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The Creation of Psychopharmacology BOOK REVIEW He claims “rationality” for the hypoth- Additional compounds were made, of The Creation of esis that the dopamine D2 receptor is which RP4.560 or chlorpromazine was Psychopharmacology the basis of antipsychotic action. one. Pierre Deniker, an assistant to the However, he asserts that prior use of head of the Department of Psychiatry, methylene blue for nervous disorders, Jean Delay, turned out to be Laborit’s by David Healy on the grounds that it stains nervous brother-in-law. When Deniker and Harvard University Press, $39.95, 469 pp, 2002 tissues, was equally rational. Delay heard about chlorpromazine, The book starts with the various ap- they tried it, with ice, as artificial hiber- proaches to madness. “Madness (from nation for treating mania. A nurse ad- REVIEWED BY PHILIP SEEMAN infections)...is not socially created, ” he ministering the therapy omitted the ice Departments of Pharmacology and Psychiatry states, but one could argue that the and the patient improved just the University of Toronto madness caused by syphilis is, in fact, same. The rest is history. Toronto, Ontario, Canada socially created. These are complex top- These are interesting anecdotes. They ics, and Healy is too superficial in his illustrate Healy’s style: breezy, gossipy, A major proportion of medicines now writing to do justice to such discus- lighting first on one little story, used in the developed world have been sions. Although the antipsychotic buzzing off to another, returning per- created for the mind. Psycho- dopamine D2 receptor was discovered haps, and buzzing off again. And Healy pharmacology is here to stay, making in Toronto in 1974–1975 using radio- knows a lot of gossip. Another example: books about the subject useful. While haloperidol made in Belgium, the book at McGill University in 1971, Herbert this book is informative, it informs gets this wrong and then blithely Marcuse and F. Qunes debated Heinz mostly the gossip behind the science. moves on to gossipy anecdotes. Lehmann (psychoanalysis versus chlor- There is, however, a thesis: David Healy Healy’s approach is reminiscent of a promazine), and Qunes threw a cream does not think psychiatric drugs were TV documentary that compresses a mil- pie at Lehmann’s face while Lehmann http://www.nature.com/naturemedicine discovered but, rather, that the need for lennium into 40 minutes. He does not kept right on speaking. them was created by the pharmaceutical pause long enough to capture the read- Healy appropriately downplays the industry. er’s attention, although there are color- paper by Carlsson and Lindqvist (1963) Healy is often sarcastic, and it is not ful exceptions. For example, “In 1874, often incorrectly cited as the origin of always clear when he is serious. “There Kahlbaum described ...catatonia...which the dopamine hypothesis of schizophre- is ...a growing body of evi- …has to be seen to be nia. In fact, these authors did not show dence that indicates a suc- believed.... in more se- that antipsychotics selectively blocked cess rate and quota of vere forms, they (the dopamine receptors; their paper specu- therapeutic rationality per patients) often lie or lated that chlorpromazine and haloperi- physician 50 years ago stand motionless in dol blocked monoamine receptors for that are higher than those odd, impossible pos- serotonin, norepinephrine and that characterize many tures for hours or days dopamine, and no mention was made of current practices.” This on end...”. selectively blocked dopamine receptors. © Group 2002 Nature Publishing seems an odd opinion, The discovery of Healy addresses the issue of dopamine since psychiatric drugs chlorpromazine is D2 receptor elevation in schizophrenia have alleviated pain and well described, and it by stating that the initial patients were distress, changed the na- is a good story. A medicated and that “…subsequent stud- ture of psychiatric institu- Rhône Poulenc com- ies that controlled for medication... failed tions, shortened psych- pound, promethazine, to support their claims.” This is not cor- iatric hospital admissions, was used as a sedative rect, because the first to report these find- kept patients in their own in sleep therapy ings, Wong et al., used drug-naive communities and probably increased of schizophrenia in 1950. A nurse need- patients. The fact is that radio-methyl- their productivity. They have certainly ing an operation on her nose could not spiperone (labeling D2 monomers) shows reduced the distress of families of the be given an anesthetic mask, so her elevation of D2 in schizophrenia but mentally ill. To intimate otherwise is to anesthetist used a cocktail of promet- radio-raclopride (labeling D2 monomers mislead. hazine and pethidine. During surgery, and dimers) does not. Healy continues: “The key question is he found the nurse to be relaxed and I suspect there may be other errors in whether we have set myth aside and be- “almost totally indifferent”. He told the book. Nevertheless, this book is rec- come more scientific…”. He does not this to Laborit, a military surgeon, who ommended for those who enjoy the think ours is a more scientific age than used this same cocktail for his surgical human stories and the gossip and who the one that preceded it, at least not procedures, and was struck by the indif- are prepared to check the facts else- when it comes to psychopharmacology. ference exhibited by his patients. where. 1194 NATURE MEDICINE • VOLUME 8 • NUMBER 11 • NOVEMBER 2002.
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