Suffering in science: Care and recovery in evidence-based psychiatric treatments

Abstract

Summary Escalating numbers of depressed, anxious, and suicidal persons in the United States have led to increased demands for clinical practice guidelines. These guidelines are designed by and for medical professionals to locate and promote the best evidence-based treatments. Clinicians suggest that a widespread application of substantiated treatments will curtail trends of increased despair, but there are a wider range of ethical and socio-political limitations that are not always immediately addressed in these assessments. Issues regarding social stigma, control and normalization, diverse life stressors, and disproportionate access to resources are often diluted in depictions of treatment efficacy. Consistent interpretations of the concepts illness, disorder, health, recovery, and need are also lacking. In this paper, I unravel the limitations of several leading evidence-based treatments and propose principles of care as preconditional commitments for future practice. This analysis specifically assesses treatment options for depression and anxiety. In response, I argue that clinical practice guidelines require a deeper engagement with the theoretical foundations of prominent therapeutic models and must consider the effects of those premises beyond controlled treatment sessions. I recommend more substantial collaborations with mental health sociology and bioethics, with a particular emphasis on care ethics.