The Ethical Treatment of Depression

Autonomy through Psychotherapy

A philosopher argues there is an ethical imperative to provide psychotherapy to depressed patients because the insights gained from it promote autonomy.

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.

This is not an anti-psychiatry book because, even though he explicitly puts more emphasis on stress than on biology in depression, he never recommends against the use of antidepressants. In that sense The Ethical Treatment of Depression contributes, in my opinion, to a hopeful trend toward more widespread application of insight oriented psychotherapy augmenting or augmented by the use of antidepressants.—Metapsychology

This is an important book for clinicians and medical ethicists who are seeking new ways to treat and understand depression's causes…Recommended.

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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.

About

A philosopher argues there is an ethical imperative to provide psychotherapy to depressed patients because the insights gained from it promote autonomy.

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.

Reviews

This is not an anti-psychiatry book because, even though he explicitly puts more emphasis on stress than on biology in depression, he never recommends against the use of antidepressants. In that sense The Ethical Treatment of Depression contributes, in my opinion, to a hopeful trend toward more widespread application of insight oriented psychotherapy augmenting or augmented by the use of antidepressants.—Metapsychology

This is an important book for clinicians and medical ethicists who are seeking new ways to treat and understand depression's causes…Recommended.

Choice

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.