Psychiatric Ethics

May 28, 2009

Editors: Sidney Bloch and Stephen Green

Edition: Fourth

Publisher: Oxford University Press

Pages: 560

Price: £.95

ISBN 9780199234318

The appearance of this volume, even though it is "just" a textbook, is both supremely timely and exquisitely disappointing. It is timely because a series of abuses arising at the interface between medical practice, clinical care and pharmaceutical company marketing are front page news in The New York Times, and all over the blogosphere, while some of our most eminent medical academics portray themselves as victims of a modern witch-hunt.

The disappointment stems perhaps from the almost inevitable risk in an edited volume like this of missing out on the breaking news - or having it slip between contributors.

There is little here on the new dilemmas linked to pharmaceutical company sequestration of data, co-opting of the guideline process and ghostwriting of academic articles that have led many senior psychiatrists to be dismissed or to retire. There is nothing on the mass drugging of infants with antipsychotics, or editorials in major journals all but advocating the compulsory treatment of pregnant women with antidepressants.

As these issues at the moment are largely American, it is tempting to suggest that some future contributor might grapple with the ethics of dealing with American enthusiasms. But there is a more general issue to ponder in this whimsy. The contributors have, for the most part, neither been players in the ethical dilemmas they deal with, nor are they ethicists dealing with the issues from a loftier plane seeking to reveal the principles underpinning a conflict.

The contributions too often are academic reviews of clinical issues with an ethical tag to the effect that these issues are complex and it would be good to be ethical. The chapters, however, commonly avoid coming to any judgments and give no indication as to what being ethical might amount to.

Psychiatry's past conflicts, such as the political use of detention on mental health grounds and antipsychotics, the forced administration of megadoses of antipsychotics or other treatments, or legal issues such as compulsory detention, are covered.

But there is effectively nothing on the Stockholm syndromes that can arise in primary care when treatment with psychotropic drugs goes wrong, even though perhaps the best account of this is in a recent book from Melbourne called Dying for a Cure. In this sense, this book feels as though its authors are offering an apologia for the psychiatry of One Flew Over the Cuckoo's Nest rather than grappling with any 21st-century Mildred Ratchets.

Who is it for? Mental health professionals as well as journalists, lawyers and others working in the mental health domain.

Presentation: Very 20th century.

Would you recommend it? Definitely, but partly because the annoyance at what is left out is consciousness-raising.

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