#502 – Psychiatry, Insane Asylums, Mental Illness, ECT, Lobotomies, Freud & Jung

“for a couple of decades. What caused it to stop, and you talk about the progress of science, was the discovery of penicillin, which was a real magic bullet. So once you had penicillin, you weren't going to continue treating people with malaria.”

“By the way, these are definitive examples of progress in medicine. Absolutely. Penicillin, making sure there's no germs in zerosurgery. So these are all just refreshingly clear examples of progress.”

“Sometimes it comes in big steps. Penicillin, I think, was a huge step. I was lucky enough to grow up in the era when penicillin and other antibiotics became widely available.”

Also filed under Antibiotics

“Again, World War II. greatly accelerates things, not least because we discover a real magic bullet called penicillin and then the other antibiotics that we subsequently come across. Penicillin had been observed by Alexander Fleming in his famously in his lab in some Gipetri tube, Petri dishes where bacteria had been killed.”

Also filed under Antibiotics

“It was really Harold Florey and his team at Oxford who developed the therapeutic potential of penicillin. And actually, Flory threw some of it in his jacket across the Atlantic to America.”

“And it was Americans that solved the critical thing. It took Florey and his team weeks to develop enough penicillin to treat a single mouse. What America learned how to do was mass produce penicillin.”

“with the third edition of the Diagnostic and Statistical Manual of the Profession. DSM-3. DSM-3, and then there's been DSM-3R, DSM-4, DSM-4TR, and now DSM-5. Finally, not with a Roman numeral, but with an Arabic numeral. So they thought with DSM-5, when they needed to modify it, it would be like a piece of software.”

“DSM-2 in 1968 expanded to 185 diagnoses, still psychodynamically flavored and reliability poor, but added more attention to childhood disorders and later removed homosexuality as a disorder in 1974 printing.”

“And then DSM-3R in 1987, revised criteria and expanded to around 297 diagnosis. DSM-4 in 94 and DSM-4TR in 2000 focused on literature-driven empirical revisions, added and deleted some disorders, increased coordination with ICD-10 and goes on.”

“That's where we got aspirin. That's where we got a whole bunch of drugs. And gradually, the drug companies become more organized. They differentiate themselves from all the quack remedies that are around.”

“there is no free lunch with medicine. If you take an aspirin, it may cause your stomach to bleed, sometimes enough to really put you in serious jeopardy. Most of the time, it's fine.”

“It transforms SmithKline and French from a small operator into a big company. And then, of course, once that's successful, it turns out that chlorpromazine can be easily tweaked as a molecule. And so copycat drugs emerge on the scene.”

“The hospital psychiatrists, once they wake up to the usefulness of thorazine and its analogs, do start using the drugs a lot.”

“something happened. 1957, when people were developing copycat versions of Thorazine, Clozapine was developed by a small company, which was subsequently bought up by a bigger company and introduced in Europe.”

“there was an attempt to revive clozapine. And it tends to, it turns out it tends to work better in treatment-resistant cases, meaning cases don't respond to the other antipsychotics that we have.”

“Freud, from the Madhouse to Modern Medicine, and Desperate Remedies: Psychiatry's Turbulent Quest to Cure Mental Illness. Andrew Skull has spent decades studying how societies have understood madness, how psychiatry rose to authority, and how often that authority was used with false confidence and catastrophic consequences.”

“So when I first conceived the idea of writing Desperate Remedies, the book, it was back in 1981. And I was in London on a Guggenheim Fellowship at the Wellcome Institute.”

“They didn't know what to do with it, but other kinds of antihistamines in the war had been used effectively. And they thought, well, let's look and see if we can find a market for this drug. And so the interesting thing to remember in those days is that investigating the property of new drugs was a wild world west phenomenon.”

“I thought was quite well done. And my friend Patrick McGrath, who's a novelist, wrote a book called Asylum. Patrick grew up in the grounds of Broadmoor. Broadmoor is England's premier hospital for the criminally insane.”

“It would act like a catalyst because it tended to make you sleepy. If you read the leaflets on dramamine, one of the cautions is it'll make you sleepy, don't drive, right? So why don't we give it to some surgeons and see if they can find a use for it.”

“So wear and tear, that was the problem. And the solution was fat and blood. That was the title of the other book. So you got scrawny and all nervous and twitchy. And what you really needed was to build back up your strength, including your nervous strength.”

“And there are two interesting findings. So you have one first-generation antipsychotic, one of those very early drugs, and you have four more recent drugs that you're looking at.”

“They'd sooner tolerate some hallucinations. That's a hard one. So there's that picture of the SSRIs that also came to be Prozac, Zoloft's past. All of that. Well, again, they're the second generation of antidepressants. So that's a complicated story.”

“And we don't have, we have, through L-DOPA, a means to delay its impact, but eventually that loses its efficacy. And unfortunately, we don't have a cure.”

“Those work really, they're muscle relaxant types of things. And, you know, later on in the 60s, we get Valium and Librium coming on adding to or and replacing those first generation drugs. So you have major tranquilizers, minor tranquilizers, minor tranquilizers.”

“The following is a conversation with Andrew Skull, a historian of psychiatry and mental health. He has authored many books that I highly recommend, including Madness in Civilization: A Cultural History of Insanity from the Bible to Freud, from the Madhouse to Modern Medicine, and Desperate Remedies: Psychiatry's Turbulent Quest to Cure Mental Illness.”

“being invented and brought to market. This is Miltown. Yeah, this is Miltown heavily promoted by the first major television star of the mid-50s, Milton Berle, who calls himself Uncle Miltown and promotes the drug heavily on his show.”

“Freud, of course, developed a much more elaborate theory of this in years to come. Bree and Breure collaborate on a book called Studies in Hysteria. And there are a series of case vignettes in there of patients Freud is treated.”

“He writes the interpretation of dreams, for example, because he begins to regard dreams as an arena where these hidden memories, these suppressed things re-emerge in disguised form in your dream life.”

“relation to the health of a patient. Yes. Pat Barker's trilogy of novels about World War I was turned into a film. I think it was called Regeneration. And that was quite powerful.”

“MAOIs, as they're called in the trade, and tricyclics, which were called tricyclics because they had a third ring of a certain element in their molecule. Those had, as I say, a limited market, but also there were complications associated with them.”

“And he tried ratback fever. He tried giving people typhoid vaccine that creates a fever to no avail. And towards the end of World War I, the Italians were fighting in World War I on the side of the British and the Americans and the French.”

“Those work really, they're muscle relaxant types of things. And, you know, later on in the 60s, we get Valium and Librium coming on adding to or and replacing those first generation drugs. So you have major tranquilizers, minor tranquilizers, minor tranquilizers.”

“Eating lots of snacks, a very high calorie. So Weir Mitchell wrote two popular bestsellers, self-help books, I suppose you'd call them in the modern genre. One was called Wear and Tear.”

“They'd sooner tolerate some hallucinations. That's a hard one. So there's that picture of the SSRIs that also came to be Prozac, Zoloft's past. All of that. Well, again, they're the second generation of antidepressants. So that's a complicated story.”