PLoS Reviews Joanna Moncrieff’s “The Bitterest Pills”

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Seena Fazel from the University of Oxford Department of Psychiatry reviews The Bitterest Pills: The Troubling Story of Antipsychotic Drugs by Joanna Moncrieff for the Public Library of Science.

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5 COMMENTS

  1. The reviewer’s bias prevents her from objectively assessing the book. The fact that the author takes “unusual” positions in counted AGAINST her. The reviewer writes:”Elsewhere, Moncrieff writes that the view that antipsychotics act by correcting an underlying disease ‘kept the genie of social control firmly inside the psychiatric lantern…. [and] made the practice of forced drugging respectable’ (page 143). This is an extreme view.” An extreme view? There is no reason to describe it as extreme. Evidently Fazel means it is a view few psychiatrists would take, and of which most would disagree.But why should that count against the view? Or make it “extreme.” There was a time when denouncing lobotomies would have been considered extreme. Einstein’s theory of special relativity was an extreme view. Fazel’s bias toward the status quo shows that she egregiously misunderstands the nature of scientific progress–or stasis– and the role of scientific revolutions.Evidently she never carefully read Thomas Kuhn’s seminal book which vitiates her own epistemological conservatism.

    She writes, “Clearly, psychiatry has occasionally been abused but psychiatrists have also been instrumental in challenging such abuses.” When? Where? Here is the US I can think of no instance in which psychiatrists have challenged such abuse. Even in the era of the lobotomy those who opposed the procedure have –according to Elliot Valenstein’s authoritative account—-with “amazing unanimity” “failed to give public utterance to their opposition.” On the other hand to call the systematic abuse of psychiatry “occasional” is bizarrely euphemistic. As Peter Breggin has shown the main treatments for “schizophrenia” in the 20th century have entailed assaults on the brain—from insulin coma therapy to lobotomies to neuroleptics. There is nothing occasional about that. And that does not even take into account the application of such procedures–the coercion and disinformation.

    “To suggest that ‘social control’ has ‘always’ been at its ‘heart’ would be a surprise to most psychiatrists” Yes it was a surprise to most slaveowners in America when the abolitionists argued they were violating the rights and dignity of men, but that does not mean the latter were wrong–most oppressors think they are acting benevolently. These psychiatrists “one would reasonably think…” Why would one RESASONABLY think that their motives were altruistic? What does reasonableness have to do with anything? If one looks at the introduction of neuroleptics into state hospitals in the US over and over psychiatrists stressed that it made ward management easier. The evidence indicates that social control WAS their primary motive–even if it is “reasonable” to think they “are mostly motivated by treating illness and reducing distress.” Today the evidence suggests they are mostly indicated in pleasing the drug companies. The problem is that most people think what is “reasonable” rather than what is true. “Other examples of unusual statements include that the dopamine hypothesis of schizophrenia is ‘pseudoscience’ (p. 74), and that the medications are ‘evil’ (p. 169).” The reviewer’s bias toward the status quo and her prejudice against unusual views make her unsuited to review Moncrieff’s book.
    Seth Farber, Ph.D.
    http://www.sethHfarber.com

  2. Seena Fazel’s comments about quite “quite eccentric” positions of Moncrieff:

    “On the penultimate page, she states that the current model of understanding antipsychotic action (‘the disease-centered model’ in which antipsychotics act to correct the underlying dopamine dysfunction) ‘has played a major part in the obfuscation of the social control function that has always been embedded at the heart of psychiatry’ (page 219). Elsewhere, Moncrieff writes that the view that antipsychotics act by correcting an underlying disease ‘kept the genie of social control firmly inside the psychiatric lantern…. [and] made the practice of forced drugging respectable’ (page 143). This is an extreme view. Clearly, psychiatry has occasionally been abused but psychiatrists have also been instrumental in challenging such abuses. To suggest that ‘social control’ has ‘always’ been at its ‘heart’ would be a surprise to most psychiatrists who one would reasonably think are mostly motivated by treating illness and reducing distress.”

    Seena’s kind of showing that Moncrieff is at least partly right when she talks about disease vs drug model. “Psychiatrists are motivated by treating illness and reducing distress.” It’s clear for anyone with a clear mind who has studied the history of psychiatry that part of it has always been about social and behaviour control. Whitaker’s books include some good history, one of my personal favourites is Chorover’s From Genesis to Genocide: The Meaning of Human Nature and the Power of Behavior Control. I think not only the current drugs and the previous tools of psychiatry (insulin shocks, lobotomy, ect, etc, lol) have been so clearly used for social control, psychiatry has also a myriad of other more subtle techniques of social control, including things such as diagnosis, lies about “inborn inferiority” such as genetic disease, biological determinism, etc. Social control has indeed always been at psychiatry’s heart. Maybe it’s a good thing the news finally got to Seena too.

    “Books for the defence need to be written that focus on key problems for patients and public health – underfunded and overstretched psychiatric services in high income countries, and the continued scarcity of such services in low and middle income countries. Even in America, the three largest institutions that treat psychiatric patients are jails, many of whom according to recent surveys by the Department of Justice are subject to appallingly high rates of sexual abuse. Books like Moncrieff’s that only target the drugs and their manufacturers miss the mark.”

    This book by Moncrieff was primarily about neuroleptics. Seena’s also worried about the scarcity of psychiatric service in low and middle income countries, but look at the WHO studies Whitaker mentioned – do they really need more psychiatrists who treat them with SSRI’s, Seroquel and Abilify?

  3. ” do they really need more psychiatrists” No, more healers, psychologists, real psychotherapists (not the fake bio-med supporting ones) etc.


    Imagine there were no psychiatrists
    It’s easy if you try
    No hell below us
    Above us only sky

    Imagine all the people
    Living for today

    Imagine all the people
    Living life in peace

    You, you may say I’m a dreamer
    But I’m not the only one
    I hope someday you will join us
    And the world will be as one

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