Skip to main content Accessibility help
×
Home
Hostname: page-component-79b67bcb76-c5xhk Total loading time: 0.477 Render date: 2021-05-13T22:22:02.703Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": false, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true }

The Bitterest Pills: The Troubling Story of Antipsychotic Drugs By Joanna Moncrieff. Palgrave Macmillan. 2013. £19.99 (pb). 296 pp. ISBN: 9781137277435

Published online by Cambridge University Press:  02 January 2018

Duncan Double
Affiliation:
Norfolk and Suffolk NHS Foundation Trust, Victoria House, 28 Alexandra Road, Lowestoft NR32 1PL, UK. Email: dbdouble@dbdouble.co.uk
Corresponding
E-mail address:
Rights & Permissions[Opens in a new window]

Abstract

Type
Columns
Copyright
Copyright © Royal College of Psychiatrists, 2014 

This is an important book. You might think I would say that as a member of the Critical Psychiatry Network, like the author, Joanna Moncrieff, senior clinical lecturer at University College London. However, I do think her critique has a sound academic grounding and engages with public concerns about antipsychotic medication.

The book describes the extent to which the prescription of antipsychotics is marketing-based rather than evidence-based. Chlorpromazine, of course, was the first drug seen as having a specific role in the treatment of mental illness. Moncrieff, instead, emphasises the non-specific nature of antipsychotic effects, which she frames by promoting a drug-centred rather than disease-centred model of their action. Nonetheless, she says that antipsychotics can ‘help individuals gain relief from intense and intrusive psychotic experiences or destructive emotional states’ (p. 18). By this she means more than their placebo effect and believes they can be of value as emotional suppressants. I would encourage you not to dismiss her approach as unbalanced. Despite what may seem like niggling overstatement at some points, she does present a genuine argument, with which I think it is important to engage.

She describes the wish-fulfilling nature of the dopamine theory of schizophrenia. She also makes a stronger case than even I was aware of for ventricular enlargement in schizophrenia being a drug-induced phenomenon. Historically, as she points out, there has been denial in psychiatry about traditional antipsychotics causing tardive dyskinesia and atypical antipsychotics producing the metabolic syndrome. Her summary critique of the early intervention approach also seems to me to be one of the best available.

I am sure this book will be too sceptical for most psychiatrists. It may seem to undermine psychiatry’s cultural system. Personally, I think psychiatry needs to face up to the truth about the psychopharmacological revolution, rather than continuing to rely on its aura of factuality. Even the past editor of this Journal Professor Peter Tyrer agrees Reference Tyrer1 we should call an end to the post-chlorpromazine era. I hope Jo’s book makes a significant contribution to this debate.

References

1 Tyrer, P. From the Editor’s desk. Br J Psychiatry 2012; 201: 168.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.
You have Access

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

The Bitterest Pills: The Troubling Story of Antipsychotic Drugs By Joanna Moncrieff. Palgrave Macmillan. 2013. £19.99 (pb). 296 pp. ISBN: 9781137277435
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

The Bitterest Pills: The Troubling Story of Antipsychotic Drugs By Joanna Moncrieff. Palgrave Macmillan. 2013. £19.99 (pb). 296 pp. ISBN: 9781137277435
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

The Bitterest Pills: The Troubling Story of Antipsychotic Drugs By Joanna Moncrieff. Palgrave Macmillan. 2013. £19.99 (pb). 296 pp. ISBN: 9781137277435
Available formats
×
×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *