[H]

So you see that, you're saying - the psychiatric industry are pursuing drugs too much, like way too much, too much everywhere? I don't know, just seems like medical malpractice to prescribe drugs the doctor knows likely won't work - or is that the point, too many psychiatrists genuinely are too all in with prescription drugs to treat psychological maladies? I guess that falls under "mistake", but even errors are malpractice if the doctor is "supposed to know better". You're saying they don't know better?

That's a difficult question.  Do they know better?  It's hard to say exactly what they know.

To not get too epistemological, even the "hardest" of "hard science" does not assert itself as "certain."  So, I'm not sure what they answer is, honestly.  It is my thought that biology and drugs are "too often" a go-to.  That doesn't mean none of them work, or that none of them are helpful.  To proscribe something one knows would not work would indeed seem like malpractice.  But what about the case where professional training informs your decision that in the case of X, give Y?  In this sense, you would likely surmise that Y will help with X, why would you question it?

It's rather complicated, honestly, because what we would want is hard, empirical data that tells us the exact quantitative results.  But we don't really have that, and we might not be able to get that.

Here is another passage from the book, as far as I am in:

Meanwhile Bleuler’s new term for dementia praecox, schizophrenia, spread, its appeal heightened because it seemed to convey a less desperate, fatalistic course than dementia praecox had done. By the 1910s, American alienists were beginning to use the new word, and by the 1920s, the term dementia praecox was on its way to becoming archaic.

What largely failed to travel to the United States, though, was Bleuler’s insistence that schizophrenia was best understood through a double lens: both neurobiologically and psychoanalytically. Instead, views on the disorder fractured. On the one side were those who assumed that schizophrenia was best understood in strictly biological terms, even as they disagreed over what those terms should be. On the other side were clinicians who were more interested in the degree to which the disorder resulted from bad experiences, bad habits, and bad upbringing. As early as 1914, the Harvard pathologist Elmer Southard referred to these two camps as the “brain spot men” and the “mind twist men.”

[H]

Another quote from the book, which this historical point likely also connects with a different point about how we came to, now, proscribe anphatamines to people now on large scales:

Then in 1955, meprobamate arrived on the scene (see Chapter 3), sold under the brand names Miltown and Equanil and known to the public as a “minor tranquilizer.” Unlike Benzedrine and Dexedrine, it did not treat depression or fatigue. It treated anxiety, now understood to be the problem underlying virtually every neurotic complaint.

That was all well and good, but many family doctors pointed out that their allegedly anxious patients frequently suffered from symptoms of depression as well. They worried incessantly but also felt despondent and had no energy. Some drug companies, responding to this market opportunity, therefore began offering “combination” drugs to doctors. In 1950, before meprobamate came on the market, Smith, Kline & French had already begun selling a drug that combined the lift of an amphetamine (Dexedrine) with the sedative properties of a barbiturate (amylobarbitone). Called Dexamyl, it targeted (in the words of one ad) “the depressed and anxiety-ridden housewife who is surrounded by the monotonous routine of daily problems, disappointments and responsibilities.” Within a few years, the drug became a staple of family medicine.

A few years later, after Carter-Wallace realized it had a best seller on its hands with Miltown, it developed a combination drug of its own that it called Deprol, which combined the active ingredient of Miltown (meprobamate) with a muscle relaxant (benactyzine). Like Dexamyl, it targeted the depressed and anxiety-ridden housewife.

It is important to realize that none of these widely dispensed combination drugs were prescribed to cure a specific disease called depression—they were prescribed to treat a symptom of neurosis. Depression was still generally assumed, by analysts and family doctors alike, to be a mask that hid something deeper. As one Philadelphia physician, writing about Dexamyl, admitted: “Of course, the ideal treatment would be to discover the causes of the patient’s emotional turmoil—the nagging wife or husband; the tyrannical parent; the unsuitable job; the financial burden—and remove it. Unfortunately, this is impracticable. Although dragging a secret worry out in the open—‘getting it off one’s chest’—is often in itself of benefit, it is not always enough.” When it was not practical to try to dig deeper, the pills could help.

[H]

Finished the book.  Pretty good and interesting.  It really is not an anti-pharma book at all.  I think the end sums it up fairly:

The 1980s bilogical revolutionaries were not the first group in the history of psychiatry to make audacious promises on which they could not deliver. The nineteenth-century mental hospital has failed as a therapeutic institution? All right, forget about therapy, and focus on learning what you can from the brains of your patients after they die. The anatomical research program has been a disappointment? No problem: focus instead on collecting all possible relevant facts and pursuing any and all somatic therapies, because times are desperate, and one can never have too much data. All those diverse facts have turned out not to add up to very much? The Wild West world of shock and surgical treatments has likely caused more harm than good? That’s okay: the postwar world is in crisis and needs the insights provided by psychoanalysis and social science. Things haven’t worked out with the Freudians’ expansive social agenda? Psychiatry is on the brink of losing all credibility as a profession? Not to worry: let the biologists take over!

The bold 1980s venture to bring about a “biological revolution” has now run into the sand as well. Far from flocking to psychiatry, many pharmaceutical companies have recently been fleeing it, as the prospects for new and potentially lucrative psychiatric drugs have dimmed. The manual on which the profession has rested so much of its biological authority has come under sharp attack, not just by cranky outsiders but by informed insiders committed to the mission. Too many of the severely mentally ill remain shamefully underserved in prisons and elsewhere. Mental illness still is stigmatized in ways that other kinds of illness are not.1 Racial bias and other inequities persist. And of course, firm understandings of psychiatry’s illnesses, of their underlying biology, continue to elude the field.

So where should the profession go from here? Can today’s biological psychiatry resist the temptation to lurch into yet another chapter of overpromising zealotry that is likely to end in tears? Can it appreciate that trashing all rivals generally means that everyone becomes more ignorant, not smarter? Can it rein in its professional insecurities and see that there is nothing to be gained from premature declarations of victory? Can it acknowledge and firmly turn away from its ethical lapses—and especially the willingness of so many of its practitioners in recent decades to follow the money instead of the suffering?

[TaoHorror]

Interesting stuff, Honorable! Thanks for sharing and giving me something to chew over. I won't respond, I simply don't know enough, but this is helpful