It is not uncommon to hear patients who suffer
from depression complain that they are not themselves.
Given that their lives during a depressive episode may be
profoundly changed, it is often easy to agree. But what
does it mean to agree here? "Not being themselvesâ€? in this
context refers to qualitative changes that have occurred in
their way of being, including changes in personality and
self-understanding. I will use the term "selfâ€? to refer to
periods of a distinguishable personality pattern in a
person"s life, without further discussion of their
metaphysical status or the criteria for a distinction between
different selves

Schmidt-Felzmann, Heike

English

Name not available

  218 Affectivity and Identity in the Treatment of mood Disorders   Heike Schmidt-Felzmann, Marburg   1. Mood disorders and the “real self” It is not uncommon to hear patients who suffer from depression complain that they are not themselves. Given that their lives during a depressive episode may be profoundly changed, it is often easy to agree. But what does it mean to agree here? “Not being themselves” in this context refers to qualitative changes that have occurred in their way of being, including changes in personality and self-understanding. I will use the term “self” to refer to periods of a distinguishable personality pattern in a person’s life, without further discussion of their metaphysical status or the criteria for a distinction between different selves.1 Given the person with a mood disorder who considers herself not really “herself” any more, what happens when she takes medication and the symptoms disappear? I will now assume for the sake of simplicity (but incorrectly)2 that patients generally consider their illness self S2 as alien to their usual self S1. Three different possible reactions to medication can thus be distinguished: (i) First, there are those who just seem go back from S2 to their usual self S1 that represents what they “really” are. They may have some side effects from the medication, but do not consider these to be relevant. (ii) Then there are those who perceive the effects of medication as changing their personality. In this case, S1 is what they remember being before S2. However, instead of regaining their “real self” through medication, they are now left with S3, which despite many similarities to S1 still seems alien to them. This can happen in the treatment of bipolar disorder with lithium, as well as in the treatment of depression with some antidepressants (e.g. Jamison 1995, Elfenbein 1995). (iii) Finally, there are those cases in which patients again perceive the resulting S3 as different from S1, but now see S1 as comparatively lacking. From the standpoint of S3, they judge S1 as alien, while S3 is now considered to be their “real self”. This phenomenon has sometimes been observed in the treatment of depression, usually with SSRIs, and famously depicted in Peter Kramer’s bestseller Listening to Prozac (also Elfenbein 1995 and Thompson 1995). How should the difference between these cases be understood? The first case seems straightforward – a “mental illness” has interrupted the person’s usual way of being and behaving; once this disruption is under control, she can go on living her life as usual. The second case, again, does not seem mysterious. Psychotropic medication has a pervasive influence on the patient’s nervous system. Its use may be necessary for keeping the “mental illness” at bay, however, it is not surprising that a person under its influence may not feel entirely the same way about herself as before. However, the third case seems puzzling. How is it possible that a person can regard as her “real self” what she has only experienced under the influence of medication, and moreover only for a very brief time? The worry behind this question seems to be above all a worry about authenticity – can a person under these                                                      1 I do not want to discuss here whether such “selves” are e.g. Parfitian selves (Parfit 1989). What I want to draw attention to resembles what Taylor refers to as “identity” (Taylor 1992), or what Quante calls “personality” (Quante 1999 and 2001). 2 For positive accounts of the experience of depression, cp. Martin 1999 or Graham 1990. circumstances authentically identify with S3? In order to bring into focus what is at issue here, I will now explore one specific important aspect that is often reported to differ between S1 and S3.  2. Medication and moral sensibilities It has long been known that changes in mood can go together with changes in moral sensibilities. Moral scrupulosity is a frequent characteristic of depression, and there is typically some moral carelessness in persons who experience mania. There is also evidence that some kinds of anti-depressant medication (e.g. Prozac) may affect not only mood, but also moral sensibilities, and promote shifts towards greater moral indifference (cp. Kramer 1997, Sobo 1999, 2001, Elfenbein 1995). That is, during the use of medication, the person seems to be more morally indifferent than before. Such malleability of moral sensibilities is an interesting phenomenon, especially in the context of discussions of personal identity. Given that moral commitments are generally acknowledged to be an important part of a person’s identity, how will such changes affect those who experience them? Empirically, reactions among patients who experience such changes seem to fall into two