Psychopharmacology: Characteristics and History

· November 18, 2018

It wasn’t until the 19th century that French and German scientists began to study human behavior in adaptive terms. A new paradigm emerged that labeled problems as “disorders”. That was the beginning of the attempt to control behavioral symptoms with psychopharmacology.

This change brought relief to many psychiatrists who were happy to be “real scientists”. They set aside Jungian and Freudian theory in favor of chemical compounds. Thanks to the testimony of people like Bessel van der Kolk, we know more about the true history of psychopharmacology. These testimonies also help us better understand the strong influence that psychopharmaceuticals have today.

The beginning of psychopharmacology

In the early 50s, a group of French scientists discovered chlorpromazine (Thorazine). This drug helped calm patients down and reduce agitation and delirium. Before this discovery, the Massachusetts Mental Health Center’s (MMHC) primary treatment for mental illness was conversational therapy. Therapists derived this kind of treatment from Freud’s psychoanalysis.

Two kinds of pills.

In the late 60s, Bessel van der Kolk witnessed the beginnings of psychopharmacology. He saw the transition towards mental illness. Bessel worked as a research assistant at MMHC. His goal was to figure out the best way to treat young people who had suffered their first psychotic breakdown.

Bessel committed to keeping his patients busy in age-appropriate activities and spent a lot of time with them. He saw things the physicians never noticed during their short visits. At night, when many of the young people had insomnia, they told him their life stories. Many had experienced abuse, sexual assault, mistreatment, etc. 

The power of active listening vs. treatment with pharmaceuticals

During morning rounds, MMHC assistants presented their cases to their superiors. However, they rarely mentioned the stories their patients shared with them. Nevertheless, many later studies confirmed the relevance of these confessions.

“It was surprising the coldness with which they talked about patient symptoms and how much time they spent trying to manage their suicidal thoughts and their self-destructive behavior instead of understanding the possible causes of their desperation and helplessness.” [translation]


-Bessel van der Kolk-

What was also surprising was the little attention they paid to their patient’s goals and achievements. They didn’t seem to care about who their patients loved or hated, what their motivations and concerns were, or what kind of mental blocks they had.

However, Bessel consulted medical histories and asked people about their lives. Many patients felt so grateful and liberated that they questioned the need for continued treatment.

Truth is stranger than fiction

Bodily hallucinations are common in patients with schizophrenia. One example would be sexual hallucinations that usually correspond to real sensations. Thus, Bessel asked himself if the stories that he heard in the wee hours of the morning were true.

Is there a clear line between memory and imagination? What if hallucinations are actually fragmented memories of real experiences? Fortunately, research shows that a lot of violent, strange, or self-destructive behaviors are the product of past trauma. Patients engage in these behaviors when they feel frustrated, confused, or misunderstood.

A woman experiencing trauma.

Bessel was surprised and alarmed by the look of satisfaction some healthcare workers had while holding a patient down for an injection. He slowly realized that an important concern of the healthcare community was to make sure that the professionals were in control of the situation. So much so, in fact, that it sometimes seemed to take precedent over what was best for the patient.

The pharmaceutical revolution

The administration of antipsychotic drugs reduced the number of psychiatric residents in the United States from 500,000 in 1955 to less than 100,000 in 1996. One by one, patients left the hospitals and many hospitals closed their doors. Others started to call themselves asylums.

In 1968, the American Journal of Psychiatry published the results of the study Bessel participated in. They looked at the effects of different treatments for schizophrenic patients. They found that medication was more effective than three therapy sessions a week. In the 70s, scientists started to find proof that linked levels of certain brain chemicals to different disorders like depression or schizophrenia.

For researchers to be able to communicate their results accurately and systematically, they needed “diagnostic criteria for investigation”. This gave way to the first system for diagnosing psychiatric issues, called the Diagnostic and Statistical Manual of Mental Disorders. The American Psychiatric Association published this manual. In 1980, experts recognized that this diagnostic system was inaccurate. However, psychologists still use it as a fundamental clinical tool since there’s no better alternative.

The triumph of psychopharmacology

Drugs helped physicians do their job better. They increased positive outcomes for their patients. What’s more, funding allowed more labs, student researchers, and sophisticated instruments. With chemistry in the mix, the whole field became more scientific.

All of these factors combined to legitimize psychiatry in the academic world. Psychiatry departments gained prestige. In the 90s, Bessel saw the effects of this transition. The MMHC had a gym and a pool for mental health patients. As a result of this “revolution”, this area became a lab to “fix” patients.

A variety of pills, the base of psychopharmacology.

On the other hand, leading medical journals rarely publish or finance studies about the treatment of mental health problems without drugs. The use of these drugs requires a standard protocol that doesn’t adapt to patients’ individual needs. In the meantime, we’re seeing an increase in the number of patients who overdose on a combination of psychopharmaceuticals and pain relievers.

The pharmacological revolution certainly has its benefits. With it come biological theories that explain chemical imbalances in the brain, for example. However, psychopharmaceuticals also negatively affect how we treat patients and intervention plans. That is because psychopharmacology replaces therapy in many places. Therapy gets pushed to the back burner, thus making it impossible to address or resolve the underlying causes.

References

Van der Kolk, B. A. (1994). The Body Keeps the Score: Memory and the Evolving Psychobiology of Posttraumatic Stress. Harvard review of psychiatry, 1(5), 23-30.