Toward a theory of social pharmacology: the actor-spectator paradox applied to the psychotropic prescribing process

Abstract

Traditionally, drug prescribing was regarded as part of the physician's decision-making role. However, recently it has been recognized that such a perspective is insufficient to understand the psychotropic prescribing process. To understand this process, a drug communication perspective is necessary. This article describes the actor-spectator paradox and its influence on drug communication and psychotropic drug prescribing. The actor-spectator paradox postulates that the actor and the spectator have divergent perspectives about the cause of the actor's behavior. The spectator makes assumptions about the actor's cognitive system other than the actor herself is making. This difference is often the basis for misunderstandings between a health professional and a patient. If a health professional can learn to make more realistic assumptions about a patient's cognitive system, communication between the two will improve. In the same way a patient has to learn to make more realistic assumptions about the cognitive systems of health professionals. The actor-spectator paradox can be applied to different areas of Social Pharmacology such as the diagnosis of patients suffering from mental health problems, drug compliance, informed consent, and the prescribing of psychotropics.