This paper conducts a critical examination of the "usual psychopharmacology standards" for clinical research. Four main areas are inspected: What is "it" that is being treated in a clinical drug study? How much is really known concerning the psychological alterations brought about by psychiatric drug treatment? To what extent are sources of bias actually controlled for in "controlled" drug treatment studies? How does the usual "dropout pattern" influence the alleged "clinical findings" of controlled drug treatment studies? The overall conclusion reached (...) is that the "usual standards" cannot produce a realistic picture of either safety or efficacy. Conceptual and methodological reforms are suggested. (shrink)

The "modern" era of psychiatric drug treatment began with the introduction of chlorpromazine into the chaotic mental hospital setting in the 1950s as a new psychotropic agent for controlling excitement, agitation, and aggressivity. In that setting the urgency of management problems operated to shrink the complexity of the patient as a psycho-social being down to specific "symptoms" targeted for chemical subjugation. From this beginning - a chemically produced quieting or "tranquilization" -- there emerged a revitalized psychiatric movement to expand the (...) "strictly medical" understanding and treatment of psychological disturbance that acknowledges no limits. This state of affairs has achieved a position of dominance and respect in the mental health industry, based upon social forces operating within psychiatry as a profession and outside of psychiatry in the larger political-economic realm. The catastrophe of widespread and expanding medically-produced disease has failed to alarm psychiatry into taking stock of the determinants of the catastrophe - indeed the existence and magnitude of the tragedy is barely recognized within psychiatry. This conclusion is illustrated by detailed examination of the psychopharmacologic agents alprazolam and fluoxetine. (shrink)