email page print pageAll Topic Reviews
Anger and Forgiveness"Are You There Alone?"10 Good Questions about Life and DeathA Casebook of Ethical Challenges in NeuropsychologyA Companion to BioethicsA Companion to BioethicsA Companion to GenethicsA Companion to GenethicsA Companion to Muslim EthicsA Cooperative SpeciesA Critique of the Moral Defense of VegetarianismA Delicate BalanceA Fragile LifeA Life for a LifeA Life-Centered Approach to BioethicsA Matter of SecurityA Natural History of Human MoralityA Philosophical DiseaseA Practical Guide to Clinical Ethics ConsultingA Question of TrustA Sentimentalist Theory of the MindA Short Stay in SwitzerlandA Tapestry of ValuesA Very Bad WizardA World Without ValuesAction and ResponsibilityAction Theory, Rationality and CompulsionActs of ConscienceAddiction and ResponsibilityAddiction NeuroethicsAdvance Directives in Mental HealthAfter HarmAftermathAgainst AutonomyAgainst BioethicsAgainst HealthAgainst MarriageAgainst Moral ResponsibilityAgency and AnswerabilityAgency and ResponsibilityAgency, Freedom, and Moral ResponsibilityAging, Biotechnology, and the FutureAlbert Schweitzer's Reverence for LifeAlphavilleAltruismAltruismAmerican EugenicsAmerican PsychosisAn American SicknessAn Anthology of Psychiatric EthicsAn Introduction to EthicsAn Introduction to Evolutionary EthicsAn Introduction to Kant's Moral Philosophy And a Time to DieAnimal LessonsAnimal RightsAnimals Like UsApplied Ethics in Mental Health CareAre Women Human?Aristotle on Practical WisdomAristotle's Ethics and Moral ResponsibilityAssisted Suicide and the Right to DieAutonomyAutonomy and the Challenges to LiberalismAutonomy, Consent and the LawBabies by DesignBackslidingBad PharmaBad SoulsBarriers and BelongingBasic Desert, Reactive Attitudes and Free WillBeauty JunkiesBefore ForgivingBeing AmoralBeing YourselfBending Over BackwardsBending ScienceBernard WilliamsBetter Humans?Better Than WellBeyond ChoiceBeyond GeneticsBeyond HatredBeyond Humanity?Beyond LossBeyond LossBeyond Moral JudgmentBeyond SpeechBeyond the DSM StoryBias in Psychiatric DiagnosisBioethicsBioethicsBioethics and the BrainBioethics at the MoviesBioethics Beyond the HeadlinesBioethics Critically ReconsideredBioethics in a Liberal SocietyBioethics in the ClinicBiomedical EthicsBiomedical EthicsBiomedical EthicsBiomedical EthicsBiomedical Research and BeyondBiosBioscience EthicsBipolar ChildrenBluebirdBodies out of BoundsBodies, Commodities, and BiotechnologiesBody BazaarBoundBoundaries and Boundary Violations in PsychoanalysisBraintrustBrandedBreaking the SilenceBuffy the Vampire Slayer and PhilosophyCapital PunishmentCase Studies in Biomedical Research EthicsChallenging the Stigma of Mental IllnessCharacter and Moral Psychology Character as Moral FictionChild Well-BeingChildrenChildren's RightsChoosing ChildrenChoosing Not to ChooseClinical Dilemmas in PsychotherapyClinical EthicsCloningClose toYouCoercion as CureCoercive Treatment in PsychiatryCognition of Value in Aristotle's EthicsCognitive Disability and Its Challenge to Moral Philosophy Comfortably NumbCommonsense RebellionCommunicative Action and Rational ChoiceCompetence, Condemnation, and CommitmentComprehending CareConducting Insanity EvaluationsConfidential RelationshipsConfidentiality and Mental HealthConflict of Interest in the ProfessionsConsuming KidsContemporary Debates In Applied EthicsContemporary Debates in Moral TheoryContemporary Debates in Social PhilosophyContentious IssuesContesting PsychiatryCrazy in AmericaCreating CapabilitiesCreatures Like Us?Crime and CulpabilityCrime, Punishment, and Mental IllnessCritical Perspectives in Public HealthCritical PsychiatryCrueltyCultural Assessment in Clinical PsychiatryCurrent Controversies in BioethicsCurrent Controversies in Values and ScienceCutting to the CoreCyborg CitizenDamaged IdentitiesDeaf Identities in the MakingDeath Is That Man Taking NamesDebating ProcreationDebating Same-Sex MarriageDecision Making, Personhood and DementiaDecoding the Ethics CodeDefining DifferenceDefining Right and Wrong in Brain ScienceDefining the Beginning and End of LifeDelusions of GenderDementiaDemocracy in What State?Demons of the Modern WorldDescriptions and PrescriptionsDesert and VirtueDesire, Practical