Professor Thomas Martin with Dr Paul Biegler whose book The Ethical Treatment of Depression won the 2011 Eureka Prize for Research in Ethics

The Ethical Treatment of Depression: Autonomy through Psychotherapy (MIT Press 2011)

The ethical treatment of depression cover image

A philosopher argues there is an ethical imperative to provide psychotherapy to depressed patients because the insights gained from it promote autonomy.

One in six people worldwide will experience depression over the course of a lifetime. Many who seek relief through the healthcare system are treated with antidepressant medication; in the United States, nearly 170 million prescriptions for antidepressants were written in 2005, resulting in more than $12 billion in sales. And yet despite the dominance of antidepressants in the marketplace and the consulting room, another treatment for depression has proven equally effective: psychotherapy—in particular, cognitive behavior therapy (CBT). Antidepressants can lift mood independent of a person’s understanding of symptoms or stressors. By contrast, CBT teaches patients skills for dealing with distressing feelings, negative thoughts, and causal stressors.

In The Ethical Treatment of Depression, Paul Biegler argues that the insights patients gain from the therapeutic process promote autonomy. He shows that depression is a disorder in which autonomy is routinely and extensively undermined and that physicians have a moral obligation to promote the autonomy of depressed patients. He concludes that medical practitioners have an ethical imperative to prescribe psychotherapy—CBT in particular—for depression. To make his case, Biegler draws on a wide philosophical literature relevant to autonomy and the emotions and makes a comprehensive survey of the latest research findings from the psychological sciences.

Forcefully argued, densely researched, and engagingly written, the book issues a challenge to physicians who believe their duty of care to depressed patients is discharged by merely writing prescriptions for antidepressants.


Biegler’s wonderful book sheds new light on autonomy, depression, and the moral purposes of medicine, making a strong case for preferring psychotherapeutic over drug treatments for depression. His clearly written, scientifically well-informed book is essential reading for all interested in medical ethics or mental disorders.  Richard Ashcroft, Professor of Bioethics, University of London

No other book combines philosophy with so much empirical information to critique overreliance on drugs in the treatment of a mental illness. Biegler’s message is both sobering and clear. His book is a significant contribution to the philosophy of psychiatry as well as to the key role that maximizing patient autonomy should play in the choice of therapies for depression.  George Graham, Professor of Philosophy and Neuroscience, Georgia State University

This book is long overdue. Biegler gives a compelling analysis of the impact depression has on autonomous decision making—a factor which, he argues, has important implications for its treatment. Given how many people suffer from this debilitating disease worldwide, his insight has the potential to transform the medical, moral, and social well-being of a substantial portion of the world’s population. The Ethical Treatment of Depression is essential for clinicians, bioethicists, lawyers, and policy practitioners.  Patricia Illingworth, Department of Philosophy and Religion, College of Business Adminstration, and School of Law, Northeastern University


This is not an anti-psychiatry book because, even though he explicitly puts more emphasis on stress than on biology in depression, he never recommends against the use of antidepressants. In that sense The Ethical Treatment of Depression contributes, in my opinion, to a hopeful trend toward more widespread application of insight oriented psychotherapy augmenting or augmented by the use of antidepressants.  Metapsychology

This is an important book for clinicians and medical ethicists who are seeking new ways to treat and understand depression’s causes…Recommended.  Choice


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