An investigation into the precedents of modern drug treatment in psychiatry

History of Psychiatry

Volumn 10, Issue 40, 1999, Pages 475-490

  Moncrieff, Joanna ^a  

^a Ealing   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; DRUG THERAPY; HISTORY; PSYCHIATRY; UNITED KINGDOM;

DRUG THERAPY; GREAT BRITAIN; HISTORY, 20TH CENTURY; PSYCHIATRY;

EID: 0033290370     PISSN: 0957154X     EISSN: None     Source Type: Journal    
DOI: 10.1177/0957154X9901004004     Document Type: Article

References (96)

1. This statement is based on my own experience as a practising psychiatrist over the last six years. I know of no written material giving quantitative data on the subject, but a brief visit to a psychiatric ward would confirm this situation.
2. Department of Health, Prescription Cost Analysis for England, 1996 (London: HMSO, 1997).
3. Edward Shorter, A History of Psychiatry. From the Era of the Asylum to the Age of Proszac (New York: John Wiley & Sons, 1997).
4. Quoted in Judith Swazey, Chlorpromazine in Psychiatry (Cambridge, MA: Massachusetts Institute of Technology, 1974) on page 8. Originally quoted in W. Johnson, 'An interesting compound'. Unpublished paper for Smith Kline & French (undated), 54-5.
5. Kathleen Jones, A History of the Mental Health Services (London: Routledge & Kegan Paul, 1972).
6. Swazey, Chlorpromazine in Psychiatry and Ann E. Caldwell, Origins of Psychopharmacology. From CPZ to LSD (Springfield, Illinois: Charles C. Thomas, 1970).
7. Swazey, Chlorpromazine in Psychiatry and Ann E. Caldwell, Origins of Psychopharmacology. From CPZ to LSD (Springfield, Illinois: Charles C. Thomas, 1970).
8. M. Shepherd, N. Goodman and D. C. Watt 'The application of hospital statistics in the evaluation of pharmacotherapy in a psychiatric population', Comprehensive Psychiatry, ii (1961), 11-19. Ø. Ødegaard, 'Pattern of discharge from Norwegian psychiatric hospitals before and after the introduction of psychiatric drugs', American Journal of Psychiatry, Ixx (1964), 772-8.
9. M. Shepherd, N. Goodman and D. C. Watt 'The application of hospital statistics in the evaluation of pharmacotherapy in a psychiatric population', Comprehensive Psychiatry, ii (1961), 11-19. Ø. Ødegaard, 'Pattern of discharge from Norwegian psychiatric hospitals before and after the introduction of psychiatric drugs', American Journal of Psychiatry, Ixx (1964), 772-8.
10. See among others U. Aviram, S. L. Symc and J. B. Cohen, 'The effects of policies and programs on reductions of mental hospitalisation', Social Science and Medicine, x (1976) 571-8; P. Lerman, Deinstitutionalisation and the Welfare State (New Brunswick: Rutgers University Press, 1982); Andrew Scull, Decarceration: Community Treatment and the Deviant - a Radical View (Englewood Cliffs, NJ: Prentice-Hall, 1977).
11. See among others U. Aviram, S. L. Symc and J. B. Cohen, 'The effects of policies and programs on reductions of mental hospitalisation', Social Science and Medicine, x (1976) 571-8; P. Lerman, Deinstitutionalisation and the Welfare State (New Brunswick: Rutgers University Press, 1982); Andrew Scull, Decarceration: Community Treatment and the Deviant - a Radical View (Englewood Cliffs, NJ: Prentice-Hall, 1977).
12. See among others U. Aviram, S. L. Symc and J. B. Cohen, 'The effects of policies and programs on reductions of mental hospitalisation', Social Science and Medicine, x (1976) 571-8; P. Lerman, Deinstitutionalisation and the Welfare State (New Brunswick: Rutgers University Press, 1982); Andrew Scull, Decarceration: Community Treatment and the Deviant - a Radical View (Englewood Cliffs, NJ: Prentice-Hall, 1977).
13. See for example W. Gronfein, 'Psychotropic drugs and the origins of deinstitutionalization', Social Problems, xxxii (1985), 437-54. He argues that the effects of drug treatment, although not responsible for initiating the decline of in-patient populations, nevertheless encouraged legislators and policy makers to hasten the process.
