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 Decent LifeA Delicate BalanceA Fragile LifeA Life for a LifeA Life-Centered Approach to BioethicsA Matter of SecurityA Mirror Is for ReflectionA Mirror Is for ReflectionA 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 Ancient Greek and Roman SlaveryAnd a Time to DieAnimal LessonsAnimal RightsAnimal Welfare in a Changing WorldAnimals Like UsApplied Ethics in Mental Health CareAre Women Human?Arguments about AbortionAristotle on Practical WisdomAristotle's Ethics and Moral ResponsibilityAristotle's WayAssisted 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 BioethicsBeyond 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 RightsChimpanzee 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 ChoiceCompassionate Moral RealismCompetence, 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 IllnessCriminal Trials and Mental DisordersCritical 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 SoulDignityDignityDisability BioethicsDisability, Difference, DiscriminationDiscrimination against the Mentally IllDisordered Personalities and CrimeDisorders of VolitionDisorientation and Moral LifeDivided Minds and Successive SelvesDoes Feminism Discriminate against Men?Does Torture Work?Doing HarmDouble Standards in Medical Research in Developing CountriesDown GirlDrugs and JusticeDuty and the BeastDworkin 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 Beyond the LimitsEthics Case Book of the American Psychoanalytic AssociationEthics Done RightEthics ExpertiseEthics for EveryoneEthics for PsychologistsEthics for the New MillenniumEthics in CyberspaceEthics in Everyday PlacesEthics 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 HumansEvilEvilEvil 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 CreaturesFellow-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 RetributionForgiveness is Really StrangeFoucault 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 Fascism WorksHow 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 Dignity and Assisted DeathHuman Dignity and Assisted DeathHuman 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's ValuesLife, 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 WayNakedNano-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 AnimalsOn 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 Studies in Normative Ethics, Volume 7Oxford 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 RightsPharmaceutical FreedomPharmacracyPharmageddonPhilosophy 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 Ethics and ResponsibilityReflections On How We LiveReframing Disease ContextuallyRefusing CareRefuting Peter Singer's Ethical TheoryRegard for Reason in the Moral MindRelative JusticeRelativism and Human RightsReligion ExplainedReprogeneticsRescuing JeffreyRespecting AnimalsResponsibilityResponsibility and PsychopathyResponsibility and PunishmentResponsibility and PunishmentResponsibility from the MarginsResponsible BrainsResponsible 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 MaximizingSchadenfreudeSchizophrenia, 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 StoriesSilent PartnersSister CitizenSkeptical FeminismSocial Dimensions of Moral ResponsibilitySocial 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 MatterSubhumanSubjectivity and Being SomebodySuffering and VirtueSuffering, Death, and IdentitySuicide ProhibitionSurgery JunkiesSurgically Shaping ChildrenTaking Morality SeriouslyTaming the Troublesome ChildTechnology and the Good Life?TestimonyText and Materials on International Human RightsThe Moral Psychology of AngerThe Age of CulpabilityThe Age of CulpabilityThe 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 Character GapThe Code for Global EthicsThe Colonization Of Psychic SpaceThe Commercialization of Intimate LifeThe Common ThreadThe Connected SelfThe Constitution of AgencyThe Cow with Ear Tag #1389The 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 Choosing ChildrenThe 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 Forgotten CreedThe 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 Life and the Great PhilosophersThe Meaning of NiceThe Medicalization of SocietyThe Merck DruggernautThe Mind Has MountainsThe Minority BodyThe Modern Art of DyingThe Modern SavageThe Moral ArcThe Moral BrainThe Moral Demands of MemoryThe Moral FoolThe Moral MindThe Moral Psychology HandbookThe Moral Psychology of DisgustThe Moral Psychology of ForgivenessThe Moral Punishment Instinct The 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 Moral ResponsibilityThe 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 Oxford Handbook of Food EthicsThe Palgrave Handbook of Practical Animal EthicsThe 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 Problem of WarThe Problem of WarThe 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 LovedThe Right to Be ParentsThe Righteous MindThe Root of All EvilThe Routledge Companion to Virtue EthicsThe Routledge Handbook of Philosophy of Animal MindsThe Routledge Handbook of Philosophy of EmpathyThe 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 VicesVoracious Science and Vulnerable AnimalsVulnerability, Autonomy, and Applied EthicsWar Against the WeakWar, Torture and TerrorismWarrior's DishonourWeaknessWelfare and Rational CareWhat are you staring at?What 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 Animals SpeakWhen 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 Does Inequality Matter?Why Honor MattersWhy 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!
I have learned, through experience in writing and reviewing books, that years of labor in writing can be undone by an hour spent in thoughtless review. I can understand it from the reviewer's perspective though too: so many books to review, so many other things to do.
Indeed most readers, who are not themselves authors of books, do not appreciate how important the reader is to the book publishing process. A writer can spend years agonizing on his material, but if a reader is not willing to put out an iota of effort to understand it, all those years will pass by the readers eyes as if they are but shadows.
