The Antidepressant Era (review)

David Healy. The Antidepressant Era. Cambridge: Harvard University Press, 1997. 336 pp. $43.50 cloth; $18.95 paper.

For better or worse, we live in a psychopharmacological age. Prozac and Valium, Thorazine and Zoloft, and a host of other psychoactive substances are daily ingested by millions and have made fortunes for those creating and peddling them to an ever expanding market of eager (and sometimes not so eager) consumers. Since 1980, when the American Psychiatric Association promulgated the third edition of its Diagnostic and Statistical Manual (DSM-III), American psychiatry has achieved worldwide hegemony, and pills have replaced talk as the dominant response to disturbances of emotion, cognition, and behavior. Pharmaceutical corporations have underwritten the revolution and have rushed to create and exploit a burgeoning market for an ever broader array of drugs aimed at treating some of the hundreds of "diseases" psychiatrists claim to be able to identify. ¹ And patients and their families have learned to attribute their travails to biochemical disturbances, to faulty neurotransmitters, and to genetic defects, and to look to their doctors for the magic potions that will produce better living through chemistry.

David Healy, director of the Department of Psychological Medicine at the University of Wales College of Medicine, has long been one of the most astute commentators on the history of this therapeutic revolution, and his new book, The Antidepressant Era, provides a wide-ranging assessment of developments in the field since the first application of chlorpromazine to the treatment of psychosis in 1951. He brings to the task a background as secretary of the British Association for Psychopharmacology but also as a researcher into cognitive therapy. He has, besides, read widely in the relevant historical and sociological literature and approaches the subject with a skeptical and sophisticated eye. Naive cheerleaders for a biologically reductionist view of mental disorder may read Healy's history as an endorsement of their blinkered viewpoint (and, indeed, one of their number, Edward Shorter, provides a remarkably enthusiastic encomium on the book's dust jacket), but, in reality, Healy's subtle and probing examination provides as little comfort for such a position as for those who dismiss the drugs as universally useless or actively harmful weapons of a "toxic psychiatry" now loosed upon the land. ²

Healy is, as he confesses at the outset of his book, "by nature . . . an enthusiast." His book, however, is a skeptical one, "skeptical of the motives of clinicians as well as the pharmaceutical industry, skeptical of both pharmacotherapists and psychotherapists" (3). He remains uncertain of whether the drugs work as well as they are supposed to and insists that "in many respects the discovery of the antidepressants has been the invention of and marketing of depression"--a once rare condition that has now been transformed by their entrepreneurial efforts into "the common cold of psychiatry" (5, 58). Spurred on by the neo-Kraepelinean revolution embodied in DSM-III and its revisions, psychiatry has embraced a conceptualization of mental illnesses as specific, identifiably different diseases, each allegedly amenable to treatment with different drugs or "magic bullets," though the whole conceptual edifice rests upon the shakiest of foundations, and the treatments themselves are decidedly less efficacious than the public relations flacks for the industry would have us believe. Meanwhile, at the level of language, both the profession of psychiatry and popular culture have become saturated with biological talk, though "it can reasonably be asked whether biological language offers more in the line of marketing copy than it offers in terms of clinical meaning" (5).

Yet skepticism, as Healy insists, is not the same as cynicism, and, though he resists a simple narrative of magic potions and medical breakthroughs, he is not blind to the way these drugs modify behavior, cognition, and emotion, often in ways that both sufferers and healers interpret as beneficial. The Antidepressant Era, in other words, is neither the work of an antipsychiatric ideologue nor a celebratory tome...