A Triad of Treatments; A Changing Zeitgeist?
By Barry Blackwell M.D.
My career has been intimately connected to the success of psychopharmacology early in the 20th Century until its gradual demise, beginning around 1980, continuing to the present.
I completed my education as a psychiatrist at Cambridge University, Guy’s Hospital and the Maudsley (London Institute of Psychiatry) in 1967, migrated to America the following year, worked briefly in industry and became friends and was mentored by Frank Ayd. Together we edited our book, Discoveries in Biological Psychiatry, published in 1970, which included the first-person accounts by all the pioneers who discovered the early drugs for mental illness.
I returned to academia, chaired two Departments of Psychiatry and retired from clinical practice in 1994.
I began a second “pro bono” career as an editor and historian in 2007 when Tom Ban invited me to become a deputy editor for the 10-volume Oral History of Psychopharmacology he created in honor of the 50th Anniversary of the American College of Neuropsychopharmacology (ACNP). I edited three volumes and wrote many of the “dramatis personae” (brief biographies), giving me a unique “bird’s eye” appreciation for the successful early years of our discipline.
In 2013 Tom founded the International Network for the History of Neuropsychopharmacology (INHN) and its website. I became Editor of Biographies, Controversies and Book Reviews.
In 2020 I decided I had enough material for a book and put together Treating the Brain; An Odyssey. Its title derived from realizing the stark contrast between two distinct time periods in the history of our field. An innovative Pioneer Era (1949-1980) and a Modern Era (1981-Present). In the book’s Prologue I compare and contrast these two periods.
The Pioneer Period, “when all the first drugs for psychiatric disorders were discovered, leading to the emptying of asylums and initiating care in the community, creating an optimistic, proud and highly productive profession.” This contrasts with the Modern Era, “characterized by dwindling innovation, corporate corruption in the pharmaceutical industry, professional and academic complicity in a cultural climate of avarice, political malfeasance, ethical lassitude and research gridlock.”
This malaise and passivity and failure to push back evolved in part from the manner in which Big Pharma had used its lucre to suborn, seduce and silence the entire mental health field including its practitioners, journals, medical education, research, Congress, professional organizations, medical schools and advocacy organizations. While “conflicts of interest” were sometimes sought and declared they were seldom pursued or punished.
To assist the reader of this book review and understand its implications there are two references that provide insight:
1.Blackwell B. Corporate Corruption in the Pharmaceutical Industry (Revised). inhn.org.controversies. March 16, 2017.
2. Shorter E. The Rise and Fall of the age of Psychopharmacology. Oxford University Press,2021.
In the last several months I have written three book reviews for the INHN website.
- The Body Keeps the Score by Bessel van der Kolk
- The Relaxation Revolution by Herbert Benson and William Proctor
- Brain Energy by Christopher M. Palmer
This “Triad” is remarkable and essential reading for two reasons:
- All three authors are alumni of Harvard Medical School
- Each describes a novel treatment that can generate optimism and hope that may dissipate the pessimism and gloom that has overtaken our profession and its treatment of mental disorders.
The Origin and Significance of the Triad
In the first of these books, published in 2010, Herbert Benson tells the story of how, in the 1970s, he obtained substantial Foundation support for his early work on Transcendental Meditation leading to an earlier book, The Resolution Response, published in 1975. This had created tensions with his mentors and fellow faculty at Harvard. The medical school’s scientific model was almost “exclusively reductionistic and mandated that a real cure for serious illness is possible only through drugs, surgery or some physical procedure.“
This formulation clearly excludes the treatment goals and findings of all three books.
The Relaxation Response is “characterized by extremely complex mind body interactions.”
In The Body Keeps the Score van der Kolk notes, “Before the advent of the pharmacological revolution it was widely understood that brain activity depends on both chemical and electrical signals. The subsequent dominance of pharmacology almost obliterated interest in the electrophysiology of the brain for several decades.”
In Brain Energy Palmer notes that when his early belief in neurotransmitters, hormones and stress failed he realized the simple truth, “no one knows what causes mental illness.” His switch to studying mitochondria and brain energy led to a novel scientific theory that came into existence with his book.
So, all three scientists dealt with research outside the Harvard framework of the need for reductionistic research. Benson was challenged by his mentor to obtain scientific funding leading to publication of his findings in an established traditional journal which he accomplished.
There seems little doubt that the research philosophy at Harvard failed to discourage all three authors who each found funding and research facilities off campus while they remained respectful of the need to invariably involve their more traditional colleagues in implementing their discoveries.
The Contemporary Question: An Intimidating Task
Widespread implementation of these new treatments advocated in the three books may not be easy to accomplish despite significant concern about the status quo.
Medical schools, Professional Organizations and State or National credentialling boards will be challenged to revise and update their criteria.
Practicing physicians, insurance companies and health care corporations (allegedly not for profit), will need to establish criteria and costs for novel procedures, some difficult to measure or quantify.
March 9, 2023