The Creation of Psychopharmacology (review)

From the synthesis of chlorpromazine in 1950 (marketed in Europe as Largactil and in the United States as Thorazine) to the present-day mass marketing of drugs like Prozac, Zoloft, and Paxil, the psychopharmacological revolution has fundamentally altered how we understand and treat psychological distress. These past fifty years have witnessed the dismantling of an enormous state-hospital system (housing at its peak more than a half-million patients), the eclipse of psychoanalysis and psychodynamic psychiatry by biological psychiatry, the creation of a multibillion-dollar psychopharmaceutical industry dependent upon particular views of psychological distress and its cure, and biological psychiatry's infiltration of nearly every nook and cranny of how we experience and define ourselves. This is the story that David Healy tells in The Creation of Psychopharmacology, a follow-up to his highly praised The Antidepressant Era (1997). Though at times frustratingly overly technical and poorly organized, this is a brilliant work: a provocative indictment of contemporary psychiatry, and the most comprehensive and important book written to date on the history of psychopharmacology.

Two major themes emerge over the course of the nearly four hundred pages of this remarkably ambitious book. The first is that psychiatric science has not progressed in any straightforward, linear way; Healy sets out to show—quite effectively—that we have good reason to wonder whether psychiatry is becoming increasingly less scientific rather than more. The second theme, closely related to the first, is that over the last fifty years it largely has been commercial interests—particularly those of the pharmaceutical industry—that have defined the nature of clinical science, psychiatric illness, legitimate interventions, and the scientific evaluation of whether a treatment works: "The possibility that marketing now determines culture is at the heart of the book" (p. 67). "Is the West leading the way toward some biomedical truth or does this development tell us more about marketing truths?" (p. 67). Healy's answer to this query is clear. Whether trying to explain the nature of schizophrenia or of depression, the market as much as science has determined how psychiatry understands psychological suffering: "The cycle whereby scientific ideas rise and fall became linked to the business cycle. The marketing efforts of companies that bolstered certain ideas within the scientific domain inhibited the development of others. From the 1990s on, scientific ideas would achieve wider acceptability only if they had commercial value, to some extent regardless of their intrinsic merits" (p. 217).

Healy makes these arguments compellingly and rigorously, demonstrating his unsurpassed knowledge of the history of psychopharmacology. However, the book is not without its faults. Though the narrative is roughly chronological, Healy introduces frequent detours backward and forward in time that can be dizzying to follow; and he is unable to resist inserting technical details that can be difficult going, even for one familiar with the science and the history. Perhaps most disappointing is that he fails to provide sufficient documentation for some of his most daring assertions, and others are overstated given the evidence he presents. For example, he contends that fluoxetine (Prozac) has never truly been shown to work—a claim that would benefit from a longer discussion and more documentation.

Nonetheless, The Creation of Psychopharmacology is easily the most important book to date on the history of psychopharmacology. It is a scholarly and impassioned argument against a psychiatry whose science and therapeutics are dictated by the interests of the pharmaceutical industry rather than by the interests of those afflicted with psychological distress. Though this book will do little to ingratiate Healy with the drug companies, it is an invaluable work for all of us interested in understanding this important part of our contemporary cultural and medical landscape.