For most of the history of humanity, there was nothing at all one could swallow when
one was mentally ill. The full force of one’s sickness had to run unchecked.
Then, in 1950, Paul Charpentier, a French chemist working at Laboratoires Rhône-Poulenc,
succeeded in synthesising a drug called 4560RP, later renamed chlorpromazine. When rats were
injected with it, placed in a crowded cage and convulsed with electric shocks, they showed
none of the expected alarm and frenzy, settling instead into a serene and indifferent mood.
When given to humans, the drug had a similar calming effect: American soldiers in the Korean
war were able to walk into the battlefield with total fearlessness. In hospitals, psychotic
patients who were placed on the drug became sociable, unaggressive and ready to rejoin
ordinary life. The world’s first antipsychotic drug was born. It would over the coming decades
be followed by dozens more seemingly miraculous medicines, all of them playing - in ways that
their creators did not and still do not entirely understand - with the brain’s receptors
for dopamine, the hormone held to be responsible for excessive excitement and fear. Alongside
these antipsychotics, there emerged a family of antidepressants, in particular those known
as SSRIs, that could increase the brain’s levels of serotonin, the neurotransmitter
and hormone associated with uplift, motivation and positive moods. The drugs were baptised
with names that put language to ever more daunting uses: fluoxetine, citalopram, paroxetine,
escitalopram, risperidone, quetiapine, aripiprazole. Whatever the particularities of each example,
modern psychiatry ended up operating with two essential instruments: pills that could
calm us down (reducing terror, paranoia, mania, disinhibition, insomnia and aggression) and
pills that could lift us up (alleviating despair, moroseness and loss of meaning).
Thanks to these medicines, occupancy rates of psychiatric hospitals plummeted, decreasing
by some 80% in developed countries between 1955 and 1990. Illnesses that had been a near-death
sentence a generation before could now be managed by swallowing one or two pills a day.
It looked as if our unruly minds had finally been tamed.
But the answer was not complete. All these medicines turned out to have serious physical
side effects (being intermittently responsible for dramatic weight gain, diabetes, kidney
malfunction and blood clots). Yet the charge against them at a psychological level was
more fundamental: that they did not and could never - on the basis of their approach - get
to grips with the true causes of mental illness. At best, they could control appalling symptoms
while being unable to grapple with what, in the individual past, had led to them in the
first place.
To be fair to psychiatry, even if this were true, it is no mean feat to be able to offer
a person a measure of control over their mental symptoms, given the horrors that these can
entail. Those of us who have known mental illness from close up would - at the height
of our suffering - generally choose to be physically tortured rather than endure yet
more of the abominations our minds can inflict. There are varieties of mental unwellness in
which we are taken over by anxiety and foreboding - and paralysed by a sense that every minute
is carrying us closer to an immense and unnameable catastrophe. We can no longer eat or speak,
we may just have to lie in a ball crying, scratching ourselves and waiting for the axe
to fall. There are states in which we wake up every morning with a conviction that we
need to take an overdose in order to put to an end to the turmoil in our minds. There
can be voices inside us that do not for one moment cease telling us that we are guilty,
shameful and abhorrent beings. We may live in terror that we are about to lose control
or might already have done so. Our imaginations can be haunted by images of stabbing a child
or tearing off our own fingernails. It can feel as if there is a monster inside us urging
us to do appalling deeds and filling our consciousness with lacerating persecutory thoughts. We may
feel our inner coherence dissolving and giving way to a maelstrom of aggression and paranoia.
We may be so mysteriously sad that no pleasantry or act of kindness can distract us and all
we wish to do is stare mutely out of the window and hope to be gone soon.
With the right pills to hand however, some of these nightmares can end. We may know our
anxiety is still there but we are granted some distance from it, we are able to stare
at it as if it were an enraged tiger in a zoo on the other side of a thick pane of glass.
We may not lose sight of our despair and self-loathing but we can acquire an attitude of detachment
in relation to it; it doesn’t matter quite so much that we are entirely awful and should
be put down. We can park the idea for a morning in order to do some work or clean the house.
We can put off thoughts of suicide until tomorrow. We don’t need to have a complete reckoning
with our sadistic ideas at every moment. The crushing sadness can partially lift and we
might have the energy for a conversation with a friend or a walk in the park. Only someone
who hadn’t endured vicious mental suffering would dare to casually dismiss such psychiatric
interventions as a plaster over a wound.
Nevertheless, most mental illness has a psychological history - and its hold on us will for the
most part only properly weaken the more episodes of this painful history we can start to feel
and make sense of. Pills may be able to change the background atmosphere of our minds, but
our thoughts about ourselves need to be challenged and adjusted with conscious instruments if
we are to be able to grow truly well. The genuine resolution of mental disturbance lies
in our ability to think - especially of our early childhoods and the key figures and events
within it.
The unfortunate paradox is that illnesses of the mind generally effect precisely the
instrument that we require in order to interpret our lives. It is our conscious reason that
is both sick and desperately needed in order to do battle with despair and fear; it is
the reason that we need in order to locate persuasive grounds to keep living. This is
where pills may usefully join up with psychotherapy to deliver a coherent solution. We might say
that the supreme role of pills is to hold back panic and sadness just long enough that
we can start to identify why we might want to continue living; they aren’t in themselves
the cure, but they are at points the essential tools that can make therapy, and through it
authentic healing, possible. They promise our minds the rest and safety they require
to harness their own strengths.