14. Thomas Szasz, Cruel Compassion (New York: John Wiley & Sons, 1994), 171.
15. A. Scull, 'Somatic treatments and the historiography of psychiatry', History of Psychiatry, v (1994), 1-12. Quotation is from page 12.
16. L. S. Jacyna, 'Somatic theories of mind and the interests of medicine in Britain 1850-1879', Medical History, xvi (1982), 233-58. A. Scull, 'From madness to mental illness: medical men as moral entrepreneurs', European Journal of Sociology, xvi (1975), 219-61.
17. L. S. Jacyna, 'Somatic theories of mind and the interests of medicine in Britain 1850-1879', Medical History, xvi (1982), 233-58. A. Scull, 'From madness to mental illness: medical men as moral entrepreneurs', European Journal of Sociology, xvi (1975), 219-61.
18. J. Braslow, Mental Ills and Bodily Cures: Psychiatric Treatment in the First Half of the Twentieth Century (Berkeley, CA: University of California Press, 1997).
19. Scull, 'Somatic treatments and the historiography of psychiatry', History of Psychiatry, v (1994).
20. R. P. Greenberg and S. Fisher (eds), From Placebo to Panacea. Putting Psychiatric Drugs to the Test (New York: John Wiley & Sons, 1997) provides a comprehensive critique of evidence in various areas of psychiatry, arguing that 'claims about the efficacy of drug therapies for everything from depression to schizophrenia have been exaggerated' (quotation from inside cover); J. Moncrieff, 'Lithium revisited', British Journal of Psychiatry, clxvii (1995), 569-73 and J. Moncrieff, 'Lithium: evidence reconsidered', British Journal of Psychiatry, clxxi (1997), 113-19 question the evidence for the efficacy of lithium. J. Moncrieff, S. Wessely and R. Hardy, 'Meta-analysis of trials comparing antidepressants and active placebos', British Journal of Psychiatry, clxxi (1998), 227-31, suggest the efficacy of antidepressants may have been overstated.
21. R. P. Greenberg and S. Fisher (eds), From Placebo to Panacea. Putting Psychiatric Drugs to the Test (New York: John Wiley & Sons, 1997) provides a comprehensive critique of evidence in various areas of psychiatry, arguing that 'claims about the efficacy of drug therapies for everything from depression to schizophrenia have been exaggerated' (quotation from inside cover); J. Moncrieff, 'Lithium revisited', British Journal of Psychiatry, clxvii (1995), 569-73 and J. Moncrieff, 'Lithium: evidence reconsidered', British Journal of Psychiatry, clxxi (1997), 113-19 question the evidence for the efficacy of lithium. J. Moncrieff, S. Wessely and R. Hardy, 'Meta-analysis of trials comparing antidepressants and active placebos', British Journal of Psychiatry, clxxi (1998), 227-31, suggest the efficacy of antidepressants may have been overstated.
22. R. P. Greenberg and S. Fisher (eds), From Placebo to Panacea. Putting Psychiatric Drugs to the Test (New York: John Wiley & Sons, 1997) provides a comprehensive critique of evidence in various areas of psychiatry, arguing that 'claims about the efficacy of drug therapies for everything from depression to schizophrenia have been exaggerated' (quotation from inside cover); J. Moncrieff, 'Lithium revisited', British Journal of Psychiatry, clxvii (1995), 569-73 and J. Moncrieff, 'Lithium: evidence reconsidered', British Journal of Psychiatry, clxxi (1997), 113-19 question the evidence for the efficacy of lithium. J. Moncrieff, S. Wessely and R. Hardy, 'Meta-analysis of trials comparing antidepressants and active placebos', British Journal of Psychiatry, clxxi (1998), 227-31, suggest the efficacy of antidepressants may have been overstated.
23. R. P. Greenberg and S. Fisher (eds), From Placebo to Panacea. Putting Psychiatric Drugs to the Test (New York: John Wiley & Sons, 1997) provides a comprehensive critique of evidence in various areas of psychiatry, arguing that 'claims about the efficacy of drug therapies for everything from depression to schizophrenia have been exaggerated' (quotation from inside cover); J. Moncrieff, 'Lithium revisited', British Journal of Psychiatry, clxvii (1995), 569-73 and J. Moncrieff, 'Lithium: evidence reconsidered', British Journal of Psychiatry, clxxi (1997), 113-19 question the evidence for the efficacy of lithium. J. Moncrieff, S. Wessely and R. Hardy, 'Meta-analysis of trials comparing antidepressants and active placebos', British Journal of Psychiatry, clxxi (1998), 227-31, suggest the efficacy of antidepressants may have been overstated.
