Better Than Well

Is it possible, through use of existing psychiatric medications or talk therapy, to treat someone who has become slightly to severely mentally ill, and not only eliminate symptoms of his illness but also leave him “better than well”? This is a question with which eminent American psychiatrist, Peter Kramer, grappled in his landmark 1993 book, Listening to Prozac. Kramer concluded, based largely on responses of his own patients to the then relatively new antidepressant Prozac, that “better than well” may indeed be attainable in some persons. Not surprisingly, this is a controversial conclusion that has been met with a large degree of skepticism, including in a number of books that have since appeared. The current book explores this issue in detail, including analysis of cutting edge neuroscience and psychiatric research, concluding that "better than well" may indeed be attainable in some individuals. If so, this phenomenon may have broad reaching implications for medicine and society in general.

"Elliott's absorbing account will make readers think again about the ways that science shapes our personal identities."—American Scientist Americans have always been the world's most anxiously enthusiastic consumers of "enhancement technologies." Prozac, Viagra, and Botox injections are only the latest manifestations of a familiar pattern: enthusiastic adoption, public hand-wringing, an occasional congressional hearing, and calls for self-reliance. In a brilliant diagnosis of our reactions to self-improvement technologies, Carl Elliott asks questions that illuminate deep currents in the American character: Why do we feel uneasy about these drugs, procedures, and therapies even while we embrace them? Where do we draw the line between self and society? Why do we seek self-realization in ways so heavily influenced by cultural conformity?

The past half-century has been marked by major changes in the treatment of mental illness: important advances in understanding mental illnesses, increases in spending on mental health care and support of people with mental illnesses, and the availability of new medications that are easier for the patient to tolerate. Although these changes have made things better for those who have mental illness, they are not quite enough. In Better But Not Well, Richard G. Frank and Sherry A. Glied examine the well-being of people with mental illness in the United States over the past fifty years, addressing issues such as economics, treatment, standards of living, rights, and stigma. Marshaling a range of new empirical evidence, they first argue that people with mental illness—severe and persistent disorders as well as less serious mental health conditions—are faring better today than in the past. Improvements have come about for unheralded and unexpected reasons. Rather than being a result of more effective mental health treatments, progress has come from the growth of private health insurance and of mainstream social programs—such as Medicaid, Supplemental Security Income, housing vouchers, and food stamps—and the development of new treatments that are easier for patients to tolerate and for physicians to manage. The authors remind us that, despite the progress that has been made, this disadvantaged group remains worse off than most others in society. The "mainstreaming" of persons with mental illness has left a policy void, where governmental institutions responsible for meeting the needs of mental health patients lack resources and programmatic authority. To fill this void, Frank and Glied suggest that institutional resources be applied systematically and routinely to examine and address how federal and state programs affect the well-being of people with mental illness.

This collection of essays emphasizes society’s increasingly responsible engagement with ethical challenges in emerging medical technology. Expansion of technological capacity and attention to patient safety have long been integral to improving healthcare delivery but only relatively recently have concepts like respect, distributive justice, privacy, and autonomy gained some power to shape the development, use, and refinement of medical tools and techniques. Medical ethics goes beyond making better medicine to thinking about how to make the field of medicine better. These essays showcase several ways in which modern ethical thinking is improving safety, efficacy and efficiency of medical technology, increasing access to medical care, and empowering patients to choose care that comports with their desires and beliefs. Included are complimentary ethical approaches as well as compelling counter-arguments. Together, the articles demonstrate how improving the quality of medical technology relies on every stakeholder -- not just medical researchers and scientists -- to assess each given technology’s strengths and pitfalls. This collection also portends one of the next major issues in the ethics of medical technology: developing the requisite moral framework to accompany shifts toward patient-centred personalized healthcare.

p.B. J. Whiting savors proverbial expressions and has devoted much of his lifetime to studying and collecting them; no one knows more about British and American proverbs than he. The present volume, based upon writings in British North America from the earliest settlements to approximately 1820, complements his and Archer Taylor's Dictionary of American Proverbs and Proverbial Phrases, 1820-1880. It differs from that work and from other standard collections, however, in that its sources are primarily not "literary" but instead workaday writings - letters, diaries, histories, travel books, political pamphlets, and the like. The authors represent a wide cross-section of the populace, from scholars and statesmen to farmers, shopkeepers, sailors, and hunters. Mr. Whiting has combed all the obvious sources and hundreds of out-of-the-way publications of local journals and historical societies. This body of material, "because it covers territory that has not been extracted and compiled in a scholarly way before, can justly be said to be the most valuable of all those that Whiting has brought together," according to Albert B. Friedman. "What makes the work important is Whiting's authority: a proverb or proverbial phrase is what BJW thinks is a proverb or proverbial phrase. There is no objective operative definition of any value, no divining rod; his tact, 'feel, ' experience, determine what's the real thing and what is spurious."

By bringing together influential critics of neo-Aristotelian virtue ethics with some of the strongest defenders of an Aristotelian approach, this collection provides a fresh assessment of the strengths and weaknesses of Aristotelian virtue ethics and its contemporary interpretations. Contributors critically discuss and re-assess the neo-Aristotelian paradigm which has been predominant in the philosophical discourse on virtue for the past 30 years.

Happy-People-Pills for All explores current theories of happiness while demonstrating the need to develop advanced pharmacological agents for the enhancement of our capacity for happiness and wellbeing. Presents the first detailed exploration of the enhancement of happiness A controversial yet rigorous argument that demonstrates the moral imperative for the development and mass distribution of ‘happy-pills’, to promote the wellbeing of the individual and society Brings together the philosophy, psychology and biology of happiness Maps the development of the next generation of positive mood pharmacology Offers a corrective to contemporary accounts of happiness