Psychiatric drugs: reconsidering their mode of action and the implications for service user involvement
| Pages | 1-10 |
| Date | 03 May 2019 |
| Published date | 03 May 2019 |
| DOI | https://doi.org/10.1108/MHRJ-08-2018-0025 |
| Author | Marc Roberts |
| Subject Matter | Health & social care |
Psychiatric drugs: reconsidering their
mode of action and the implications for
service user involvement
Marc Roberts
Abstract
Purpose –The purpose of this paper is to examine two competing pharmacological models that have been
used to understand how psychiatric drugs work: the disease-centred model and the drug-centred model. In
addition, it explores the implications of these two models for mental health service users and the degree to
which they are meaningfully involved in decisions about the use of psychiatric drugs.
Design/methodology/approach –The approach is a conceptual review and critical comparison of two
pharmacological models used to understand the mode of action of psychiatric drugs. On the basis of this
analysis, the paper also provides a critical examination, supported by the available literature, of the
implications of these two models for service user involvement in mental health care.
Findings –The disease-centred model is associated with a tendency to view the use of psychiatric drugs as
a technical matter that is to be determined by mental health professionals. In contrast, the drug-centred
model emphasises the centrality of the individual experience of taking a psychiatric drug and implies a more
equitable relationship between practitioners and mental health service users.
Originality/value –Although infrequently articulated, assumptions about how psychiatric drugs work have
important consequences for service user involvement in mental health care. Critical consideration of these
assumptions is an important aspect of seeking to maximise service user involvement in decisions about the
use of psychiatric drugs as a response to their experience of mental distress.
Keywords Mental health services, Pharmacology, Service user involvement, Psychiatric drugs
Paper type Conceptual paper
Introduction
A widespread and enduring notion about psychiatric drugs is that they work by targeting and
correcting various biological dysfunctions that supposedly underlie the emergence and maintenance
of mental distress. Despite its pervasiveness, this understanding of how psychiatric drugs work is
increasingly being contested by those who work within and those who use mental health services
(Moncrieff, 2008; Lacasse and Leo, 2015; Whitaker, 2015; Roberts, 2018). Such a reconsideration of
the mode of action of psychiatric drugs has important implications for the way in which they are used,
the manner in which their potential benefits are balanced against their adverse effects and the extent
to which those who use psychiatric drugs are meaningfully involved in decisions about their use. In
seeking to explore these implications, this paper will begin by critically examining the popular notion
that psychiatric drugs work by selectively acting upon some form of biological dysfunction or
chemical imbalance of which mental distress is a supposed manifestation. However, in contrast to
this notion, it will move on to discuss an alternative understanding of psychiatric drugs as powerful
psychoactive substances that, by acting upon the central nervous system in a non-specific rather
than a targeted way, produce a range of physiological and psychological effects. Finally, this paper
will consider critically the implications of these two ways of understanding how psychiatric drugs work
for those who use mental health services and for thedegreetowhichserviceusersaremeaningfully
involved in decisions about the use of those drugs as a response to the experience of mental distress. Received 14 August 2018
Accepted 3 December 2018
Marc Roberts is based at the
Department of Health &
Society, University of
Worcester, Worcester, UK.
DOI 10.1108/MHRJ-08-2018-0025 VOL. 24 NO. 1 2019, pp. 1-10, © Emerald Publishing Limited, ISSN 1361-9322
j
MENTALHEALTH REVIEW JOURNAL
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PAG E 1
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