Joanna Moncrieff | |
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| Born | 1966 (age 58–59 years) |
| Occupation(s) | Psychiatrist and academic |
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Joanna Moncrieff is a British psychiatrist and academic. She is Professor of Critical and Social Psychiatry atUniversity College London and a leading figure in theCritical Psychiatry Network. She is a critic of the modern 'psychopharmacological' model of mental disorder and drug treatment, and the role of the pharmaceutical industry. She has written papers,[1] books and blogs on the use and over-use of drug treatment for mental health problems, the mechanism of action of psychiatric drugs,[2] their subjective and psychoactive effects, the history of drug treatment, and the evidence for its benefits and harms. She also writes on thehistory and politics of psychiatry more generally. Her best known books areThe Myth of the Chemical Cure[3] andThe Bitterest Pills.[4]
Moncrieff qualified in medicine from theUniversity of Newcastle upon Tyne in 1989. She trained in psychiatry in London and southeast England during the 1990s, becoming anMRCPsych in 1994. In 2001 she received an MD (in the United Kingdom, an advancedresearch doctorate) from theUniversity of London. From 2001 for 10 years she was the consultant for apsychiatric rehabilitation unit for people with severe and enduring mental disorders.[5] She works as a consultant in adultcommunity psychiatry at theNorth East London NHS Foundation Trust,[6] and she is Professor of Critical and Social Psychiatry atUniversity College London, having previously been a senior lecturer in the Division of Psychiatry.[7] She is also currently the Principal Investigator for theNIHR-funded RADAR (Research into Antipsychotic Discontinuation And Reduction) study.[8]Dr Moncrieff is a founding member and the co-chairperson of theCritical Psychiatry Network.[9]
Professor Moncrieff unsuccessfully stood in the Ingatestone, Fryerning and Mountnessing: Brentwood council election in 2021 and 2022 as the Labour Party candidate.[10]
In 2023, Dr.Peter Lehmann published her interviewMyth of the Chemical Cure inGerman language with the titleDer Mythos der Heilung durch Chemie in Will Hall,Jenseits der Psychiatrie – Stimmen und Visionen des Wahnsinns im Madness Radio. Berlin & Lancaster: Peter Lehmann Publishing, pp. 46–53.ISBN 978-3-910546-23-3 (paperback),ISBN 978-3-910546-26-4 (e-book).
Moncrieff's work challenges the idea that drugs or medications have specific effects on underlying diseases or abnormalities. She is known for challenging the theory that mental disorders are caused by chemical imbalances.[11] She believes that there is little evidence forserotonin abnormalities indepression,[12] ordopamine abnormalities inpsychosis orschizophrenia.[13] She traces the history of the idea thatpsychiatric drugs aremagic bullets and she explores the alleged role of thepharmaceutical industry, the psychiatric professional and the state in fostering this model. She has taken part in papers that have documented the increasing rates of prescriptions of psychiatric drugs over the last decade,[14] and maintains the claim that the pharmaceutical industry has created conditions likeadult ADHD[15][16] and the ‘newbipolar disorder’ to helpmarket these drugs.[17]
Moncrieff states she is not completely opposed to the use of drugs for mental health problems, but believes that the action of drugs in these situations is misunderstood. Moncrieff developed two alternative 'models' for understanding what drugs might be doing when they are prescribed to people with mental health problems. The current mainstream understanding of psychiatric drug action is based on a 'disease-centred' model that suggests that drugs work by rectifying the underlying abnormality that is presumed to lead to the symptoms of the disorder in question. Moncrieff contrast this with an alternative 'drug centred' model, which suggests that since psychiatric drugs arepsychoactive substances, they work because they change the way people think, feel and behave. According to this model, psychiatric drugs have no specific biological effects in people with a mental disorder, and they produce their characteristic effects in everyone who takes them. The changes induced by some sorts of drugs may, however, lead to the suppression of the manifestations (symptoms) of some mental disorders.[18]The Myth of the Chemical Cure traces the emergence and development of the disease-centred model from the 1950s onwards. It purports to highlight the lack of evidence for the disease-centred model of drug action for every major class of psychiatric drug, despite the psychiatric consensus. It also explores supposed commercial, professional and political interests behind the disease-centred model.[3][page needed]
Moncrieff has written several papers criticising the methodology ofantidepressant research.[19] She did aCochrane meta-analysis of the small group of trials of antidepressants that compared them with an 'active'placebo containing a drug used to mimic some of the side effects of the antidepressants used.[20] She has published a paper that describes the psychoactive effects of modern antidepressants and their association withsuicidal ideation, and with physical effects.[21]
Together with Dr. Mark Horowitz, Moncrieff in 2022 conducted the first[citation needed] systematic umbrella review of the evidence for the serotonin "chemical imbalance" theory of depression, which suggests that the evidence does not support the hypothesis.[22][23]
The Bitterest Pills traces the history ofantipsychotic drugs from the introduction ofchlorpromazine in the 1950s. The book also looks at recent developments, including the marketing of antipsychotics through theEarly Intervention movement, and the promotion of a new and expanded concept of bipolar disorder.[4][page needed] Moncrieff also describes the cultural development of the new concept of bipolar disorder, which she refers to as ‘themedicalisation of "ups and downs"’. Research by Moncrieff and colleagues described and compared the subjective or psychoactive effects of different antipsychotics.[24] This included publication in the controversial and non-peer reviewedMedical Hypotheses.[25]
In early work Moncrieff analysed the evidence for the efficacy oflithium. She claimed there was no evidence that lithium was superior to other sedatives for the treatment of acutemania, and that lithium's efficacy in preventing a relapse of manic depression was due to the adverse effects caused by the sudden withdrawal of lithium.[26] In later work she showed that studies on the outcome of lithium treatment in the real world fail to demonstrate useful or worthwhile effects, and suggest it may even worsen the outcome of manic depression.[27]
Moncrieff has critically reviewed the literature on the use of drug treatments likeacamprosate andnaltrexone foralcohol problems[28] and the use ofstimulants in children.[29][page needed]
Moncrieff has developed a political analysis of the drivers of modern mental health theory and practice and explored the influence ofneoliberalism.[30][31] She has published papers on the historical context of the emergence of modern drug treatment,[32] the history of psychiatric thought in the 20th century[33] and of ‘rapid tranquilisation’ in psychiatry,[34] as well as her books on the history of drug treatments.
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