Barry Blackwell’s reply to Hector Warnes’ comment

Heinz Lehmann by Barry Blackwell
Collated by Thomas A. Ban

       Thanks are due to Hector for his personal reminiscences after training under Heinz at the Verdun Protestant Hospital. He provides a broad and sensitive perspective of Heinz’s persona and modus operandi.

      Clearly this biography has triggered Hector’s reflections based on an extensive knowledge of biological treatments and the evolution of asylum care to which I will make a response.

       The period which Heinz Lehmann was concerned with extended from the tail end of the second revolution Hector describes and well into the third, roughly what might be considered the “Golden Era” of modern psychopharmacology (late 1940s to mid-1970s). This period progressed from dangerous, publicly unappealing, partially effective and ineffective symptomatic treatments including lobotomy, ECT (sans muscle relaxants and anesthesia), insulin coma and sleep therapy. Reserpine, barbiturates, amphetamine, chloral and paraldehyde followed by the modern spectrum of lithium, antipsychotics, MAOI, tricyclic antidepressants, SSRI’s and mood stabilizers. The newer drugs helped more people, but not without side effects, and were not etiologic - the root causes of mental illness remain a mystery without a cure in sight. Nosology is a lost art and what we are treating is a DSM miasma.

       The impact of the advent of modern biological treatments is debatable and not all asylum care was equally good or bad. A picture of what the best that humane and intelligent asylum care could provide on the cusp of the modern era is told in Enoch Calloway’s memoir, Asylum: A Midcentury Madhouse and its Lessons about our Mentally Ill Today. Artistic, publicly appealing portraits of the worst care during this era are seen in the movies, The Snake Pit and One Flew over the Cuckoo’s Nest.

      Today there are no asylums; community care is in tatters and inpatient care reduced to the travesty of days or, at best, a few weeks of treatment determined less by clinical wisdom than by insurance company parsimony.

      We cannot know what Heinz Lehmann might think of this if still alive today. From Hector’s account, we can speculate it would be reflective, highly informed, pragmatically and rationally expressed, but above all, appealing to an agnostic mind in search of truth yet to be revealed.

January 4, 2018