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 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 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 SoulsBasic 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 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 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 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 ValueFaking 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 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 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!
Mad In America is a
powerfully troubling argument against the way that psychiatry treats
schizophrenia and other major mental illnesses. The first two parts of the book set out the history of treatment
for the insane in the US and Europe from 1750 until 1950, and Whitaker’s
account does not differ significantly from others, such as Edward Shorter’s,
although it is shorter and highlights different details. But while other accounts say that since the
Second World War, the availability of neuroleptic medication has meant a
dramatic improvement in the treatment of schizophrenia, Whitaker argues the new
medications are comparable in their dangerousness and ineffectiveness to the
barbaric ‘remedies’ that were forced on patients in earlier times. The essential question for any reader of Mad
In America is whether Whitaker presents compelling evidence for his
The problem that nearly all readers
will face in assessing Whitaker’s criticisms of psychiatry is that they, like
me, are not experts in psychopharmacology.
They, like me, will not know the relevant scientific literature
concerning the testing of medications or the detailed history of psychiatric
treatment in the twentieth century – and, unfortunately, merely having read a
few books on the subject does not make one an expert. Furthermore, if Whitaker is right, then readers will have strong
reasons to doubt the opinions of most experts, since one of his main claims is
that they do not face the real evidence that is available concerning the danger
and lack of effectiveness of medication.
Under the influence of the pharmaceutical industry, from the 1960s psychiatric
experts changed their descriptions of neuroleptic drugs from “brain damaging”
to “virtually free of side-effects” and ignored the studies that show that
unmedicated schizophrenics have a lower rate of relapse than those who take
medication. Whether they are corrupt or
simply unwitting pawns of the drug companies, on Whitaker’s view, most
psychiatrists do not have an unbiased understanding of the evidence; it follows
that readers should read psychiatrists’ predictable protests about Mad in
America with a great deal of suspicion.
Most readers of Mad in America
will have the luxury of waiting to see what happens in this debate. We can hope that some neutral institution
will be able to assess Whitaker’s claims about both neuroleptic medication and
the new ‘atypical’ medications for schizophrenia. This may require finding researchers who do not have financial
relationships with the pharmaceutical industry, and in the US, there are few
such people. Even federal research
bodies such as the National Institute of Mental Health employ researchers who
are tightly connected with drug companies.
It seems that we may need to look to research done in other countries
where there is more done to avoid financial influence tarnishing the
objectivity of scientific testing of new medications and more effort is made to
evaluate the efficacy of alternative treatments.
However, some readers of this book
will themselves have a diagnosis of schizophrenia, or will have a family member
or close friend with that diagnosis.
They will face a far more difficult decision: whether to accept the
recommendation of psychiatrists to take neuroleptic or atypical medication for
their condition, or to take a different course. On what basis can patients or legal guardians make such a decision? What can family and friends of people
diagnosed with schizophrenia say to them that might be helpful when
deliberating about medication? I know
that if I had a family member with a diagnosis of schizophrenia, I would now be
very scared about the possible long-term effects of medication after reading Mad
in America. Let me say a little
about how I might think through the issues.
Whitaker is not the first person to
make worrying claims about the effects of medication for schizophrenia. The most well known critic of psychiatric
medication is Peter Breggin, and he has a large section of his Toxic Psychiatry
devoted to the dangers of treatments of psychiatry. While Breggin has asked some difficult questions, I’ve never
found him a very compelling critic of psychiatry: he has been too closely tied
with the antipsychiatric view that mental illness is a myth, and his
understanding of psychiatric illness often seems problematic. For example, he thinks that schizophrenia is
not a brain disease but is instead a “psychospriritual crisis.” (Toxic Psychiatry, p. 24). His writing style seems a little too
sensational to ring true, and, far more importantly, his discussion of the
empirical literature is on the brief side.
He makes a great many accusations in the hope that some will stick, but
in the end, he undermines his own credibility.
