Toward a Hippocratic Psychopharmacology

Abstract

Objective: To provide a conceptual basis for psychopharmacology. Method: This review compares contemporary psychopharmacology practice with the Hippocratic tradition of medicine by examining the original Hippocratic corpus and modern interpretations (by William Osler and Oliver Wendell Holmes). Results: The Hippocratic philosophy is that only some, not all, diseases should be treated and, even then, treatments should enhance the natural healing process, not serve as artificial cures. Hippocratic ethics follow from this philosophy of disease and treatment. Two rules for Hippocratic medicine are derived from the teachings of Osler (treat diseases, not symptoms) and Holmes (medications are guilty until proven innocent). The concept of a diagnostic hierarchy is also stated explicitly: Not all diseases are created equal. This idea helps to avoid mistaking symptoms for diseases and to avoid excessive diagnosis of comorbidities. Current psychopharmacology is aggressive and non-Hippocratic: symptom-based, rather than disease oriented; underemphasizing drug risks; and prone to turning symptoms into diagnoses. These views are applied to bipolar disorder. Conclusions: Contemporary psychopharmacology is non-Hippocratic. A proposal for moving in the direction of a Hippocratic psychopharmacology is provided.