categories: (i) Some patients are rather disturbed when they notice these changes, and struggle to keep up their previous moral standards. Their current moral sensibilities as S3 appear to them inadequate when compared with S1. Despite experiencing a certain degree of moral indifference now, the patients still think that they were morally right when they perceived the moral demands of situations differently. Interestingly, just being cognitively aware of this experiential difference seems not to be enough. While using the medication, patients seem not to be able to fully make up cognitively for the experiential difference and act as they would think right. As a consequence, they may choose to rather go back to a state of depression than compromise their moral standards (Sobo 2001). (ii) Alternatively, other patients may also be aware of similar changes, but not be worried by them. Instead, they consider their current moral sensibilities as more adequate than their previous ones. That is, the more rigid moral standards of S1 are now regarded as obsolete for S3. Not only do these patients not experience the urgency of certain moral demands any more, but they also explicitly discount their validity now, despite being well aware that previously they had thought otherwise about them (Kramer 1997, Elfenbein 1995).  3. Medication and the inauthentic self When confronted with such changes in personality that have been brought about through medication, the first impulse seems to be to consider them as alien. That is, the patient herself would be considered as suffering from some kind of self-deception if she insists on identifying with S3. Different reasons can be given for this attitude: Some critics would assume that any interference which is not due Affectivity and Identity in the Treatment of mood Disorders - Heike Schmidt-Felzmann    219to internal or “natural” causes has to be alien to the “real self”; others would only accept changes as authentic when they come about as a result of a process of rational reasoning; others would claim that authenticity depends on the exercise of autonomous choice in a very strong sense (to name but the most popular options). How is it possible that persons nevertheless come to identify with S3 as their “real self”? First of all, the influence of medication could be understood as intoxication. That is, while patients are under the influence of the medication, they are presumably not in a state in which they can judge these matters correctly. While it may seem to them that they have the ability to judge their former moral convictions as invalid, they are in fact mistaken, and just unable to acknowledge their impairment. Another possibility is the hedonist explanation, based on the assumption that people prefer feeling better to feeling worse. Accordingly, patients may endorse S3 because it suddenly turns out to be much nicer to live that way. However, while understandable, just feeling good will not be enough to warrant the endorsement of S3. In other words, endorsing S3 is ultimately a sign of moral weakness and not of authentic choice; it means to give in to the temptation of hedonism. Alternatively, there is the explanation from social values: S3 may be endorsed because it is correlated with enhanced fulfillment of certain social norms. Given the current cultural stereotypes, it is no wonder that it is Prozac, a medication that seems to bring about carefree, outgoing, assertive and socially adaptive behavior, that is particularly often involved in cases of endorsement of S3. Once the medication has enabled patients to receive social rewards, so the critic, the formerly accepted restrictive moral norms may now seem insignificant. Identification with S3 and rejection of S1 would again turn out to rely on the wrong kind of motives and not support the claim that this is an authentic endorsement of S3.3  4. The possibility of authenticity Is there any reason to assume that the critics may be mistaken in their diagnosis of S3 as inauthentic? As I want to argue, there is. The main worry in the criticisms in the previous section is concerned with the nature of the patients’ rejection of formerly held moral values. This is indeed a puzzling phenomenon, but I do not think the de-authorization of the patients’ self-understanding is warranted by the given arguments. First of all, there is little indication that the intoxication model correctly represents the effects of anti-depressant medication. The medication brightens patients’ mood and has some circumscribed side-effects, but does not usually lead to any significant impairment. (Also, neurophysiologically, these anti-depressants do not target those transmitters usually involved in substances of abuse.) The observable changes at least will not be sufficient to establish the presence of an “intoxication” that could justify discounting their judgments. What about the hedonist and social values explanations? Both assume that the nature of the value change is of a kind that justifies regarding it as inauthentic. However, taking their criticism seriously would entail that authentic selves are extraordinarily hard to come by in ordinary life, as apparently many people are similarly                                                      3 For other accounts of similar worries, see also Kramer 1997 and the Hastings Center Report 2000. motivated.4 I would want to argue that the kind of authenticity that is at issue when the role of medication is concerned