Reviews for The creation of psychopharmacology

The average rating for The creation of psychopharmacology based on 2 reviews is 4 stars.

Review # 1 was written on 2019-07-19 00:00:00 Ulrich Reischel All of David Healy’s books are with reading. They are very well researched & incredibly informative. This book is slow & thick in parts so I would recommend jumping into this one first but it does supply the science & research supporting what he’s written elsewhere.

Review # 2 was written on 2012-01-21 00:00:00 Michael Legend This is a massive book which straddles an uneasy line between scholarly and popular. Deeply researched, Heely draws from some high-level theory to try and explain the transformation in psychiatric care in the 20th century. However, the scope of the book leads to some organizational difficulties, and Heely's own speculations on what happens next don't quite match up to his research. David Heely attempts to offer a wide-ranging description of the characteristics of modern psychiatric care, both positive and negative. He engages in a historical development of psychiatry through the 20th century, from asylums engaged in confinement, psychodynamic and analytic theories, and finally, modern drug-based psychiatry, as exemplified by the use of chlorpromazine (Thorazine). Heely’s work is theoretically grounded in Foucault’s idea of biopower, the responsibility of states and individuals to engage in the management of health, and Thomas Kuhn’s ideas about paradigmatic science. Psychopharmacology is not dominant because it is more “true” than other forms of psychiatric care, but because it sustains a powerful system of interlocking scientific, economic, and cultural forces. Heely is most skeptical about the power of randomized clinical trials (RCTs) In brief, the concentrate of the ‘raving insane’ in asylums in the 19th century gave early alienists the human raw material to formulate a wide variety of nosologies of mental illness, and the possible origins behind them. Psychoanalytic formulations a la Freud, dominated the intellectual style of the time. WWI and WWII created massive new systems of psychiatric care for shell-shocked veterans. The expansion of office based psychiatric care post-WW2 enrolled millions of new patients into the mental health system, at the same time as ‘psychobabble’ permeated popular culture, along with the notion that poverty, personality disorders, social stress, crime, addiction, etc were proper areas of expertise for psychiatrists. The expansion of psychoanalysis lead to the anti-psychiatric backlash of the 1960s (the counter-culture trying to decolonize insane minds), severely damaging the paradigmatic authority of psychoanalysis. Concurrently, in the 1950s, a group of European scientists (Jean Delay, Labriot) were experimenting with a new class of drugs that showed astonishing progress in curing the deeply insane in the back wards. Hopeless patients given chlorpromazine showed remarkable improvements. Scientific theory did not explain the action of these substances, but these neuroleptics cured the raving mad, and demonstrated powerful effects on the mind and body, including tardive dyskinesia and akathisia. Concurrent developments with LSD and amphetamines pointed towards a theory of molecular basis of madness and sanity, but the counter-culture’s embrace of LSD ended its use as a legitimate scientific tool. Instead, experiments with radiotagged molecules proved the existence of neurotransmitter and receptors in the human brain, leading to a host of amine-based theories of madness. Brains are essentially chemical organs, and by adjusting chemical activity through drugs, they can be restored to sanity. The new practice and theory of psychopharmacology demanded new ways of regulating and using drugs. Relapses on chlorpromazine soon proved to a major problem, reframing the problem of psychiatry away from “showing the patient a moral mirror of himself” and towards ensuring compliance with a drug regime. The thalidomide crisis lead to the 1962 amendments to the Food and Drug Act which established that drugs could only be given by prescription as a treatment for well-defined illnesses. These amendments inculcated a culture of risk management, a drug could be both beneficial and/or harmful in an individual case, but on average, had to help patients. The 1962 amendments, along with new funding priorities in the NIH, established the randomized clinical trial as the gold standard of efficacy. Heely argues that RCTs are in fact highly flawed instruments for psychiatry, in that their need for objective and portable results relies on symptomatic scales that do not translate to improved patient quality of life. Drugs may vary in effectiveness between patients with different biologies or temperaments, data which is not captured by RCTs. Additionally, the regulatory environment surrounding medicine means that from a business standpoint, the most sensible policy is to increase the number of people suffering from a given mental illness. The growth in depression, OCD, social anxiety, and ADHD are mirror by increases in drugs to treat those conditions. The immense amount of money flowing from patients to pharmaceutical companies to doctors (see White Coat, Black Hat—Elliot) has effectively corrupted science. Finally, according to Heely, current theories about the brain are no more well-grounded than Freudian psychodynamics. The idea that a single neurotransmitter path is linked to a defined illness or its cure is not supported by the powerful action of drugs which work on many neural systems, or the way in which a single drug might cure multiple disorders (Prozac is actually not very good at treating classical depression. It works much better on OCD). Heely leads me to three major questions. First, if we are not going to rely on RCT, what other methods do we have for knowing how to match treatments to diseases to symptoms? The idea of how science should operate, and what counts as science, and thorny and complex. Second, how will the current biological paradigm be replaced? Psychoanalysis was destroyed because it overstepped its bounds without bringing consummate benefits; patients felt oppressed rather than helped. Heely proposes that genetics and brain imaging will upend the biological paradigm, but after 10 years I am doubtful. Thirdly, what is the appropriate place of psychiatric drugs in society? Who should be responsible for their use, and what counts as a treatable condition? If we’re really moving towards an era of ‘cosmetic psychiatry’, what does that imply about the authority of those administering treatments, and what counts as an acceptable risk?