The Creation of Psychopharmacology

Rating:
Summary: most objective, nuanced history of psychopharmaceuticals
Review: David Healy is probably the top historian of psychopharmacology in the last three years. He tells the story of the use of neuroleptics in treating schizophrenia that shows how the interests of certain parties (ie pharmaceutical companies and psychiatrists desperate to do something about horrendous and overcrowded conditions in state mental hospitcals) came to define the nature of psychopharmaceuticals and even the nature of schizophrenia - a pretty vaguely-defined illness - itself. Somehow, chlorpromazine went from being looked at as pretty similar as lobotomy, insulin therapy, or many of the other treatments previously used for schizophrenia, in the early 1950s, to being a magic bullet, saving schizophrenics from a lifetime of insanity without side effects, which is simply not the case.

As the previous reviewer notes, Healy seems to give short shrift to some evidence. However, Healy's coming from the perspective of a historian of science - a discipline that tends to begin with a critical analysis and without starting from the viewpoint that science is king, but the viewpoint of a skeptic. To use the example of the previous reviewer, Healy's point when e talks about the withdrawal symptoms of SSRI's is partially to note that, when we talk about mental illness and that fuzzy boundary between the mental and the physical, there's a lot of flexibility in where that boundary is placed in the mind of the public. The concept of withdrawal itself *is* a very fluid, unscientific one: why some classes of drugs are considered to exhibit withdrawal effects while others dont is a highly politicized question - one whose answer lies more on the side of special interests and the state of american politics than real scientific evidence.

one more note: the other major history of psychopharmacology to date is judith swazey's 1974 "chlorpromazine in psychiatry: a revolution in innovation." if you read swazey's book you can see why a critical history of psychopharmacology was desperately needed. this book balances the picture and serves as an excellent introduction to the history of psychopharmacology without being overly optimistic about medicine and progress.

Rating:
Summary: most objective, nuanced history of psychopharmaceuticals
Review: David Healy is probably the top historian of psychopharmacology in the last three years. He tells the story of the use of neuroleptics in treating schizophrenia that shows how the interests of certain parties (ie pharmaceutical companies and psychiatrists desperate to do something about horrendous and overcrowded conditions in state mental hospitcals) came to define the nature of psychopharmaceuticals and even the nature of schizophrenia - a pretty vaguely-defined illness - itself. Somehow, chlorpromazine went from being looked at as pretty similar as lobotomy, insulin therapy, or many of the other treatments previously used for schizophrenia, in the early 1950s, to being a magic bullet, saving schizophrenics from a lifetime of insanity without side effects, which is simply not the case.

As the previous reviewer notes, Healy seems to give short shrift to some evidence. However, Healy's coming from the perspective of a historian of science - a discipline that tends to begin with a critical analysis and without starting from the viewpoint that science is king, but the viewpoint of a skeptic. To use the example of the previous reviewer, Healy's point when e talks about the withdrawal symptoms of SSRI's is partially to note that, when we talk about mental illness and that fuzzy boundary between the mental and the physical, there's a lot of flexibility in where that boundary is placed in the mind of the public. The concept of withdrawal itself *is* a very fluid, unscientific one: why some classes of drugs are considered to exhibit withdrawal effects while others dont is a highly politicized question - one whose answer lies more on the side of special interests and the state of american politics than real scientific evidence.

one more note: the other major history of psychopharmacology to date is judith swazey's 1974 "chlorpromazine in psychiatry: a revolution in innovation." if you read swazey's book you can see why a critical history of psychopharmacology was desperately needed. this book balances the picture and serves as an excellent introduction to the history of psychopharmacology without being overly optimistic about medicine and progress.

