杏吧原创

The Creation of Psychopharmacology by David Healy, Harvard, $39.95, ISBN 0674006194

IT USED to be all repressed urges or childhood abuse. Now, the root cause of sadness is low levels of serotonin. Psychobabble has given way to biobabble. And as psychotropic drugs to treat the levels of feel-good brain chemicals proliferate, the definitions of all kinds of mental suffering are changing.

Everything from catatonia to shyness, it seems, is now a biological process that drugs can cure. We are now 鈥渕edicalising distress鈥�, as David Healy says in his remarkably thorough history of the phenomenon, The Creation of Psychopharmacology.

Healy, a reader in psychological medicine at the University of Wales College of Medicine, shows how this bio-monopoly emerged to save psychiatry in the 1950s. At the time there were a huge variety of talking cures and other treatments for mental illness, so the 鈥渁wakening鈥� of severely psychotic patients on chlorpromazine looked near-magical, the classic miracle cure. It inaugurated the new industry of psychopharmacology, and paved the way for a Faustian contract between psychiatrists and the pharmaceuticals companies.

Psychiatrists were swift to capitalise on the benefits of the drugs that followed chlorpromazine, perhaps in reaction to severe criticism from the social psychiatry movement of the 1960s. These radicals pointed out that psychoanalysis had led to many abuses, especially in the US. Parkinson鈥檚 disease, for instance, was supposed to stem from anger the sufferer could not cope with. George Gershwin鈥檚 analyst declared Gershwin fell off his piano stool because he was hysterical. Gershwin had a brain tumour.

Drugs for treating psychosis, depression, anxiety and many other kinds of mental disturbance gradually emerged, and Healy shows how their undoubted effectiveness was overestimated and oversold again and again. He also points out admission rates to psychiatric wards have multiplied by a factor of 15 over the past century, and rates of detention increased threefold. Patients suffering from schizophrenia and bipolar disorder (the current name for manic depression) now spend more time in hospitals than they would have a century ago.

Everyone from psychopaths, drug abusers and paedophiles to the shy and unhappy are all now seen as manageable through pills and potions. Healy uncovers the interrelated mix of forces that have driven us to look to drugs as the answer to these psychological and social discomforts. The interests of the pharmaceuticals industry itself are not the least of these forces. As Healy says, the industry 鈥渉as highly developed capacities to gather and market evidence favourable to its business interests鈥�.

Healy shows how this, combined with the political interests of medicine, have created flawed procedures that are then used to defend the power of drugs. These include misdiagnosis, crude qualitative models of mental illness rather than more complex multidimensional ones, and evaluation procedures that rely on artificially controlled conditions rather than direct clinical experience.

He argues that these weaknesses go to the centre of the scientific debates about mental illness. For example, explanations for schizophrenia far outlived their credibility because they were so useful for selling drugs.

Drugs companies encourage and reflect a culture in which, Healy says, 鈥渢he quest for health is replacing the quest for holiness鈥�. What he calls a cosmetic psychopharmacology is emerging to change lifestyle and experience under the guise of treating disease.

This is a dense, detailed book, but its message is very important. I hope Healy, or someone else, writes a simpler version for the mass market. The creation of psychopharmacology has changed our society and our lives, and we need to take the measure of it.