Reason, and the GoodDestructive Trends in Mental HealthDeveloping the VirtuesDid My Neurons Make Me Do It?Difference and IdentityDigital HemlockDigital SoulDignityDisability BioethicsDisability, Difference, DiscriminationDisordered Personalities and CrimeDisorders of VolitionDisorientation and Moral LifeDivided Minds and Successive SelvesDoes Feminism Discriminate against Men?Does Torture Work?Double Standards in Medical Research in Developing CountriesDrugs and JusticeDworkin and His CriticsDying in the Twenty-First CenturyEarly WarningEconomics and Youth ViolenceEmbodied RhetoricsEmerging Conceptual, Ethical and Policy Issues in BionanotechnologyEmotional ReasonEmotions in the Moral LifeEmotions in the Moral LifeEmpathyEmpathy and Moral DevelopmentEmpathy and MoralityEmpirical Ethics in PsychiatryEncountering NatureEncountering the Sacred in PsychotherapyEngendering International HealthEnhancing EvolutionEnhancing Human CapacitiesEnoughEros and the GoodErotic InnocenceErotic MoralityEssays on Derek Parfit's On What MattersEssays on Free Will and Moral ResponsibilityEthical Choices in Contemporary MedicineEthical Conflicts in PsychologyEthical Dilemmas in PediatricsEthical Issues in Behavioral ResearchEthical Issues in Dementia CareEthical Issues in Forensic Mental Health ResearchEthical Issues in the New GeneticsEthical LifeEthical Reasoning for Mental Health ProfessionalsEthical TheoryEthical WillsEthically Challenged ProfessionsEthicsEthicsEthicsEthics and AnimalsEthics and ScienceEthics and the A PrioriEthics and the Discovery of the UnconsciousEthics and the Metaphysics of MedicineEthics at the CinemaEthics at the End of LifeEthics Case Book of the American Psychoanalytic AssociationEthics Done RightEthics ExpertiseEthics for EveryoneEthics for PsychologistsEthics for the New MillenniumEthics in CyberspaceEthics in Health CareEthics In Health Services ManagementEthics in Mental Health ResearchEthics in PracticeEthics in PsychiatryEthics in PsychologyEthics in Psychotherapy and CounselingEthics of PsychiatryEthics without OntologyEthics, Culture, and PsychiatryEthics, Sexual Orientation, and Choices about ChildrenEvaluating the Science and Ethics of Research on HumansEvilEvil GenesEvil in Modern ThoughtEvil in Modern ThoughtEvolution, Gender, and RapeEvolutionary Ethics and Contemporary BiologyEvolutionary Psychology and ViolenceEvolved MoralityExperiments in EthicsExploding the Gene MythExploiting ChildhoodFacing Human SufferingFact and ValueFacts and ValuesFaking ItFalse-Memory Creation in Children and AdultsFat ShameFatal FreedomFellow-Feeling and the Moral LifeFeminism and Its DiscontentsFeminist Ethics and Social and Political PhilosophyFeminist TheoryFinal ExamFirst Do No HarmFirst, Do No HarmFlashpointFlesh WoundsForced to CareForgivenessForgivenessForgiveness and LoveForgiveness and ReconciliationForgiveness and RetributionFoucault and the Government of DisabilityFoundational Issues in Human Brain MappingFoundations of Forensic Mental Health AssessmentFree WillFree Will And Moral ResponsibilityFree Will and Reactive AttitudesFree Will, Agency, and Meaning in LifeFree?Freedom and ValueFreedom vs. InterventionFriendshipFrom Darwin to HitlerFrom Disgust to HumanityFrom Enlightenment to ReceptivityFrom Morality to Mental HealthFrom Silence to VoiceFrom Valuing to ValueFrontiers of JusticeGender in the MirrorGenetic PoliticsGenetic ProspectsGenetic ProspectsGenetics of Original SinGenetics of Original SinGenocide's AftermathGetting RealGluttonyGood WorkGoodness & AdviceGreedGroups in ConflictGrowing Up GirlGut FeminismHabilitation, Health, and AgencyHandbook for Health Care Ethics CommitteesHandbook of BioethicsHandbook of Children's RightsHandbook of PsychopathyHappinessHappiness and the Good LifeHappiness Is OverratedHard FeelingsHard LuckHardwired BehaviorHarmful ThoughtsHeal & ForgiveHealing PsychiatryHealth Care Ethics for PsychologistsHeterosyncraciesHistorical and Philosophical Perspectives on Biomedical EthicsHoly WarHookedHookedHow Can I Be Trusted?How Propaganda WorksHow to Do Things with Pornography How to Make Opportunity EqualHow Universities Can Help Create a Wiser WorldHow We HopeHow We Think About DementiaHuman BondingHuman EnhancementHuman