does not usually seem to imply a highly demanding understanding of authenticity. At least for many of the critics, their worry is rather linked more specifically to the sudden appearance switch in value orientation, and the apparent causal role of medication in it. But is this really sufficient for a de-authorization of the personal identification with S3? Sudden onset of value changes can be found at other times, e.g. in religious conversions. Should we discount these as well, despite their considerable significance for those who experience them? The main issue here is probably that these changes are due to the use of some specifiable chemical agent. However, given that the intoxication model is inadequate, what does the problem consist in? After all, chemicals influence everybody’s way of perceiving the world; human psychological life is dependent on the action of exactly such chemicals. Establishing a significant difference between medication and the usual brain chemicals that is relevant for the question of authenticity would require more argument than has been provided. What is perhaps most irritating in these cases, especially for philosophers, is the apparently non-rational way in which values are changed. However, it is important to note that these changes are not to be understood in terms of chemical brain washing: None of the patients wakes up and finds that overnight a completely different set of beliefs has been installed. Instead, it is their affective experience that has changed, and with it the comparative salience of morally relevant features in their experience. Apparently, changes in affective experience can shape a person’s general moral outlook to a significant degree. Interestingly, such experience seems to present itself to the person as having a certain intrinsic authority, so that following its demands may be perceived as justified in virtue of its affective characteristics (and it will not e.g. be seen as giving in to a temptation).5 Nevertheless, accepting the evaluative authority of affective experience does not seem to be an automatism. Persons under the influence of anti-depressant medication are still able to reflect rationally and may even come to the conclusion that their current experience does not do justice to their moral convictions. In the absence of serious impairments, it does not seem justified to discount the patients’ endorsement of S3 as inauthentic. The identification with S3 is apparently viable in the patients’ lives (Kramer 1997, Elfenbein 1995). If the same value changes had occurred independently of the use of medication, de-authorization of the perspective of these fully competent persons would not have seemed warranted. One may perhaps doubt the value of their specific form of life, but one should be aware that this makes them no different from many other cases. If what we mean by authenticity is not something that succeeds only rarely and requires extraordinary efforts, then the specific causal role of medication does not seem to provide sufficient reason against the possibility of authenticity in this case. In being so visibly dependent on the presence of affective factors, this case is perhaps just a particularly clear example of what is more generally involved in the endorsement of value.                                                      4 Arguably, some of the critics who take depressives to have special insight would agree. 5 This is also supported by observations in more extreme cases of depression and mania. While the episode lasts, patients with depression will frequently explain why they are indeed as morally blameworthy as they feel, and patients with mania are usually convinced that acting on their impulses is fully justified. After the episode is over, both will usually revert to their former understanding of values. – For some neuroscientific evidence of the specific role of affective factors in moral reasoning see also the results of the recent fMRI study by Greene et al. 2001.  Affectivity and Identity in the Treatment of mood Disorders - Heike Schmidt-Felzmann    220 References Elfenbein, D. (ed.) 1995 Living with Prozac and Other Selective Serotonin-Reuptake Inhibitors – Personal Accounts of Life on Antidepressants, New York: HarperCollins. Graham, G. 1990 “Melancholic Epistemology”, Synthese, 82, 399-422. Greene, J. et al. 2001 “An fMRI investigation of emotional engagement in moral judgment”, Science, 293, 2105–2108. Hastings Center Report 2000 “Prozac and Alienation”, Hastings Center Report, 30, 7-18, 31-40. Jamison, K. R. 1995 An Unquiet Mind, New York: A. Knopf. Kramer, P. 1997 Listening to Prozac, New York: Penguin. Martin, M. 1999 “Depression: Illness, Insight, and Identity”, Philosophy, Psychiatry, and Psychology, 6, 271-286. Parfit, D. 1989 Reasons and Persons, Oxford: Clarendon Press. Quante, M. 1999 “Precedent Autonomy and Personal Identity”, Kennedy Institute of Ethics Journal, 9, 365-381. Quante, M. 2002 Personales Leben und menschlicher Tod – Personale Identität als Prinzip der medizinischen Ethik, Frankfurt a.M.: Suhrkamp. Sobo, S. 1999 “Psychotherapy Perspectives in Medication Management”, Psychiatric Times, 16(4). Sobo, S. 2001 “A Reevaluation of the Relationship between Psychiatric Diagnoses and Chemical Imbalances”, http://ourworld.cs.com/ssobo2/myhomepage. Taylor, Ch. 1992 The Ethics of Authenticity, Cambridge: Harvard University Press. Thompson, T. 1995 The Beast – A Reckoning with Depression, New York: G.P. Putnam.  

