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Thursday, 22 March 2012

The Creation of Psychopharmacology by David Healy - book review Duncan Double criticalpsychiatry - FIDDAMAN

Review of The Creation of Psychopharmacology by David Healy. Harvard University Press, 2002

Reprinted from Health Service Journal 20 June 2002 pp42-3

David Healy has recently gained notoriety after an invitation to be Professor of Psychiatry at the University of Toronto was withdrawn. Healy claimed that the pharmaceutical companies, and certain influential psychiatrists, who receive consultancy fees from the companies, swayed the decision to rescind the job offer. He sought redress for breach of contract, libel and violation of academic freedom leading to an out of court settlement. Healy is prepared to confront the all-pervasive influence of the pharmaceutical industry in psychiatry.

A principal thread running through the conflict is Healy's controversial belief that the SSRI group of antidepressants, which includes the well-known drug Prozac, may have the potential to trigger suicidality in a subgroup of users.

Whilst taking paroxetine, an SSRI antidepressant, Donald Schell shot his wife, daughter, and granddaughter, before turning the gun on himself. A unanimous jury, primarily on Healy's evidence, found that paroxetine can cause some individuals to commit suicide and/or homicide and awarded a total of $8 million in damages to the families involved.

I suspect that Healy enjoys the limelight. He tends to adopt an idiosyncratic, maverick position in psychiatry. His best book is probably The Antidepressant Era. It gives an account of the phenomenon of the antidepressants. The Creation of Psychopharmacology is a follow-up, telling the story of the discovery and development of anti-psychotic medication, such as chlorpromazine and haloperidol. There are nuggets of information in this book. Most of them derive from interviews with prominent people in the field of psychopharmacology, which Healy has published in three volumes entitled The Psychopharmacologists.

For example, I was not previously aware that Jean Delay, who, with Pierre Deniker, was the first to proclaim the anti-psychotic properties of chlorpromazine, had his office ransacked by students in the protests of 1968 at the University of Paris. Healy makes grand links between this event and the overall history of psychopharmacology that he describes. He sees 1968 as the culmination of the Enlightenment begun by Rousseau and Voltaire. He makes connections, however tenuous, with the anti-psychiatry movement.

But the generalisations and tangentiality of this book are serious weaknesses. At times it is difficult to follow the juxtaposition of ideas.

Some of the references Healy gives are useful and well worth following. However, more time and effort should have been expended in distilling the essence of the material and providing coherence to the argument.

Commentators have made these criticisms in reviews of his books since his first book the Suspended Revolution. He has never hidden his personal style and approach, which is why it is surprising that a rather rambling lecture led to the revocation of the job offer in Toronto. The University should have known what kind of person they were taking on.

The commendation for the book on the back cover comes from Edward Shorter, social historian of medicine at the University of Toronto. Shorter suggests that The Creation of Psychopharmacology is the most important contribution to the history of psychiatry since Ellenberger's Discovery of the Unconcious. Do not believe the blurb. Healy's book is not without value. But more work is needed to produce a longlasting, consequential account from his material.

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