This book is important and should be essential reading for all psychiatrists, politicians, service providers, and user groups. Why? Because Dr Joanna Moncreiff's central tenet is right, and the implications for service delivery are profound. There is little or no reliable evidence to suggest current drugs specifically treat an underlying biochemical abnormality. They are better seen as toxic or potentially toxic agents causing changes in brain function which may in some circumstances mask or alleviate symptoms. Rather than the current push within psychiatry to use available psychotrophic drugs to 'treat' as many people as possible, as early as possible, and to force extended compliance, the complete evidence base, in fact, suggests that use of drugs should be more limited and more cautious than it is at present, and that this would lead to better functional outcomes. This is counter-intuitive to many, which only serves to underline the importance of the book.
This book is psychiatry's Silent Spring. Joanna's book portends Scrambled Minds rather than a Silent Spring, but in both books we see illustrations of irresponsible behaviours and practices in the face of jaw dropping flaws and omissions in the evidence- base. Including the the planning, execution, interpretation, and dissemination of 'scientific' trials. The true nature of short term effect, long-term efficacy, safety, and cost/benefit is obscured by bad science and or the complexity of the issues involved.
Psychiatry is particularly vulnerable to systematic misreading and or distortion of the evidence-base because of the uncertainties surrounding diagnosis, mechanism of drug 'efficacy', identification of psychiatric and physical side-effects, and assessment of outcomes. The potential for habituation and or forced treatment, particularly long-term in the community, adds a unique ethical dimension. I have read much of the primary literature first hand, including the papers underpinning N.I.C.E guidelines, and Cochrane Reviews, and independently reached very similar conclusions to Joanna.
The book is closely argued and well referenced. Even if you disagree with some of it's overall premises, it is not legitimate to dismiss it. I urge you to read it if only as a prompt to a critical evaluation of the status quo, never a bad thing, and almost always an illuminating exercise .