24. M. Shepherd, 'Neurolepsis and the psychopharmacological revolution: myth and reality', History of Psychiatry, v (1994) 89-96.
25. P. Breggin, Toxic Psychiatry (London: Fontana, 1993). A. Rogers, D. Pilgrim and R. Lacey, Experiencing Psychiatry - Users' Views of Services (London: Macmillan Press and MIND, 1993).
26. P. Breggin, Toxic Psychiatry (London: Fontana, 1993). A. Rogers, D. Pilgrim and R. Lacey, Experiencing Psychiatry - Users' Views of Services (London: Macmillan Press and MIND, 1993).
27. D. Healy (ed.), The Psychopharmacologists (London: Chapman & Hall, 1996).
28. Interviews with Herman van Praag and Heinz Lehmann in Healy, The Psychopharmacologists, record the rapidity with which biological approaches to mental illness triumphed over other models within psychiatry. The collection as a whole contains much material on the many fields of research related to the new drugs that were being researched shortly after their discovery.
29. Interview with Heinz Lehmann in Healy, The Psychopharmacologists.
30. Swazey, Chlorpromazine in Psychiatry, 137.
31. Swazey, Chlorpromazine in Psychiatry, 162
32. R. Kuhn quoted in F. J. Ayd and B. Blackwell (eds), Discoveries in Biological Psychiatry (Philadelphia: Lippincott Co, 1970), 205-17.
33. W. Mayer-Gross, E. Slater and M. Roth, Clinical Psychiatry, 1st edn (London: Cassell & Co, 1954).
34. The papers on treatment include two on malarial treatment for tertiary syphilis, one on 'forced respiration' in schizophrenia, one on colonic irrigation and one on social services and aftercare, although these are specified as an 'adjunct to mental treatment'. Twenty-one of the remaining articles dealt with biological explanations or investigations, and conditions such as syphilis, dementia and epilepsy were the main focus of attention with only one article on schizophrenia and none on depression.
35. In 1945 only 10 out of 43 articles address treatment. Six of these concern insulin coma therapy, shock treatment and leucotomy, one is on the use of sex hormones in schizophrenia and there are two on child psychiatry and one on a therapeutic regime for war veterans. In 1950, 27 of 59 articles are concerned with treatment. Nineteen address insulin coma therapy, shock treatment and frontal lobe surgery, there are three on drug treatments, one on 'abreaction,' and four on psychotherapy.
36. D. Henderson and R. D. Gillespie, Henderson and Gillespie's Textbook of Psychiatry (London: Oxford University Press). Editions one to nine, 1927-1962. W. Mayer-Gross, E. Slater and M. Roth, Clinical Psychiatry (London: Cassell & Co). Editions one to three, 1954, 1960, 1969. These were suggested by Professor Alec Jenner. A book review in the Journal of Mental Science, xci (1945), 123, confirms that Henderson and Gillespie was regarded as the 'best textbook of psychiatry published in this country'.
37. D. Henderson and R. D. Gillespie, Henderson and Gillespie's Textbook of Psychiatry (London: Oxford University Press). Editions one to nine, 1927-1962. W. Mayer-Gross, E. Slater and M. Roth, Clinical Psychiatry (London: Cassell & Co). Editions one to three, 1954, 1960, 1969. These were suggested by Professor Alec Jenner. A book review in the Journal of Mental Science, xci (1945), 123, confirms that Henderson and Gillespie was regarded as the 'best textbook of psychiatry published in this country'.
38. D. Henderson and R. D. Gillespie, Henderson and Gillespie's Textbook of Psychiatry (London: Oxford University Press). Editions one to nine, 1927-1962. W. Mayer-Gross, E. Slater and M. Roth, Clinical Psychiatry (London: Cassell & Co). Editions one to three, 1954, 1960, 1969. These were suggested by Professor Alec Jenner. A book review in the Journal of Mental Science, xci (1945), 123, confirms that Henderson and Gillespie was regarded as the 'best textbook of psychiatry published in this country'.
