The Creation of Psychopharmacology

Psychiatrists and historians owe a debt to David Healy. Over the years he has conducted interviews with all the leading figures in psychopharmacology. The resultant three volumes of The Psychopharmacologists (Healy, 1996, 1998, 2000) captured a crucial period in the history of psychiatry. Drawing on these interviews and his wide reading of the scholarly literature, Healy has now constructed a subtle and compelling narrative of the development of psychotropic drugs, in particular of chlorpromazine, whose discovery he hails as as important as that of penicillin. This is not a narrow, internalist account of events. Rather, Healy ambitiously relates the emergence of drugs to the wider culture and shows how the two have interacted. He begins with the new science of the Enlightenment; looks at the changing clientele of 19th-century asylums; examines the counterculture’s advocacy of LSD (acid) in the 1960s; charts the growth of the mighty drug companies of today; and, finally, considers what biomedical advances hold for the future of humanity. En route, he boldly challenges received readings of the past and the accepted wisdom about psychiatric drugs. For example, he demonstrates that lithium was first prescribed in the 19th century and that the pre-neuroleptic era, far from representing some kind of ‘dark age’, witnessed the development of several effective treatments. With regard to recent times, Healy judges that the evidence that the selective serotonin reuptake inhibitors (the SSRIs) and the ‘atypical’ antipsychotics are superior to older drugs is weak. Healy asks how we arrived at our present position. It is a position, he suggests, where biological explanations of mental disorder and, indeed, of an increasing proportion of human behaviour are now in the ascendancy; where powerful drug corporations shape how we perceive and classify emotional distress; and where the ‘psychopharmaceutical complex’ ensures that the only therapy considered is medication. For Healy, the key lies with the discovery of chlorpromazine. The advent of this drug in the 1950s saw many patients ‘awake’ from their psychoses and leave the asylum. Thus was community psychiatry born: as a result, clinicians began to see an increasing number of patients with nonpsychotic disorders. In North America, the therapeutic triumph of chlorpromazine dealt a deathblow to psychoanalysis, and medication became the treatment of choice not only for severe mental illness, but for all types of psychic distress. Psychiatry underlined its commitment to a biomedical perspective with the publication of DSM– III in 1980. In tandem, drug companies created markets for their products rather than creating medication in response to the needs of patients. Healy maintains that we are becoming less rather than more rational in our development of new treatments. Science does not evolve progressively in response to carefully conducted research; instead, serendipity plays a major role, leaving scientists to construct a post hoc theory to accommodate the new data. Healy places his treatise in a wider philosophical framework. He contends that our views about the nature of humans have changed dramatically and that a ‘new biomedical self’ is being born. He follows its conception during the time of the Enlightenment, when God was dethroned and La Mettrie postulated that man is a machine, to its birth in the present day when, in the eyes of many, the neurosciences and the Human Genome Project are demonstrating that notions of spirituality and free will are redundant and that human beings can be understood entirely in terms of their biology. Since the Enlightenment, there have been many voices objecting to such a materialist view of man. From Thomas Reid in the 18th century; through Søren Kierkegaard and William James, to Francis Fukuyama in the present day, powerful arguments have been raised in opposition. Perhaps Healy does not give sufficient space to these dissenting voices. However, he has written a highly stimulating and original book, which is brimful of ideas and deserves to be read and debated throughout the psychiatric community and beyond.