Mind and Matter

Advertisement for Thorazine from 1972. (Alan J. Klawans Papers/CHF Collections/Gregory Tobias)

Advertisement for Thorazine from 1972. (Alan J. Klawans Papers/CHF Collections/Gregory Tobias)

In the early 1950s French physician Henri Laborit experienced a moment of serendipity that would fundamentally alter the landscape of psychiatry and mental illness.

Laborit, a military surgeon, was experimenting with a new drug named chlorpromazine in the hope of discovering a more effective anesthetic. While the drug did not cause his patients to lose consciousness, it did induce a remarkable calmness. Laborit immediately notified his psychiatric colleagues of the drug’s potential and supplied them with samples.

As chlorpromazine made its way from France to the rest of the world between late 1952 and 1954, medical journals overflowed with news of what some joyously christened the “chemical lobotomy.” Early researchers testified to the drug’s transformation of psychiatric wards, relating tales of unmanageable patients destined for the isolation of state asylums or the “icepick” of lobotomy turning overnight into “ideal patients.” Previous biomedical treatments for mental illness, such as insulin coma therapy and electroconvulsive treatment, were difficult to administer and produced mixed results. The new psychotropic medication promised ease of treatment and seemed to reconnect psychiatry with mainstream medicine.

The drug appeared to have nearly unlimited psychiatric potential. Philadelphia’s N. William Winkelman, the first American to publish research on chlorpromazine, wrote that the “drug is especially remarkable in that it can reduce severe anxiety, diminish phobias and obsessions, reverse or modify a paranoid psychosis, quiet manic or extremely agitated patients, and change the hostile, agitated, senile patient into a quiet, easily managed patient.” Some patients also embraced the drug; one particularly anxious woman recalled the newfound feeling of serenity being “like a chairman taking control of a meeting where everybody previously had been shouting at once.”

By the late 1960s chlorpromazine, under the trade names of Largactil and Thorazine, had been prescribed to nearly 50 million patients worldwide. Doctors credited it with altering the psychiatric landscape and emptying asylums around the world. Undoubtedly it allowed many patients to receive care in the community rather than behind the locked doors of psychiatric hospitals, pivotal to reducing the stigma of mental illness. The drug’s success sparked a frenzied search for other chemical compounds capable of altering brain chemistry in such dramatic ways and gave birth to an entirely new field of scientific endeavor—psychopharmacology. To this day chemical treatment dominates all others in psychiatry.

While chlorpromazine’s popularity was central to shifting how doctors approach mental illness, some argued that it signaled an end to treating the whole of the person in favor of treating only the brain. Rather than spending long sessions talking with patients and attempting to resolve their underlying problems, many psychiatrists took to rapidly prescribing pills in an attempt to maximize the number of appointments they could get through in a day. For these critics, many of them practitioners themselves, the art of psychiatry was being replaced with an uncertain science. Others, although more accepting of the drug’s potential, were troubled by the side effects, including shakiness, blurred vision, and involuntary facial movements. Finally, and significantly, no one could determine exactly how the drug worked.

Sixty years after the drug’s introduction many of these concerns remain. Chlorpromazine is still prescribed to many patients with schizophrenia, but it’s now just one among whole families of psychopharmaceuticals developed in its wake. Like chlorpromazine, these newer drugs have been dogged by questions surrounding side effects and concerns over spiraling costs, effectiveness, and overprescription.

These drugs, such as Prozac and Ritalin, have stimulated a number of theories regarding the biochemistry behind mental illness—usually focusing on imbalances of such neurotransmitters as dopamine, serotonin, and norepinephrine. So far, though, no one has arrived at any clear and universally accepted explanation of neurochemistry’s relation to mental illness. Although most scientists and physicians agree that neurochemicals play an important part in regulating a person’s mood and cognitive processes, the “chemical imbalance” theory of mental illness is increasingly being criticized as too simplistic. In other words, a person’s psychological and emotional pain cannot be explained solely on the basis of the surplus or deficit of a few neurotransmitters. Regardless of this and other related debates the discovery of chlorpromazine, more so than any other event in the postwar period, has fundamentally altered the way society thinks about—and treats—mental illness.