge and power. The main thesis is that the disease-centered model of drug action has been adopted, not because the evidence for it is compelling, but because it helped to promote the interests of certain powerful social groups, namely the psychiatric profession, the pharmaceutical industry and the modern state.
This book contrasts the disease-centered model with a more accurate drug-centered model which suggests that the drugs themselves create abnormal body states.
If there is anyone you love who has been prescribed drugs for depression, anxiety, or any other mood disorder you will want to read this book. No, you must read this book.
This book contrasts the disease-centered model with a more accurate drug-centered model which suggests that the drugs themselves create abnormal body states.
If there is anyone you love who has been prescribed drugs for depression, anxiety, or any other mood disorder you will want to read this book. No, you must read this book.
May 9, 2014
This is another must read on the myth of mental illness. I think Moncrieff makes a good argument that psychopharmacology only suppresses symptoms in a crude form and does not affect any of the mechanisms that give rise to symptoms. A must read for anyone in the mental heath field. These books are paradigm shifters!
Want to read
November 16, 2010refreshingly different take, well researched, goes into depth about many things that have been bothering me about our system. Like most of the more advanced thinking the author hails from Great Britain.
Not finished yet, will come back to.
Not finished yet, will come back to.
July 11, 2024
Joanna Moncrieff’s "The Myth of the Chemical Cure" is a thought-provoking critique that challenges prevailing notions about psychiatric drug treatments. In this meticulously researched book, Moncrieff, an addiction psychiatrist argues against the widespread belief that psychiatric drugs target specific brain abnormalities to cure mental disorders. Instead, she contends that these medications primarily induce alterations in mental states and behaviors, often without addressing the root causes of psychological distress.
One of the book’s strengths lies in its thorough exploration of the historical and cultural contexts that have shaped the rise of psychiatric medication. Moncrieff traces the evolution of psychopharmacology and questions the validity of the disease-centered model of mental illness that heavily relies on drug interventions. She advocates for a more nuanced understanding of psychiatric drugs, emphasizing their potential role in managing symptoms rather than curing underlying conditions.
Throughout the text, Moncrieff challenges both professionals and the general public to critically examine the evidence supporting psychiatric drug efficacy. She highlights the limitations of clinical trials and argues that the benefits of these medications may be overstated while their long-term risks and adverse effects are often downplayed.
"The Myth of the Chemical Cure" is not merely a critique; it also offers alternative perspectives on mental health treatment. Moncrieff, drawing on her expertise as an addiction psychiatrist, encourages a broader consideration of psychosocial approaches, such as therapy and community support, which she argues can be as effective or more effective than pharmacological interventions alone.
While some readers may find Moncrieff’s arguments controversial, her book serves as an essential contribution to the ongoing dialogue about the appropriate use of psychiatric medications. It challenges the dominance of the biomedical model in psychiatry and advocates for a more holistic approach to mental health care.
One of the book’s strengths lies in its thorough exploration of the historical and cultural contexts that have shaped the rise of psychiatric medication. Moncrieff traces the evolution of psychopharmacology and questions the validity of the disease-centered model of mental illness that heavily relies on drug interventions. She advocates for a more nuanced understanding of psychiatric drugs, emphasizing their potential role in managing symptoms rather than curing underlying conditions.
Throughout the text, Moncrieff challenges both professionals and the general public to critically examine the evidence supporting psychiatric drug efficacy. She highlights the limitations of clinical trials and argues that the benefits of these medications may be overstated while their long-term risks and adverse effects are often downplayed.
"The Myth of the Chemical Cure" is not merely a critique; it also offers alternative perspectives on mental health treatment. Moncrieff, drawing on her expertise as an addiction psychiatrist, encourages a broader consideration of psychosocial approaches, such as therapy and community support, which she argues can be as effective or more effective than pharmacological interventions alone.
While some readers may find Moncrieff’s arguments controversial, her book serves as an essential contribution to the ongoing dialogue about the appropriate use of psychiatric medications. It challenges the dominance of the biomedical model in psychiatry and advocates for a more holistic approach to mental health care.
