Psychopharmacology

There are almost limitless spin-offs from the work I have done digitizing my files. For example, access to the internet gives me the potential to track down authors whose work I had looked at 40-50 years ago and see what has become of them, what else they have written. One of the files I digitized last week was just a bibliography on the topic of "work." There was no author's name attached to it, but the title of the book did appear at the top of the page: "Work and Community in the West." So I entered that title into the "World Cat" website (World Cat being a catalogue of all the books in all the libraries of the world!!) and found that it was written by Edward Shorter. Then a search of Edward Shorter turned up some interesting things. "Work and Community in the West," turned out to have been written in 1973, which means it was a pretty recently published book when I was getting interested in the topic of work (I became a college career counselor at Windham College, School for International Training and Marlboro College in 1973 when we moved back to Vermont, built our house and I had to find paid employment. I knew very little then about career counseling, so I created a crash course on "working" for myself).

"Work and Community in the West" was written early in Prof. Shorter's career - he was 32 years old. It isn't even mentioned in standard summaries of his publications. That's probably because he has gone on to specialize in the history of psychiatry, and within that field, he has zeroed in on the issue of the use of drugs in the treatment of mental illness, and especially the treatment of depression. This is an area I know very little about and have very little experience with. I have never been prescribed an anti-depressant. But I am very interested in it. That interest goes back to my teen-age years when I entertained the idea of becoming a psychiatrist myself, and actually spent two summers working in a mental hospital, the summer of 1952 at Independence State Hospital in Iowa and the summer of 1955 at Danville State Hospital in Pennsylvania. Those two experiences were just on the cusp of the introduction of psychotropic drugs into the psychiatric arsenal. Within a fairly short time, the hospitals where I worked had been emptied out! A vast proportion of the patients who had needed to be institutionalized were able to function (more or less) outside the hospital on medication of some sort.  Types of therapy that were being used in the early 1950s, and which I was involved in - e.g., music therapy, hydrotherapy, psychodrama, insulin shock therapy, etc., mostly withered away. Electro-convulsive therapy (ECT) was abandoned for a while, but I think has returned. So my experience was all "pre-drug." Shorter seems to have taken a real interest in that transition, and seems  (from a perusal of his bibliography) to have said some trenchant things about the impact of psychotropic drugs on the field of psychiatry itself - and not all for the good! So I thought it would be interesting to read one of his books and decided to order Before Prozac through inter-library loan. It came in yesterday.

Before Prozac is a pretty dense book, primarily because there are literally hundreds of drugs that have been used and/or are being used by psychiatrists today (or as of 2008 when the book was written). A chart of all the drugs mentioned in the book takes up several pages. Shorter's thesis, however, is quite simply stated: The effectiveness of psychotropic drugs has steadily declined since the 1950s. This is due primarily to two, maybe three, causes: (1) The FDA has a policy that the patent on a drug expires after 20 years. After that, generics are allowed, and that means that the drug company which originally marketed the drug loses interest in promoting it, even if it has been very effective. (2) When a drug company conducts clinical trials to bring a new drug on the market, FDA requires that it conduct those trials against a placebo, not against an existing drug of a similar type. So,  if a new drug works better than a sugar pill, it is registered by the FDA and the drug company promotes it, even if it is far less effective than the one whose patent just expired. And (3) the academic community has largely supported these policies. And thus the decline in the effectiveness of drugs.  In a word, he believes that Prozac is not as effective as some earlier drugs that have disappeared from the market.

These are obviously controversial assertions. I'm not sure yet how to evaluate them, or whether I even can make an independent evaluation of them. But they certainly are interesting and they deal with a very important issue in our society.

Prof. Edward Shorter

"A social historian of medicine and clinical science, Professor Shorter has published widely in this field, including histories of obstetrics and gynaecology (Women’s Bodies), the doctor-patient relationship (Doctors and Their Patients), psychosomatic illness (From Paralysis to Fatigue), and sexuality (Written in the Flesh: A History of Desire). He is also the author of Partnership for Excellence: Medicine at the University of Toronto and Academic Hospitals (2013), which traces the evolution of Toronto’s academic health science network. Since 1991 Shorter’s primary appointment has been in the Faculty of Medicine, where he holds the Jason A. Hannah Chair in the History of Medicine. Since then he has emerged as an internationally recognized historian of psychiatry and the author of numerous books on the evolution of the discipline, including A History of Psychiatry (1997); Before Prozac (2009); and How Everyone Became Depressed (2013). In 1996 he was cross-appointed as a Professor of Psychiatry. His latest book, The Madness of Fear: A History of Catatonia (2018), co-written with Dr. Max Fink, provides an accurate understanding of the symptoms and treatments for an illness that has long been hidden under other diagnoses."  

                                                 -- from the University of Toronto website where Shorter is a professor.