GoodnessHuman Identity and BioethicsHuman TrialsHumanism, What's That?Humanitarian ReasonHumanityHumanizing MadnessI am Not Sick I Don't Need Help!I Was WrongIdentifying Hyperactive ChildrenIf That Ever Happens to MeImproving Nature?In Defense of FloggingIn Defense of SinIn Love With LifeIn Our Own ImageIn the FamilyIn the Land of the DeafIn the Name of IdentityIn the Wake of 9/11In Two MindsInclusive EthicsInformed Consent in Medical ResearchInnovation in Medical TechnologyInside Assisted LivingInside EthicsIntelligence, Race, and GeneticsIntensive CareInto the Gray ZoneIs Human Nature Obsolete?Is Long-Term Therapy Unethical?Is There a Duty to Die?Is There an Ethicist in the House?Issues in Philosophical CounselingJudging Children As ChildrenJust a DogJust BabiesJust CareJustice for ChildrenJustice for HedgehogsJustice in RobesJustice, Luck, and KnowledgeJustifiable ConductKant on Moral AutonomyKant's Theory of VirtueKids of CharacterKilling McVeighLack of CharacterLack of CharacterLaw and the BrainLearning About School ViolenceLearning from Baby PLeaving YouLectures on the History of Political PhilosophyLegal and Ethical Aspects of HealthcareLegal Aspects of Mental CapacityLegal ConceptionsLegal InsanityLegalizing ProstitutionLet Them Eat ProzacLevelling the Playing FieldLiberal Education in a Knowledge SocietyLiberal EugenicsLife After FaithLife at the BottomLife, Sex, and IdeasListening to the WhispersLiving ProfessionalismLosing Matt ShepardLostLuckyMad in AmericaMad PrideMadhouseMaking Another World PossibleMaking Babies, Making FamiliesMaking Genes, Making WavesMaking Sense of Freedom and ResponsibilityMalignantMasculinity Studies and Feminist TheoryMeaning and Moral OrderMeaning in LifeMeaning in Life and Why It MattersMeans, Ends, and PersonsMeans, Ends, and PersonsMedical Enhancement and PosthumanityMedical Research for HireMedicalized MasculinitiesMedically Assisted DeathMeditations for the HumanistMelancholia and MoralismMental Health Professionals, Minorities and the PoorMental Illness, Medicine and LawMerit, Meaning, and Human BondageMetaethical SubjectivismMill's UtilitarianismMind FieldsMind WarsMind WarsModern Theories of JusticeModernity and TechnologyMoney ShotMonsterMoral Acquaintances and Moral DecisionsMoral BrainsMoral ClarityMoral CultivationMoral Development and RealityMoral Dilemmas in Real LifeMoral DimensionsMoral EntanglementsMoral FailureMoral LiteracyMoral MachinesMoral MindsMoral OriginsMoral Panics, Sex PanicsMoral ParticularismMoral PerceptionMoral PsychologyMoral Psychology: Volume IVMoral RealismMoral RelativismMoral RepairMoral Responsibility and Alternative PossibilitiesMoral Status and Human LifeMoral StealthMoral Theory at the MoviesMoral TribesMoral Value and Human DiversityMoral, Immoral, AmoralMoralismMorality and Self-InterestMorality in a Natural WorldMorality, Moral Luck and ResponsibilityMorals, Rights and Practice in the Human ServicesMorals, Rights and Practice in the Human ServicesMore Than HumanMotive and RightnessMovies and the Moral Adventure of LifeMurder in the InnMy Body PoliticMy Brain Made Me Do ItMy Sister's KeeperMy Sister's KeeperMy WayNano-Bio-EthicsNarrative MedicineNarrative ProsthesisNatural Ethical FactsNatural-Born CybogsNaturalized BioethicsNeither Bad nor MadNeoconservatismNeonatal BioethicsNeurobiology and the Development of Human MoralityNeuroethicsNeuroethicsNeuroethicsNew Takes in Film-PhilosophyNew Waves in EthicsNew Waves in MetaethicsNietzsche on Ethics and PoliticsNo Child Left DifferentNo Impact ManNormative EthicsNormativityNothing about us, without us!Oath BetrayedOf War and LawOn ApologyOn Being AuthenticOn EvilOn Human RightsOn The Stigma Of Mental IllnessOn the TakeOn Virtue EthicsOn What MattersOn What We Owe to Each OtherOne ChildOne Nation Under TherapyOne World NowOne World NowOur Bodies, Whose Property?Our Bodies, Whose Property?Our Daily MedsOur Faithfulness to the PastOur Posthuman FutureOut of EdenOut of Its MindOut of the ShadowsOverdosed AmericaOxford Handbook of Psychiatric EthicsOxford Studies in Normative EthicsOxford Textbook of Philosophy of PsychiatryPassionate DeliberationPatient Autonomy and the Ethics of ResponsibilityPC, M.D.Perfecting VirtuePersonal AutonomyPersonal