39. Henderson and Gillespie, 1st edn (1927), 330.
40. Henderson and Gillespie, op. cit., 154.
41. Henderson and Gillespie, 9th edn (1962), 247.
42. Henderson and Gillespie, op. cit., 248.
43. Henderson and Gillespie, op. cit., 248.
44. Clinical Psychiatry, 1st edn (1954), 287.
45. Clinical Psychiatry, 2nd edn (I960), 300.
46. Clinical Psychiatry, op. cit., 226.
47. A selection was made from the patient records of the Bethlem and Maudsley Hospitals where case notes are organized by date of birth. Records were sampled starting in 1890 in a non-systematic manner. The objective was to obtain a sample with a mixture of diagnoses of depression, neurosis and schizophrenia that could reveal changes or continuities in the treatment of these conditions between the 1930s and 1960s. Records with full documentation, particularly with reference to recurrent admissions, were therefore given preference. Patients whose primary diagnosis was an organic condition or learning disability were excluded. Notes were also excluded because they contained no usable clinical information or replicated the situation in the notes already selected. Sampling finished when no new information was forthcoming from subsequent notes examined. Therefore, although the sample of twenty constituted only a small proportion of the total number of notes, and was not representative in a statistical sense, the author was satisfied that a fair overview of the subject of interests had been obtained.
48. Alec Jenner, personal interview, 6 May 1997.
49. Henderson and Gillespie, 1st edn (1927), 154.
50. Henderson and Gillespie, 6th edn (1944), 261.
51. Henderson and Gillespie, 5th edn (1940), 197.
52. Braslow, Mental Ills and Bodily Cures, 102-3.
53. Henderson and Gillespie, 6th edn (1944), 402.
54. Clinical Psychiatry, 1st edn (1954) 286.
55. In Henderson and Gillespie, 6th edn (1944), 415, it is stated 'the general aim of the operation is to modify the disordered behaviour of many psychotic and neurotic patients whose illness has been of prolonged type. The tendency is to select patients more on a symptomatic than on a nosological basis.'
56. Braslow, Mental Ills and Bodily Cures, 141-2.
57. Even Mayer-Gross, Slater and Roth, enthusiastic advocates of insulin treatment, confess that 'Little can be said about the rationale for insulin treatment.' Clinical Psychiatry, 1st edn (1954), 286.
58. Braslow, Mental Ills and Bodily Cures.
59. For example, in the paper by H. C. Beccle, 'On the action of certain drugs in schizophrenia', Journal of Mental Science, lxxxi (1935), 46-60, it is claimed that types of schizophrenia 'depend to a great extent upon endocrine dyscrasia with particular reference to the gonads'.
60. Sex hormone treatment was not mentioned in the textbooks reviewed here or recorded in any case notes examined. Thyroid hormone treatment and the rationale for its use were covered briefly in Mayer-Gross, Slater and Roth, Clinical Psychiatry, and its use was recorded in the case notes of two patients with schizophrenia.
61. Braslow, Mental Ills and Bodily Cures, 37-8.
62. Henderson and Gillespie, 9th edn (1962), 350.
63. Clinical Psychiatry, 2nd edn (1960), 386.
64. Clinical Psychiatry, 3rd end (1969), 330.
65. J. Elkes and C. Elkes, 'Effects of chlorpromazine on the behaviour of chronically overactive psychotic patients', British Medical Journal, ii (1954), 560-5. Described in Swazey, Chlorpromazine and Psychiatry, 148-9.
66. J. Elkes and C. Elkes, 'Effects of chlorpromazine on the behaviour of chronically overactive psychotic patients', British Medical Journal, ii (1954), 560-5. Described in Swazey, Chlorpromazine and Psychiatry, 148-9.
67. N. W. Winkelman, Jr., 'Chlorpromazine in the treatment of neuropsychiatrie disorder', Journal of the American Medical Association, civ (1954), 8-21. Quoted in Swazey, Chlorpromazine in Psychiatry on p. 198.
68. N. W. Winkelman, Jr., 'Chlorpromazine in the treatment of neuropsychiatrie disorder', Journal of the American Medical Association, civ (1954), 8-21. Quoted in Swazey, Chlorpromazine in Psychiatry on p. 198.