March 11, 2025
Psikiyatri alanında önüne geçilemeyen ilaçla tedavi furyasına güzel bir eleştiri metni. Joanna Moncrieff bu kitabında şu anda dünyada sadece ruhsal bozuklukların ilaç temelli biyolojik bir rahatsızlık olarak algılanmasına karşı çıkıyor. Bunu yaparken ilaçla tedavinin aslında ne kadar tutarsız sonuçlar verdiğini yapılan çalışmalarla gösteriyor. Ve ruhsal bozuklukların, ilaç şirketlerinin ya da bu alanda çalışanların anlattıkları gibi çok büyük oranda ilaçla tedavi konusunda bir başarı sağlanmadığı yönünde. Örnek verilen çalışmaların çoğunda ilacın etkisinin Plasebo etkisinden çoğu zaman çok az farkla daha etkili olduğu gösteriliyor. Ama ilaç şirketleri daima bunu bize "mucize ilaç" gibi sunuyor. üstüne üstlük yapılan çalışmaların çoğu ilaç şirketlerinin finansal desteği ile yapılıyor. Bu da hem bağımsızlığı hem de çokça şikayet edilen yan etkilerin göz ardı edilmesine neden oluyor. Yazar bunun halka yeteri kadar dürüst bir şekilde açıklanmadığını belirtiyor. Aslına bakarsanız bu ilaçlarla ilgili yeteri kadar faydalı olduğuna dair çalışma bulabileceğiniz gibi, tam tersi çalışma da bulursunuz. Literatür bu konuda çok tutarlı ilerlemiyor. Burada karar verilmesi gereken hangi şartlalar altında bu ilaçların gerçekten hastaların faydasına olacak şekilde yazılması gerektiği ve bunu psikoterapiyle ne kadar desteklediğiniz. Yani iş yine gelip meslek etiğine dayanıyor. Bu konuda DSM-5 dair eleştirileri göz ardı etmemek lazım. Tanı ölçütlerinin her geçen gün genişletilmesi ve bunu hazırlayan kurulun ilaç şirketleri ile olan bağları gittikçe daha çok sorgulanıyor. Ben hala ilaç kullanımını desteklesem de bu tarz eleştiri kitaplarının olmasının ruh sağlığı alanına fayda getireceğini düşünüyorum.
March 28, 2025
Before reading this I recommend reading A Straight Talking Introduction to Psychiatric Drugs also by Joanna Mocrieff, the latest edition as of writing is the 2nd edition. Should you choose to come of psychiatric drugs, please do so with the guidance of a psychiatrist. I highly reccomend this for those considering or are on medication for depression or bipolar (manic depression).
January 17, 2021
Not the most up to date book on medicine in , but psychiatry has changed very much in the past ten years. This is an essential and readable critique for anyone who’s been prescribed psychiatric medication.
February 2, 2018
Some interesting points
July 19, 2019
She makes some good points. I find these sweeping denunciations of psychiatric drugs unpersuasive.
October 15, 2023
Ruh sağlığı alanında çalışan herkese tavsiye ediyorum
August 3, 2024
Yazarın fikirlerine katılmakla beraber yazılmasının üstünden 15 sene geçtiğini ve birçok yeni araştırma olduğunu görmezden gelecek hastaların kitaptan yarardan ziyade zarar göreceği kanısındayım.
October 22, 2025
SHOULD THE "DISEASE MODEL" OF MENTAL ILLNESS BE ABANDONED?
Joanna Moncrieff is Senior Lecturer in the Department of Mental Health Sciences at University College London, and is co-founder of the Critical Psychiatry Network. She has also written books such as 'The Bitterest Pills: The Troubling Story of Antipsychotic Drugs,' 'Straight Talking Introduction to Psychiatric Drugs,' 'De-Medicalizing Misery: Psychiatry, Psychology and the Human Condition,' etc.