Autonomy in SocietyPersonal Identity and EthicsPersonalities on the PlatePersonhood and Health CarePersons, Humanity, and the Definition of DeathPerspectives On Health And Human RightsPharmacracyPharmageddonPhilosophy and This Actual WorldPhilosophy of BiologyPhilosophy of Technology: The Technological ConditionPhysician-Assisted DyingPicturing DisabilityPilgrim at Tinker CreekPlaying God?Playing God?Political EmotionsPornlandPowerful MedicinesPractical Autonomy and BioethicsPractical EthicsPractical Ethics for PsychologistsPractical RulesPragmatic BioethicsPragmatic BioethicsPragmatic NeuroethicsPraise and BlamePreferences and Well-BeingPrimates and PhilosophersPro-Life, Pro-ChoiceProcreation and ParenthoodProfits Before People?Progress in BioethicsProperty in the BodyProzac As a Way of LifeProzac on the CouchPsychiatric Aspects of Justification, Excuse and Mitigation in Anglo-American Criminal Law Psychiatric EthicsPsychiatry and EmpirePsychological Concepts and Biological PsychiatryPsychology and Consumer CulturePsychology and LawPsychotropic Drug Prescriber's Survival GuidePublic Health LawPublic Health Law and EthicsPublic PhilosophyPunishing the Mentally IllPunishmentPursuits of WisdomPutting Morality Back Into PoliticsPutting on VirtueQuality of Life and Human DifferenceRaceRadical HopeRadical VirtuesRape Is RapeRe-creating MedicineRe-Engineering Philosophy for Limited BeingsReason's GriefReasonably ViciousReckoning With HomelessnessReconceiving Medical EthicsRecovery from SchizophreniaRedefining RapeRedesigning HumansReducing the Stigma of Mental IllnessReflections On How We LiveReframing Disease ContextuallyRefusing CareRefuting Peter Singer's Ethical TheoryRelative JusticeRelativism and Human RightsReligion ExplainedReprogeneticsRescuing JeffreyResponsibilityResponsibility and PsychopathyResponsibility and PunishmentResponsibility and PunishmentResponsibility from the MarginsResponsible GeneticsRethinking CommodificationRethinking Informed Consent in BioethicsRethinking Mental Health and DisorderRethinking RapeReturn to ReasonRevolution in PsychologyRightsRights, Democracy, and Fulfillment in the Era of Identity PoliticsRisk and Luck in Medical EthicsRobert NozickRousseau and the Dilemmas of Modernity Rule of Law, Misrule of MenRun, Spot, RunRunning on RitalinSatisficing and MaximizingSchizophrenia, Culture, and SubjectivityScience and EthicsScience in the Private InterestScience, Policy, and the Value-Free IdealScience, Seeds and CyborgsScratching the Surface of BioethicsSecular Philosophy and the Religious TemperamentSeeing the LightSelf-ConstitutionSelf-Made MadnessSelf-Trust and Reproductive AutonomySentimental RulesSex Fiends, Perverts, and PedophilesSex OffendersSex, Family, and the Culture WarsSexual DevianceSexual EthicsSexual PredatorsSexualized BrainsShaping Our SelvesShock TherapyShould I Medicate My Child?ShunnedSick to Death and Not Going to Take It AnymoreSickoSide EffectsSidewalk StoriesSister CitizenSkeptical FeminismSocial Inclusion of People with Mental IllnessSocial JusticeSociological Perspectives on the New GeneticsSome We Love, Some We Hate, Some We EatSovereign VirtueSpeech MattersSpiral of EntrapmentSplit DecisionsSticks and StonesStories MatterSubjectivity and Being SomebodySuffering, Death, and IdentitySuicide ProhibitionSurgery JunkiesSurgically Shaping ChildrenTaking Morality SeriouslyTaming the Troublesome ChildTechnology and the Good Life?TestimonyText and Materials on International Human RightsThe Aims of Higher EducationThe Almost MoonThe Altruistic BrainThe American Psychiatric Publishing Textbook of Forensic PsychiatryThe Animal ManifestoThe Animals' AgendaThe Art of LivingThe Autonomy of MoralityThe Beloved SelfThe Best Things in LifeThe Big FixThe Bioethics ReaderThe Biology and Psychology of Moral AgencyThe Blackwell Guide to Medical EthicsThe Body SilentThe BondThe Book of LifeThe Burden of SympathyThe Cambridge Companion to Virtue EthicsThe Cambridge Companion to Virtue EthicsThe Cambridge Textbook of BioethicsThe Case against Assisted SuicideThe Case Against PerfectionThe Case Against PunishmentThe Case for PerfectionThe Case of Terri SchiavoThe Challenge of Human RightsThe Code for Global EthicsThe Colonization