The Ethical Treatment of Depression
One in six people worldwide will experience depression over the course of a lifetime. Many who seek relief through the healthcare system are treated with antidepressant medication; in the United States, nearly 170 million prescriptions for antidepressants were written in 2005, resulting in more than $12 billion in sales. And yet despite the dominance of antidepressants in the marketplace and the consulting room, another treatment for depression has proven equally effective: psychotherapy—in particular, cognitive behavior therapy (CBT). Antidepressants can lift mood independent of a person’s understanding of symptoms or stressors. By contrast, CBT teaches patients skills for dealing with distressing feelings, negative thoughts, and causal stressors.
In The Ethical Treatment of Depression, Paul Biegler argues that the insights patients gain from the therapeutic process promote autonomy. He shows that depression is a disorder in which autonomy is routinely and extensively undermined and that physicians have a moral obligation to promote the autonomy of depressed patients. He concludes that medical practitioners have an ethical imperative to prescribe psychotherapy—CBT in particular—for depression. To make his case, Biegler draws on a wide philosophical literature relevant to autonomy and the emotions and makes a comprehensive survey of the latest research findings from the psychological sciences.
Forcefully argued, densely researched, and engagingly written, the book issues a challenge to physicians who believe their duty of care to depressed patients is discharged by merely writing prescriptions for antidepressants.
About the Author
Paul Biegler is Adjunct Research Fellow at the Centre for Human Bioethics, Monash University. He was the recipient of a 2011 Australian Museum Eureka Prize.
Table of Contents
- The Ethical Treatment of Depression
- Philosophical Psychopathology: Disorders of the Mind
- Jeffrey Poland and Jennifer Radden, Series Editors
- The Ethical Treatment of Depression: Autonomy through Psychotherapy,
- Paul Biegler (2011)
- Addiction and Responsibility,
- Edited by Jeffrey S. Poland and George Graham (2011)
- Psychiatry in the Scientific Image,
- Dominic Murphy (2006)
- Brain Fiction: Self-Deception and the Riddle of Confabulation,
- William Hirstein (2004)
- Imagination and Its Pathologies,
- Edited by James Phillips and James Morley (2003)
- Imagination and the Meaningful Brain,
- Arnold H. Modell (2003)
- When Self-Consciousness Breaks: Alien Voices and Inserted Thoughts,
- G. Lynn Stephens and George Graham (2000)
- The Myth of Pain,
- Valerie Gray Hardcastle (1999)
- Divided Minds and Successive Selves: Ethical Issues in Disorders of Identity and Personality,
- Jennifer Radden (1996)
- The Ethical Treatment of Depression
- Autonomy through Psychotherapy
- Paul Biegler
- The MIT Press
- Cambridge, Massachusetts
- London, England
- Massachusetts Institute of Technology
- All rights reserved. No part of this book may be reproduced in any form by any electronic or mechanical means (including photocopying, recording, or information storage and retrieval) without permission in writing from the publisher.
- For information about special quantity discounts, please email special_sales@ mitpress.mit.edu
- This book was set in Stone Sans and Stone Serif by Toppan Best-set Premedia Limited. Printed and bound in the United States of America.
- Library of Congress Cataloging-in-Publication Data
- Biegler, Paul, 1963–
- The ethical treatment of depression : autonomy through psychotherapy / Paul Biegler.
- p. ; cm. — (Philosophical psychopathology)
- Includes bibliographical references and index.
- ISBN 978-0-262-01549-3 (hardcover : alk. paper)
- 1. Depression, Mental—Treatment—Moral and ethical aspects. 2. Cognitive therapy—Moral and ethical aspects. 3. Autonomy (Psychology) I. Title. II. Series: Philosophical psychopathology.
- [DNLM: 1. Depressive Disorder—therapy. 2. Antidepressive Agents. 3. Cognitive Therapy—ethics. 4. Personal Autonomy. WM 171]
- RC537.B487 2011
- 10 9 8 7 6 5 4 3 2 1
- To the memory of my mother, Beryl Biegler
- Series Foreword ix
- Acknowledgments xi
- 1 Introduction 1
- 2 Autonomy:
- The Importance of Justified Beliefs about Material Facts 9
- 3 Autonomy:
- The Importance of Justified Beliefs about Affect 39
- 4 Depression:
- Disorder of Affect, Disorder of Autonomy 65
- 5 Understanding Negative Biases Promotes Autonomy in Depression 97
- 6 Understanding Causal Stressors Promotes Autonomy in Depression 119
- 7 A Special Duty to Promote Autonomy in Depression:
- The Moral Case for Psychotherapy 143
- Appendix: The Hamilton Rating Scale for Depression 169
- Notes 175
- Index 207
—Richard Ashcroft, Professor of Bioethics, University of London
—George Graham, Professor of Philosophy and Neuroscience, Georgia State University
—Patricia Illingworth, Department of Philosophy and Religion, College of Business Adminstration, and School of Law, Northeastern University