Psychiatry and the Human Condition: Joanna Moncrieff, MD

This interview (conducted by Dr. Awais Aftab) with psychiatrist Joanna Moncrieff is part of a series called “Conversations in Critical Psychiatry“, as published in the Psychiatric Times.

Here is an extract:

Aftab: Models of drug action have been an important focus of your work, in particular, the distinction between disease centered model and drug centered model. In the disease centered model, drugs help correct an abnormal brain state and the therapeutic effects of drugs are derived from their effects on an underlying disease process. In the drug centered model, drugs are psychoactive agents that create an abnormal brain state, and therapeutic effects are derived from the impact of drug-induced state on behavioral and emotional problems. Can you elaborate for us how ignoring this has distorted our understanding of the treatment of psychiatric conditions and has biased our assessments of risks and benefits?

Moncrieff: Assuming that drugs work by acting on the underlying biological mechanisms of mental symptoms (the disease-centered model) has obscured the fact that the drugs we use in psychiatry are psychoactive drugs-that is, drugs that change the brain in ways we do not fully understand and by doing so produce more or less subtle alterations to normal mental experiences and behavior-what I have called the “drug-centered” model of drug action. Because we have ignored the fact that psychiatric drugs are psychoactive substances, we have not bothered to properly research or even describe the physical and mental physical alterations they produce and all the short and long-term consequences of these. Therefore, we are not making fully informed assessments of the benefits and harms of drug treatment, and because we assume we are rectifying an underlying abnormality, we tend to over-estimate the benefits of treatment and understate its harms.

So although I think there are some situations in which some drugs can be useful (antipsychotics in acute psychosis, benzodiazepines in acute agitation, for example), this has led, in my view, to a situation in which millions of people world-wide are taking drugs that are doing them little or no good, but are causing them harm-both harm that we know about and harm that we have not properly researched yet …”

You can read the whole interview from here.

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