PSYCHIATRY AND THE MEDIA

Maupassant was aware of his diagnosis and at survive. Nonetheless, it seems that he saw in his the time he wrote Le Horla had been the victim of own affliction a sign that he was marked by neuralgias, ocular troubles, and chronic in destiny for great things, a spur rather than an somnia which he described graphically in letters obstacle to his endeavours. to his friends. He was well aware that when Literary commentators have protested against he wrote about madness his readers might see psychiatric dissection of the story, preferring to his work as a confessional account of his own interpret it symbolically as a visitation by the symptoms and illness. He had visited Charcot in ghost of Literature, or perhaps of Flaubert him the Salpêtrièreand was himself fascinated with self. Paradoxically, some saw the writing of ideas in vogue at the time, including the work of the story as a kind of therapeutic exorcism for Mesmer, which inspire the dinner party episode Maupassant. Written in the first person, there in the story when a psychiatrist demonstrates can be little doubt about the author's personal hypnosis to sceptical guests. He was also involvement in the work. In Le Horla, what is particularly interested in abulia, believing essentially a monologue chronicling a psychotic human will to be a very fragile mechanism as our breakdown is sustained by the vigour and im sensibilities are continually being affected by a mediacy of the language. It is a compelling dra myriad of influences of which we are scarcely matic piece by a man evidently still at the height aware. of his creative powers. It is ironic that so much is known about the illness of this man who deplored the posthumous Roisin Kemp, Research Worker, Academic De revelations of his mentor Flaubert's epilepsy, partment of Psychological Medicine, King's Col believing that details of the writer's life should lege Hospital and Honorary Senior Registrar, remain hidden, and that the work alone should Maudsley Hospital, London SE5

Not so smart drugs

Dr Kwame McKenzie of the Institute of Psychiatry con suffering from diabetes insipidus, that there are trasts the publicity and the evidence behind drugs that unrefuted claims that piracetam can help dys are claimed to make us brighter. lexic children learn to read and that piracetam, other 'acetam' drugs, co-dergocrine mesylate, Research into smart drugs is a field of pharma hydergine and pyroglutamate produce a im cology which never fails to capture the public provement in memory and alertness in dementia. imagination. And, because the idea of being able Other researchers have been less rigorous but to take a pill to circumvent hours of studying is have been effective in producing a popular image so appealing, much has been made of successes of smart drugs which does not correspond with in this field. research evidence. The best known publicists are There have been claims of memory enhancing probably Dr Ward Dean, a Florida based geria properties for over a hundred substances - trician, and John Morgenthaler, a journalist and acetyl-L-carnitine, choline, inositol, lecithin, entrepreneur whose book is credited by some phenylalanine, hydergine, piracetam, anirac- with starting a smart drug consumer boom. Un etam, oxiracetam, pramiracetam, pyroglutamate, ashamedly titled Smart Drugs and Nutrients: how vasopressin and bromocriptine to name but a to improve your memory and increase your few. However, a recent unpublished review by intelligence using the latest discoveries in neuro Dr Stephen Rose, from the Open University, con science, it includes chapters on 'over the counter cluded that there was no justification for the cognition enhancers', 'overseas drugs by mail' claim that any of the smart drugs can boost the and 'taking exams', and six pages of uncritical memory of unimpaired humans. testimonials and case histories in case readers There is evidence, though, of some effects in are in any doubt of the efficacy of the compounds people with cognitive impairments of various covered. kinds. A 1993 article from the Consumer's Not long after the book's publication interest in Association based on Dr Rose's report claimed smart drugs crossed the Atlantic. Initially a that studies have shown that vasopressin small-scale underground black market supplied improves the memory and alertness of people students but the trade became big business, with

Noi so smart drugs 419 PSYCHIATRY AND THE MEDIA mail order firms claiming that the drugs could In humans there were claims of improved EEC assure an examination pass, give you an edge in rated vigilance and verbal learning and memory, business negotiations or protect your memory the latter on the strength of four positive but from the effects of ageing. small double blind controlled studies. In one Until recently companies were still legally double-blind cross-over study 16 university selling smart drugs including, vasopressin, students took 1600 mg of piracetam or placebo piracetam, hydergine, choline, inositol, lecithin, three times a day for two weeks and undertook a acetyl-L-carnitine, and pyroglutamate direct verbal learning test at the end of each week. This to the public. A loophole in the Medicines Act, consisted of series of words presented as stimuli designed to allow foreign nationals to continue to on a drum which they had to remember. In the obtain personal supplies of drugs which they had second week, the students did significantly been prescribed in their own countries, was better when taking piracetam than when taking exploited. By taking orders and money here but placebo. posting medicines to customers from abroad, Many researchers have failed to replicate these these companies stayed within the law. Adepart findings. There has been no published positive ment of Health crack-down in May 1993 ended study on the cognitive enhancing effects of pirac this trade. However, the history of one drug - etam in normals since 1980 and it is now com piracetam - shows how tenuous the smart drug mon for piracetam to be used as a placebo in label often is and how difficult it is to remove trials of other supposed smart drugs. Despite once it has been ascribed. this lack of efficacy, piracetam has retained its Piracetam is one of the most popular smart smart label among the subculture of users. drugs. It is taken either by itself or in combi Meanwhile, the search continues for drugs nation with other smart drugs such as choline with memory enhancing properties and re and hydergine. It was developed in the late 1960s searchers such as Professor James L. McGaugh in Belgium and developed a reputation as a of the University of California are sure that a smart drug following animal and human experi smart drug will eventually be developed. He has ments in the 1970s. Facilitation of learning in been working in the field for 26 years but is rats, rabbits and goldfish given large doses - up unimpressed by what he calls "media hype". to ten times that recommended in humans - put "The whole smart drug use thing is a joke," he piracetam on the smart drug map. It was also has said. His words are well worth remembering. claimed that the drug increased resistance to learning impairment due to age, hypoxia, stress Kwame McKenzie, Researcher. Institute of and sensory deprivation in animals. Psychiatry, London SES 8AF

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