Thomas A. Ban
Neuropsychopharmacology in Historical Perspective
Education in the Field in the Post-Neuropsychopharmacology Era
Fifty years CINP
“Fifty Years CINP” is anelaboration of Thomas A. Ban’s November 14, 2005, presentation in Lima, Peru,entitled“History of CINP.”
Fifty Years CINP
Developments which led to neuropsychopharmacology and the CINP began in 1952 with the introduction of chlorpromazine in psychiatry. The therapeutic and commercial success of chlorpromazine generated interest within the pharmaceutical industry in developing drugs with psychiatric indications. By the end of the 1950s there was a rapidly growing number of new psychotropic drugs and the scope of psychopharmacology, a term coined by Macht in 1920, was extended from the study of psychotomimetics and model psychosis to include the study of psychotherapeutic drugs and their effectiveness in mental illness.
Simultaneously with the introduction of the first set of effective drugs in the treatment of mental pathology there was a shift in the understanding of the nature of synaptic transmission from a purely electrical (physical) to a chemically-mediated event; by the end of the 1950s six neurotransmitters had been identified in the central nervous system. Recognition of chemical mediation at the site of the synapse, coupled with the introduction of the spectrophotofluorometer, led to the development of neuropharmacology, the scientific discipline that deals with the detection and identification of structures responsible for the psychotropic effects of centrally acting drugs. Spectrophotofluorometry has provided direct access to the detection of the biochemical changes which might be responsible for their therapeutic effects.
Developments in pharmacotherapy, psychopharmacology and neuropharmacology triggered the development of neuropsychopharmacology, the scientific discipline dedicated to the study of the pathophysiology of mental syndromes with the employment of psychoactive drugs.
Recognition that one of the essential prerequisites of successful neuropsychopharmacological research is a continuous dialogue between clinicians (psychiatrists) and basic scientists (pharmacologists) created a need for the founding of an association which would provide a suitable platform for interaction among the different disciplines of the new field.
To start the dialogue between clinicians and basic scientists an International Symposium on Psychotropic Drugs was hosted by the University of Milan in May 1957. It was chaired by Emilio Trabucchi, professor of pharmacology, and organized by Silvio Garattini, a pharmacologist in the Department of Pharmacology of the university. It was during the Milan Symposium that Wolfgang de Boor, the author of the monograph Pharmacopsychologie und Psychopathologie (1956) and Corneille Radouco-Thomas, a pharmacologist from the University of Geneva, proposed the founding of an “international association” to provide a forum for interaction between clinicians and basic scientists for the study of the rapidly emerging new drugs with psychiatric indications (Garattini and Ghetti 1957).
The formal inauguration of the Collegium Internationale Neuro-Psychopharmacologicum (CINP), a name coined by Radouco-Thomas, took place four months after the Milan Symposium, on September 2, 1957, during the 2nd World Congress of Psychiatry, at a dinner meeting hosted by Ernst Rothlin, held in the buffet of the Zurich railway station. By the end of the dinner Rothlin, a former director of Sandoz, a major Swiss pharmaceutical company at the time, was elected president; W.A. Stoll, treasurer; Corneille Radouco-Thomas and Herman Denber, secretaries; and Pierre Deniker and Philip Bradley, councilors. The 32 invited guests became the founders of CINP.
The primary objective of the Collegium was to organize meetings for its members at least once every twoyears “to consider and discuss matters related to neuropsychopharmacology and through the organization encourage and promote international scientific study, teaching and application of neuropsychopharmacology” (Constitution, Article II).
There was disagreement whether membership should be restricted to those actively involved in the new field or open to all interested in the new drugs. A compromise was reached: it was decided that congresses should alternate between “open” meetings with free attendance for everyone interested in the field and “closed” meetings with attendance restricted to CINP members and their invited guests. The idea was that open meetings with larger audiences would provide a forum to communicate new developments in neuropsychopharmacology, whereas closed meetings would allow interaction among the disciplines and provide feedback from clinicians to basic scientists and vice versa.
