Forwarded to HISTNEUR-L and CHEIRON from H-PCAACA (Popular
Culture Association and the American Culture Association) via
H-SCI-MED-TECH.
Russell Johnson
--- Begin Forwarded Message ---
Date: Mon, 3 May 1999 21:38:51 -0400
From: "N. Lerman, H-SCI-MED-TECH" <[EMAIL PROTECTED]>
Subject: REVIEW: Healy, _The Antidepressant Era_
Sender: "H-NET List on the History of Science, Medicine, and
Technology" <[EMAIL PROTECTED]>
H-NET BOOK REVIEW
Published by [EMAIL PROTECTED] (May, 1999)
David Healy. _The Antidepressant Era_. Cambridge: Harvard
University Press, 1997. x + 317 pp. Bibliographical references and
index. $39.95 (cloth), ISBN 0-674-03957-2.
Reviewed for H-PCAACA by Catherine Calloway, Arkansas State
University
The sudden emergence of modern medication after World War II, when
specific illnesses first received specific treatments, is the focus
of David Healy's book _The Antidepressant Era_. Well written and
thoroughly researched, the book provides an excellent overview of
the history of psychotropic medicine from Hippocrates to the age of
Prozac, using depression as a paradigm of the ways in which the
popularity of such drugs may have been influenced more by
pharmaceutical marketing rather than by medical necessity. What
disturbs Healy, a previous secretary of the British Association of
Psychopharmacology and the current Director of the North Wales
Department of Psychological Medicine at the University of Wales
College of Medicine, is that as the discovery and marketing of
antidepressants have increased so have the cases of diagnosed
depression and other related disorders, such as social phobias and
obsessive-compulsive disorder, as well as the number of
prescriptions written. Healy thus questions the role that
pharmacologists play in changing people's perceptions of illness and
in making certain diseases so popular that they acquire their own
biological language and become icons of popular culture.
Chapter One traces the history of diseases, illnesses, and remedies,
beginning with the philosophies of Hippocrates and Galen of Pergamon
and concluding with the 1950s and the emergence of a
diagnosis-oriented medicine. Healy shows how the study of medicine
evolved from the humoral system, which centered around why one was
ill, to the present system, which focuses upon how particular
illnesses occur and how to best treat them. In Chapters Two through
Six, Healy chronicles the discovery and development of
antidepressants, the significance of double-blind randomized
placebo-controlled drug trials, the ways in which the study of
psychiatry and the development of medication have become
standardized, the advent of a biological, psychiatric language, and
the effects of pharmaceutical maketing strategies.
While Healy addresses a more professional than general audience, the
book still offers much for the lay-reader. Healy takes care to
define medical concepts and terminology throughout the text. He
explains, for example, the ideas behind interpersonal theory, the
neo-Kraepelinian movement, Eysenck's personality theory, the 1970s
emphasis on receptor theory, the Oedipus, Luke, and Matthew Effects,
and pharmacological Calvinism. He also details the many key figures
involved in the development of modern psychiatry, such as Adolf
Meyer, Emil Kraepelin, Nathan Kline, Bernard Brodie, and Gerald
Klerman. Throughout _The Antidepressant Era_, Healy reveals some
interesting facts that even readers possessing some familiarity with
psychotropic medications may not know. For instance, both Prozac
and Clozapine were developed a number of years before they were
marketed, and the first antipsychotic medication was chlorpromazine.
A major issue that emerges in Healy's discussion concerns the type
of treatment best suited for psychiatric-related disorders. A
conflict exists as to which is most effective: drug treatment or
psychotherapy. Should mental illnesses be considered neurological
brain disorders and thus actual diseases that should be treated with
medication, or is medication merely a substitute for evading the
reality of life's problems? Could, in fact, psychotherapy replace
much of the medication currently being prescribed? Unfortunately,
Healy limits himself to one main example, the two-decade old Dr.
Rafael Osheroff case, detailed in Chapter Seven, which focuses on a
patient who was treated as having a personality disorder rather than
the depression he was initially diagnosed with and who received only
psychotherapy while hospitalized for seven months in 1979. The
denial of drug treatment during that hospitalization resulted in the
degeneration of Dr. Osheroff's health and the loss of much of his
personal and professional life. The Osheroff case spawned much
critical debate, especially between two leading figures in
psychiatry, Gerald Klerman and Alan Stone. Klerman advocated
randomized control trials and more patient participation in choice
of treatment, especially since drug therapy is regulated by the
Federal Drug Administration, while Stone argued that there was no
real evidence that psychotherapy was less effective than drug
treatment.
Healy's book leads one to wonder if medical advances are really so
determined by political and financial factors and if highly trained
physicians, as well as the general populace, are indeed so
susceptible to clever marketing ploys. Would the majority of
today's psychiatrists, if surveyed, consider themselves so
vulnerable to the influence of the pharmaceutical industry? In
addition, while Healy admits that it has never been proven that
psychotropic medication has been overprescribed, he only hints at
the possibility that it may have been underprescribed. Perhaps the
symptoms were there all along and merely went unrecognized by
general physicians who had little training in psychiatry. Mental
illness has long been an unpopular topic, subject to being placed on
the back-burner or hidden in the closet. Many who take psychotropic
medications have been stigmatized by society and denied full medical
coverage by insurance companies who refuse to recognize their
illnesses as valid diseases. Perhaps we should thank the
pharmaceutical industry for making us more aware that mental
illnesses do exist and are treatable with drug therapy.
This review is copyrighted (c) 1999 by H-Net and the
Popular Culture and the American Culture Associations.
It may be reproduced electronically for educational or
scholarly use. The Associations reserve print rights
and permissions. (Contact: P.C.Rollins at the following
electronic address: [EMAIL PROTECTED])
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___________________________________________________
Russell A. Johnson [EMAIL PROTECTED]
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