She wrote in the first chapter of this 2009 book, "Since the 1960s we have lived in an age characterized by the idea that drugs can cure the problems that are now referred to as 'mental illness'... By 'cure' I mean the idea that drugs can improve symptoms by helping to rectify the underlying pathological mechanism that is presumed to give rise to the symptoms in the first place... The story by which drugs first came to be seen in this way, as specific treatments for specific mental disorders ... and whether or not this way of thinking about drugs and their actions is justified, are the subjects of this book." (Pg. 1)
She adds, "Over the following pages I hope to convince readers that the modern understanding of what drugs do in psychiatry ... is fatally flawed; that most knowledge about psychiatric drugs is, at best, only a partial account. This is because it ... has been inspired and promoted by professional, commercial and political interests. This misconception has led to the misdirection of research, the misinterpretation of available evidence and the obstruction of a fuller and more accurate understanding of what psychiatric drugs do." (Pg. 2)
She argues, "The disease-centered model has been imported from general medicine, where... most drug action can be appropriately understood in this way." (Pg. 7) She says, "This book concerns the creation of a myth, the myth of the disease-centered model of drug action, and how that myth could be accepted as a real description of the world." (Pg. 11) She adds, "I will... attempt to uncover the interests that led to the development and success of the disease-centered model of drug action and its accompanying model of psychic distress... I will outline an alternative 'drug-centered' approach that is consistent with a wide range of evidence, yields more information about what effects drugs have in different situations and forms a better basis from which to weigh the pros and cons of drug treatment." (Pg. 13)
She points out, "A further problem with modern clinical drug trials is that people are usually dropped from the study once they relapse or if they stop the study drug for any reason. Therefore, there is no information about the ultimate outcome of these participants... In addition, we know that positive studies are more likely to be published than negative ones... and within published studies measures that show positive effects are reported and negative ones sometimes ignored ... Therefore, published data is likely to be inaccurately skewed towards showing beneficial effects of treatment." (Pg. 20-21)
She concludes, "The data surveyed in this book suggest that psychiatric drug treatment is currently administered on the basis of a huge collective myth; the myth that psychiatric drugs act by correcting the biological basis of psychiatric symptoms or diseases... the evidence suggests that these drugs induce characteristic abnormal states that can account for their so-called therapeutic effects." (Pg. 237)
She adds, "this book demonstrates the eagerness of the psychiatric profession to embrace the myth of disease-specific treatments. This is understandable, given the profession's long-standing battle to align itself squarely as a branch of the medical profession... From the beginning of the 20th century psychiatry sought to relocate its practice in general hospitals and outpatient departments. Drug treatments, if they could be presented as acting on a disease process, were well suited to this new environment... The psychiatric profession was supported in its aims by a State that was seeking technical solutions for various social problems. Psychiatry offered the possibility of transforming the complex political problem of how to manage psychiatric disturbance into a medical and technical issue... the ability to remove difficult issues of social control from the political arena was appealing... The new drugs... helped justify both the turn towards community care and the development of more medicalized legislation." (Pg. 243)
This critique will be "must reading" for anyone studying the modern role of psychopharmacology---whether or not one always agrees with Moncrieff.
Joanna Moncrieff is Senior Lecturer in the Department of Mental Health Sciences at University College London, and is co-founder of the Critical Psychiatry Network. She has also written books such as 'The Bitterest Pills: The Troubling Story of Antipsychotic Drugs,' 'Straight Talking Introduction to Psychiatric Drugs,' 'De-Medicalizing Misery: Psychiatry, Psychology and the Human Condition,' etc.
