What You Can Change _. And What You Can't - Martin E. Seligman [18]
It follows for all mental illness that real change is possible only after eliminating the physical illness. Kill the spirochetes, for example, and the mental deterioration ends. Raise the neurotransmitter level and cure depression; lower the level and cure schizophrenia. Lobotomize—cut out the appropriate brain centers—and cure the anxiety disorders. Reset the appetite center with a drug and cure overweight. Psychotherapy for a biological illness, from this point of view, is sentimental nonsense. At best, it might be cosmetic: A therapist might help a paretic adjust to his worsening mental and physical state; a therapist might urge a schizophrenic not to forget to take his pills and not to tell his boss about his delusions.
Drugs and Emotion
Here is what florid psychosis look like:
Lester shows up at his father’s dry-goods store one morning in a terrifying costume. He is stark naked, painted a dull brownish red from head to toe, and is daubed with slime. There is an enormous barbed fishhook sticking out of his cheek.1
“I’m a worm!” he babbles as he crawls along the floor. The cashier calls the police, and Lester is dragged off to Baptist Memorial Hospital
In the hospital, Lester is floridly schizophrenic. He hallucinates the sounds offish in a feeding frenzy. He believes that he is the object of their frenzy. He retains the singular delusion that he is a worm, probably related to his despair over his girlfriend’s walking out on him (“You worm!” she shouted as she slammed the door). His mood fluctuates wildly from terror to giddy mania to deep sadness.
Lester is as crazy as they come. But what happens next seems little short of a miracle. It is the late summer of 1952. One of the residents at Baptist Memorial has just returned to Memphis from a year in France. Before he left Europe, he had heard a startling paper delivered in Luxembourg at the French Congress of Psychiatrists and Neurologists. Professor Jean Delay, chief psychiatrist at the Hôpital Sainte-Anne in Paris, announced a breakthrough in the treatment of psychosis.
Psychosis: the most ferocious mental illness. In 1952, the back wards of mental hospitals in Paris, New York, Moscow, and Memphis were filled beyond their capacities with patients like Lester. These wards were called “snake pits.” The inmates were hallucinating and unreachable, or mutely catatonic, or wild with delusions and straitjacketed, or giggling out word salad, or simply broken, with their faces turned toward the wall. Everything was tried on these schizophrenics: electroshock therapy, artificial hibernation, lobotomy, insulin shock, cocktails of drugs. Nothing worked. The psychotic might have some remissions, but his future was widely believed to be hopeless.
Delay announced a cure. He and Pierre Deniker had tested a new antihistamine, synthesized for hay fever by the Rhone-Poulenc drug company two years earlier. Their patients became amazingly calm: Delusions dissolved in a matter of days, like shakos of snow melting slowly off a tree after an ice storm on a warm winter morning. The psychotics’ contact with the real world resumed.
At Lester’s case conference there is a heated quarrel. The psychoanalysts advocate psychotherapy. They believe that his delusion is caused by homosexual panic. All schizophrenia is “latent homosexuality,” they say. Drugging Lester will only be cosmetic, and, worse, it may impede his gaining insight into his underlying conflict. But the resident fresh from Paris is dogged. He reiterates Delay’s findings and he prevails. Lester is injected with this new drug, chlorpromazine. He relaxes immediately. (The new drug was described as a “major tranquilizer.”) By the weekend, Lester is aghast at his garb and washes off all traces of the paint. The idea that he is a worm now seems as crazy to him as it does to us. Within three weeks, Lester is back at work as a stock boy.
The new drug exploded across the psychiatric world. At every major medical center, chlorpromazine was used for psychotic