The 1st CINP Congress, during Ernst Rothlin’s presidency, was an open meeting in 1958 in Romewith about 500 participants; the 2nd(also during Rothlin’s presidency)was a closed meeting in 1960 in Basel, Switzerland, with about 250participants.It was at the Basel meeting that Arvid Carlsson, a Swedish pharmacologist who was to receive the 2000 Nobel Prize in physiology or medicine, presented his findings on selective changes in brain monoamines, especially catecholamines,brought about by psychotropic drugs, providing the theoretical framework which was to dominate neuropsychopharmacology for more than two decades. It was also at the Basel meeting that Fritz Freyhan, one of the American pioneers of psychopharmacology, called for a “critical examination” of the commonly held belief (atthetime)that there is a linear relationship between the potency of neuroleptic drugs and their therapeutic effects (Bradley, Deniker andRadouco-Thomas 1959; Rothlin 1961).
The 3rd Congress in 1962 in Munichduring Paul Hoch’s presidency was an open meeting;the 4th in 1964 in Birmingham, England, during Hans Hoff’s presidencywas a closed one (Bradley, Flugel and Hoch 1964).The Birmingham meeting was devoted to one topic: The Mode of Action of Psychotropic Drugs and Its Implications for the Pathophysiology of Psychotic Disturbances. The program of the meeting was uniquely structured in that the first day was dedicated to a plenary session in which speakers with different backgrounds, such as H. Eysenck, a psychologist, F. Brucke, a pharmacologist, WW. Schleidt, an ethologist, and H. Selbach, a psychiatrist, introduced the problem from their own point of view; the second and third days were given to discussion in working groups; and the fourth and final day to a second plenary session at which deliberations of the working groups were summarized in reports (Bente and Bradley 1965).
Many of those who attended the Birmingham Congress felt that the format of the meeting was optimal for interaction and should have been adopted at future meetings. This did not happen, however, and by the end of the 1960s ˗ after another open meeting in 1966 in Washington, D.C.,during JeanDelay’spresidency,and another closed one in 1968 in Tarragona, Spain,during the presidency of F.G.Valdecasas– the difference between closed and open meetings began to wither away (Brill et al. 1967;Cerletti andBove 1969).
1968 - 1984
During the 1970s pharmacotherapy with psychotropic drugs became the primary form of treatment in mental illness and CINP congresses were transformed into meetings with less and less emphasis on feedback, and with more and more sessions dedicated to the presentation of new findings in the different areas of research. Thus, the 7th CINP Congress in 1970 in Prague during Heinz Lehmann’s presidency, included symposia on lithium with special attention on the prophylactic treatment of bipolar disorder and on the evaluation of anxiolytic drugs; the 8th in 1972 in Copenhagen, Denmark, during Eric Jacobsen’s presidency, on the pharmacotherapy of sexual disorders and on the long-term effects of psychotropic drugs; the 9th in 1974 in Parisduring the presidency of Hans Hippius, on the effect of neurotropic drugs on cyclic AMP in the brain and on pharmacogenetics; the 10th in 1976 in Quebec City, Canada,during the presidency of Pierre Deniker, on geriatric psychopharmacology and on the interrelationship among neurotransmitter systems; and the 11th in 1978 in Vienna during the presidency of Leo Hollister, on endorphins and narcotic antagonists in the treatment of schizophrenia and on the role of GABAergic mechanisms in the action of benzodiazepines(Banet al. 1973; Boisier, Hippius and Pichot 1975; Deniker, Radouco-Thomas and Villeneuve 1978; Saletu, Bernerand Hollister 1979; Vinar, Votava and Bradley 1971).
By the end of the 1970s CINP congresses had become increasingly dominated by neuropharmacology and driven by technological progress, such as the development of receptor binding assays, which opened the path for the determination of the norepinephrine- and serotonin-blocking potencies of drugs, and the identification of receptor subtypes, which led to the delineation of the receptor profiles of neuroleptics and antidepressants.
By the early 1980s basic research in neuropharmacology was extended from cerebral monoamines to include neuropeptides and prostaglandins. The 12th CINP Congress in 1980 in Goteborg, Sweden, during Arvid Carlsson’s presidency, reflected “the shift from neurotransmitter biochemistry at the synaptic cleft to receptor research”; the 13th CINP Congress in 1982 in Jerusalem during the presidency of Paul Janssen, “documented the effort to understand mental disease in terms of molecular processes”; the 14th CINP Congress in 1984 in Florence, Italy, during the presidency of Paul Kielholz,reinforced the belief that employment of molecular neurobiology “could lead to research that will transcend the existing boundaries of neuropsychopharmacology”; and at the 15th Congress in 1986 in San Juan, Puerto Rico,during the presidency of Ole Rafaelsen, Floyd Bloom in his plenary lecture described a “Brave New World” that would be known in terms of cell function at the molecular level and a galaxy of transmitters and their modifiers “signaling” to each other (Bunney,Costa and Potkin 1986).
