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.