Of Psychic SpaceThe Commercialization of Intimate LifeThe Common ThreadThe Connected SelfThe Constitution of AgencyThe Creation of PsychopharmacologyThe Criminal BrainThe Decency WarsThe Difficult-to-Treat Psychiatric PatientThe Disability PendulumThe Disability Rights Movement: From Charity to ConfrontationThe Domain of ReasonsThe Double-Edged HelixThe Duty to ProtectThe Emotional Construction of MoralsThe End of Ethics in a Technological SocietyThe End of Stigma?The Essentials of New York Mental Health LawThe Ethical BrainThe Ethical Dimensions of the Biological and Health SciencesThe Ethics of BioethicsThe Ethics of Human EnhancementThe Ethics of ParenthoodThe Ethics of SightseeingThe Ethics of the FamilyThe Ethics of the Family in SenecaThe Ethics of the LieThe Ethics of TransplantsThe Ethics of WarThe Ethics ToolkitThe Evolution of Mental Health LawThe Evolution of MoralityThe FamilyThe Fat Studies ReaderThe Forgiveness ProjectThe Form of Practical KnowledgeThe Fountain of YouthThe Freedom ParadoxThe Future of Assisted Suicide and EuthanasiaThe Future of Human NatureThe Good BookThe Good LifeThe Great BetrayalThe Handbook of Disability StudiesThe Healing VirtuesThe High Price of MaterialismThe History of Human RightsThe HorizonThe Idea of JusticeThe Ideal of NatureThe Illusion of Freedom and EqualityThe Immortal Life of Henrietta LacksThe Importance of Being UnderstoodThe Insanity OffenseThe Joy of SecularismThe Language PoliceThe Last Normal ChildThe Last UtopiaThe Limits of MedicineThe LobotomistThe Love CureThe Lucifer EffectThe Manual of EpictetusThe Mark of ShameThe Meaning of NiceThe Medicalization of SocietyThe Merck DruggernautThe Mind Has MountainsThe Modern Art of DyingThe Modern SavageThe Moral ArcThe Moral BrainThe Moral Demands of MemoryThe Moral FoolThe Moral MindThe Moral Psychology HandbookThe Moral, Social, and Commercial Imperatives of Genetic Testing and ScreeningThe Most Good You Can DoThe Myth of ChoiceThe Myth of the Moral BrainThe Nature of NormativityThe New Disability HistoryThe New Genetic MedicineThe New Religious IntoleranceThe Offensive InternetThe Origins of FairnessThe Oxford Handbook of Animal EthicsThe Oxford Handbook of Ethics at the End of LifeThe Perfect BabyThe Philosophical ParentThe Philosophy of NeedThe Philosophy of PornographyThe Philosophy of PsychiatryThe Politics Of LustThe Portable Ethicist for Mental Health Professionals The Power of Religion in the Public SphereThe Price of PerfectionThe Price of TruthThe Problem of PunishmentThe Prosthetic ImpulseThe Psychology of Good and EvilThe Psychology of Good and EvilThe PsychopathThe Purity MythThe Pursuit of PerfectionThe Relevance of Philosophy to LifeThe Right Road to Radical FreedomThe Right to Be ParentsThe Righteous MindThe Root of All EvilThe Rules of InsanityThe Second SexismThe Second-Person StandpointThe Silent World of Doctor and PatientThe Sleep of ReasonThe Social Psychology of Good and EvilThe Social Psychology of MoralityThe Social Psychology of MoralityThe Speed of DarkThe Stem Cell ControversyThe Stem Cell ControversyThe Story of Cruel and UnusualThe Story WithinThe Stubborn System of Moral ResponsibilityThe Suicide TouristThe Terrible GiftThe Theory of OptionsThe Therapy of DesireThe Trauma of Psychological TortureThe Trauma of Psychological TortureThe Triple HelixThe Trolley Problem MysteriesThe Trouble with DiversityThe Truth About the Drug CompaniesThe Ugly LawsThe Varieties of Religious ExperienceThe Virtue of Defiance and Psychiatric EngagementThe Virtues of FreedomThe Virtues of HappinessThe Virtuous Life in Greek EthicsThe Virtuous PsychiatristThe Voice of Breast Cancer in Medicine and BioethicsThe War Against BoysThe War for Children's MindsThe Whole ChildThe Woman RacketThe Worldwide Practice of TortureTherapy with ChildrenThieves of VirtueThree Generations, No ImbecilesTimes of Triumph, Times of DoubtTolerance Among The VirtuesTolerance and the Ethical LifeTolerationToxic PsychiatryTrauma, Truth and ReconciliationTreatment Kind and FairTrusting on the EdgeTry to RememberUltimate JudgementUnborn in the USA: Inside the War on AbortionUndermining ScienceUnderstanding AbortionUnderstanding CloningUnderstanding EmotionsUnderstanding EvilUnderstanding