Aldous Huxley imagined a brave new world in which technology had triumphed in all facets of human life. In his dystopic world, the euphoria-inducing drug soma had placated the masses and subdued human emotion. Now, 80 years after the publication of Brave New World, the book’s themes are more relevant than ever.
I was reminded of this at the most recent annual meeting of the American Psychiatric Association (APA). While psychiatrists from around the world gathered inside the convention hall, “Occupy the APA” protesters stood outside to sound their concern that the association’s new DSM-5 (Diagnostic and Statistical Manual), due to be unveiled in 2013, would unduly pathologize the human condition. Furthermore, protestors were worried that medications for treating these “pathologies” would come to suppress the full range of human experience.
Indeed, there is an ever-burgeoning brave new world of psychopharmacology. However, it is not just advances in psychotropic medication that have been taking psychiatry by storm. Advances in digital technology, biotechnology, and genetics are also changing the landscape of psychiatry in the twenty-first century.
This month’s issue of Virtual Mentor examines the powerful role of rising technologies in psychiatry and how they are shaping our conversations in psychiatric ethics. David H. Brendel, MD, PhD, explores the ethics of reading patients’ blogs. Anthony P. Weiss, MD, MBA, comments on using firewall protections to segregate psychiatric information in electronic medical records, and Richard A. DeVaul, MD, discusses treating bereavement with antidepressant medications.
As new technologies are introduced to the field, policy makers struggle to understand what sorts of regulations will be needed to manage unforeseen ethical questions and problems that arise from their use. Daphne C. Ferrer, MD, and Peter M. Yellowlees, MD, highlight this concern using the emergence of telepsychiatry as an example. Dien Ho, PhD, wonders whether the FDA’s placing a black-box warning on antidepressants was the best possible policy action, given the absence of sufficient evidence.
Perhaps even more importantly, we must ask how the medical profession should deal with emerging, yet-to-be proven technologies. Martha J. Farah, PhD, and Seth J. Gillihan, PhD, examine the clinical role for brain imaging in the diagnosis of psychiatric disorders, and Aaron D. Besterman, MD, offers his thoughts on a literature review of ethical considerations in psychiatric genetics. Does what we know about the brain allow us to predict with any accuracy who might become violent? Robert T. M. Phillips, MD, PhD, explains how the courts treat expert predictions of future dangerousness and defines various approaches to making those predictions.
Advances in psychiatry and neuroscience have social as well as medical implications. Using images and language from psychotropic drug ads, Jonathan M. Metzl, MD, PhD, illustrates that pharmaceutical companies exploited social fears and racism in the 1960s and ’70s to promote sales of their treatments for psychosis. Nada Gilgorov, PhD, comes closest to Huxley’s imagined world when she probes the question of humans’ accountability for their actions. Do correlations between specific behaviors and localized patterns of brain activity challenge the belief that we have free will?
Much is said in this issue about how mental conditions get pathologized and often subsequently depathologized. In her op-ed article, Christina Nicolaidis, MD, offers physicians insights from the autism self-advocacy movement, encouraging them to treat each autistic person as an individual. In a medical education article, David Elkin, MD, Erick Hung, MD, and Gilbert Villela, MD, suggest ways to help resident physicians think critically about many of the topics that this month’s authors raise.
With a new edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders coming out next spring, the ethical concerns examined in this issue of Virtual Mentor will remain topical and controversial.