When I lecture to my students, I tell them that medicine has two arms. One is diagnosis, and I hold out my left arm and wiggle it. The other is treatment, and I extend my right arm and wave it a bit. Psychiatry, as part of medicine, also has two arms, and events with them over the last 50 years have gone seriously awry. As the discipline pulled itself out of the swamp of psychoanalysis in the middle third of the twentieth century, one might have expected to see progress, as achievement was built upon achievement, and the wall of knowledge rose higher. This is approximately what happens in the other medical disciplines.
This increment of knowledge has not happened in psychiatry, at least not in the diagnosis and treatment of mood disorders, the bulk of the discipline’s clinical burden. Instead, knowledge has been forgotten, with the result that in the early twenty-first century psychiatry is not demonstrably further down the road on which it found itself in the mid-1950s. This is not only a scandal for the responsible advancement of knowledge, it is a disaster for public health, as patients in the grips of often terrible illnesses cannot count on the certainty of state-of-the-art diagnosis and treatment, simply because the state of the art has been duly forgotten, or trampled in the latest surge of herd behavior that seems to characterize psychiatrists more than clinicians in other disciplines. How something that wasn’t supposed to happen actually occurred is the subject of this book.
Main Drug Classes Discussed in Before Prozac
2 Before Psychopharmacology
3 The First Drug Set
4 Power Play
5 Killer Drugs!
6 Death Sentences
7 “The Plague of Affective Disorders”
8 Losing Ground
9 What Now?
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