Kant's EthicsUnderstanding Moral ObligationUnderstanding Physician-Pharmaceutical Industry InteractionsUnderstanding TerrorismUnderstanding the GenomeUnderstanding the Stigma of Mental IllnessUnderstanding Treatment Without ConsentUnhingedUnprincipled VirtueUnsanctifying Human Life: Essays on EthicsUnspeakable Acts, Ordinary PeopleUp in FlamesUpheavals of ThoughtUsers and Abusers of PsychiatryValue-Free Science?Values and Psychiatric DiagnosisValues in ConflictVegetarianismViolence and Mental DisorderVirtue EthicsVirtue, Rules, and JusticeVirtue, Vice, and PersonalityVirtues and Their VicesVulnerability, Autonomy, and Applied EthicsWar Against the WeakWar, Torture and TerrorismWarrior's DishonourWeaknessWelfare and Rational CareWhat Genes Can't DoWhat Have We DoneWhat Is a Human?What Is Good and WhyWhat Is Good and WhyWhat Is the Good Life?What Price Better Health?What Should I Do?What We Owe to Each OtherWhat Would Aristotle Do?What's Good on TVWhat's Normal?What's Wrong with Children's RightsWhat's Wrong with Homosexuality?What's Wrong With Morality?When Is Discrimination Wrong?Who Holds the Moral High Ground?Who Owns YouWho Qualifies for Rights?Whose America?Whose View of Life?Why Animals MatterWhy Animals MatterWhy I Burned My Book and Other Essays on DisabilityWhy Not Kill Them All?Why Punish? How Much?Why Some Things Should Not Be for SaleWisdom, Intuition and EthicsWithout ConscienceWomen and Borderline Personality DisorderWomen and MadnessWondergenesWould You Kill the Fat Man?Wrestling with Behavioral GeneticsWriting About PatientsYou Must Be DreamingYour Genetic DestinyYour Inner FishYouth Offending and Youth Justice Yuck!
The best way to read Let Them Eat Prozac is to first consider
the events surrounding Healy's writing of the book. He reports to us that he wrote this book and The Creation of Psychopharmacology (2002) during 2000 (2004,
286). The year 2000 turns out to be a
pivotal year in Healy's career because of two separate scrapes with what
becomes the focus of Let Them Eat Prozac:
conflicts of interest between the pharmaceutical industry and academia.
The David Healy Affair
First, in late November 2000, Healy
travels to the University of Toronto's Department of Psychiatry who invites him
to speak for its seventy-fifth anniversary meeting, entitled "Looking
Back: Looking Ahead." A year before this trip, The Center for Addiction
and Mental Health (CAMH) has hired Healy as a professor of psychiatry in the
Mood and Anxiety Disorders Program.
Healy has not yet made the move to Canada because he was waiting on his
visa. Healy delivers a talk entitled:
"Psychopharmacology and the Government," which is basically an
outline of The Creation of
Psychopharmacology along with the assertion that SSRIs could make people
suicidal. This last point is, as I will
explain below, the occasion for which Healy pens Let Them Eat Prozac. The
chief physician at CAMH, David Goldbloom, hears Healy's talk and reacts quite
strongly to the content, particularly--to his mind--the irresponsible and
unscientific suggestion that SSRI drugs can lead to suicidality in
patients. Shortly after an
uncomfortable exchange with Goldbloom, Healy learns via email from Goldbloom
that CAMH has decided to withdraw the offer to of a position as Clinical
Director of the Mood and Anxiety Disorders program. Healy describes, briefly, these events in chapter 9, "The
Plot Thickens" (215-219), however, website dedicated to exposing these
makes public the email exchanges between Goldbloom and Healy, Healy's talk, and
subsequent letters written between various players in the scandal that
I strongly recommend reading
through these documents before delving into Let
Them Eat Prozac (even though Healy wrote most of the book before this took
place). Reading these documents brought
to life, more powerfully than the events narrated in the book, the dangerous
position that folks like Healy may be in regarding academic freedom now that
mega pharmaceutical corporations, like Eli Lilly and Co., fund department
research at places such as the CAMH at the University of Toronto. At the time Healy delivers his talk, the
Mood Disorders Program receives over 50 percent of its funding from
pharmaceutical companies (2004, 215).
