Anne Harrington is the Franklin L. Ford Professor of the History of Science and faculty dean of Pforzheimer House at Harvard University. Her recent book, Mind Fixers, traces the history of psychiatry as a medical specialty with an analysis of its successes and failures. It has received rave reviews.

For the past 150 years psychiatry has been a battleground between the biologists and advocates of interpersonal dialogues. Are psychiatric problems rooted in anatomy and/or chemicals or are they rooted in thoughts? The teachings of Freud and his onetime associate Jung dominated psychiatric practice until the 1950’s when chlorpromazine (Thorazine) initiated a revolution in thought and practice. Severely schizophrenic patients were now usually manageable; they did not have to sit around in straight jackets or a catatonic trance all day. Most could now function well enough to be discharged from the huge psychiatric hospitals which had served as warehouses for the seriously deranged.

Lithium had been used as a tonic for years: it was the basis for many elixirs including 7-Up, but it was regarded as quackery by the medical profession. In the 1940’s an Australian researcher discovered lithium’s effect on the mood of lab animals and then confirmed this in severely depressed patients, especially those with bi-polar disorder (euphoria alternating with severe depression), but his results were mostly ignored. He persisted and found a few Australian supporters but many years passed before a Dutch psychiatrist came across his work and re-confirmed the power of lithium in this condition.

Several radical non-pharmacological treatments for severe psychiatric problems were attempted. These included electric shocks; inducing coma with insulin; giving the patient malaria in the hope that high fevers would be curative; pre-frontal lobotomy (destroying a small part of the brain).

With the success of Thorazine Big Pharma started to take over psychiatry; Freudians, Jungians and other non-drug practitioners were increasingly marginalized. Drugs were developed for anxiety, milder forms of depression, and a wide variety of other psychological conditions. In the last third of the 20th century these drugs were the biggest money makers in the pharmaceutical industry and every year saw several new ones introduced, each with the support of prominent psychiatrists and big advertising budgets. For many professors of psychiatry drug company sponsored appearances multiplied their income several times. You could now be a rich professor without inheriting money or inventing something; few resisted the temptation to be a shill for Big Pharma.

This century has brought a re-assessment of the role of drugs in psychiatry; drug research and new products have almost ceased. Most of these drugs are addicting and have significant side effects; they don’t even work that well. Clinical trials were carefully designed to emphasize success, and studies which showed no positive drug effect were scraped and never published. The whole industry and their professor-shills were discredited. The FDA was shamed for their investigations and drug approvals.

What of value is left? Electro-shock therapy can now be done humanely and helps some people with the worst depression. Lithium is critical for those with bi-polar disorder and some with severe depression. Thorazine allows severe schizophrenics some respite. All of these treatments come at high cost in side effects and a loss of vibrancy to life. A typical comment by a treated patient is “I’ve lost my uniqueness, what it is to be me, and my joy of living. The world is flat and gray.”

Harrington asks: “Can psychiatry acknowledge and firmly turn away from its ethical lapses- and especially the willingness of so many of its practitioners in recent decades to follow the money instead of the suffering?” Her recommendations for the future of psychiatry: psychiatrists should concentrate on the care of the psychotic, those with schizophrenia, bi-polar disease and severe depression. Leave the rest to psychologists, social workers, marriage and family counselors who are well trained in non-drug techniques. Unfortunately psychotics often have little money and the treatment of a large number of anxious and unhappy people who can hold a job will continue to be the major income source for psychiatrists unless we greatly increase community funding for severe mental illness.