Book Review

The Psychopharmacologists: Interviews by Dr. David Healy

N Engl J Med 1997; 337:135-136July 10, 1997

Article

The Psychopharmacologists: Interviews by Dr. David Healy
By David Healy. 633 pp. New York, Chapman and Hall, 1997. $82.95. ISBN: 1-86036-008-4

The Psychopharmacologists, a series of interviews by David Healy, is at once a fascinating and a disturbing book. Dr. Healy attempts to capture the birth pangs and promise of psychopharmacology in a series of interviews with major figures involved in the development of modern psychiatric drugs. The era began with the discovery of chlorpromazine, introducing a paradigm shift that saw popular culture move from psychological explanations of behavior to biologic ones. Dr. Healy has attempted to write a history of this shift through interviews with people who were directly involved. His choices are slanted a bit toward European investigators and industrial investigators related to Ciba–Geigy. For example, in considering the role of industry, how can one leave out Paul Janssen, the discoverer of haloperidol? Nonetheless, the picture that emerges is relatively complete and illustrates the disturbing themes that must concern us today. How much do the current diagnostic categories simply reflect the marketing goals of large drug firms? How can a simplistic view of behavior related to one or two transmitter systems be reconciled with the complex and subtle actions of the central nervous system? What is the relation between neuroscience and clinical psychopharmacology, and what should it be? The dichotomy between the empirical clinical work and the rational theory based on investigations of neuroscience illustrates an area of current conflict that will remain until this gap can be bridged by better neuroscientific data.

A major problem with such a book is that it attempts to give a history of an era through an unrepresentative sample of those who made that history. As Hans Hippius states in his chapter, individual recollection leads to the Mark Twain effect. As stated by Twain, “The older I get, the more vivid is my recollection of things that never happened.” For that reason, I can't recommend this book as accurate history. Dr. Healy hoped to show how important personalities are in the work of science, and as he states in the preface, this failed to come through adequately — in part, I feel, because people are still fighting for their place in history and are cautious and often a little self-serving in their answers. As I see it, science in general and psychopharmacology in particular grow by a series of small, discrete contributions, much like the building of a coral reef through the accumulation of small grains of sand. Occasionally, a dominant figure may add several grains, but most of us are lucky to add one, and given the drive and strength of ego necessary to get ahead in science we tend to overvalue the role of our grain. History is best written after the fact by outside observers.

The personal nature of a book composed of interviews makes up for the historical bias, through fascinating portraits of the various personalities and their views of events. It is also striking that a book that was undertaken to document the history of an era says so much about the future of a field. We get a clear picture that systems approaches must become more important and that we are almost certainly not dealing with distinct disease categories in depression or schizophrenia. The case for complex models comes through again and again. All in all, this book is an enjoyable read for anyone interested in how drugs have come to dominate our discussions of behavior and in the people involved in this transformation.

Fritz A. Henn, Ph.D., M.D.
Central Institute of Mental Health, Mannheim 68072, Germany