Affectivity and Identity in the Treatment of mood Disorders

Elektronisch archivierte Theorie - Sammelpunkt

  218 
Affectivity and Identity in the Treatment of mood Disorders  
 
Heike Schmidt-Felzmann, Marburg 
 
 
1. Mood disorders and the “real self” 
It is not uncommon to hear patients who suffer 
from depression complain that they are not themselves. 
Given that their lives during a depressive episode may be 
profoundly changed, it is often easy to agree. But what 
does it mean to agree here? “Not being themselves” in this 
context refers to qualitative changes that have occurred in 
their way of being, including changes in personality and 
self-understanding. I will use the term “self” to refer to 
periods of a distinguishable personality pattern in a 
person’s life, without further discussion of their 
metaphysical status or the criteria for a distinction between 
different selves.1 
Given the person with a mood disorder who 
considers herself not really “herself” any more, what 
happens when she takes medication and the symptoms 
disappear? I will now assume for the sake of simplicity (but 
incorrectly)2 that patients generally consider their illness 
self S2 as alien to their usual self S1. Three different 
possible reactions to medication can thus be distinguished: 
(i) First, there are those who just seem go back from S2 to 
their usual self S1 that represents what they “really” are. 
They may have some side effects from the medication, but 
do not consider these to be relevant. (ii) Then there are 
those who perceive the effects of medication as changing 
their personality. In this case, S1 is what they remember 
being before S2. However, instead of regaining their “real 
self” through medication, they are now left with S3, which 
despite many similarities to S1 still seems alien to them. 
This can happen in the treatment of bipolar disorder with 
lithium, as well as in the treatment of depression with some 
antidepressants (e.g. Jamison 1995, Elfenbein 1995). (iii) 
Finally, there are those cases in which patients again 
perceive the resulting S3 as different from S1, but now see 
S1 as comparatively lacking. From the standpoint of S3, 
they judge S1 as alien, while S3 is now considered to be 
their “real self”. This phenomenon has sometimes been 
observed in the treatment of depression, usually with 
SSRIs, and famously depicted in Peter Kramer’s bestseller 
Listening to Prozac (also Elfenbein 1995 and Thompson 
1995). 
How should the difference between these cases 
be understood? The first case seems straightforward – a 
“mental illness” has interrupted the person’s usual way of 
being and behaving; once this disruption is under control, 
she can go on living her life as usual. The second case, 
again, does not seem mysterious. Psychotropic medication 
has a pervasive influence on the patient’s nervous system. 
Its use may be necessary for keeping the “mental illness” 
at bay, however, it is not surprising that a person under its 
influence may not feel entirely the same way about herself 
as before. However, the third case seems puzzling. How is 
it possible that a person can regard as her “real self” what 
she has only experienced under the influence of 
medication, and moreover only for a very brief time? The 
worry behind this question seems to be above all a worry 
about authenticity – can a person under these 
                                                     
