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Philosophy, Psychiatry, & Psychology 12.2 (2005) 137-141



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From Lab Bench to Bedside . . . to Nowhere Premises, Problems, and Paths

Keywords
depression, psychopharmacology, self, dimensionality, antidepressants, existentialism

A Basic Problem and Areas of Agreement

As a frequent consumer of psychiatric lit-erature (both solicited and not) I am more and more troubled by the common use of titles such as: "Molecules of the Mind," "The Physiological Basis of (fill in the blank) Disorder," Neurological Underpinnings of . . . " and the most distressing "From Lab Bench to Bedside. New Strategies in the Management of . . . " What, I find myself asking, are they talking about? Scientists have a lot of information about psychiatric disorders. They also know a lot about how to make medicines that alleviate symptoms. All of this is pretty sophisticated science. This is different from knowing a disorder's biological cause or cure. The latter implies a reductionistic understanding of the biology.

To be clear, no one knows the biological underpinnings of any psychiatric disorder or of any higher mental function. With the exception of a class of medicines for Alzheimer's disease, none of our present psychiatric treatments came from lab bench to bedside (they usually go in reverse). Even in the case of the Alzheimer's drugs (cholinesterase inhibitors), it is a long way to molecules of the mind.

I raise this concern about the present hypertrophied confidence in our knowledge of the biological bases of mental disorders because it bears squarely on a central matter in this discussion of the problems of psychotropic drug use. This present confidence is based on very weak premises regarding the explanatory and therapeutic implications of current neurophysiology. Weak premises lead to weak conclusions. We have already been down this road with psychoanalysis and we are headed down it again.

Surprisingly, one finds the same weak premises in the critical enhancement literature. References to "mood brighteners" and the fixing of alienation with a pill abound. Rather than being "technophobic" as Jennifer Hansen describes the critics (or assumes that I would describe them), it seems to me that the critics share the assumptions of the scientifically convinced, who presently rule the roost in psychiatry. That is to say that scientists understand the biology of mood and personality and can make compounds to [End Page 137] control them at will. This is an inaccurate and vastly overgeneralized point of departure, but one that underlies discussions of treating "normal sadness" or alienation.

It is from this starting point that I wrote the essay "What Are (and What Are Not) the Existential Implications of Antidepressant Use?" In it I attempted to flesh out some concerns about the capabilities of antidepressants as they relate to aspects of our humanity (the existential loss hypotheses, or ELH in Hansen's commentary). I also endeavored to outline a set of concerns that I think are raised by new and effective treatments to old and common problems.

In her commentary, "Existential Fright or Ferocious Market Forces?" Hansen takes a critical look at my analysis. My first comments are of agreement. Hansen's critique is supported throughout by assumptions she believes I hold, inferences I may have made, and premises that are supposedly implicit in my argument (all of which she disagrees with). Included are the belief that selective serotonin reuptake inhibitor (SSRIs) address the cause of depression and are the best treatment for it. I am with Hansen in that I do not believe either of these premises.

She also names problems such as direct-to-consumer advertising, drug lobbyists, and inappropriate and cursory prescription of antidepressants, and finds my paper incomplete without discussion of these. Perhaps it is disorienting to the reader for me to not place my concerns in some stance vis-à-vis these. To correct that let me state that I think all these things are very problematic and did not include them because the paper is not about market forces and so on. Certainly the effects of these problems and the concerns I address overlap in the influence of any one patient or...

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