Joanna Moncrieff – Rethinking the Drug Treatment of Psychosis

THE LETTER 55 & 56 Spring/Summer 2014, pages 13-25.

This talk challenges the current assumption that psychiatric drugs work by correcting an underlying ‘chemical imbalance,’ or any other brain-based abnormality. An alternative, ‘drug-centred’ model of drug action will be out-lined that proposes that psychiatric drugs induce altered mental and physical states, and that these states may sometimes be ‘therapeutic’ by helping to sup-press the manifestations of mental distress and disturbance. A drug-centred account of antipsychotic action will be presented that stresses the cognitive and emotional suppression produced by the drugs and how the desired and adverse effects of the drugs cannot be neatly distinguished. The impact of these effects on the symptoms of severe mental disorders will be discussed along with the practical and ethical implications of this sort of approach.

Keywords: anti-psychotics; disease-centred versus drug-centred model of action; adverse effects; long-term effects 


I would like to begin by thanking Patricia McCarthy for inviting me to speak at this conference. Part of my reason for attending is to hopefully learn some-thing about Lacan and the opportunity he provides in saying something new to psychiatrists about psychosis. I also wanted to add my agreement to the comments made by the last speaker, Cormac Gallagher with regard to allow-ing the patient tell his or her story. It is time not only to restore the patient’s story but to also put the history back into psychiatry.

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