1 I do not want to discuss here whether such “selves” are e.g. Parfitian selves 
(Parfit 1989). What I want to draw attention to resembles what Taylor refers to 
as “identity” (Taylor 1992), or what Quante calls “personality” (Quante 1999 
and 2001). 
2 For positive accounts of the experience of depression, cp. Martin 1999 or 
Graham 1990. 
circumstances authentically identify with S3? In order to 
bring into focus what is at issue here, I will now explore 
one specific important aspect that is often reported to differ 
between S1 and S3. 
 
2. Medication and moral sensibilities 
It has long been known that changes in mood can 
go together with changes in moral sensibilities. Moral 
scrupulosity is a frequent characteristic of depression, and 
there is typically some moral carelessness in persons who 
experience mania. There is also evidence that some kinds 
of anti-depressant medication (e.g. Prozac) may affect not 
only mood, but also moral sensibilities, and promote shifts 
towards greater moral indifference (cp. Kramer 1997, Sobo 
1999, 2001, Elfenbein 1995). That is, during the use of 
medication, the person seems to be more morally 
indifferent than before. 
Such malleability of moral sensibilities is an 
interesting phenomenon, especially in the context of 
discussions of personal identity. Given that moral 
commitments are generally acknowledged to be an 
important part of a person’s identity, how will such changes 
affect those who experience them? Empirically, reactions 
among patients who experience such changes seem to fall 
into two categories: 
(i) Some patients are rather disturbed when they 
notice these changes, and struggle to keep up their 
previous moral standards. Their current moral sensibilities 
as S3 appear to them inadequate when compared with S1. 
Despite experiencing a certain degree of moral 
indifference now, the patients still think that they were 
morally right when they perceived the moral demands of 
situations differently. Interestingly, just being cognitively 
aware of this experiential difference seems not to be 
enough. While using the medication, patients seem not to 
be able to fully make up cognitively for the experiential 
difference and act as they would think right. As a 
consequence, they may choose to rather go back to a 
state of depression than compromise their moral standards 
(Sobo 2001). 
(ii) Alternatively, other patients may also be aware 
of similar changes, but not be worried by them. Instead, 
they consider their current moral sensibilities as more 
adequate than their previous ones. That is, the more rigid 
moral standards of S1 are now regarded as obsolete for 
S3. Not only do these patients not experience the urgency 
of certain moral demands any more, but they also explicitly 
discount their validity now, despite being well aware that 
previously they had thought otherwise about them (Kramer 
1997, Elfenbein 1995). 
 
3. Medication and the inauthentic self 
When confronted with such changes in personality 
that have been brought about through medication, the first 
impulse seems to be to consider them as alien. That is, the 
patient herself would be considered as suffering from 
some kind of self-deception if she insists on identifying with 
S3. Different reasons can be given for this attitude: Some 
critics would assume that any interference which is not due 
Affectivity and Identity in the Treatment of mood Disorders - Heike Schmidt-Felzmann 
 