I once gave one of my books to a senior colleague, a friend and advisor in the world of academia. A few months later, in one of our meetings, he said he had read the book and proceeded to make some vague and general criticisms. He admitted that he had read it in 2-3 days, because he "speed reads." I could not say it, but I thought: You must also "speed think" and thereby you missed the point of my book.
Some books are to be tasted, Bacon once said, others swallowed whole, others chewed and digested slowly. I would go further: No book can be "speed read", with proper respect to the efforts of the author.
I say all this because I could not read, understand, and certainly comment on this book without having waited quite a while to digest what it means. In so doing, I still fear I won't do it complete justice; I'm sure I've misunderstood some things. But I will try.
A disclosure: I have known the author for two decades since he was a medical student, and we serve on the same academic faculty, and we trained in similar residencies with similar teachers, and he helped me publish one of my first books. So we have a long, positive personal history, which readers should take into account. If anything, I think my personal regard has made me even more hesitant to express disagreement with the content of Dr. Carlat's ideas. But the academic life has, as William James said, its heroic responsibilities, and so I will try to present my views here in relations to the author's ideas although I may be biased in his favor given my personal experiences with him.
A younger colleague told me he was much impressed by Dr. Carlat's book because it at least does not take psychiatry for granted; it sees something as wrong, and seeks to address it. I agree. This is the main benefit of the book, in my view, and a not inconsiderable one. On the one hand, it is not particularly original, because there are a host of books that criticize psychiatry these days. On the other hand, there still seems to be a bedrock of resistance with psychiatry to recognizing that our ship is not sailing straight. Or if we think it is off course, that the course correction is to go further off course, thinking that we are setting it straight.
My view is that Dr. Carlat takes the latter approach. I agree with his diagnosis that something is wrong. I don't agree with his prescription for a solution. I'm not even entirely clear what that prescription is.
One reads about "integrative" psychiatry; the specific examples he gives here and in earlier newspaper articles have to do with listening to patients more, not just giving them pills for symptoms in rapid "med checks." Agreed. But in the example he gives in a New York Times magazine article, he listens to someone more closely, then determines the patient has marked inattention, and prescribes an amphetamine, which of course makes the patient feel better, hence confirming his approach.
This seems to me to be analogous to seeing a patient with pain symptoms, listening closely to all the descriptions of pain symptoms, then prescribing opiates for the pain symptoms, which of course make the patient feel better. But, in the process, one might ignore that the pain symptoms might be caused by a disease, like bone marrow cancer, and that person's disease would be left untreated, and ultimately harm the patient.
In this book, the author discusses the overdiagnosis of ADHD and the risks of overuse of amphetamines, but he doesn't seem to appreciate the inherent risks of this symptom-based approach to psychopharmacology: "…while I prescribe plenty of stimulants, I also know how important it is to scrutinize [the pharmaceutical industry's] claims at every turn."
The fatal flaw I see in Dr. Carlat's approach is that he simply replaces "med-check" symptom-based psychopharmacology with "integrative" symptom-based psychopharmacology. One listens to patients more, but then does the same thing. Since symptom-based psychopharmacology is simple (anxiolytics for anxiety symptoms, antidepressants for depressive symptoms, amphetamines for cognitive symptoms), he then recommends expanding prescribing privileges to psychologists. This is not just an answer to a practical problem (not enough psychiatrists) but importantly it is an answer to a theoretical problem (psychiatry is too biological). I think it just exaggerates the problem (psychopharmacology is symptom-based).
He ends this book with another example of eclectic psychopharmacology: a young woman who was abused by her father as a child has PTSD symptoms. The authors listens carefully and attentively and takes many notes, and prescribes the SRI Celexa. She notices some benefit but also feels she needs therapy for her anxieties especially in relation to her own children. I agree with the need for psychotherapy; I don't see the need for the Celexa, especially when this is just the kind of scenario when the benefits of antidepressants are minimally, if at all, better than placebo.
"Medications became the new [psycho]therapy" as one chapter title has it. It seems the solution is psychotherapy plus medications, the standard eclectic solution of more is better. We still don't see, in this approach, an answer to the question: What is the best solution in circumstance X versus Y? Are there conditions or setting where just medications, or just therapy, might be the right answer?
