History of the Pharmacological Therapy of Schizophrenia |
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| Translation of the conclusion of the book
"Geschichte der medikamentösen Therapie der Schizophrenie" by Hans Bangen
(Berlin 1992) p. 105-106 Table of Contents More information and update (in German) here
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| 1. Attempts to cure
mental illness by drugs are as old as psychiatry itself. 2. From the beginning there have been advocates and critics of somatic treatments of the mentally ill. The attitude is independent from being a doctor, psychologist, layman or patient.3. Before the discovery of the neuroleptics there were somatic therapies for schizophrenia which were considered as quite successful. Most important were cardiazol-coma-therapy and electro-convulsive-therapy. 4. The discovery of the new somatic treatments was independent from research in psychopathology and aetiology. The question if the schizophrenic psychosis is acute or chronic was more important than the division into different forms. 5. A definitive appraisal of the effectiveness of psychiatric treatments is historically not possible. Only through the introduction of double-blind-studies and standardized observation of the course in the past years can we make valid and reproducible judgements. The spontaneous course of schizophrenic psychoses in an always changing environment is still a problem for the research. 6. The question of the causality of psychopharmacological treatment is often discussed. Because of the acceptance of a somehow positive effect of neuroleptics this discussion is often only academic. 7. Most of the advocates of somatic therapies point out the importance of supporting psychotherapy and social meassures. Psychoactive drugs are accepted as useful by most psychologists. 8. In neuroleptics studies there are very few references to healthy probands and the subjective feelings of patients. 9. One of the most important implications of neuroleptics on psychiatry was the use in ambulant care. This aspect which was pivotal for the acceptance of psychiatry in general medicine is very seldom mentioned in literature. 10. For no other group of drugs were side effects as important as for the neuroleptics. This concerns the risk/effectiveness relation and the research in aetiology. 11. Until the beginning of the sixties chlorpromazine was used as a drug for almost every psychiatric syndrome. The introduction of antidepressants and benzodiazepines led to the split of the indications endogenous depression and neurosis. 12. Neuroleptic-therapy is the longest used and widest spread therapy for the somatic treatment of schizophrenia. However it is remarkable that specific drugs are only used intensively for a couple of years and then they are replaced by new or rediscovered drugs. A return to the "drastic therapies" seems impossible. Also really new therapies are not in sight. |
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| update 2004: Since the publishing of "History of the pharmacolocigal therapy of schizophrenia" there was no big breakthrough in schizophrenia research. Although the nineties have been hailed as the decade of the brain and the human genome project has been completed, psychiatry is still faced with the old problem to treat unknown diseases with inexplicable therapies. Also striking is the discrepancy between hard scientific facts and postulated knowledge about schizophrenia (a chemical imbalance which can be healed by antipsychotics). Here we have to ask if this is a necessary self-delusion to avoid a nihilistic stance which would not help the patient. Since the antipsychiatry movement has not offered a comprehensive, workeable alternative to the medical/ psychiatric model one can say that as long as we do not gain anything by abandon this conviction we better stay with it. In view of the fact that 2000 years have passed from the Golden age of the 5th century BC and the discovery of blood circulation the question is justified if it needs some more centuries before man can unterstand mental disorder. |
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