1984 - 1994
In contrast to major advances in neuropharmacology, there was little progress made in clinical psychopharmacology after the 1970s. The methodology of clinical investigations with its sensitized rating scales and consensus-based diagnostic end-points had the capability only to detect and demonstrate therapeutic efficacy, but not to translate the differential receptor profiles of drugs into therapeutic profiles relevant to patients and treatment. Replacement of isolated investigator-initiated studies by multi-center, centrally-coordinated clinical investigations with all the data readily accessible to the sponsoring drug company did not help to resolve the problem.
By the late 1980s the gap between basic and clinical research could not be bridged and there was a growing need to translate the findings in basic research to clinicians in order to render them accessible for clinical use. With these changes CINP Congresses were gradually transformed to provide a platform for translating the findings of basicresearch to clinicians and to disseminating the findings generated in multicenter clinical investigations.
The shift of emphasis in the program of CINP Congresses led to a closer collaboration between theCollege andthe pharmaceutical industrywhich became tangible during the presidency of Ole Rafaelsen, a Danish neuropsychopharmacologist, with the presentation of industry-supported Travel Awards to Young Investigators to facilitate their participation in the Congress and with the first president’s reception and dinner, supported by Bristol-Myers-Squibb, at the San Juan (Puerto Rico) Congress in 1986.
The closer collaboration between the College and the pharmaceuticalindustrywas extended to a closer collaboration between the College and national (sister) organizations in neuropsychopharmacology during the presidency of William Bunney, a prominent American neuropsychopharmacologist. It was also during Bunney’s presidency that corporate membership for pharmaceutical companies was implemented and the first corresponding organizations’ luncheon, supported by Hoechst Marion Russell (now Aventis) was held in 1988 at the Munich Congress.
The changes culminated with a past-presidents’ symposia, as well as with a past-presidents’ and meeting-organizers’ luncheon, during the presidency of Alec Coppen, a pioneer British neuropsychopharmacologist.It was also during the presidency of Coppen that the first award for recognizing excellence, the Max Hamilton Prize, was established with the support of Bristol-Myers Squibb and presented in 1990 at the Kyoto (Japan) Congress to Steven Paul, vice president of research of Eli Lilly, an American pharmaceutical company (Yamashita, Toru and Coppen 1990).
The presidencies of Julien Mendlewicz (1990-1992), a prominent Belgian psychiatrist and psychopharmacologist, Giorgio Racagni (1992-1994), a prominent Italian neuropharmacologistand Lewis Judd (1994-1996), a former director of the National Institute of Mental Health of the United States, were years of consolidation with memorable Congresses held in Nice, France (1992), Washington, D.C. (1994) and Melbourne, Australia (1996). It was during the presidency of Judd that the organization of Regional Congresses between the biennial World Congresses was proposed (Coronella and Meltzer 1994; Darcourt and Pranguay 1992; Norman, Burrows and Maguire 1996).
1994 - 2004
To correspond with the changes in the activities of the organization, CINP’s Constitution and By Laws were amended several times from 1986 to 2004, with the last amendment approved in April 2002. A move toward democratization started after the Melbourne Congress during the presidency of Claude de Montigny (1996-1998), a Canadian neuropsychopharmacologist, with the nomination of a slate of two –instead of one – candidates for each of the five offices of the executive and for each of the 10 positions on the council. During the presidency of Helmut Beckmann (1998-2000), a prominent German psychiatrist, CINP became legally incorporated; between the Glasgow Congress in Scotland (1998), presided by de Montigny, and the Brussels Congress in Belgium (2000), presided by Beckmann,CINP became a legal entity registered in Switzerland with domicile in Zurich (Lerer 1998, 2000).
The first president of CINP in the new millennium, and its first elected president, was Eugene Paykel, a prominent British psychiatrist. During his tenure from 2000 to 2002 a regional structure was established with “conveners” responsible for the coordination of activities in the different geographic regions; a Central Office was set up for continuity and the smooth operation of the College. Paykel was succeeded by Herbert Meltzer (2002-2004), an American neuropsychopharmacologist, who was instrumental in complementing the Central Office with a Meeting Organizer Group to channel back to CINP’s treasury the money spent on congress-organizer business companies. The first two CINP Congresses in the new millennium were held in Montreal (2002), and Paris (2004), respectively (Lerer 2002, 2004).
