The Creation of Psychopharmacology [Paperback]

This is a fascinating and well written account of the creation of psychopharmacology and the impact it has had on psychiatry, culture and our perception of ourselves. Despite radical changes in each of these areas since the introduction of chlorpromazine for psychiatric disorders little is known about how it happened or its consequences. Healy - though a psychiatrist, no partisan for biological reductionism - remedies this with his wide-ranging and engaging account. The book is easy and often thrilling to read, though some terms may be troublesome for the initiate. However, the story at times feels a little unwieldy with the result his overarching point can be obscured momentarily.

I thoroughly recommend this book to all psychiatrists and those interested in considered reflections on psychiatric practice. If its a polemic against psychiatry you're after then I suggest you save your money. But don't worry, there are plenty around.

N Poole

I read this book in 3 days;it is a brilliant history of biological psychiatry, all the games and the players. As a GP, I have been at times horrified by the way the medical profession has bought into the 'defeat depression' campaign, and its exploitation by some dubious pharmaceutical claims. The SSRI's are not benign drugs, to be liberally dished out for any kind of discontent, as they have for the last 20years. Healy seems to be a lone warrior against in this fight, and many more are needed. I look forward to reading Pharmageddon.

You may remember David Healy's rise to headlines when a Canadian University fired him on his first day. He had committed the academic error of biting the hand that fed him by criticizing the pharmaceutical industry that funded his chair.
This book is a critique of that industry regarding psychotropic drugs, and in particular the role of marketing and government regulations in that industry. Fascinating to read, though the chemical details were often a bit above my head, was the description of how copy-cat drugs are developed, and why claims for specificity are laughable hoaxes. The choice for calling some of these drugs antipsychotics and others antidepressants he calls a matter of historical accident. In fact, he says, in Japan, depression is treated with atypical antipsychotics, not SSRIs.

Healy isn't coy about the horrific damage these drugs do, and the fact that doctors knew, or could have known, about it all along. It seems that doctors today are less, not more, aware of this harmfulness.

The book includes interesting historical notes, though I was occasionally dismayed by Healy's naive acceptance of unlikely case scenarios recorded by early psychiatrists. For instance, he uncritically quotes that people were cured by chlorpromazine after having been in catatonic states, "frozen into several positions" for years. How is it likely, in the days before medical heroics, that someone survived such a condition? Healy does not question it. What caused catatonia, how did chlorpromazine relieve it, and why is the condition unknown today? Healy does not say. Yet he acknowledges the fraud of psychiatric diagnoses in more recent times, as well as the deception in drug company testing.

Buried among the otherwise highly informative material is the odd statement that totally contradicts the rest of the book. For instance, Healy says about insulin coma therapy, "It... was used for twenty years... A therapy that did not produce some good would surely have faded away, given... the risk of fatalities." You would expect Healy to realize that medicine does not follow such logic, much less psychiatry. Furthermore, it *did* fade away, unlike the drugs which he criticizes. Equally baffling is his terse and unexplained claim for the efficacy of ECT. And though he himself coins the term "biobabble," he doesn't shirk from a bit of biobabble himself, such as "Brain imaging will make it clear that our brains are as social as they are biological and that being biological means having social arrangements stamped into our neuroendocrine systems."

Among the implied advice that Healy includes in his book is the abolition of regulations, yet he comments that they cannot be abolished. Why not? He also endorses the free availability of SSRIs, so without a doctor's prescription. But why not free availability of all drugs, as he himself states (though he is not the first to do so), "The 'good' drugs are now difficult to access because they are available only by prescription, while the 'bad' drugs, which prescription-only status was introduced to control, are widely available."

In short, Healy wrote an excellent book, though it contains the occasional slip which probably reflects a lack of critical editing.

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