This discussion of the philosophical issues around psychiatric drugs is inspired by rising rates of their use and by claims that they may be able to enhance intelligence, social performance and general well-being. The author seeks to explore when the use of psychiatric drugs is justified and when it might not be. He provides a sweeping overview of philosophy and psychiatry, raising many fundamental questions about the nature of psychiatric disorders and how we should study them.
Stein sets out two contrasting positions. One is the classical approach, which regards psychiatric disorders as unproblematic categories that can be understood and studied in the same way as physical phenomena, like medical diseases. The opposing ‘critical’ position holds that psychiatric disorders are social constructions that reflect the values of the societies that create them. Stein then attempts to outline a middle way which he calls the ‘integrative’ position, one that reflects the findings of ‘cognitive–affective’ science. However, this middle position is never clearly differentiated from the classical position and the term cognitive–affective is used in many different and confusing ways.
Stein also makes a number of assumptions about the nature of psychiatric drug treatment that need to be questioned. He accepts at face value the idea that psychiatric drugs are ‘effective’, without ever interrogating what that statement might mean. He suggests that modern psychiatric drugs work in a specific way, by acting on the ‘neuronal circuitry’ that gives rise to particular symptoms. However, he never seriously considers alternative explanations, such as the view that psychiatric drugs create altered mental states that may suppress the symptoms of mental disorders in a non-specific way. It is therefore difficult to agree with his premise that drug treatment of disorders like depression and social anxiety disorder is generally desirable.
The fictional cases presented throughout the book reproduce and reinforce the notion that psychiatric drugs can reverse pathological processes. There is no consideration of the harmful effects associated with psychiatric drugs, the trade-off between benefits and harms and the social impact of drug use. The analysis of the moral principles that might guide the use of psychiatric drugs veers off into a discussion about the neuronal basis of moral judgement.
A deeper analysis of the nature of psychiatric drugs might have challenged the assumption of benefit that is embedded in current views on psychiatric treatment, and provided a more thought-provoking discussion of the moral implications of drug treatment.
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