Customer Reviews

The Creation of Psychopharmacology

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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.

I'm embarrassed to say that I had not read this book until recently. I was aware that it existed and even had a copy laying around for over 3 years. Convergent events led me to read it and I must say that I found it particularly enjoyable. Readers will need to have more than a modicum of knowledge in several fields of science. Those that do will be rewarded with a book that is difficult to put down.

My only criticism: The editing is poor. Someone with a better knowledge of punctuation needed to have reviewed this before publication. There are also more than a few sentence fragments, misspellings, and poor word choices. In the context of his otherwise thoughtful and clearly highly educated prose, these editorial errors stuck out like a sore thumb.

You may remember David Healy's rise to headlines when a Canadian University fired him on his first day. He had committed the academic error of biting the hand that fed him by criticizing the pharmaceutical industry that funded his chair.
This book is a critique of that industry regarding psychotropic drugs, and in particular the role of marketing and government regulations in that industry. Fascinating to read, though the chemical details were often a bit above my head, was the description of how copy-cat drugs are developed, and why claims for specificity are laughable hoaxes. The choice for calling some of these drugs antipsychotics and others antidepressants he calls a matter of historical accident. In fact, he says, in Japan, depression is treated with atypical antipsychotics, not SSRIs.

Healy isn't coy about the horrific damage these drugs do, and the fact that doctors knew, or could have known, about it all along. It seems that doctors today are less, not more, aware of this harmfulness.

The book includes interesting historical notes, though I was occasionally dismayed by Healy's naive acceptance of unlikely case scenarios recorded by early psychiatrists. For instance, he uncritically quotes that people were cured by chlorpromazine after having been in catatonic states, "frozen into several positions" for years. How is it likely, in the days before medical heroics, that someone survived such a condition? Healy does not question it. What caused catatonia, how did chlorpromazine relieve it, and why is the condition unknown today? Healy does not say. Yet he acknowledges the fraud of psychiatric diagnoses in more recent times, as well as the deception in drug company testing.

Buried among the otherwise highly informative material is the odd statement that totally contradicts the rest of the book. For instance, Healy says about insulin coma therapy, "It... was used for twenty years... A therapy that did not produce some good would surely have faded away, given... the risk of fatalities." You would expect Healy to realize that medicine does not follow such logic, much less psychiatry. Furthermore, it did fade away, unlike the drugs which he criticizes. Equally baffling is his terse and unexplained claim for the efficacy of ECT. And though he himself coins the term "biobabble," he doesn't shirk from a bit of biobabble himself, such as "Brain imaging will make it clear that our brains are as social as they are biological and that being biological means having social arrangements stamped into our neuroendocrine systems."

Among the implied advice that Healy includes in his book is the abolition of regulations, yet he comments that they cannot be abolished. Why not? He also endorses the free availability of SSRIs, so without a doctor's prescription. But why not free availability of all drugs, as he himself states (though he is not the first to do so), "The `good' drugs are now difficult to access because they are available only by prescription, while the `bad' drugs, which prescription-only status was introduced to control, are widely available."

In short, Healy wrote an excellent book, though it contains the occasional slip which probably reflects a lack of critical editing.

Copyright © MeTZelf

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?