Joanna Moncrieff, MD, s professor of critical and social psychiatry at University College London and works as a consultant in community psychiatry in London. She has researched and written about theories of drug action, drug efficacy, the subjective experience of taking psychiatric drugs; decision-making; the history of drug treatment; and the history, politics, and philosophy of psychiatry more generally. She is currently leading a United Kingdom (UK) government-funded study of antipsychotic reduction and discontinuation, called the RADAR study (Research into Antipsychotic Discontinuation and Reduction). She is one of the founders and the co-chairperson of the Critical Psychiatry Network. She has authored numerous papers and several books including The Myth of the Chemical Cure (Palgrave Macmillan, 2008); The Bitterest Pills: The Troubling Story of Antipsychotic Drugs (Palgrave Macmillan, 2013); and A Straight-Talking Introduction to Psychiatric Drugs (PCCS Publishers, 2013).
Moncrieff's views on psychopharmacological mechanisms of action, although controversial, have been influential within the critical psychiatry community. We have discussed some implications of the drug-centered model in an earlier interview with Sandra Steingard, MD. Moncrieff's ongoing randomized controlled trial investigating the long-term impact of gradual antipsychotic dose reduction and discontinuation in schizophrenia on outcomes such as psychotic relapse and social functioning (versus maintenance treatment) could alter how the field approaches management of chronic psychotic disorders.
This interview, however, largely focuses on conceptual concerns, exploring her views on the nature of psychiatric suffering. My first conscious exposure to Moncrieff was at the 2017 annual meeting of the Association for the Advancement of Philosophy and Psychiatry, where Moncrieff gave the keynote lecture titled "Many Ways of Being Human," in which she challenged the medical view of mental disorders and argued that medical and psychiatric conditions have a different relationship to agency, responsibility, and selfhood.
Moncrieff s ideas carry on the legacy of Thomas Szasz, MD, and given my own disagreements with how Szasz conceptualizes the notion of disease, this interview also represents an attempt on my part to understand how deep our philosophical disagreements go.
The article in Philosophy, Psychiatry, & Psychology referred to by Moncrieff was in press at the time this interview was conducted but has since been published online. I would also like to add that there is a large body of literature critically engaging with the ideas of Thomas Szasz, such as the 2019 book Thomas Szasz: An Appraisal of his Legacy (International Perspectives in Philosophy and Psychiatry; 2019), which I would encourage readers to explore.
AFTAB: Can you briefly tell us about the Critical Psychiatry Network? Its mission and how it has impacted British psychiatry over the years?
MONCRIEFF: When I was a trainee in psychiatry, I felt the way psychiatry was portrayed in the mainstream--in textbooks and medical journals--did not match my ideas about the nature of mental health problems or my experience of individuals who were deemed to have such problems. I was aware that other trainees felt like this too, so I started a club while I was at the Institute of Psychiatry in 1997. Initially...