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Book Forum: Psychopharmacology   |    
The Psychopharmacologists I: Interviews ? The Psychopharmacologists II: Interviews ? The Psychopharmacologists III: Interviews
Am J Psychiatry 2003;160:1895-1896. doi:10.1176/appi.ajp.160.10.1895
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By David Healy. New York, Chapman & Hall, 1997, 633 pp., $82.95. • By David Healy. Philadelphia, Lippincott Williams & Wilkins, 1998, 672 pp., $78.50 (paper). • By David Healy. London, Arnold, and New York, Oxford University Press, 2000, 580 pp., $98.50.

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It should be apparent to even the most casual observer that psychotropic medications revolutionized the practice of medicine. Not as readily apparent, however, is the irony that this great revolution began with a minuscule nanometer adjustment. In creating chlorpromazine, the French chemist Paul Charpentier in effect moved promethazine’s side-chain nitrogen from the second to the third carbon atom. This new position inadvertently bestowed to chlorpromazine an antipsychotic potential not shared by promethazine. Dr. Charpentier’s fortuitous tinkering became the basis for one of medicine’s great awakenings. Yet more ironic, it was a French naval surgeon, Dr. Henri Laborit (here also described as an anesthesiologist), not a psychiatrist, who first noted the new drug’s psychotropic activity (though he sensibly sought the collaboration of psychiatrist colleagues at his own Val-de-Grace Hospital for confirmation). After impressive results in their psychotic patients (it was reportedly given in combination with barbiturates), chlorpromazine was recommended to Drs. Delay and Deniker at St. Anne’s Psychiatric Hospital in Paris. These psychiatrists administered it alone to their patients and validated the therapeutic breakthrough with a promptness that would not be seemly today.

The publications and advocacy of Drs. Delay and Deniker promoted the new treatment around Western Europe, Britain, and, with unprecedented speed, the world. Chlorpromazine was recognized as the first genuinely effective treatment for some of psychiatry’s most devastating diseases. The biological mechanisms of both its therapeutic effects and its troubling range of side effects became the central subject of a new scientific specialty that would become known as psychopharmacology. Psychopharmacologists (and other scientists) introduced scientific method into psychiatry, often against stiff opposition from our profession’s then regnant psychoanalytic establishment, and began its reintegration into a medical establishment that was itself realizing extraordinary advances through embracing science and technology.

All this is a mere précis of a highly complex and oft-told legend. The excitement of this remarkable multivolume presentation is that Dr. David Healy has chosen uniquely to archive this consequential history by capturing the personal accounts of scientists and clinicians who played leading roles in the psychopharmacology revolution. In a survey of truly international scope, Dr. Healy’s relaxed interviews reveal consistently fascinating minutiae in personalized accounts of the travails, triumphs, and periodic frustrations of many of our most notable colleagues, men and women who literally founded and matured a new branch of medicine in just a little more than half a century.

Not all of the big names are here, but all those included are major figures—brilliant, accomplished, indispensable. They range from the renowned to the nearly obscure, from Nobel laureates to those of more esoteric reputation. The 77 individuals and one committee whose comments make up the three volumes represent but do not exhaust the supply of luminaries of the field. In the front matter Dr. Healy acknowledges some of the pioneers who had passed before his project began, and there are many, many others who could have been included justifiably but for whatever reason were not.

Readers will note recurring themes and details within these collective narratives as individual original and critical thinkers independently approached shared problems. This repetition ultimately provides the reader with a delightful "parallax" as subsequent narrators describe the same phenomenon from their own perspectives. The interested reader can begin anywhere and enjoy and be informed by any of the individual parts. The pieces are well edited, but each retains a personal, conversational tone, which I believe increases the overall appeal of the books and sense of authenticity. The chapters are identified by proper names, with descriptive subtitles indicating the content and areas of concentration of the individual. Brief biographicalDramatis personae of the interviewees round out the extensive front matter and increase the interest and utility of the material.

The editor attempts no ranking of participants (which in this case would be forbiddingly difficult) but begins volume I with Pierre Pichot (fittingly, a notable historian in his own right). Dr. Pichot, an associate of Drs. Delay and Deniker, was near the center of inaugural events in Paris, became a prime mover in the promulgation of chlorpromazine and subsequent psychotherapeutic agents, and was a major figure in developing the sustaining scientific organizations. His insights elucidate some of the early personal competitions and controversies attendant to chlorpromazine’s discovery and the subsequent publicity and honors.

In volume III, Vanderbilt’s charismatic Fridolin Sulser relates the saga of his development as a scientist as well as the mentors and colleagues important to his career work of elucidating important neuropharmacology of antidepressants. The truly international career of the innovative Tom Ban is revealed in volume I; through his seminal imagination and tireless organizing, Dr. Ban fostered psychopharmacology within the world scientific and clinical community. Volume I also includes an interview with Jonathan Cole, an important early (and continuing) presence in American psychopharmacology, a veritable "Johnny Appleseed" diligently seeking out programs and investigators around the United States to encourage and fund their work through government and private granting agencies.

Volume II contains an interview with Leo Hollister, the crusty Stanford internist who, insisting on scientific rigor, guided the introduction and development of controlled studies and large multicenter trials for psychopharmacology. In volume I, Donald Klein, a leader in the psychobiology of panic disorders, credits Freud and psychoanalysis in his development as a clinical scientist. Volume III ends with Jean Thuillier, a Parisian contemporary of Pierre Pichot and many other prominent pioneers of the time. His narration is a fascinating complement (even with the few minor factual disagreements) to Dr. Pichot’s, and their two related memoirs offer to the front-to-back reader suitable binding threads for the substance of the three volumes.

Psychopharmacology’s most prominent and enduring contribution to human knowledge may ultimately be the insights it provides into brain function. As our profession moves into the 21st century and ever closer to a culminating understanding of the crucial but elusive convergence of mind and brain, we would do well to contemplate the early days of this astounding revolution. These volumes offer us the wisdom and inspiration of our spiritual, intellectual, and professional godfathers. We are grateful to Dr. Healy for his great service of making them accessible.




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