What was to become CINP’s History Committee started as an informal collaboration between Thomas A.Ban, Hanns Hippius and Ole Rafaelsen at the tail end of Rafaelsen’s presidency in 1986 at the biennial Congress in San Juan, Puerto Rico. The objective of the collaboration was to reconstruct the history of CINP from eye-witness records before it was too late.
Rafaelsen died the same year the collaboration began butBan and Hippius continued with the work and from 1986 to 1994 prepared a series of four bookletson the history of CINP (Ban and Hippius 1988, 1892, 1894). The fourth booklet was prepared in collaboration with Oakley Ray, a professor of psychology, who a few years later, during Paykel’s presidency, was to set up CINP’s first Central Office in Nashville, Tennessee (Ban, Ray and Hippius 1996).
Shortly after the fourth booklet was completed a 457-page book entitled“A History of the CINP” was prepared. Itincluded the four booklets under one cover supplemented with some complementary information on the history of the College from the San Juan Congress in 1986 to the Sydney Congress in 1994(Ban and Ray 1996).
By 1996 the History Committee became one of the Constitutional Committees,chaired by Ban. It was also extended to include nine members and was strengthened with the inclusion of David Healy, a critic of therapeutic practices with psychotropic drugs,and Edward Shorter, a social historian with a background in the history of psychiatry and a special interest in psychopharmacology. From 1996 to 2004 the committee published CINP’s International Photo Archives in Neuropsychopharmacology (Ban, Ray and Beckmann 2000); theSelected Writings of Joel Elkes (Ban 2001), one of the CINP-Pfizer pioneers; and a series of four books on The History of Psychopharmacology and the CINP: (1) The Rise of Psychopharmacology and the Story of CINP; (2)The Triumph of Psychopharmacology and the Story of CINP; (3) From Psychopharmacology to Neuropsychopharmacology in the1980s; and (4) Reflections on Twentieth Century Psychopharmacology (Ban, Healy and Shorter 1998, 2000, 2002, 2004).
In 2004 Ronaldo Ucha Udabe, an Argentine psychiatrist, succeeded Ban as chairofCINP’s History Committee. Ucha passed away in early 2006 by the time of CINP’s Chicago Congress (2006) presided by Brian Leonard. During his tenure the Committee contributed to CINP’s History Committee series:The Neurotransmitter Era in Neuropsychopharmacology (Ban and Ucha Udabe 2006; Lerer 2006).
2004 - 2008
The shift of emphasis in CINP from research-oriented interactions to communication of information and education about the use of psychotropic drugs was formally recognized in 2006 during Brian Leonard’s presidency (2004 -2006) with the amendment of CINP’s constitution to include the organization of training programs as one of the three activities for the CINP to achieve its objectives. By appointing Norman Sartorius, the former director of the Division of Mental Health of the World Health Organization, as chairman of a special task force with the mandate to review the evidence for the use of antidepressant medications, Leonard succeeded in having the report of the task force, and CINP’s recommendations about the use of antidepressants based on the report, discussed worldwide.
While CINP’s educational activities were extended by meetings worldwide, organized by the antidepressant task force, CINP’s administrative structure was completed in 2006 during TorgnySvensson’s presidency (after moving the Central Office from Nashville to Glasgow) with the appointment of Mike Mitchell as the corporation’s first executive director. Svensson’s presidency concludes the first 50 years in the history of CINP with the organization (by Hans-Jurgen Moller) in 2008 of its26thCongress (Lerer 2008).
By the time of its 50th birthday the membership of the CINP was approaching 1,500 from 52 countries on six continents. During its first 50 years it has remained an active, energetic society which by the 21st century, in addition to providing a platform for presentations, also provided a journal for publications. The International Journal of Neuropsychopharmacology, CINP’s journal, was launched in 1998 during de Montigny’s presidency with Bernard Lerer, a prominent Israeli psychiatrist,as founding editor.
Duringthe business meeting of the Munich Congress in 2008 Robert Haim Belmaker took the baton from TorgnySvensson to lead the CINP into a new epoch. I
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Ban TA, Beckmann H, Ray OS editors. CINP International Photo Archives in Neuropsychopharmacology. Budapest: Animula; 2000.
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August 16, 2018