François Ferrero: Inquiry of the Geneva 1980s’ Psychiatry Crisis
Barry Blackwell’s comment on Hanfried Helmchen’s comment (Some background)
I thank Professor Helmchen for his exemplary, detailed and insightful analysis of the psychiatry background relevant to the controversial events in Germany during the 1980s raised by François Ferraro.
Helmchen’s frame of reference is the Zeitgeist – a German word for a German epoch defined, according to the Oxford English Dictionary (OED), as: The defining spirit or mood of a particular period in history.
As he notes, “Zeitgeist is an undetermined term for the prevailing pattern of thinking and interpreting.” The term lacks a more precise definition in terms of the degree to which a “particular period” was changed, what factors contributed to bringing the change about and how severe or prolonged the change was.
Helmchen provides telling answers to these issues concerning Germany beginning with a student rebellion in 1968 and an atmosphere persisting for more than 30 years up until the turn of the 21st century. He combines personal experiences throughout, backed up by professional publications, analyses of the lay media and details of the role played in perpetuation by students, patients, quasi-professional organizations and the press.
My comments are directed toward examining and comparing events in Germany to the worldwide anti-psychiatric sentiments present throughout the modern psychotropic drug era in differing forms for variable durations. The countries involved include America, France, Canada and Germany.
As the first psychotropic drugs began to appear in the mid-20th century they encountered an existing anti-psychiatric sentiment due to the Catholic church’s concern that psychoanalysis might usurp the spiritual domain. This idea died an early death due to the efforts of two Catholic psychiatrists, Jack Dominian and Frank Ayd.
When I joined the Maudsley Hospital in 1962 Jack Dominian, who went on to a distinguished career as both a psychiatrist and theologian, was among my peers. His ideas, expressed in 32 books, helped resolve the tension and enlighten the doctrinal understanding of intimate relationships.
After completing residency, I migrated to America and met Frank Ayd, a pioneer psychopharmacologist and founding member of the ACNP, who became a friend and colleague. Frank, father of 12 children, was invited by Pope Pius XII to spend a sabbatical in Rome where on Vatican radio he spoke and taught about ethics and psychiatry.
When the first annual meeting of the newly formed CINP met in Rome in September 1958 the Pope gave an opening address. Frank Ayd commented: “Of all the Popes who have reigned in the Catholic Church Pope Pius XII had the greatest interest in medicine. During his papacy he addressed more medical groups and wrote more on medicine, human research and the ethics of medical practice than any of his predecessors” (Ayd 1998).
In 1970 Frank invited his fellow Catholic John Cade to describe his discovery of lithium, the first of the modern psychotropic medicines for manic psychosis, at an international conference in Baltimore (Ayd and Blackwell 1970). The Pope’s representative to the Nixon White House was present during the awards ceremony. This is an example of how skillful advocacy can ameliorate a potentially inclement Zeitgeist.
However, the pioneer psychopharmacologists in America had far more refractory antagonists in the form of their fellow psychiatrists steeped in psychoanalytic ideology. When I joined the Department of Psychiatry at University of Cincinnati in 1970 the chair of almost every academic program in America was an analyst. Ayd describes the atmosphere: “Every pioneer in psychopharmacology can attest that in the early years there was a marked resistance to such therapy by many leaders in psychiatry. In fact many were ridiculed and denigrated by colleagues faithful to psychodynamic concepts” (Ayd 1998).
While I was welcomed as a faculty member in psychiatry and pharmacology, teaching both medical students and psychiatric residents, the intellectual climate remained mildly hostile. Every other faculty member was an analyst and most of the residents were in analysis with them at a time when the National Board of Examiners waived the need for graduating medical students to do a rotating internship in medicine before entering residency. Anthropologist Margaret Mead, a visiting professor, gave the Department Chair, Maury Levine, a hard time about the residents’ ignorance of medicine. This did not prevent the faculty from warning that if they spent time on the psychosomatic unit under my supervision it “might ruin their career,” a suggestion I challenged and confronted in an open debate with a leading analyst.
Shortly before I left Cincinnati in 1974 Maury Levine developed acute leukemia; on his death-bed he wrote me one if his famous “Memo’s from Maury” promising we would jointly teach a conference integrating dynamic and biological concepts. Sadly, Maury died with the promise unfulfilled and I left to become Chair of Psychiatry at Wright State University in Dayton, Ohio, where funding was provided by the Federal Government for training humanistic primary care physicians willing to work in underserved areas. This was just before American psychiatry adopted the DSM III and renounced the psychodynamic diagnostic concepts of its predecessors. So, for almost 20 years the early American Zeitgeist had been largely antagonistic to biological treatments.
Events in France are related in a biography of Jean Delay (Moussaoui 2002) which was reviewed and abstracted on INHN (Blackwell 2014).