Rating:
Summary: Where's The Beef?
Review: Hopefully without offending vegetarians, my question about this book is...where's the beef? The Creation of Psychopharmacology is filled with claims which the author, David Healy, appears to believe the reader will be sufficiently knowledgeable to take at face value. But it is the claims themselves - and evidence for and against their accuracy - which presumably should be at the heart of this book. For example, at p. 170, the author states that when "SSRI withdrawal was shown to exist in the late 1990s, the medical establishment denied that SSRIs could be addictive." Nevertheless, the author reports, by the time millions were taking SSRIs, "users faced the prospect of inadvertantly being hooked." What does any of this mean? "SSRI withdrawal" presumably means withdrawing from using SSRIs just as a politician might consider withdrawing from an election campaign. If the author means SSRI withdrawal SYMPTOMS or CONSEQUENCES were shown to exist, then the part about the late 1990s is weird. Consequences exist when the use of ANY drug, perhaps any medication, is terminated. One did not have to wait for the 1990s. If you withdraw from using a nasal spray, you may have a rebound effect. If you stop drinking coffee cold turkey, you may experience withdrawal symptoms. So too with SSRIs, the use of which should not be abruptly terminated, as it says on the little plastic bottle. This is news? If the author means that in the late 1990s, it was discovered that SSRIs cause "dependence," then we might reasonably expect to be told what that means. Millions "depend" on SSRIs to cope with depression. Uh...okay. That sounds good, not bad. Something you can finally depend on! But if the author means "dependence" as in "addiction," then where's the proof? Xanax is "fiercely addictive," as Peter Kramer says, in Listening to Prozac. But the author of The Creation of Psychopharmacology offers NO evidence at all that SSRIs are "addictive" in the sense that Valium or Heroin are addictive. When is the last time you were mugged by someone desperate for money to buy Zoloft? So here you have a book by a psychiatrist who testifies on SSRIs and suicide in federal court, a book published by Harvard Univ. Press with one blurb on the back, by the noted historian Edward Shorter, which makes the extraordinary claim that millions risk "inadvertantly" (they take the medication by accident? they are being lied to by the 'medical establishment'?) becoming "hooked" (shooting Celexa with a needle?)or addicted to SSRIs without providing any proof for this claim other than the suggestion that when you stop using an SSRI, presumably gradually as advised by your physician, you may feel different than when you were taking the medication? You feel different when you stop taking aspirin for headaches (more pain in the head region) or stop eating so much ice cream and other dairy products (e.g., less congestion). Surely there must be more to addiction, being inadvertantly hooked, than this. Perhaps Harvard Univ. Press or even David Healy could straighten us out as to why this book skims along the surface, taking ever so much for granted, while supplying oh so little research. Bald statements may be enough for the historian, Professor Shorter, or even a lay person jury in a civil trial, but serious readers have a right to expext more...don't we?

Rating:
Summary: Disappointing
Review: In this history of psychopharmacology, Healy attempts to trace the development of psychopharmacological agents; to describe their use in the context of changing views of mental illness; and ultimately to conceptualize our society as one that has been restructured by it's interaction with modern psychopharmacology. From the discovery of dyes through chlorpromazine to the SSRI's, from Rousseau and the Enlightenment through Pinel and Freud to Mismanaged Care - it's all here.

The current state of affairs in American psychiatry is indeed deplorable. The drug companies reign supreme. Intensive marketing by these companies, the rise of managed care and the domination of the DSM are all factors in the creation of our drug nation. As medications have become the only acceptable solution for the ever expanding population of people with diagnoses, any chance of a real human encounter between doctor and patient has been crushed, to be replaced with a two part ritual : the Handing Out of the Prescription and the Filling of the Paperwork. Biobabble has transplanted thought, both in professional circles and in the public sphere - thought about the psychological and sociological underpinnings of suffering; thought about the ethical aspects of treatment; and perhaps most significantly, biobabble has obscured thought about medications themselves - what we really know about their effects, what they were created for and in which circumstances would it be of benefit to use them. We are sorely in need of people who are able to bring thinking back into psychiatry. One way to do this would be to shed light on the way the bio-dictatorship has come into being - to detail the shifts in perception of illness and well-being that have occurred over time and to place these in the context of larger social transformations; to detail what role medications played in this - both as cause and as effect; to show the intrapsychic and interpersonal dynamics of the persons involved; to explain how economic agendas influenced the course of events. Details, clear and accurate chains of events - these are what would be needed. There is nothing quite as illuminating as a detailed and accurate description of historical events from which a new understanding of the present arises on it's own, on the strength of the evidence.

I am very sorry to say that this book does nothing of the kind. The writing is characterized by leaps from point A to point Z. How Healy got there remains unexplained. Diagnoses are used in a manner that is confusing and will be unfamiliar to most readers. When details are present, they are too dry. So-and-so worked with so-and-so from March to April and then left for hospital X in May. Not much is given by way of interesting personal dynamics. It made for quite boring reading. The biggest failing of the book is that, in the end, it is all so muddled it is almost incoherent.

I suspect that Healy was attempting a Grand Unified Theory of the World as a Psychopharmacological Creation. I think he tried to encompass too much, was lax in explaining and connecting the dots, and ended up with a collection of bland rhetorical statements that explain nothing.

This saddens me because when it comes to the history of psychopharmacology, Healy is probably the single most knowledgeable person around. Though he does not, to my knowledge, engage in basic research, he has interviewed all the major psychopharmacologists who were involved in discovery and research, something no one else has done. In addition, he is a practicing psychiatrist and is well aquainted with current diagnoses and treatment. He has also had very real life struggles with the drug industry that exemplify the force unleashed by these powers against people who attempt to challenge their dogma.

I would very much look forward to another book by Healy. Perhaps a smaller portion of this could be rewritten and edited with more care, so that the progression from statement to statement would be outlined in a logical manner that readers could follow. Perhaps more attention to details could lead to the grand conclusions that would then leap up from the pages on their own accord.