What You Can Change _. And What You Can't - Martin E. Seligman [19]
Thus began the drug revolution, dubbed “the third revolution” in psychiatry. The first had been Pinel’s striking the shackles of the insane; the second was Freud’s invention of psychoanalysis. The premise of the drug revolution is that disordered mood and emotion reflect disordered brain chemistry. Correct the chemistry of the brain with drugs, and correct mood and emotion.
The drug revolution spread rapidly. Drugs were compatible with the venerable disease model. Giving drugs rescued psychiatrists from the disdainful skepticism of their more traditionally scientific medical colleagues. Drugs were cheap and quick. Drugs were very big business, and there was a huge lobby to sell them to physicians, to Congress, to the media, and to the public.
And drugs worked. Case histories poured in. Outcome studies of the new antipsychotics were done, and the drugs were usually more effective than sugar pills given to control groups. Perhaps 60 percent of the patients improved, though few recovered completely.2
Depression, mania, and anxiety. As the fervor for drugging psychotics grew, new drugs were tried on patients suffering from other maladies. The first antidepressant was discovered by accident: A new drug had been tried on tuberculosis. The patients improved. They were pleased. Enormously pleased. They danced in the corridors and shouted in ecstasy. The drug—iproniazid—was primarily a euphoriant. It also relieved depression. The first year it was available, 1957, 400,000 patients were treated with it.3 Unfortunately, iproniazid is toxic, even occasionally lethal. It was soon outsold by milder antidepressants, called tricyclics, as the drug companies fell over each other to mint new, slightly different (and therefore patentable) versions. These also worked, and their side effects were subtler. About 65 percent of patients became less depressed.4 Prozac, hyped as “A Breakthrough Drug for Depression” on the cover of Newsweek in 1990, works at just the same rate as the earlier medications, but milder side effects were claimed.5 Prozac seized the lion’s share of the market.
The antidepressants were moderately helpful. In contrast, a true “miracle” drug—lithium carbonate—was discovered for mania. John Cade, an Australian physician, working alone and under primitive conditions, found that the urine of his manic patients killed guinea pigs: The rodents trembled, twitched violently, collapsed, and died. He injected them with lithium, an element known to be a poison, and the guinea pigs became calm and lethargic—and they survived injections of the manics’ urine. Cade then tried lithium on the manic humans whose urine was so lethal. Within days their agitation, their racing thoughts, their distractibility, and their euphoric excitement gave way to calm.6
By 1970, psychiatrists prescribed lithium routinely for manic-depression. Before lithium, manic-depression was a crippling and hopeless illness: 15 percent of manic-depressive patients killed themselves, and most—many manic-depressives are very talented—could not hold jobs. So obnoxious are manics that their families were universally miserable, and 60 percent of their marriages ended in divorce (in the days when divorce was rare). With lithium, this is no longer so. Roughly 80 percent of manic-depressives are helped by it, most of them markedly.7
The biggest splash was made with the anti-anxiety drugs. Anxiety has usually been thought of as an inevitable, if uncomfortable and disorganizing, part of life we all face. Freud thought of it as the fundamental emotion, and the first half of this century was dubbed the age of it. When extreme and out of control, however, anxiety is indisputably a clinical problem.
In the mid-1950s, Miltown (meprobamate) was first