 
 219
to internal or “natural” causes has to be alien to the “real 
self”; others would only accept changes as authentic when 
they come about as a result of a process of rational 
reasoning; others would claim that authenticity depends on 
the exercise of autonomous choice in a very strong sense 
(to name but the most popular options). 
How is it possible that persons nevertheless come 
to identify with S3 as their “real self”? First of all, the 
influence of medication could be understood as 
intoxication. That is, while patients are under the influence 
of the medication, they are presumably not in a state in 
which they can judge these matters correctly. While it may 
seem to them that they have the ability to judge their 
former moral convictions as invalid, they are in fact 
mistaken, and just unable to acknowledge their 
impairment. 
Another possibility is the hedonist explanation, 
based on the assumption that people prefer feeling better 
to feeling worse. Accordingly, patients may endorse S3 
because it suddenly turns out to be much nicer to live that 
way. However, while understandable, just feeling good will 
not be enough to warrant the endorsement of S3. In other 
words, endorsing S3 is ultimately a sign of moral 
weakness and not of authentic choice; it means to give in 
to the temptation of hedonism. 
Alternatively, there is the explanation from social 
values: S3 may be endorsed because it is correlated with 
enhanced fulfillment of certain social norms. Given the 
current cultural stereotypes, it is no wonder that it is 
Prozac, a medication that seems to bring about carefree, 
outgoing, assertive and socially adaptive behavior, that is 
particularly often involved in cases of endorsement of S3. 
Once the medication has enabled patients to receive social 
rewards, so the critic, the formerly accepted restrictive 
moral norms may now seem insignificant. Identification 
with S3 and rejection of S1 would again turn out to rely on 
the wrong kind of motives and not support the claim that 
this is an authentic endorsement of S3.3 
 
4. The possibility of authenticity 
Is there any reason to assume that the critics may 
be mistaken in their diagnosis of S3 as inauthentic? As I 
want to argue, there is. The main worry in the criticisms in 
the previous section is concerned with the nature of the 
patients’ rejection of formerly held moral values. This is 
indeed a puzzling phenomenon, but I do not think the de-
authorization of the patients’ self-understanding is 
warranted by the given arguments. 
First of all, there is little indication that the 
intoxication model correctly represents the effects of anti-
depressant medication. The medication brightens patients’ 
mood and has some circumscribed side-effects, but does 
not usually lead to any significant impairment. (Also, 
neurophysiologically, these anti-depressants do not target 
those transmitters usually involved in substances of 
abuse.) The observable changes at least will not be 
sufficient to establish the presence of an “intoxication” that 
could justify discounting their judgments. 
What about the hedonist and social values 
explanations? Both assume that the nature of the value 
change is of a kind that justifies regarding it as inauthentic. 
However, taking their criticism seriously would entail that 
authentic selves are extraordinarily hard to come by in 
ordinary life, as apparently many people are similarly 
                                                     
3 For other accounts of similar worries, see also Kramer 1997 and the 
Hastings Center Report 2000. 
motivated.4 I would want to argue that the kind of 
authenticity that is at issue when the role of medication is 
concerned does not usually seem to imply a highly 
demanding understanding of authenticity. At least for many 
of the critics, their worry is rather linked more specifically to 
the sudden appearance switch in value orientation, and the 
apparent causal role of medication in it. But is this really 
sufficient for a de-authorization of the personal 
identification with S3? Sudden onset of value changes can 
be found at other times, e.g. in religious conversions. 
Should we discount these as well, despite their 
considerable significance for those who experience them? 
The main issue here is probably that these changes are 
due to the use of some specifiable chemical agent. 
However, given that the intoxication model is inadequate, 
what does the problem consist in? After all, chemicals 
influence everybody’s way of perceiving the world; human 
psychological life is dependent on the action of exactly 
such chemicals. Establishing a significant difference 
between medication and the usual brain chemicals that is 
relevant for the question of authenticity would require more 
argument than has been provided. 
What is perhaps most irritating in these cases, 
especially for philosophers, is the apparently non-rational 
way in which values are changed. However, it is important 
to note that these changes are not to be understood in 
terms of chemical brain washing: None of the patients 
wakes up and finds that overnight a completely different 
set of beliefs has been installed. Instead, it is their affective 
experience that has changed, and with it the comparative 
salience of morally relevant features in their experience. 
Apparently, changes in affective experience can shape a 
person’s general moral outlook to a significant degree. 
Interestingly, such experience seems to present itself to 
the person as having a certain intrinsic authority, so that 
following its demands may be perceived as justified in 
virtue of its affective characteristics (and it will not e.g. be 
seen as giving in to a temptation).5 Nevertheless, 
accepting the evaluative authority of affective experience 
does not seem to be an automatism. Persons under the 
influence of anti-depressant medication are still able to 
reflect rationally and may even come to the conclusion that 
their current experience does not do justice to their moral 
convictions. 
In the absence of serious impairments, it does not 
seem justified to discount the patients’ endorsement of S3 
as inauthentic. The identification with S3 is apparently 
viable in the patients’ lives (Kramer 1997, Elfenbein 1995). 
If the same value changes had occurred independently of 
the use of medication, de-authorization of the perspective 
of these fully competent persons would not have seemed 
warranted. One may perhaps doubt the value of their 
specific form of life, but one should be aware that this 
makes them no different from many other cases. If what 
we mean by authenticity is not something that succeeds 
only rarely and requires extraordinary efforts, then the 
specific causal role of medication does not seem to 
provide sufficient reason against the possibility of 
authenticity in this case. In being so visibly dependent on 
the presence of affective factors, this case is perhaps just 
a particularly clear example of what is more generally 
involved in the endorsement of value. 
                                                     