While I think it is very important that there should be people focusing
on the efficacy and safety of medications, I have not been convinced by
Breggin’s arguments that psychiatric medication is always the wrong choice.
By way of contrast, I found the
arguments of Whitaker far more convincing and worrying. His writing style, for what it is worth, is
clear and careful; even though he goes into the details of empirical studies in
surprising depth, and even when he makes extremely grave accusations (backed up
by explanations and references to the academic literature as well as
interviews) his tone is calm. The book
is well written and the argument is easy to follow. He keeps his focus on his central claims: current psychiatric
treatment for schizophrenia increases the danger of relapse, so patients
would be better off with no treatment.
The clinical approach to schizophrenia that seems most
promising to Whitaker is the gentle “moral treatment” started by the York
Quakers in England at the end of the eighteenth century and brought to America
in the nineteenth century in Philadelphia, Boston, and New York. By 1841, there were sixteen private and
public asylums in the US. He cites
evidence that 60-80% of patients admitted to these asylums in the first half of
the nineteenth century were discharged as “cured” or “improved.” But then other more invasive or brutal
treatments started to become popular, and treatment for insanity never again
achieved the success it did during that period. It is clear that Whitaker would favor an attempt to replicate the
results of the Quakers achieved in their asylums, treating people with severe
mental illnesses gently and giving them time for their period of insanity to
One of the problems for research
into testing new psychiatric medications these days is that it is difficult to
find patients who have never taken any psychiatric medication and to compare
the results in a double blind studies with patients randomly assigned to either
the test group or the control group.
Double blind studies are especially hard to perform because psychiatric
medication for schizophrenia has such obvious side effects that patients may be
able to tell whether they are getting the medication or a sugar pill, and so
the study is not “blind” at all.
Studies that would be able to compare medication against no treatment
may be flawed or they simply have not been done. Far more frequent are comparisons between different medications,
where one is shown to be more effective than another. Whitaker explains some of the methodological problems of many of
these experiments, casting doubt on the apparently positive results they give for
Also alarming are recent cases of
clear fraud that have occurred in some important drug trials. Whitaker goes into the details, which do not
need repeating here. He acknowledges
that these cases of unethical behavior by researchers do not show that
medications are unsafe, but they do suggest that there are not sufficient
safeguards to prevent breaches in scientific procedure. The picture he paints is of a testing
process that is vulnerable to the corruption of individuals ready to make money
from drug companies at any cost, with drug companies ready to turn a blind eye
to such irregularities because it helps them in their grab for the huge profits
they can make from a new medication.
Combining this with the history of
psychiatry in the first half of the twentieth century, when the mentally ill in
America were considered by many prominent scientists and politicians to be
genetic defects that should not be allowed to breed, Whitaker’s book leaves one
to conclude that psychiatry is in a deep crisis. In its rush to become more biological and avoid the accusations
of being pseudoscientific that came from its affiliation with psychoanalysis,
it has linked itself too closely with the financial interests of the
pharmaceutical industry. Psychiatry
tries to give the impression that it has left its dark past long behind, but in
fact it may actually just be repeating the mistakes of the past. Whitaker concludes in the last line of the
book, “The day will come when people will look back at our current medicines
for schizophrenia and the stories we tell to patients about their abnormal
brain chemistry, and they will shake their heads in utter disbelief.”
As I have said, Whitaker’s
arguments are powerful and need to be taken very seriously. They put in a difficult position both those
who need to decide whether to take medication for schizophrenia, and those who
need to decide whether to encourage or discourage someone they love to take
medication. They need to ask whether
there are any reasons to doubt Whitaker’s claims.
