Chemicals for the Mind: Psychopharmacology and Human Consciousness

In Chemicals for the Mind, Ernest Keen expresses profound skepticism about the motives of modern psychiatry. He criticizes the medical model of symptom identification and diagnosis, noting that medicalizing human suffering "unobtrusively reduces moral and mental issues to technological ones." Keen, a professor of psychology at Bucknell University, challenges the ethical principles of psychiatric treatment, claiming that "the academic setting of psychology, in contrast to psychiatry, can and generally does avoid the pressures of professional profits and market economics."

The theme of this book is that "biological reductionism is psychiatry's way of avoiding coping with (mind-body) dualism." Keen criticizes psychiatry's attempt to "objectify" the functioning of the brain. Psychiatrists depersonalize their patients when they view them as "mere brain matter," he observes.

Keen frequently expresses skepticism about the safety of modern medicine. He compares pharmacotherapy to lobotomy: both are means of inflicting violence by altering brain functioning. He warns, "It is far from clear that we are not committing the same errors with our latest technology of pharmacology as we did in the disastrous mutilation of brains that came from the surgical hubris of lobotomists."

Differentiating free will from natural events, he finds it frustrating that assigning a biological etiology to behavior removes responsibility and morality from that behavior. For instance, referring to schizophrenia as a means of individuals' expressions of their individuality and conflicts with morality, Keen questions the biological etiology of severe mental illnesses. He observes that if schizophrenia is viewed in terms of free will, then neither the family nor the patient "can escape the responsibility of making a choice." Alternatively, if it is viewed from a purely biological standpoint, Keen warns that patients and their families "both give up the struggle and accept the inevitable," in a defeatist manner. Comparing individuals surviving mental illnesses to those surviving cancer, he notes that the latter "are richer for the experience of the physical and spiritual struggle of facing the ultimate and inevitable shutdown of the physical body." Treating schizophrenia with medication, he feels, "nullifies the mental life of a schizophrenic."

Keen expresses apprehension about the detrimental effects of medications. He remarks, "When one masks or chemically ablates a personal struggle, the wisdom of such treatment might be questioned. . . . Although brain defects and neurological diseases certainly are problems, it is plausible that the wildest delusional patient has a perfectly normal brain." After criticizing psychiatrists for "remaining blind to the simultaneous creation of tardive dyskinesia" while treating patients with the older antipsychotics, he acknowledges only in a footnote that these older medications are being replaced with novel and safer agents.

Keen expresses similar concerns about the treatment of depression with antidepressants. "It does not speak to the part of the individual's experience that is free to choose an attitude, a behavior, a course of action, a lifestyle, or a career." Reminding us not to neglect the experiences of consciousness, individual will, and interpersonal struggles that may be affecting the lives of our patients, he says, "Drugs that change consciousness may impoverish human experience." By using the technical mastery of psychotropic drugs, he believes, "humans are invading not simply the brain, but the shape and tenor of human experience."

Throughout this text, Keen grossly minimizes the impact of psychopharmacology on reducing suicidality and limiting institutionalization while increasing the likelihood of patients' reintegration into the community. Although the book sensationalizes the use of medication in treating mental illness, its merits include an interesting historical and philosophical overview differentiating mind and brain. Keen reminds us that we should focus on individual struggles and conflicts rather than be distracted by a generalized diagnosis in mental health treatment. Despite the author's strong bias toward nonpharmacological interventions, Chemicals for the Mind offers a stimulating counterpoint to the aggressive use of increasingly available psychoactive medications.