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[quote=Anonymous]In case you missed this brilliant piece in The NEW YORKER last year.. good read and fun at times..

[b]The Troubled History of Psychiatry[/b]

few random highlights.. with source link at the end..

[b]Finally, Thomas Szasz, in “The Myth of Mental Illness,” argued that psychiatric diagnoses were too vague to meet scientific medical standards and that it was a mistake to label people as being ill when they were really, as he termed it, “disabled by living”—dealing with vicissitudes that were a natural part of life.[/b]

Challenges to the legitimacy of psychiatry forced the profession to examine the fundamental question of what did and did not constitute mental illness. Homosexuality, for instance, had been considered a psychiatric disorder since the time of Krafft-Ebing. But, in 1972, the annual A.P.A. meeting featured a panel discussion titled “Psychiatry: Friend or Foe to Homosexuals?”

One panelist, disguised with a mask and a wig, and using a voice-distorting microphone, said, “I am a homosexual. I am a psychiatrist. I, like most of you in this room, am a member of the A.P.A. and am proud to be a member.” He addressed the emotional suffering caused by social attitudes, and called for the embrace of “that little piece of humanity called homosexuality.” He received a standing ovation.

As the century progressed, the schism between the biological camp and the psychoanalytic camp widened. [b]With advances in bacteriology, the biological camp embraced the idea that microbes in the intestine, the mouth, or the sinuses could release toxins that impaired brain functions. Harrington writes of schizophrenia treatments that included “removing teeth, appendixes, ovaries, testes, colons, and more.”[/b]

In 1963, Betty Friedan’s “Feminine Mystique” denounced neo-Freudian mother blamers. She wrote, “It was suddenly discovered that the mother could be blamed for almost everything. In every case history of a troubled child . . . could be found a mother.”

In 1961, three influential critiques appeared. “Asylums,” by the sociologist Erving Goffman, compared mental hospitals to prisons and concentration camps, places where personal autonomy was stripped from “inmates.” Michel Foucault’s history of psychiatry, “Madness and Civilization,” cast the mentally ill as an oppressed group and the medical establishment as a tool for suppressing resistance.

[b]Today, around one in six Americans takes a psychotropic drug of some kind. The medication era stretches back more than sixty years and is the most significant legacy of the biological approach to psychiatry. It has its roots in the thirties, when experiments on rodents suggested that paranoid behavior was caused by high dopamine levels in the brain. The idea that brain chemistry could offer a pathogenesis for mental illness led researchers to hunt for chemical imbalances, and for medications to treat them.[/b]

[b]In 1954, the F.D.A., for the first time, approved a drug as a treatment for a mental disorder:[/b] the antipsychotic chlorpromazine (marketed with the brand name Thorazine). The pharmaceutical industry vigorously promoted it as a biological solution to a chemical problem. One ad claimed that Thorazine “reduces or eliminates the need for restraint and seclusion; improves ward morale; speeds release of hospitalized patients; reduces destruction of personal and hospital property.” By 1964, some fifty million prescriptions had been filled. The income of its maker—Smith, Kline & French—increased eightfold in a period of fifteen years.

Next came [b]sedatives. Approved in 1955[/b], meprobamate (marketed as Miltown and Equanil) was hailed as a[b] “peace pill” and an “emotional aspirin.” [/b][b]Within a year, it was the best-selling drug in America,[/b] and[b] by the close of the fifties one in every three prescriptions written in the United States was for meprobamate[/b]. An alternative, [b]Valium, introduced in 1963[/b], became the most commonly prescribed drug in the country the next year and remained so until 1982.

One of the f[b]irst drugs to target depression was Elavil, introduced in 1961,[/b] which boosted available levels of norepinephrine, a neurotransmitter related to adrenaline. Again there was a[b] marketing blitz[/b]. Harrington mentions “Symposium in Blues,” a [b]promotional record featuring Duke Ellington, Louis Armstrong, and Artie Shaw[/b]. Released by RCA Victor, it was paid for by Merck and distributed to doctors. The liner notes included claims about the benefits that patients would experience if the drug was prescribed for them.

Focus shifted from norepinephrine to the neurotransmitter serotonin, [b]and, in 1988, Prozac[/b] appeared, soon followed by other selective serotonin reuptake inhibitors (SSRIs). Promotional material from GlaxoSmithKline couched the benefits of its SSRI Paxil in cozy terms: “Just as a cake recipe requires you to use flour, sugar, and baking powder in the right amounts, your brain needs a fine chemical balance.”

[b]Yet, despite the phenomenal success of Prozac, and of other SSRIs, no one has been able to produce definitive experimental proof establishing neurochemical imbalances as the pathogenesis of mental illness.[/b]

Indeed, quite a lot of evidence calls the assumption into question. Clinical trials have stirred up intense controversy about whether antidepressants greatly outperform the placebo effect. And, while SSRIs do boost serotonin, it doesn’t appear that people with depression have unusually low serotonin levels. What’s more, advances in psychopharmacology have been incremental at best; Harrington quotes the eminent psychiatrist Steven Hyman’s assessment that “no new drug targets or therapeutic mechanisms of real significance have been developed for more than four decades.” This doesn’t mean that the available psychiatric medication isn’t beneficial. [b]But some drugs seem to work well for some people and not others, and a patient who gets no benefit from one may do well on another. [b]For a psychiatrist, writing a prescription remains as much an art as a science.[/b]

[/b]

Harrington’s book closes on a sombre note. In America, the final decade of the twentieth century was declared the Decade of the Brain. But,
in 2010, the director of the National Institute of Mental Health reflected that the initiative hadn’t produced any marked increase in rates of recovery from mental illness. Harrington calls for an end to triumphalist claims and urges a willingness to acknowledge what we don’t know.

[b]Although psychiatry has yet to find the pathogenesis of most mental illness,[/b] it’s important to remember that medical treatment is often beneficial even when pathogenesis remains unknown. After all, what I was taught about peptic ulcers and stress wasn’t entirely useless; though we now know that stress doesn’t cause ulcers, it can exacerbate their symptoms. Even in instances where the discovery of pathogenesis has produced medical successes, it has often worked in tandem with other factors. Without the discovery of H.I.V. we would not have antiretroviral drugs, and yet the halt in the spread of the disease owes much to simple innovations, such as safe-sex education and the distribution of free needles and condoms.

[b]Still, the search for pathogenesis in psychiatry continues.[/b] Genetic analysis may one day shed light on the causes of schizophrenia, although, even if current hypotheses are borne out, it would likely take years for therapies to be developed. [b]Recent interest in the body’s microbiome has renewed scrutiny of gut bacteria; it’s possible that bacterial imbalance alters the body’s metabolism of dopamine and other molecules that may contribute to depression. Meanwhile, Edward Bullmore, the chief of psychiatry at Cambridge University, argues that the pathogenesis of mental disorders will be deciphered by linking the workings of the mind to that of the immune system. Bullmore’s evidence, presented in his recent book, “The Inflamed Mind” (Picador), is largely epidemiological: inflammatory illness in childhood is associated with adult depression, and people with inflammatory autoimmune disorders like rheumatoid arthritis are often depressed.[/b]

full article here:..
https://www.newyorker.com/magazine/2019/05/27/the-troubled-history-of-psychiatry
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