One issue that will occur to some
is that Whitaker is not a psychiatrist himself; he is an investigative
journalist. Some may say that since he
himself is not a psychiatric expert, he is not qualified to make judgments on
these issues. But this would be a weak
response, since it is simply an ad hominem prejudice, and does not
address Whitaker’s argument at all. He
has clearly researched his book very carefully, and has gathered and assessed
the views of many researchers in the field, and his arguments cannot be so easily
More problematic is the fact that
Whitaker does not address the problems of assessing the positive results of the
Quaker asylums and comparing them with modern treatments. Unless one knows what kind of illnesses those
people classified as insane in the early nineteenth century actually had, it
makes little sense to compare the high rates of success in treatment with the
current success rates. Indeed, it seems
that there is very little data concerning the relapse rates for those treated
in the asylums, so we have little basis to judge how successful the
moral-treatment actually was.
Also worth noting is the fact that Whitaker spends
little time discussing the experience of schizophrenia itself and the
seriousness of the illness, and this seems like a weakness of the book. While
Breggin downplays the seriousness of the condition by calling it a
psychospiritual crisis, Whitaker gives very little description of
schizophrenics at all. But many would
say that paying attention to the experience and behavior of schizophrenics
shows that they need to be protected against themselves, and that we need to
protect society from them. Whether or
not the medications currently in use actually stop the symptomatic delusions or
simply stop patients from acting on them, they are effective in changing the
behavior of people with schizophrenia.
That much is uncontroversial.
Whitaker has not made a strong case that there is a viable alternative
to using medication – unless we bring back large-scale compulsory hospitalization,
which was abandoned because it was though too expensive and simply fostered the
helplessness of patients.
In considering how best to treat someone diagnosed
with schizophrenia, I’d also keep in mind that the FDA does regulate new
medication and the US does have a number of regulatory bodies concerned with
the safety of medications. Whitaker
himself often quotes from FDA reports in making his case against medications,
and the cases of scientific fraud were ones that were uncovered. It is certainly not the case that the
pharmaceutical industry is unregulated; there are safeguards in
place. Even if these safeguards are not
perfect, there’s still reason to think that they are playing an important
role. Unless one is ready to come to
the conclusion that government and regulatory bodies are utterly in the pocket
of big business and that none of the scientists working in these areas has any
integrity, one should acknowledge that there is evidence for the relative
safety of FDA approved medication.
Finally, if I were making a decision for a family
member, I would also take into account the advice of psychiatrists and other
mental health professionals I trust, who have a great deal of experience with
the treatment of schizophrenia. Even
though the current health care system is putting psychiatrists into the role of
pill-prescribers and leaving other, less well paid, workers to do the rest of
the work in the care of the mentally ill, it still remains true that most
mental health professionals I know care deeply about their patients. The health care system may be bureaucratic
and may turn individuals into faceless cases, but people who work with patients
chose their work for a reason, and that reason is rarely the money, since they
could make more money more easily by doing something else.
So, even after being so impressed by Mad in
America, I think I would advise a family member diagnosed with
schizophrenia to take the advice of psychiatrists if I knew those psychiatrists
and had developed a relationship with trust with them. Most of all, I’d fight to get the best care
for my family member. (I recommend Jay
Neugeboren’s book Transforming
Madness for an inspiring discussion of the care available for people
with severe mental illness; Neugeboren’s discussion indeed lends some credence
to Whitaker’s faith in moral-treatment.)
If anything is clear from the available evidence, it is that medication
alone will not solve the problems of schizophrenia.
That said, Mad in America shows how pressing
is the need for the public to be able to get an unbiased assessment of current
psychiatric treatment, untainted by the profit motive of the pharmaceutical
industry. Even though Whitaker himself could
be accused of being overly critical of psychiatry, his argument against schizophrenia
medication is cogent enough to urgently require an answer. I strongly recommend this book to anyone
interested in the current state of psychiatry.
© 2002 Christian Perring. First Serial Rights.
Ph.D., is Chair of the Philosophy Department at Dowling College,
Long Island. He is editor of Metapsychology Online Review.
His main research is on philosophical issues in psychiatry.
He is especially interested in exploring how philosophers can
play a greater role in public life, and he is keen to help foster
communication between philosophers, mental health professionals,
and the general public.