Psychopharmacology & the Government of the Self

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Here is a picture of Jean Delay wearing the dark coat, along with Pierre Pichot on his right and Pierre Deniker on his left, with Bernard Sadoun, Jean Thuillier and Thérese Lemperière to Pichot’s right (Slide 1).

 

Within the walls of the hospital you see behind them, the ice has just melted -- literally. Following the ideas of Henri Laborit, they had been giving chlorpromazine as part of an effort to enable the body to be cooled down with ice, in the hope that cooling would produce an anti-stress effect that would be useful in the treatment of nervous problems. The nursing staff observed that it made little difference whether chlorpromazine was given with or without ice - it was beneficial either way. Delay and his team had stumbled into the crucial discovery of the antipsychotic effect of chlorpromazine that underpins modern psychiatry.

 

The spontaneity of the photograph is misleading however. It almost suggests a father whose child has just been born and who is rushing out to tell the world the good news. However, this is far from a spontaneous photograph. There is a rigid hierarchical arrangement here. Delay is distinguished by his navy blue coat, which he and only he wore around the university and hospital ground. When he was later elected to the Academie Francaise, he would wear the ceremonial sword that went with membership whenever possible. He is talking to Pichot rather than to Deniker, the discoverer of chlorpromazine because Pichot is, strictly speaking, the second most senior person in the Department.

 

This is a hierarchical world in which, had an emissary been sent from a University Department elsewhere in the world to visit Delay, even one considerably junior to Pichot and Deniker, Deniker and Pichot would nevertheless have been summoned to stand behind Delay while he talked to the emissary from elsewhere. Possibly for up to an hour without their opinions being sought. If the fellow had been from an ethnic minority, or was a woman or a senior member of a pharmaceutical company it is unlikely that Delay would have seen them. Women such as Helene Deschamps and later Ruth Koeppe were written out of the chlorpromazine story.

 

There are two things happening in the background, however, that will change everything, unbeknownst to Delay and his group. Both in North American psychiatry. In the course of the Second World War, psychiatrists associated with the military have discovered that group therapies can have a dramatic impact on the nervous disorders produced in soldiers by the War. These therapies work best it seems where they involve a dissolution of the hierarchies of both preWar European social life and Army life. This is particularly clear in Great Britain. The more informal the setting, the better.

 

American military psychiatrists viewing this group therapy, in particular Karl Menninger, take home a message. The options were that groups work or that therapy works. Menninger opted for a message of psychodynamic therapy works. This led American psychiatrists returning from the War and also those manning the asylums during the War to abandon the asylums and to set up office practice. The asylums are left to the Europeans. Power and influence in American psychiatry uniquely moves into the community. In so doing, American psychiatrists capture for psychiatry the vast range of nervous and psychosomatic complaints that have previously been the province of neurologists and internists with an interest in psychosomatic medicine.

 

The other thing that is happening stems from another war that began in 1914 - a War on Drugs. This began with the Harrison’s Narcotics Act, which made the opiates and cocaine available on prescription-only. In 1951, a Humphrey-Durham Amendment to the 1938 Foods Drugs and Cosmetics Act makes all the new drugs produced by the pharmaceutical revolution following the Second World War, the new antibiotics, antihypertensives, antipsychotics, antidepressants, anxiolytics and other drugs, available on prescription-only.

 

Not everybody is happy with the new arrangement. Many complain that a system designed for addicts is not appropriate for the citizens of a free country.

 

A combustible set of ingredients has been put in place that will lead to an explosion. It only took 16 years for the explosion to come.

 

continued at this link:

 

http://www.pharmapolitics.com/feb2healy.html

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