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Excerpt
This is a superb book by a gifted, erudite, and energetic medical-psychiatric historian with a special interest in the history of psychopharmacology. He has accumulated an amazing amount of data beginning with historical precedents that have contributed to the development of psychoactive drugs and attest to the broad scope of his reading and data collecting. On this foundation, he has carefully tape-interviewed a large and important segment of the Who's Who of modern psychopharmacology. He adroitly and candidly presents what he has garnered from these pioneers, including clinicians, clinical investigators, basic scientists, pharmacologists, neuroscientists, employees of the pharmaceutical industry, government regulatory agencies, and research centers, such as the NIMH.
The harvest of Healy's thorough collection and critique of information in the literature, from those who have played key roles in the evolution of modern psychopharmacology to the tools used to assess the efficacy and safety of today's psychotropic drugs (randomized controlled trials, rating scales, etc), is an insightful, fascinating, enlightening, and accurate account of the multitude of factors-human, scientific, social, and economic-that have interacted to mold contemporary diagnostic criteria and the scientific and regulatory requirements for establishing the clinical indications for these drugs.
As one who has been involved in modern psychopharmacology from its genesis and who has been privileged to know personally most of the psychiatrists and scientists mentioned in this book, I can attest to the comprehensiveness, balance, and accuracy of Dr. Healy's portrayal of an important era in psychopharmacology, and the roles of those who have contributed to the growth of psychopharmacology, to our knowledge of the illness depression, its biochemical and neurobiological bases, to its pharmacotherapy, and to the mechanisms and sites of action of antidepressants. He rightfully gives credit to those who deserve it. He cites the role of American psychiatrists who Gerald Klerman dubbed neo-Kraeplinians. This group is composed of biological psychiatrists who believe in the importance of psychiatry in traditional medical diagnoses. They profess that psychiatry is a branch of medicine, that there is an identifiable boundary between the normal and the sick, and discrete and identifiable mental illnesses exist which psychiatry should treat and not problems of living and unhappiness. These neo-Kraeplinians were very influential in molding the classifications of psychiatric disorders in DSM-III. Healy calls attention to published views of opinion leaders in American psychiatry in 1997 who contend that the psychiatric profession faces disaster if it does not stop offering to solve social ills and pull back to a biomedical focus (Detre and McDonald, 1997), a position I wholeheartedly support.
A most important aspect of psychopharmacotherapy highlighted by Healy is that the success of antidepressant drug therapy is contingent on therapists who treat not only an illness but a person who has the illness. Success depends on accurate diagnosis, judicious selection of an antidepressant drug, and the prescription of an adequate dose for an adequate period of time, all combined with the therapist providing empathetic, compassionate and supportive care. Successful treatment of depression can be due as much to the patient's response to the therapist as to the antidepressant drug, if not more so.
This book is an inexpensive treasury of valuable information for psychiatrists, basic scientists, academicians, employees of the pharmaceutical industry, and government regulatory agencies and research centers. Dr. Healy has shared with readers not only historical facts but also his personal views of contemporary psychopharmacology. His views are thought-provoking and worthy of serious consideration.
