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James Le Fanu, The rise and fall of biological psychiatry, Brain, Volume 137, Issue 6, June 2014, Pages 1850–1852, https://doi.org/10.1093/brain/awu085
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Medicine, to its great credit, has over the past 60 years become the most visible symbol of the Great Enlightenment Project where scientific progress would vanquish the twin evils of ignorance and suffering to the benefit of all. So dramatically successful has it been, it is now almost impossible to imagine what life was like at the close of the World War II when death in childhood was commonplace, there were no effective drugs for virtually any of the illnesses doctors encountered—at a time when the ‘chronic’ wards at Fulbourn Mental Hospital outside Cambridge were ‘a scene of human degradation’.
In the same year, across the Atlantic, in the Verdun Protestant Hospital in Montreal, psychiatrist Heinz Lehmann had obtained a small supply of the antihistamine derivative chlorpromazine famously observed by French naval surgeon Henri Laborit to induce a state of ‘euphoric quietude’ in his patients. Lehmann, a Jewish refugee from Nazi Germany had over the years experimented with ‘all kinds of drugs’ convinced that psychotic illness must have a biological cause—large amounts of caffeine, typhoid antitoxin, injections of turpentine and sulphur suspended in oil. ‘Nothing helped’, but with chlorpromazine:‘I was taken in by someone who had a key to unlock the door and lock it behind you,’ recalls Dr David Clark on his first visit to the hospital in 1953 as a newly appointed psychiatrist. ‘The crashing of the keys in the lock was an essential part of asylum life then just as it is today in jail. This led into a big bare room with scrubbed floors, bare wooden tables, benches screwed to the floor, overcrowded with people milling around in shapeless clothing. The disturbed women’s ward was a phantasmagorical place. They were in “strong clothes” made of reinforced cotton that couldn’t be torn. Many of them were in locked boots which couldn’t be taken off and thrown. They all had their hair chopped off short giving them identical wiry grey mops. As soon as you came in they’d rush up and crowd around you. Hands would go into your pockets grabbing at you, pulling at you, clambering for release, for food, for anything until they were pushed back by the sturdy nurses who shouted at them to sit down and shut up. At the back of the ward were the padded cells, in which would be one or two naked women, smeared with faeces, shouting obscenities at anybody who came near …’.
Chlorpromazine would be followed over the next few years by several further classes of similarly serendipitously discovered drugs, most notably lithium and the tricyclic antidepressants with apparently similar dramatic results. ‘The patients became generally more lively,’ wrote Roland Kuhn of the effects of imipramine on his patients in the Munsterlingen Clinic in Switzerland noting how they ‘now jumped out of bed in the morning to take part in the general life of the hospital and interested themselves again in their family affairs’.‘two or three patients with schizophrenia became symptom-free. Now I had never seen that happen before. I thought it was a fluke – something that would never happen again, but anyhow there they were. At the end of four or five weeks there were several more whose hallucinations, delusions and thought disorders seemed to have disappeared.’
