Re: Medicalising unhappiness: new classification of depression risks more patients being put on drug treatment from which they will not benefit
In reply to Dr Anand: “It is interesting that medical ethicists are staying silent in these debates”, I suggest that medical ethicists find it pretty much impossible to get heard in these debates when they do speak out.
As long ago as 2008, Dr Paul Biegler, Melbourne emergency physician, and, for some years now, bioethicist from Monash University, had a relevant article published in this very journal (1). The article was a brief preliminary write up of a point of view he later expressed in his PhD thesis. That view, and I hope I am stating it well enough, is that doctors have an ethical duty to promote therapies which are likely to help sufferers of “depression” regain their autonomy and, moreover, help them to gain insight into why they are “depressed”. He argues that these therapies are the psychotherapies or talking therapies (and mainly discusses cognitive behaviour therapy) and not drug therapy approaches. (Note: The “depressed” people whom Dr Biegler considers in his work are those with uncomplicated mild, moderate and severe “depression”, (2, page 176 note 25) not those individuals with melancholia or complicated depressions. Further, he emphasises the well recognised role of stressful life events in causation of most instances of uncomplicated “depression” in his work). The article received 2 rapid responses from doctors, and they weren’t overly supportive of his argument.
In 2010, Dr Biegler went on to publish another article in the journal Bioethics (3) which, again, provides an excellent summation of his thesis which was to come.
In 2011, he published his PhD thesis as a book: “The ethical treatment of depression: autonomy through psychotherapy” (2). This book is an extremely well argued and scholarly work, but, indeed, heavy going for those who aren’t bioethicists. What is more it won the Australian Eureka Science prize for the Ethics category in 2011. I heard Dr Biegler speak about his work on Australian government radio in September 2011(4). Another excellent brief summary of his work can be found in an article he more recently penned for The Conversation website (5).
In 2013, the Medical Journal of Australia published a cursory and dismissive review of Dr Biegler’s book (6). Undoubtedly, the psychiatrist who wrote the review is a worthy and very busy physician, but nevertheless such a landmark book merited a far more thorough and focused critique.
It can be easy for other ethicists to refute Dr Biegler’s well argued case (7). Nevertheless, I would maintain that his argument stands up to close scrutiny.
I believe that he is fully justified in stating that:
“…doctors [are] failing on a vast scale to uphold their ethical obligations to patients with [uncomplicated] depression” (2, page 2).
1. Beigler P Autonomy, stress and treatment of depression BMJ 2008;336:1046
2. Biegler P The Ethical treatment of depression: autonomy through psychotherapy” 2011 MIT Press, Cambridge, Mass.
3. Biegler P Autonomy and ethical treatment of depression Bioethics 2010 May;24(4):179-89
6. Wilhelm KA. The case for CBT over antidepressants. Med J Aust. 2013;198:507.
7. Boghossian P Review of “The ethical treatment of depression: autonomy through psychotherapy” Essays in Philosophy 2012; 13 (1) article 20 Open Access
Competing interests:
I have never suffered from uncomplicated or complicated depression. I am a member of Healthy Skepticism which aims to reduce the harms of misleading health information.
Rapid Response:
Re: Medicalising unhappiness: new classification of depression risks more patients being put on drug treatment from which they will not benefit
In reply to Dr Anand: “It is interesting that medical ethicists are staying silent in these debates”, I suggest that medical ethicists find it pretty much impossible to get heard in these debates when they do speak out.
As long ago as 2008, Dr Paul Biegler, Melbourne emergency physician, and, for some years now, bioethicist from Monash University, had a relevant article published in this very journal (1). The article was a brief preliminary write up of a point of view he later expressed in his PhD thesis. That view, and I hope I am stating it well enough, is that doctors have an ethical duty to promote therapies which are likely to help sufferers of “depression” regain their autonomy and, moreover, help them to gain insight into why they are “depressed”. He argues that these therapies are the psychotherapies or talking therapies (and mainly discusses cognitive behaviour therapy) and not drug therapy approaches. (Note: The “depressed” people whom Dr Biegler considers in his work are those with uncomplicated mild, moderate and severe “depression”, (2, page 176 note 25) not those individuals with melancholia or complicated depressions. Further, he emphasises the well recognised role of stressful life events in causation of most instances of uncomplicated “depression” in his work). The article received 2 rapid responses from doctors, and they weren’t overly supportive of his argument.
In 2010, Dr Biegler went on to publish another article in the journal Bioethics (3) which, again, provides an excellent summation of his thesis which was to come.
In 2011, he published his PhD thesis as a book: “The ethical treatment of depression: autonomy through psychotherapy” (2). This book is an extremely well argued and scholarly work, but, indeed, heavy going for those who aren’t bioethicists. What is more it won the Australian Eureka Science prize for the Ethics category in 2011. I heard Dr Biegler speak about his work on Australian government radio in September 2011(4). Another excellent brief summary of his work can be found in an article he more recently penned for The Conversation website (5).
In 2013, the Medical Journal of Australia published a cursory and dismissive review of Dr Biegler’s book (6). Undoubtedly, the psychiatrist who wrote the review is a worthy and very busy physician, but nevertheless such a landmark book merited a far more thorough and focused critique.
It can be easy for other ethicists to refute Dr Biegler’s well argued case (7). Nevertheless, I would maintain that his argument stands up to close scrutiny.
I believe that he is fully justified in stating that:
“…doctors [are] failing on a vast scale to uphold their ethical obligations to patients with [uncomplicated] depression” (2, page 2).
1. Beigler P Autonomy, stress and treatment of depression BMJ 2008;336:1046
2. Biegler P The Ethical treatment of depression: autonomy through psychotherapy” 2011 MIT Press, Cambridge, Mass.
3. Biegler P Autonomy and ethical treatment of depression Bioethics 2010 May;24(4):179-89
4. Biegler P The ethical treatment of depression ABC Radio National, Sydney 7 September 2011 http://www.abc.net.au/radionational/programs/lifematters/the-ethical-tre...
5. Biegler P Treating depression ethically requires more than drugs The Conversation 22 January 2013 http://theconversation.com/treating-depression-ethically-requires-more-t...
6. Wilhelm KA. The case for CBT over antidepressants. Med J Aust. 2013;198:507.
7. Boghossian P Review of “The ethical treatment of depression: autonomy through psychotherapy” Essays in Philosophy 2012; 13 (1) article 20 Open Access
Competing interests: I have never suffered from uncomplicated or complicated depression. I am a member of Healthy Skepticism which aims to reduce the harms of misleading health information.