69. NIMH Psychopharmacology Service Centre, 'Phenothiazine treatment in acute schizophrenia. Effectiveness', Archives of General Psychiatry, x (1964), 246-61. Quoted in Swazey, Chlorpromazine in Psychiatry on p. 257.
70. NIMH Psychopharmacology Service Centre, 'Phenothiazine treatment in acute schizophrenia. Effectiveness', Archives of General Psychiatry, x (1964), 246-61. Quoted in Swazey, Chlorpromazine in Psychiatry on p. 257.
71. Original articles in Journal of Mental Science, ci and cvi (1955 and 1960).
72. Gerald N. Grob, The Inner World of American Psychiatry 1890-1940 (New Brunswick: Rutgers University Press, 1983).
73. L. S. Jacyna, 'Somatic theories of mind and the interests of medicine in Britain 1850-1879', Medical History, xvi (1982) 233-58.
74. David Armstrong, Political Anatomy of the Body (Cambridge: Cambridge University Press, 1983).
75. Personal interview with Alec Jenner, 11 June 1997.
76. A. A. W. Petrie, 'Psychiatric developments. The presidential address delivered at the one hundred and third annual meeting of the Association on Wednesday November 29, 1944', Journal of Mental Science, xci (1945), 267-80.
77. Jones, A History of Mental Health Services, 273-6.
78. A. Scull, The Most Solitary of Afflictions. Madness and Society in Britain 1700-1900 (New Haven: Yale University Press, 1993).
79. Armstrong, Political Anatomy, describes these changes, particularly the development of interest in the neuroses. An influential report by C. P. Blacker, Neurosis and the Mental Health Services (Oxford: Oxford University Press, 1946) is described in Jones, A History of Mental Health Services, 273-4.
80. Armstrong, Political Anatomy, describes these changes, particularly the development of interest in the neuroses. An influential report by C. P. Blacker, Neurosis and the Mental Health Services (Oxford: Oxford University Press, 1946) is described in Jones, A History of Mental Health Services, 273-4.
81. Armstrong, Political Anatomy, describes these changes, particularly the development of interest in the neuroses. An influential report by C. P. Blacker, Neurosis and the Mental Health Services (Oxford: Oxford University Press, 1946) is described in Jones, A History of Mental Health Services, 273-4.
82. A. Scull, 'Psychiatry and social control in the nineteenth and twentieth centuries', History of Psychiatry, ii (1991), 149-69.
83. E. D. Pellegrino, 'The sociocultural impact of twentieth-century therapeutics'. In M. J. Vogel and C. E. Rosenberg (eds), The Therapeutic Revolution (Philadelphia, PA: University of Pennsylvania Press, 1979), 245-66.
84. Shorter, A History of Psychiatry.
85. J. Liebenau, Medical Science and Medical Industry (London: Macmillan Press, 1987).
86. Thorazine is the SK&F brand name for chlorpromazine.
87. Swazey, Chlorpromazine in Psychiatry, chap. 7.
88. The fact that F. Bowyer, the chairman of SK&F went on national television to promote Thorazine shortly after its official launch is recorded by W. Johnson, see note 4 above, who is quoted in Swazey, Chlorpromazine in Psychiatry, 190. F. Ayd in Healey, The Psychopharmacologists, recalls how he made appearances on Ciba's television programme.
89. The fact that F. Bowyer, the chairman of SK&F went on national television to promote Thorazine shortly after its official launch is recorded by W. Johnson, see note 4 above, who is quoted in Swazey, Chlorpromazine in Psychiatry, 190. F. Ayd in Healey, The Psychopharmacologists, recalls how he made appearances on Ciba's television programme.
90. D. Healy, The Antidepressant Era (Cambridge, MA: Harvard University Press, 1997) 48-54.
91. Healy, The Antidepressant Era, 75-6.
92. Frank Ayd, interview in Healy, The Psychopharmacologists, 106.
93. Healy, The Psychopharmacologists.
94. Tom Ban, interview in Healy, The Psychopharmacologists, 593.
95. Braslow, Mental Ills and Bodily Cures, 174.
96. Healy, The Antidepressant Era, 21-8, for a description of the course of restriction of drug availability in the United States.