Drugs, Therapy, And Professional Power

The current practices of prescribing psychotropic drugs, according to Keen, are both inconsistent and irrational. Overprescription alone is epidemic, and is driven largely by popular demand and professional convenience. The fact that mental life is being affected with physical agents leads to theoretical complexities no simpler than the metaphysics of mind-body relationships. These deeper questions are being ignored, Keen asserts, in favor of pragmatic attitudes driven by convenience, cost, popular demands, insurance protocols, and theoretical preferences.

Keen first examines some of the reactions of psychiatry to the advent of pharmacotherapy. Parallels to the enthusiasm with lobotomy and deinstitutionalization are then explored. He argues that the treatment of the mentally ill must find some other way to mix pharmacotherapy with psychotherapy, for the theoretical and assumptive basis of the treatment profession is not settled. He asks how we can understand chemicals and experiences in the same theoretical framework, who exactly ought to prescribe, and whether ritual and placebo aspects of what is done by therapists are as likely to determine outcome as are chemical factors. In the last section of his book, Keen analyzes the implications of these issues for the rest of American society. A controversial book that will be important reading for teaching as well as practicing psychologists.

The book contains black-and-white illustrations.

Keen argues that current practices of prescribing psychotropic drugs are both inconsistent and irrational.

Virginia Galloway

This book provides an historical perspective on psychiatry's struggle for legitimacy and culminates in a frank discussion of current treatment methods. The author probes into the psychology of pharmacology, elucidating overprescription driven by popular demand and professional convenience. He has three objectives: to narrate the story of psychiatry's struggle with medication; to discuss the compatibility of psycho- and pharmacotherapies, psychology of pharmacology, and whether psychologists should prescribe; and to encourage mental health professionals to examine their future as well as psychiatry's future in light of current attitudes and social power. The book is targeted toward mental health care professionals. It would also be useful for students interested in public policy and sociology. The author focuses on current practices of prescribing psychotropics, which he describes as inconsistent and irrational. He honestly and clearly examines the theoretical beliefs, convenience, and corporate foundations on which we base our current ways of thinking about mental health and disease. He does not address the problems in psychology, and he largely ignores problems in determining efficacy of different forms of therapy being practiced by different levels of professionals, as well as who should pay for such therapies. This book is extremely pedagogical, forcing readers to examine the current mental health atmosphere in light of all the factors that contribute. The analysis is unnerving because it is logical and rarely discussed. This is a useful book for all mental health professionals, especially psychiatrists.

ERNEST KEEN is Professor of Psychology at Bucknell University.