While the reasons why Goldbloom rescinds his offer to Healy may never be
fully known, Healy points out that fear of losing precious and necessary
funding from Eli Lilly and Co. for research may, in fact, be a contributing
The second threat to Healy's
academic freedom follows an article that Healy publishes, entitled "Good
Science or Good Business?", in the March/April issue of The Hasting Center Report, which is a
bioethics journal. In this issue, Healy
Possibly, Prozac's success has also
depended partly on a lack of information . . .Current methods to estimate the
side effects of drugs in clinical trials actually underestimate them . . .the
SSRIs have been sold on the back of a claim that the rate of suicide is 600 per
every 100,000 patient years. But this
is the rate for people with severe depression, for which Prozac does not
work. The rate for primary care
depression is on the order of 30 out of every 100,000 people. Yet in these populations, suicide rates of
189 for every 100,000 on Prozac have been reported. Thus there are good
grounds to believe that Prozac can trigger suicidality. The pharmaceutical companies are not
investigating, however; one wonders whether they are receiving legal advice
echoing that given to the tobacco companies, that any investigation of these
issues may increase product liability" (2000, 21, my emphasis).
Soon after publication of this article, Eli Lilly and Co.
withdraws what constituted a substantial donor gift to the Hastings Center,
citing Healy's "unscientific" claim above as the reason. Hence, the writing of Let Them Eat Prozac is mired in disquieting examples of exactly
what Healy warns is discrediting the science of psychopharmacology: the need for
Big Pharma to make profits for its shareholders is more pressing that the need
for good science.
Good Science or Good
Them Eat Prozac is Healy's careful and, at times, tedious account of the
discovery of SSRIs and the events that lead to the unprecedented marketing and
prescribing of these drugs. Healy is a
first class scholar, supplying the reader with all available facts, figures and
names of major players in this episode of psychopharmacology. To an outsider to the field, keeping track
of all the major names and dates in this history can be challenging. Healy assiduously cites every possible
scientific and factual claim he makes in the book, which requires a great deal
of flipping back and forth to the comprehensive footnotes and bibliography. However, when I realized the stakes in the
writing of this book, reflecting on the Hastings Center, CAMH scandals and the
three trials against Big Pharma that Healy chronicles, it became a lot clearer
why Healy takes such pains to tell this story as completely and rigorously as
Healy begins the book by giving a
brief overview of the major changes occurring in psychiatry at the time that
Prozac is first discovered. What is
notable in these chapters is Healy's claim that the downfall of Valium and
other benzodiazepines in popular culture--due to claims that it was
addictive--coincide with a growing awareness that severe depression and bipolar
disorder is largely undetected and untreated.
Moreover, the conceptual framework of psychiatry shifts away from the
language of neuroses and anxiety, towards biological psychiatric paradigms that
conceive of mental disorders in terms of neurochemistry. The vacuum created by the public dismissal
of Valium then becomes filled by SSRIs, such as Prozac. Rather than treat "nerves" or
anxiety disorders, psychiatrists shift their attention to depression and its
biological mechanism (which the public wrongly assumes is low serotonin levels
). Pharmaceutical companies
quickly see a new market opening up for SSRIs, in part because the drugs
purportedly are more tolerable and patients could not overdose on these
drugs. The further you get into Let Them Eat Prozac, however, the sooner
you will be disabused of the belief that SSRIs are relatively safe.
The current pervasiveness and
popularity of the Prozac (and its SSRI cousins) for treating depression is
particularly remarkable because early clinical trials suggest that it is not
effective in treating severe depression, but rather for treating milder or subclinical
depressions (something to which Peter Kramer's book Listening to Prozac is a testament) (32). What also emerge early on in the clinical
trials of Prozac and in clinical practice is a concern that it causes akathisia (agitated states) (14-15). Shortly
after Prozac is released, in 1990, Martin Teicher, Carol Gold and Jonathan Cole
publish an article in the American
Journal of Psychiatry that suggests Prozac induces suicidality in patients
(42-45). Eli Lilly quickly moves to
discredit this study because it is conducted in a center that specialize in
suicidal patients, thus beginning the now familiar retort to the claim that
Prozac induces suicidality: it's the
disease, not the drug (see 59).
Healy dedicates the rest of the
book to cast doubt on this simple retort.
He details three court cases against Big Pharma: Fentress et al. vs. Eli
Lilly, Forsyth v. Eli Lilly, Tobin v. SmithKline Beecham. Each of these cases involves a suicide
and/or homicide allegedly brought on by Prozac, or Zoloft in the Tobin
case. Eli Lilly wins the first two
cases, but SmithKline Beecham loses the third case. Healy is an expert witness in the Forsyth case and latter the
Tobin case, which incidentally is pending during the whole "affair"
at the University of Toronto. Healy
inform how the lawyers for SmithKline Beecham could use this
"scandal" to discredit Healy's testimony, thereby weakening Tobin's
case. The details of these cases are
quite interesting as well as profoundly sad.