Do I have a better solution? I've written two books on the topic and can't do justice to the matter in a paragraph, and this review is about the author and not about me, but I'll try to give the essence of my alternative. Psychiatry has always gone back and for the between dogmatisms, initially biological reductionism and then psychoanalytic orthodoxy. About three decades ago, an eclectic cease-fire occurred, called the biopsychosocial model, in which any or all approaches were deemed acceptable. Consequently, the new medications were increasingly used, and the old psychotherapies maintained. This approach is at its core, conceptually, eclecticism: the view that any method or theory can be right. The eclectic philosophy assumes that more is better, hence the common combination of drugs and psychotherapies. But the problem is that this approach produces professional anarchy: there is no rhyme or reason to what many clinicians do. (This agrees with the diagnosis made in this book, though I provide a cause not discussed in this book). Because no one can really defend what they are doing well, the pharmaceutical and insurance industries push the profession economically in the direction of drugs and brief visits or hospitalizations. The solution: one has to be neither eclectic nor dogmatic. There is not one single method or theory that applies everywhere (dogmatism), nor are any or all methods fine (eclecticism). Some methods are better for some conditions, and not others. One can call this method-based psychiatry. So the biological disease method is appropriate for likely diseases, like schizophrenia or manic-depression, but not for likely social problems, like divorce-related insomnia. The psychoanalytic method is appropriate for trauma, the existential method for problems of living, social methods for public health problems (poverty-related child abuse, neglect-related childhood inattention). Dimensional approaches are appropriate for understanding extremes of personality traits (like neuroticism, rather than the disease-like categories of "personality disorders"). In each of these settings, one method is the best, and the other ones should not be used. Occasionally, if the scientific evidence shows it to be the case, some conditions (like perhaps "neurotic depression", an appellation missing in DSM-IV, but which has reasonable scientific merit) might be best understood by use of more than one method (e.g., biological and existential approaches), although even there methods might be used sequentially rather than simultaneously, or ad hoc, as is currently the case. This kind of thinking has been fleshed out in the works of Karl Jaspers, originally, and Leston Havens and Paul McHugh, more recently, and I've tried to extend and expand it. It is much more complicated than eclectic treatment of symptoms with drugs and/or psychotherapy, but it is both more conceptually clear and scientifically-based.
So, on the question of when and how to use drugs, my solution would be to reject symptom-based psychiatry and move to a disease-based psychiatry, just as in medicine. That patient's inattention may be due to depression or mania or anxiety, all of which can happen in bipolar disorder, for instance. If she has that disease, then the treatment is lithium, not amphetamines, which in fact can worsen bipolar disorder in the long run. If the patient does not have bipolar disorder, I'm not certain I would recommend any medication prescription, much less an addictive drug which, in animal studies, causes hippocampal atrophy, and thus may worsen cognition in the long run. In this sense, I think my approach is more conservative pharmacologically, even though it is more biological, than what is recommended here.
This is only one aspect of the discussion in the book. I will not get into the deserved critique of the excessive marketing of the pharmaceutical industry, although that is the main aspect of the book that seems discussed in some settings, such as the author's National Public Radio interview. Such public influences are not minor. This is a "trade" book, in the publishing lingo, put out by a major New York publisher for the general public. It is not an academic book published by a university press. As such, it has wider impact in society. The author knows how to write for the larger public, a skill which is to be admired, and which we psychiatrists should all seek to practice. What he says, though, will be interpreted through the assumptions of our larger society. In the general public, whatever the author's intentions, this book will be seen as another attack on psychiatry, feeding into the stigma against the field and against mental illness that is already a major social prejudice. One gets the sense of this from the press release provided by the publisher: "….the overdiagnosis of mental illness has gotten so out of control that the diagnosis of bipolar disorder in children has increased by 8000 percent [italics in original] in just nine years." What the press release doesn't say is that the starting point was a diagnosis rate of practically zero (literally 0.01%) which increased 40-fold (yes 8000%) to the whopping figure of 0.4%, which, by the way, is the actual frequency of bipolar disorder in children according to the most accepted scientifically valid NIMH epidemiological study. Put another way, 99.6% of children are not diagnosed with bipolar disorder: a major epidemic.
This kind of exaggeration is expectable and appears to have happened since the book's publication; unfortunately such books lend themselves to such misinterpretations. In that sense, I think the book may be both more and less than people might understand. It is not just another critique of the pharmaceutical industry, and as such, it may just add to the cacophony of critiques that does not inherently clarify many of our current problems. It is a larger critique of psychiatry, with a proposal for more psychotherapy and more symptom-based medication treatment extended to non-physicians. In that larger critique, I think the view expressed here is an extension of, not the solution to, the current fatal problem of psychiatry: an "anything goes" eclecticism whereby any and all symptoms are treated with any and all drugs (plus or minus psychotherapies). The authors seems only to want to remove the minus sign in front of the psychotherapies, and to remove pharmaceutical marketing as the reason to use drugs: drugs are still to be used plenty, based on deeper psychotherapeutic understanding of a patient's symptoms. For those seeking a broadside against the pharmaceutical industry, there is plenty of legitimate material here. For those more profoundly critical of the overuse of drugs in psychiatry, or seeking a new approach to psychiatry beyond our current eclecticism, this is a sheep in wolf's clothing.
© 2011 Nassir Ghaemi
S. Nassir Ghaemi, M.D., M.A., M.P.H., Director, Mood Disorders Program, Tufts Medical Center, Dept of Psychiatry. Dr. Ghaemi is author of The Concepts of Psychiatry: A Pluralistic Approach to the Mind and Mental Illness, Johns Hopkins University Press, 2003. His book A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness will be published later in the year.