Modern psychiatry has gone through three stages, suggests Barber: the "asylum psychiatry" of the Victorians, with its confinement and involuntary lobotomies, gave way to "community psychiatry" after the invention of the first antipsychotic drug, Thorazine. Now, after an explosion in brain imaging, and the discovery of drugs such as Valium and Prozac that seem to be able to help more and more of the population, the age of "corporate psychiatry" is upon us.
Besides being a great summary of the history of psychiatry, Barber points out some of the limitations of our age of brain scans and psychoactive drugs advertised on prime-time TV.
To this day, no one knows exactly how psychoactive drugs work. The etiology of depression remains an enduring scientific mystery, with entirely new ways of understanding the disease—or diseases, since what we think of as “depression” now is probably dozens of discrete disease entities—constantly emerging. Indeed, the basic tenet of biological psychiatry, that depression is a result of a deficit in serotonin, has proven to be one that was too eagerly embraced. When this “monoamine” theory of depression emerged in the 1960s, it gave the biologically minded practitioners of psychiatry what they had long been craving—a clean, decisive scientific theory to help bring the field in line with the rest of medicine. For patients, too, the serotonin hypothesis was enormously appealing. It not only provided the soothing clarity of a physical explanation for their maladies, it absolved them of responsibility for their illness, and to some degree, their behavior. Because, after all, who’s responsible for a chemical imbalance?Will there be a new age of psychiatry? I wonder if our increasing knowledge of the brain, and our progress in designing and refining new psychiatric drugs, will only take us so far. So many psychiatric problems may be, in part, a "problem in living" rather than a problem in chemistry.
