Joanna Moncrieff

Joanna Moncrieff is a British psychiatrist and academic. She is Professor of Critical and Social Psychiatry at University College London and a leading figure in the Critical Psychiatry Network.^[1][2][3] Her books The Myth of the Chemical Cure and The Bitterest Pills are central texts in the critical psychiatry movement.^[2] She is critical of mainstream psychiatry's medical approach to mental illness. She has stated that while she does prescribe drugs to her patients sometimes, she's "not convinced that antidepressants have any use" and that there's a need "to find more non-medical ways of supporting people through crises".^[1][2]

Joanna Margaret Moncrieff
Born	1966 (age 58–59)
Nationality	British
Alma mater	University of Newcastle upon Tyne
Scientific career
Fields	Psychiatry Neuroscience
Institutions	National Health Service University College London
Website	www.joannamoncrieff.com

Moncrieff argues against what she calls the "disease-centred" model of psychiatric drug action, where the drugs are hypothesized to correct for an abnormality and therefore restore normal functioning (similar to how insulin is given for diabetes). Instead, she has proposed that a "drug-centred" model better explains their effects, where the drugs themselves actually cause abnormal states or alterations which coincidentally relieve symptoms (similar to how alcohol's disinhibiting effect may relieve social phobia, but doesn't "correct" for a chemical imbalance).^[4][5][6]

Career

In 1989, Moncrieff qualified in medicine from the University of Newcastle upon Tyne, then trained in psychiatry during the 1990s. In 2001, she started at University College London (UCL), where she's currently a teacher and researcher.^[7] For 10 years, she was a consultant at a psychiatric rehabilitation inpatient unit, then worked in various community mental health services.^[7] Her current title is Professor of Critical and Social Psychiatry at UCL, and she's a consultant psychiatrist at North East London NHS Foundation Trust.^[3][8]

Moncrieff is a founder and co-chair of the Critical Psychiatry Network, a group founded in 1999 to scientifically challenge assumptions held by mainstream psychiatry about the nature of mental disorders and the effects of psychiatric interventions.^[1][9][10] The network now has over 400 members.^[2]

In 2022, a Rolling Stone article criticized her because her research had been promoted by right-wing commentators, and because she had seemingly aligned with the political right on some other matters such as criticizing governmental COVID-19 vaccine mandates.^[10] Moncrieff has called the article "bizarre, gutter journalism", saying that she's always considered herself "on the left".^[1] Moncrieff has run (unsucessfully) in multiple local UK elections as a Labour Party candidate.^[11][12][13]

Currently, she is leading the NIHR-funded RADAR study, which is evaluating an antipsychotic discontinuation program for people with schizophrenia and similar problems.^[14]

Research and writing

The role of drugs in modern psychiatry

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.^[15] She believes that there is little evidence for serotonin abnormalities in depression,^[6] or dopamine abnormalities in psychosis or schizophrenia.^[16] She traces the history of the idea that psychiatric drugs are magic bullets and she explores the alleged role of the pharmaceutical 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,^[17] and maintains the claim that the pharmaceutical industry has created conditions like adult ADHD^[18][19] and the ‘new bipolar disorder’ to help market these drugs.^[20]

Models of drug action

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 are psychoactive 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.^[5] 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.^{[21][page needed]}

Antidepressants

Moncrieff has written several papers criticising the methodology of antidepressant research.^[22] She did a Cochrane 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.^[23] She has published a paper that describes the psychoactive effects of modern antidepressants and their association with suicidal ideation, and with physical effects.^[24]

Together with Mark Horowitz, in 2022 Moncrieff conducted the first systematic umbrella review of the evidence for the serotonin "chemical imbalance" theory of depression, which found that "there is no convincing evidence that depression is associated with, or caused by, lower serotonin concentrations or activity".^[25][26] The research has been called "important" and "the most comprehensive rebuttal to date".^[27] According to critics of Moncrieff, the conclusions of the paper are well-founded, but obvious because the serotonin theory has not been viewed as serious for awhile.^[10] Moncrieff believes that depression should be seen as a "mood state" rather than an illness, and argues that it's a largely normal reaction to adverse circumstances which some people are more prone to than others.^[1][2]

Andrea Cipriani, the author of a 2018 systematic review published in The Lancet which found all antidepressants to be more effective than placebo, has been quoted as saying that what Moncrieff is doing—challenging evidence and asking questions—is very important. While still defending the use of antidepressants, Cipriani has agreed that their effect is "not big".^[28][2]

Moncrieff's review was widely covered in the media at the time, but also adopted and misinterpreted by right-wing commentators as evidence that antidepressants do not work as a treatment for depression.^[10]

Antipsychotics

The Bitterest Pills traces the history of antipsychotic drugs from the introduction of chlorpromazine in the 1950s. The book also looks at recent developments, including the marketing of antipsychotics through the Early Intervention movement, and the promotion of a new and expanded concept of bipolar disorder.^{[29][page needed]} Moncrieff also describes the cultural development of the new concept of bipolar disorder, which she refers to as ‘the medicalisation of "ups and downs"’. Research by Moncrieff and colleagues described and compared the subjective or psychoactive effects of different antipsychotics.^[30] This included publication in the controversial and non-peer reviewed Medical Hypotheses.^[31]

Lithium

In early work Moncrieff analysed the evidence for the efficacy of lithium. She claimed there was no evidence that lithium was superior to other sedatives for the treatment of acute mania, 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.^[32] 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.^[33]

Other drugs

Moncrieff has critically reviewed the literature on the use of drug treatments like acamprosate and naltrexone for alcohol problems^[34] and the use of stimulants in children.^{[35][page needed]}

History and politics of psychiatry

Moncrieff has developed a political analysis of the drivers of modern mental health theory and practice and explored the influence of neoliberalism.^[36][37] She has published papers on the historical context of the emergence of modern drug treatment,^[38] the history of psychiatric thought in the 20th century ^[39] and of ‘rapid tranquilisation’ in psychiatry,^[40] as well as her books on the history of drug treatments.

Books

• The Myth of the Chemical Cure: a critique of psychiatric drug treatment, Palgrave, 2008. ISBN 978-0-230-57431-1
• A Straight Talking Introduction to Psychiatric Drugs, PCCS Books, 2009. ISBN 978-1-906254-17-9
• The Bitterest Pills: The Troubling Story of Antipsychotic drugs, Palgrave, 2013. ISBN 978-1-137-27742-8
• Chemically Imbalanced: The Making and Unmaking of the Serotinin Myth, Flint, 2025 ISBN 978-1803996790