Edward Shorter: The Rise and Fall of the Age of Psychopharmacology New York: Oxford University Press;2021
David Healy’s comments
Short of people who have had conversions from a life of debauchery and drug abuse to sainthood, it’s very unusual to have someone write a bestseller like A History of Psychiatry: From the Era of the Asylum to the Age of Prozac (Shorter 1998), a book that wrote off Freud in unequivocal fashion, and then write another recanting their previous life as Ned Shorter has done here.
To be fair, Shorter doesn’t entirely disown his past life – he makes it clear in the first section of this book that there was a rise to psychopharmacology that was based on drugs that worked and solid work in neuroscience to elucidate some of their mechanisms of action. There was enough to say that psychiatry had established itself as something substantial. That psychopharmacology had dragged it out of a backwater in which it had been marooned for more than a century.
As I put it in a review of History of Psychiatry, Shorter showed that the devil (antipsychiatry) doesn’t have all the best tunes.
In recanting his past life, Shorter has not turned to antipsychiatry. He remains committed to science and the idea of progress but finds that psychiatry has lost its moorings in science and progress leaving him and others isolated.
In writing this book, he draws heavily on the observations of others who lived through these times in both clinics and laboratories and indeed companies. Mickey Nardo, Max Fink, Barney Carroll, Jay Amsterdam, Mark Kramer and Tom Ban. Not all of these agree with each other or with Shorter himself but it’s difficult to think of a better group of observers, given to being trenchant in their observations, to call upon who provide him with the juiciest of details to make his point – in addition to a wealth of archival material. He couldn’t have a better set of sources.
He has also been blessed in the “villains” he has been able to put in the frame – from the Boss of Bosses to the ghostwriters who greased his path. The book is full of scenes to chuckle over if you’re an insider, likely to be jaw-dropping if you’re not.
Ultimately, he paints a scathing picture of puffed-up Key Opinion Leaders that industry regards with contempt and a process that is scripted to the last punctuation mark where once key conversations happened on the beach among colleagues puzzling at inconsistencies and welcoming adverse events for the light they shed on the way drugs often revealed individuality rather than eternal truths.
But there is one big problem with the book. The title. The Rise and Fall inevitably conjures up The Third Reich. And we breathe a sigh of relief because we know the Reich is no more. Not so with psychopharmacology. Despite being hollowed out to the point where continued life, as we know it Captain, is impossible, psychopharmacology today has a zombie existence that is increasingly threatening and dangerous.
Psychopharmacology blazed a path for the concealment of trial data and ghostwriting, which now infects all of medicine. Healthcare has been taken over by zombies.
We’ll have to see if the Covid pandemic is the moment where psychopharmacology finally swallows its tail. What do I mean? Well, the vaccines have been approved on the basis of surrogate markers. The trials almost certainly have been ghostwritten. Substitute the use of tropes like anti-vaxxers for scientologists and you have the beginnings of a disinformation playbook that originated with Lilly and Prozac and was turbocharged with Zyprexa.
Now, at least in Britain, a national vaccine committee handpicked to be pro-vaccine, state unequivocally that the risk-benefit balance does not support vaccinating children (12–15-year-olds) but the government over-rides them on the basis that preserving the mental health of children tips the balance in favor of vaccinating.
The Covid pandemic, and vaccines for it, came too late for this book but Shorter makes it very clear that psychopharmacology is no longer about treating illnesses but about numbing emotions or abolishing negative ideas. And if vaccines don’t cheer the children up, we always have SSRIs and related antidepressants. Here is the crowning glory of zombieology: we have 45 RCTs done in depressed children – all negative, with no relationship between the claims made in published articles, except in the early negative studies, and the underlying data when we get to see it.
In the 1990s, there were almost no depressed children. Companies had to scour the world to get children into trials. Now every child is depressed and antidepressants are the second most commonly taken drugs by teenage girls. This is a more lethal virus than Covid.
Towards the book’s end the author makes his position clear – we can’t get much more bizarre than this or tolerate much more of this sham. He knows of course that we can, and we do. How exactly it’s going to end isn’t clear. When even Ned Shorter ends on a perhaps Freud wasn’t so bad after all note, you realize that things are very strange indeed.
Shorter E. A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. Wiley; 1998.
December 23, 2021