Healy reports on these cases to illustrate how messy and dangerous the
overlapping of Big Pharma, academics, physicians, and the FDA are:
One of the many chilling things
about the Prozac story is that a mistake or conspiracy would probably have cost
fewer lives. Instead, a sequence of
historical events made a poor drug fashionable, made the treatment of an
illness all but a matter of public policy, and removed the natural cautions and
safeguards that should have saved us.
In the midst of this, the one group with a professional brief, because of
prescription-only arrangements, to save us from ourselves--physicians--appears
to have followed its self-interest as much, if not more, than any other party
to the story(251).
A rather interesting revelation in
this book is that the Church of Scientology unwittingly contributes to lack of
studies and information on how SSRIs may induce suicidality. Scientologists are
a virulent strain of the "anti-psychiatrists." Their entire mission
is to bring down psychiatry and strategically focus their campaign by protesting
antidepressants and ADHD drugs (for an example, review the many news stories
about Tom Cruise's campaign against antidepressants). A 1990 Time article
reports that Scientologists rely heavily on lawsuits to bring down
psychiatrists and the pharmaceutical industries (59). This ticks off psychiatrists who then unite behind Big Pharma.
Relaying a conversation he has with an attorney involved in suits against Big
Pharma, Healy writes: " . . . I launched into the influence of the
Scientologists on the whole Prozac controversy. If they hadn't intervened, U.S. psychiatry wouldn't have stood
behind Lilly the way it had" (138).
Another troubling practice that
Healy exposes is how deeply Big Pharma has penetrated academic journals and
conferences. Apparently, Big Pharma hires writing agencies, such as Current
Medical Directions (CMD) to write up:
studies, review articles,
abstracts, journal supplements, product monographs, expert commentaries, and
textbook chapters. It conducts
meta-analyses and organizes journal supplements, satellite symposia, consensus
conferences, and even advisory boards for its clients. In the course of 1998, CMD, on behalf of
Pfizer, coordinated the authorship of approximately eighty-seven articles on
Zoloft. Of these, fifty-five were
published by early 2001. They targeted
the leading journals in the field, including the New England Journal of Medicine (NEJM), JAMA, Archives of General Psychiatry, and The American Journal of Psychiatry, in addition to journals well
known for the placement of psychopharmacology articles (116-117).
For Healy, the real concern that "ghostwritten"
articles pose is that the academics who allow their name to be put on the
article often never see the original data from which conclusions were made;
their judgment of the data is therefore skewed by what the pharmaceutical
company chooses to report. Big Pharma
owns all data of from clinical trials and RCTs, hence scientists cannot easily
get their hands on it to make independent judgments about the studies.
Healy reports his own experience
with being approached to present at symposia wholly underwritten and organized
by a pharmaceutical company as well as putting his name on a ghostwritten
article (112-116). The fact that Healy
reveals his own participation in these practices is interesting, since it opens
him up to charges of hypocrisy or complicity with the very market forces that
he thinks are threatening academic freedom and good scientific research in
psychopharmacology. To me, these
admissions reveal Healy's humanity.
Rather than resembling a "Socrates," whose pure dedication to
morality seems far from our all-too-human natures, Healy shows us how easy it
is to get involved with Big Pharma, to have them corrupt your own work, and the
ugly side to all of this as well: how
publicly disagreeing or discrediting them can put your livelihood and
reputation at stake.
Them Eat Prozac is a bold book and likely to draw a lot of criticism from
fellow psychopharmacologists. Moreover,
the problems and questions that Healy raise seem far from any easy solutions,
hence likely to make many readers--who might need psychopharmacological
treatment--weary of trusting their physicians or the pharmaceutical
industry. While certainly Healy doesn't
wish to wholly discredit his profession and carefully points out how hard it is
to tell the good from the bad guys in this story, it is possible that the less
careful or subtle readers of his book will make conclusions about psychiatry
that will unfortunately resemble anti-psychiatrists or even
Scientologists. I hope, however, that
those who undertake this book take the time to appreciate the balance and care
that Healy takes to present this story.
Side note: A companion website to this Let Them Eat Prozac is located at http://www.healyprozac.com/.
Healy, David. 2000.
"Good Science or Good Business?" Hastings Center Report
Healy, David. 2002.
The Creation of Psychopharmacology. Cambridge, MA: Harvard University Press.
2005 Jennifer Hansen
Jennifer Hansen is an Associate Professor of
Philosophy at Gettysburg College. Her
research focuses on feminist theory and the intersection of psychiatry and
philosophy, with particular interest in affective disorders, such as