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Tuesday, 14 July 2015

Medicating History

The history of the discovery of neuroleptic drugs for psychosis is often (more often than not?) used for professional-political ends. I recently read Jeffrey Lieberman's book on the history of psychiatry, in which he provides a description of the first psychiatric use of chlorpromazine. If you take it at face value you get the impression that the new drug was immediately impressive because of its dramatic impact on the symptoms of psychosis per se. Here's Lieberman's description (with some underlining of parts I found particularly striking):
On January 19, 1952, chlorpromazine was administered to Jacques L., a highly agitated twenty four- year-old psychotic prone to violence. Following the drug’s intravenous administration, Jacques rapidly settled down and became calm. After three steady weeks on chlorpromazine, Jacques carried out all his normal activities. He even played an entire game of bridge. He responded so well, in fact, that his flabbergasted physicians discharged him from the hospital. It was nothing short of miraculous: A drug had seemingly wiped away the psychotic symptoms of an unmanageable patient and enabled him to leave the hospital and return to the community. (p.164)
Compare that to a 2007 piece by Thomas Ban, which is sufficiently similar that it could have provided the model for Lieberman's description, but for a few subtle differences (again with extra underlining):
Jacques Lh., a 24-year-old severely agitated psychotic (manic) male was the first psychiatric patient to receive CPZ; he was administered 50 mg of the drug, intravenously, at 10 am, on January 19, 1952. The calming effect of CPZ was immediate but since it lasted only a few hours several  treatments were required before the patient’s agitation was controlled. Repeated administration of the drug caused venous irritation and perivenous infiltration. Hence, on several occasions barbiturates and electroshock were substituted for CPZ. Nonetheless, after 20 days of treatment, with a total of 855 mg of CPZ, the patient was ready “to resume normal life.” (p.496)
It's amazing how word choice and subtleties of description can paint radically different pictures of the same set of events. I know nothing else about Jacques L/Lh. What were the nature of his psychotic symptoms? To what extent was he actually manic? Was it psychosis, mania or his agitation that was most affected by the chlorpromazine? Finally, what happened to Jacques, and what did he think of the new medication he had tried?

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