Healy and Goliath ================= * Shane Neilson * © 2004 Canadian Medical Association or its licensors **The creation of psychopharmacology** David Healy Cambridge, Mass: Harvard University Press; 2002 $42.50 pp. 480 ISBN 0-674-00619-4 ![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/170/4/501/F1.medium.gif) [Figure1](http://www.cmaj.ca/content/170/4/501/F1) Figure. ![Figure2](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/170/4/501/F2.medium.gif) [Figure2](http://www.cmaj.ca/content/170/4/501/F2) Figure. Photo by: Art Explosion I admire David Healy, but for a potentially book-review-distorting reason. Such is the case with the infamous: their press often prejudices the public reception of any honest effort they might make, including the writing of a history book. To summarize recent history: Healy, a leading historian of psychiatry, is better known as the fellow the University of Toronto didn't quite want to have around. According to press accounts of “*l'affaire* Healy,” he was eagerly courted for the position of clinical director of the mood and anxiety program with the Centre for Addiction and Mental Health, only to be unceremoniously dumped after he delivered a lecture that was scientifically unflattering to a pharmaceutical company that happened to be a University donor. This matter became litigious and was settled in secrecy (along with a good deal of speculation). So I admire Healy for his iconoclasm *in addition* to his scholarship. The issue precipitating the brouhaha was Healy's lifelong bugbear: his unease with the ascendancy of modern pharmaceuticals and market-driven prescribing practices. By voicing these concerns in public he became embroiled in the foremost medical research issue of our age: broadly, the suspect role of the drug industry in funding medical research and, more specifically, the role of that industry in institutions of higher learning. This background is relevant to discussion of a book that documents the advent and proliferation of drug therapy for mental illness. In *The Creation of Psychopharmacology*, Healy's inferences about the widespread use of drugs to treat insanity in human history may, on the basis of his own personal history, be charitably thought to possess bias. For example, Healy's own estimation of his book's importance is no less than revolutionary, and the introduction has a David-versus-Goliath tone. The following is a mere sampling of polemic from only eight pages of prose: There is in fact a growing body of evidence that indicates a success rate and quota of therapeutic rationality per physician fifty years ago that are higher than those that characterize many current practices ... Neither historians nor psychiatrists have confronted these issues. One of the messages of this book is that we are becoming less rather than more rational. Far from our problems yielding to science, science has become something of a problem. Far from history coming under control, things may in fact be spinning further out of control. In this new world, psychiatric concepts have become products in a marketplace in a way that leaves the rise and fall of psychiatric theories subject to the vagaries of industrial regulation and patenting. With the debate so framed, one wonders about Healy's motives. Is this a self-aggrandizing exercise in sensationalism, or the product of an honest inquiry? Healy further undermines his objectivity with a distressing habit of personal evangelism: in the references for the first chapter he cites himself 10 times out of a total of 50; in the second chapter, 10 out of 82 references are self-citations. This practice continues throughout the book, such that, out of a total of 938 entries, 149 references, or 16%, are to his own work. That being said, one's verdict on a book should not be based merely on the author's psychology. I turn, then, to Healy's argument and its development. A history text concerned with drug therapies for mental illness could not begin without a brief overview of the philosophical and theological underpinnings of psychiatry, along with the major trends within the field. Healy's first two chapters accomplish this commendably; of particular interest is his discussion of the ramifications of laws by which previously available psychoactive substances could henceforth be obtained only by prescription. Unfortunately, the brevity of these two contextual chapters is not preserved through the remainder of the book. In fact, the main problem with *The Creation of Psychopharmacology* is that it attempts too much. Instead of sticking to the history of psychopharmacology, Healy is compelled to provide the greater context of the history of pharmacology, the randomized trial, the antipsychiatry movement and psychiatry in general. In tackling several subjects simultaneously and at considerable length, he loses focus. This is not to say that Healy's main theses are lost in detail, for his book is as accessible as it is informative. He convincingly shows that society's conception of mental illness has changed along with the evolving role of drugs to treat those illnesses. He raises important questions about the efforts of pharmaceutical companies to “therapize” what have historically been variants of normal psychological states. He documents the many conundrums, fiascoes and contradictions of the marketing, use and abuse of pharmaceuticals. In fact, Healy's major objection to the market-driven treatment of mental illness is supported so well that I expect this book to become a seminal critique of the drug industry. It is to Healy's credit that he makes this critique a human story: amidst the PR machinations of corporations exists a sad, hubristic tale of egos warring for the supremacy of pet postulates and discoveries. Healy makes his narrative especially interesting when he recounts the actions of Nobel-seeking scientists who sabotage each other's reputations in the overweening quest for the prize. Healy has so revolutionized my own outlook on the fraught social context of mental illness (and I imagine that my perspective was typical of recent graduates of Canadian medical schools) that I'd argue he should be offered a dual appointment in the faculties of history and of medicine. I wish I had been exposed to a professor who might have railed as follows, One of the components of the trick the living play on the dead that we call writing history is to paint a picture of progress. Nowhere in history is this seen more clearly than in the history of medicine, where former ages are portrayed as dark ages. Bracing stuff for an undergraduate, no? Particularly so is the aftermath of this statement, wherein Healy defends the efficacies of such derided therapies as psychosurgery and the induction of insulin coma. Such dogged unfashionability is entertaining in itself, but more often than not Healy lays out common preconceptions in order to completely destroy them. *The Creation of Psychopharmacology* can be thought of as one gigantic, erudite disputation of the most familiar beliefs in psychiatry today. On this point Healy sounds a sinister and cautionary note: the official history of psychiatry is amnesiac and revisionist, in which the “new” is the “only,” and the definitions of mental illness are written on the basis of treatments and not on any intrinsic idea of disease. He derides modern psychiatry's method of conceiving of mental disorders in terms of therapies, implying that the advent of a new therapy brings a new condition that must be treated. As the first comprehensive history of drug treatment of mental illness in the Western world, this work is a landmark volume with appeal beyond the narrow demographic of mental health practitioners. Healy has convincingly indicted the often bizarre and distressingly commercial logic used to support the treatment of the mentally ill. Yet, amid the immense scholarship of this work, I imagine that a very personal score has been settled here. After all, what better way to have the last word than to write the book on the subject? **Shane Neilson** Family Physician Guelph, Ont.