4 Arguably, some of the critics who take depressives to have special insight 
would agree. 
5 This is also supported by observations in more extreme cases of depression 
and mania. While the episode lasts, patients with depression will frequently 
explain why they are indeed as morally blameworthy as they feel, and patients 
with mania are usually convinced that acting on their impulses is fully justified. 
After the episode is over, both will usually revert to their former understanding 
of values. – For some neuroscientific evidence of the specific role of affective 
factors in moral reasoning see also the results of the recent fMRI study by 
Greene et al. 2001. 
 
Affectivity and Identity in the Treatment of mood Disorders - Heike Schmidt-Felzmann 
 
 
 220 
References 
Elfenbein, D. (ed.) 1995 Living with Prozac and Other Selective 
Serotonin-Reuptake Inhibitors – Personal Accounts of Life 
on Antidepressants, New York: HarperCollins. 
Graham, G. 1990 “Melancholic Epistemology”, Synthese, 82, 399-
422. 
Greene, J. et al. 2001 “An fMRI investigation of emotional 
engagement in moral judgment”, Science, 293, 2105–
2108. 
Hastings Center Report 2000 “Prozac and Alienation”, Hastings 
Center Report, 30, 7-18, 31-40. 
Jamison, K. R. 1995 An Unquiet Mind, New York: A. Knopf. 
Kramer, P. 1997 Listening to Prozac, New York: Penguin. 
Martin, M. 1999 “Depression: Illness, Insight, and Identity”, 
Philosophy, Psychiatry, and Psychology, 6, 271-286. 
Parfit, D. 1989 Reasons and Persons, Oxford: Clarendon Press. 
Quante, M. 1999 “Precedent Autonomy and Personal Identity”, 
Kennedy Institute of Ethics Journal, 9, 365-381. 
Quante, M. 2002 Personales Leben und menschlicher Tod – 
Personale Identität als Prinzip der medizinischen Ethik, 
Frankfurt a.M.: Suhrkamp. 
Sobo, S. 1999 “Psychotherapy Perspectives in Medication 
Management”, Psychiatric Times, 16(4). 
Sobo, S. 2001 “A Reevaluation of the Relationship between 
Psychiatric Diagnoses and Chemical Imbalances”, 
http://ourworld.cs.com/ssobo2/myhomepage. 
Taylor, Ch. 1992 The Ethics of Authenticity, Cambridge: Harvard 
University Press. 
Thompson, T. 1995 The Beast – A Reckoning with Depression, 
New York: G.P. Putnam. 
 


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Elektronisch archivierte Theorie - Sammelpunkt