She wrote in the first chapter of this 2009 book, "Since the 1960s we have lived in an age characterized by the idea that drugs can cure the problems that are now referred to as 'mental illness'... By 'cure' I mean the idea that drugs can improve symptoms by helping to rectify the underlying pathological mechanism that is presumed to give rise to the symptoms in the first place... The story by which drugs first came to be seen in this way, as specific treatments for specific mental disorders ... and whether or not this way of thinking about drugs and their actions is justified, are the subjects of this book." (Pg. 1)
She adds, "Over the following pages I hope to convince readers that the modern understanding of what drugs do in psychiatry ... is fatally flawed; that most knowledge about psychiatric drugs is, at best, only a partial account. This is because it ... has been inspired and promoted by professional, commercial and political interests. This misconception has led to the misdirection of research, the misinterpretation of available evidence and the obstruction of a fuller and more accurate understanding of what psychiatric drugs do." (Pg. 2)
She argues, "The disease-centered model has been imported from general medicine, where... most drug action can be appropriately understood in this way." (Pg. 7) She says, "This book concerns the creation of a myth, the myth of the disease-centered model of drug action, and how that myth could be accepted as a real description of the world." (Pg. 11) She adds, "I will... attempt to uncover the interests that led to the development and success of the disease-centered model of drug action and its accompanying model of psychic distress... I will outline an alternative 'drug-centered' approach that is consistent with a wide range of evidence, yields more information about what effects drugs have in different situations and forms a better basis from which to weigh the pros and cons of drug treatment." (Pg. 13)
She points out, "A further problem with modern clinical drug trials is that people are usually dropped from the study once they relapse or if they stop the study drug for any reason. Therefore, there is no information about the ultimate outcome of these participants... In addition, we know that positive studies are more likely to be published than negative ones... and within published studies measures that show positive effects are reported and negative ones sometimes ignored ... Therefore, published data is likely to be inaccurately skewed towards showing beneficial effects of treatment." (Pg. 20-21)
She concludes, "The data surveyed in this book suggest that psychiatric drug treatment is currently administered on the basis of a huge collective myth; the myth that psychiatric drugs act by correcting the biological basis of psychiatric symptoms or diseases... the evidence suggests that these drugs induce characteristic abnormal states that can account for their so-called therapeutic effects." (Pg. 237)
She adds, "this book demonstrates the eagerness of the psychiatric profession to embrace the myth of disease-specific treatments. This is understandable, given the profession's long-standing battle to align itself squarely as a branch of the medical profession... From the beginning of the 20th century psychiatry sought to relocate its practice in general hospitals and outpatient departments. Drug treatments, if they could be presented as acting on a disease process, were well suited to this new environment... The psychiatric profession was supported in its aims by a State that was seeking technical solutions for various social problems. Psychiatry offered the possibility of transforming the complex political problem of how to manage psychiatric disturbance into a medical and technical issue... the ability to remove difficult issues of social control from the political arena was appealing... The new drugs... helped justify both the turn towards community care and the development of more medicalized legislation." (Pg. 243)
This critique will be "must reading" for anyone studying the modern role of psychopharmacology---whether or not one always agrees with Moncrieff.
April 18, 2025
After reading A Straight Talking Introduction to Psychiatric Drugs, I wanted to revisit the models of drug action, of which her alternative drug-centered model is the cornerstone of the arguments in this text and the primary reason to engage with it. This critical lens is just as relevant today as at the time of publication and can be a helpful tool in evaluating new and existing psychiatric drug research.
Moncrieff’s style is concise and unwavering in its conclusions, which are clearly organized and cited heavily. There is also brief critique of the randomized control trial within this model, on the grounds of potential unblinding, lack of information on ultimate outcomes, and issues relating to discontinuation/withdrawal effects. When introducing historical developments in the disease-centered model she often lets the details of these developments speak for themselves first before following with a review of the evidence and then application of the model for each drug: neuroleptics/antipsychotics, antidepressants, and lithium. In my opinion, this approach allows for stronger rebuttals and a satisfying conclusion that ties in history and research alongside philosophical insights.
Moncrieff’s style is concise and unwavering in its conclusions, which are clearly organized and cited heavily. There is also brief critique of the randomized control trial within this model, on the grounds of potential unblinding, lack of information on ultimate outcomes, and issues relating to discontinuation/withdrawal effects. When introducing historical developments in the disease-centered model she often lets the details of these developments speak for themselves first before following with a review of the evidence and then application of the model for each drug: neuroleptics/antipsychotics, antidepressants, and lithium. In my opinion, this approach allows for stronger rebuttals and a satisfying conclusion that ties in history and research alongside philosophical insights.
Displaying 1 - 16 of 16 reviews