Despite the debates that exist regarding the move to psychiatric medication as the dominant treatment, its development has been a major factor in service use.
Psychopharmacology allowed for a very different system of practices to be introduced that previously would not have been possible.
The discovery that drug therapy could be useful in treating mental health disorders was not a result of research directly focused on mental health. It occurred through an accidental finding that drugs used as anti-histamines could have a sedating effect on people experiencing psychosis. This came about after a French naval surgeon, Henri Laborit, had been experimenting with different forms of anaesthesia with a focus on treating patients in shock (Le Fanu, 1999). His working hypothesis held that a pre- shock trauma may result in the release from red blood cells of chemicals known as histamines. If he could identify a workable anti-histamine (drugs now well known in the treatment of allergies), post-trauma shock could potentially be reduced. With this aim, he administered patients with anti-histamines, which he noticed had a sedating, almost euphoria-inducing effect. With an idea that these kinds of drugs may have a similar outcome in psychiatric patients, he invited the French pharmaceutical company Rhone-Polenc to work with the drug to reduce its anti-histaminic nature, and increase its sedative nature (Jones, 1993).
In 1950 Rhone-Polenc initiated a considerable research programme to investigate the potential of this class of drug, known as phenothiazines, with one of the leading chemists observing many of the same sedative effects in rats, using one phenothiazine, Chlorpromazine. It was not long before these considerable efforts led two French psychiatrists, Jean Delay and Pierre Deniker to be the first to administer
Chlorpromazine to a patient diagnosed schizophrenic.
Their patient was known as Giovanni A, a fifty-seven year old male labourer. He had been admitted to hospital due to a series of events, which included “making improvised speeches in cafes, becoming involved in fights with strangers, and walking around the street with a pot of flowers on his head proclaiming his love of liberty” (Le Fanu, 1999: 68). Within two weeks of first administration of Chlorpromazine, Giovanni was able to hold coherent conversation, and so great was his observed improvement that within three weeks he was discharged. This experiment was soon joined by others in the UK and United States (e.g. Elkes & Elkes, 1954; Lehmann & Hanrahan, 1954). Within a few years other drugs were designed and found to be effective in other forms of mental
distress, such as affective disorders. The road towards drug therapy becoming the dominant treatment for mental disorders was well on the way.
These observations as to the effects on psychotic symptoms of Chlorpromazine fitted in well with the previous alliance struck between the treatment of general and mental health. Ideas around the nature of mental disorders as operating organically could be supported, allowing for further investigation into the nature of the biological basis of disorders. In this way, mainstream psychiatric practice could draw on theories of medical science, which had a greater history and cultural value in being prescriptive systems of thought about treating problems in health. In addition to this, drug therapy could be drawn upon by the debates regarding the most appropriate location for mental health treatment (Rogers & Pilgrim, 2005). If symptoms could be lessened, it made the necessity to house the ‘mentally ill’ under one roof less apparent. Previous symptoms, including active hallucinations, catatonic behaviour, and persecutory delusions, amongst others, were suddenly far less overt. According to these knowledge practices, institutional care had been necessary to manage the symptoms of these neurological abnormalities, as very close observation and a controlled environment was required. However, when medication was found to be effective in reducing symptoms, re- integration into society was argued to be possible (Rogers & Pilgrim, 2005).
These moves were premised on the idea that mental disorders were, in some form, operational in neurological terms. This activity could be impacted upon by the effects of the new drugs, and illnesses could be controlled (it soon became apparent that symptoms were lessened rather than cured by the drugs (Jones, 1993)). Critiques of this approach though were quick to highlight the continued lack of aetiological evidence to support biological claims as to the causality of mental disorders. Drugs had been found to be effective in reducing the overt expression of symptoms, but did not eradicate them completely, as patients still reported occasional symptoms (Le Fanu, 1999). Additionally, aetiological evidence remained absent regarding underlying causality, and as such the whole paradigm shift towards drug therapy was based upon an
accidental finding, rather than any linear progression of hypothesis-based empiricism. In Jones’s (1993) history, these findings became utilised in government policy to further strengthen the case for a shift in emphasis from hospital to community. In this
way, bodies were represented as now controllable by medication, which had previously required the controlled and limited spaces of institutions.
Rogers and Pilgrim (2000) offer an alternative account to the ‘pharmacological revolution’ narrative about the key facilitators of the development of community care. For them the evidence that the introduction of neuroleptic medication was the dominant factor is not clear cut, with some European countries reporting increases in in-patient numbers after widespread use of medication. Rogers and Pilgrim prefer to lay the causal flag at the feet of several different factors, with emphasis placed on economical and ideological issues. Following on from Scull’s (1977) argument that in the early 1950s, the Government sought to radically reduce the financial cost of mental health care, and envisaged a care framework based in communities, rather than asylums, as a cheaper, and thus more desirable, financial option. This was seen to combine with ideologies that segregating people, rather than integrating them, was the way forward; a line of thought combined with the perceived negative views of asylum care that had become widespread in the first half of 20th Century (Rogers and Pilgrim, 2000).
Despite the debate over the role of the advent of medication as the dominant treatment in the move from in-patient to community care, its existence and operation in current psychiatric practice is a central part through which the model of service use operates as a control society, and it is the technological machinery that facilitates control to be maintained. The move from hospital care as the prime location for service provision to community settings was a prime goal of critiques of hospital-based care. Let us now consider some of the key figures in the critical literature, prior to moving into the area of ‘anti-psychiatry’ that they came to embody, and its role in the development of the area of ‘critical psychiatry’ that now operates.