Doctors are supposed to live by the Latin phrase generally translated as First, Do No Harm: Primum non nocere. Andrew Scull’s Desperate Remedies: Psychiatry’s Turbulent Quest to Cure Mental Illness (Harvard University Press, 2022) is a history of purported cures for mental illness that have often been worse than the disease.
Desperate Remedies is so important and readable that for the first time I’m devoting an entire Olasky Books newsletter to one book. Since the first half of the twentieth century brought wonder medicines like insulin and penicillin for physical ailments, drug companies in the second half hoped cures for mental problems would be as forthcoming. But Scull shows that heavily-marketed antipsychotics and antidepressants have been “no more than Band-Aids” mainstreamed by aggressive public relations.
A 1990 Newsweek cover story on the wonders of Prozac asked readers: “Shy? Forgetful? Anxious? Fearful? Obsessed?… Science will let you change your personality with a pill.” Studies from 2013 through 2018 showed more than one of eight Americans 12-and-older taking antidepressants. Scull says one in five American high school boys and one in eleven high school girls have ADHD diagnoses in their files. By the age of eight, 20 percent of children in Medicaid families have received a psychiatric diagnosis: One in ten has ingested psychotropic medication.
Scull says “we are very far from possessing psychiatric penicillin.” He does not think psychiatry will succeed in “doubling down on its wager that mental disturbance is nothing but brain disease.” He quotes Thomas Insel, who led the National Institute of Mental Health from 2002 to 2015: “I succeeded in getting lots of really cool papers published by cool scientists at fairly large cost — I think $20 billion — I don’t think we moved the needle in reducing suicide, reducing hospitalization, [or] improving recovery for the tens of millions of people who have mental illness.”
Scull’s skepticism does not lead him to embrace Christian Science, New Age, or Scientology contentions that we are purely spiritual beings. We have bodies as well as souls: Ignoring either is oversimplification. While decrying over-drugging we should also note that the 1900-1950 good old days were pretty bad. Doctors who linked all mental illness to physical causes removed body organs, created artificial comas and epileptic seizures with drugs or electricity, severed brain tissue through surgical operations on frontal lobes, thrust ice picks through eye sockets, etc. etc.
Some of Scull’s history is grotesque. Yale neurosurgery professor William Beecher Scoville “inserted a suction catheter — a small electrical vacuum cleaner — and sucked out a portion of the patient’s frontal lobes.” Journalists did public relations for slicing and dicing. Washington science reporter Thomas Henry waxed on about an “actual, tangible, physical basis in the brain for… abnormal psychology which can be attacked with the surgeon’s knife as easily as can an inflamed appendix or diseased tonsils.” The New York Timesembraced “surgery of the soul” that “cuts away the sick parts of the human personality.”
After 1950 the concept of improving by removing fell into disrepute. Columbia psychiatry professor Nolan Lewis said, “It disturbs me to see the number of zombies that these operations turn out.” Swedish psychiatrist Gosta Rylander said lobotomized patients “can feel neither real happiness nor deep sorrow. Something has died within them.” In 1956 University of Chicago neurosurgery professor Percival Bailey sarcastically acknowledged, “The most favorable result seems to be that the disturbed patients after lobotomy are easier to manage in the hospital. But… they would be still less trouble if taken to the gas chamber.”
Scull says mental illness is about “memories and meanings, and crude jolts of electricity [were] hardly the way to deal with people’s psychopathology.” Now the slogan could be “In drugs we trust,” but the mind is still a mystery. Guesswork abounds: For physical ailments, patients seeking a second opinion usually find it the same as the first, but one study found psychiatrists making the same diagnosis of an ailment only 42 percent of the time.
New theories continue to fail. Often-cited psychiatry researcher Kenneth Kendler admits, “despite our wishing it were so, individual gene variants of large effect appear to have a small to non-existent role in the etiology of major psychiatric disorders.” The Washington Post’s favorable review of Desperate Remedies acknowledges, “After decades of research and billions of dollars spent, not a single biomarker for psychiatric sickness has been discovered.”
The results of such failure are evident not only in homes and offices but on city streets. Mental institutions discharged inmates with assumptions that they would compliantly take meds of questionable efficacy. Sane people, finding the drugs ineffective and the effects unpleasant, often stopped using them. So did the insane, as I note in my fixhomelessness.org columns yesterday and next Friday.
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