A LONG-TERM INVESTIGATION OF CHLORPROMAZINE
A Study of Constant and Inconstant Chlorpromazine Administration Over a Period of Six Years With a Discussion of the Evolution of Our Theoretical Thinking
N. WILLIAM WINKELMAN JR. M.D.1
1 Dept. of Psychiatry, Sidney Hillman Medical Center, and Dept. of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pa.
1. The paper is a concise summary of what has been learned and how our thinking has evolved during a 6 year experience with chlorpromazine. It also reports the results of 75 patients who have been on the drug for 6 years. The discussion is divided into 3 areas: 1. Technique of treatment, 2. Results of treatment, and 3. Theory of treatment.
2. Theory of treatment is discussed first. Our present concept of the psychologic actions of chlorpromazine we explain by using the concept of psychic energetics. We feel it is from our understanding of the patient's conflicts and an understanding of the struggle of opposing forces and not merely evaluating the degree of his motor agitations that, in the long run, will help us treat him effectively. It has, therefore, been our main thesis that optimum therapeutic results can be achieved only by understanding of the patient's personality and by understanding how a drug can influence this structure.
3. All psychiatric treatment is divided into two categories: 1. Helping the patient suppress and repress painful conflicts, and 2. Helping the patient recall and relive the memory and emotions of the conflict with feeling and understanding and more successfully. It is pointed out that chlorpromazine can be utilized in either of these basic techniques, and each is described separately.
4. It sumarizes how chlorpromazine affects intra-psychic activities and how, in turn, these can help the psychiatrist predict results and treat patients. The orientation of treatment, accordingly, must be the patient, not the chemical compound; the psychiatrist is concerned with psychology, not with chemistry.
5. The orientation of all treatment is an ego orientation, and optimum treatment is achieved by following the status of the ego and doing everything to strengthen that structure. The therapeutic attitude should be less of treating the illness and its symptoms and more of helping the recuperative powers of the patient cure himself.
6. It is suggested that optimum therapy is carried out by those who are well trained in understanding the patient's psycho-dynamic make up, who have experience in the use of the compounds, and apply this combined knowledge in treatment.