Delay, a brilliant polymath, gifted author and lifetime member of the Acadamie Francaise, was the youngest Professor of Medicine in France when, in 1942, he joined the Clinic of Mental Illness and the Brain (CMME) in Paris. He became Chair in1946, at age 39, and turned a virtual asylum into a multi-disciplinary academic institute with laboratories in all the disciplines related to psychiatry. Akin to and contemporary with Aubrey Lewis’s Maudsley Hospital and Institute of Psychiatry in London, CMME was unique and exceptional in France; it was a magnet for the best young doctors from around the world. During his scientific career Delay published more than 40 books and more than 700 scientific papers on a wide variety of topics. He convened the first World Congress of Psychiatry at Paris in1950 and two years later his team published the discovery of chlorpromazine (Delay, Deniker and Harl 1952), the drug that transformed world psychiatry, lead to the closure of asylums and fostered the birth of community care.
In May 1968 dramatic events intruded on this idyllic academic environment: “a sudden thunderstorm in a clouded sky” (Moussaoui 2002). A national Trotskyist revolution erupted, paralyzing France with widespread strikes, blocked public transport and student protests. Ideology was profoundly anti-authoritarian and anti-psychiatric; psychotic and delusional patients were not mentally ill but “victims of the system.” Delay became a scapegoat, an alleged prototype of a “contemptible order of mandarins.” Five hundred students invaded the department, occupied his office and lecture hall, ridiculing his teaching and demanding the separation of psychiatry from medicine. Within two years some of these changes were implemented and Delay, now 70, decided to retire, driven both by ill health and a deep desire to devote himself to literature, his first love.
In his sad concluding remarks, Driss Moussaoui describes the long-term impact of Jean Delay’s fall from grace on French psychiatry: “It is clear that a major page in French psychiatry was turned with Jean Delay’s retirement in1970… and with it the important role that France played internationally… a gradual disinvolvement from the international scene by French psychiatrists occurred” (Moussaoui 2002). Driss identifies contributory factors in this decline including the arrival of DSM III a decade later and the biological shift in modern psychiatry, as well as the fact that English became the predominant language for international scientific dialogue.
Anti-psychiatric events also intruded on the career of Heinz Lehmann in Canada but with a very different outcome.
Heinz migrated from Germany to Canada in the run up to World War II. At age 26 he had completed his medical education in Germany at Marburg where he studied Ernst Kretschmer, then Vienna to meet Julius Wagner-Jauregg. Familiar with classical psychiatric literature he opted, like Joel Elkes, to shun residency in favor of “on the job” training as a junior psychiatrist at Verdun Hospital in Montreal, an asylum affiliated with the medical school at McGill University (Blackwell 2015)
Here Lehmann was exposed to the full spectrum of psychopathology in mental illness and became a self-taught scientist in early attempts at treatment until he was appointed the Medical Director in 1954 by which time he was well-versed and a published author in biological research. In that year he learned of the discovery of chlorpromazine in France and conducted his own trial, the first published in English, and for which he received the Lasker Award (Lehmann and Hanrahan 1954). Heinz would later publish the first controlled trial of imipramine in depression (Lehmann, Cahn and Devertuil 1968).
Beginning in 1961 Lehmann began a highly productive epoch of research with Tom Ban in what later became the lead component in the Early Clinical Drug Evaluation Units (ECDEU), funded by the NIMH. Together they studied and published their findings on almost all the new drugs developed during nearly two decades. The decade between 1960 and 1970 saw the “Quiet Revolution” in Quebec during which a Liberal elected government usurped control over health and education from the Catholic Church, establishing Ministries of Health and Education that triggered intense social, political and cultural change which secularized society and created a welfare state.
These events had a profound impact on McGill University with faculty unrest and political turmoil. Seeking to prevent the Department of Psychiatry from falling apart the Dean of the School of Medicine persuaded a very reluctant Professor Lehmann to accept the Chair and restore calm, which he accomplished in 1970. This feat coincided with a small Marxist uprising provoked by a visit from French General Charles De Gaulle who urged French-speaking Quebec citizens to push for political sovereignty from Canada. Part of that agenda radicalized youth on the alleged evils of totalitarian government and included a few psychiatric residents who protested the use of psychotropic drugs in psychotic patients as “mind control.” This in turn fed into a broader North American movement among Scientologists and conspiracy theorists led by psychiatrist Peter Breggin, who expressed concern over the Project MKUltra, also called the CIA mind control program, during the Vietnam War. Among the recipients was Ewan Cameron, a predecessor of Lehmann as Chair of Psychiatry at McGill.
In reaction to allegations of psychiatric patient abuse the Canadian government appointed a Citizens Commission of Mental Health that toured 70 major psychiatric facilities throughout Canada, interviewed thousands of patients and catalogued “harmful psychotropic drug effects.” These findings were published in the Scientology magazine, Freedom that included a photograph of Verdun Hospital with a caption, “Some of Lehmann’s experiments were fatal, yet have gone virtually without comment.”
These allegations, which were refuted and discredited, are still posted on Google today. Heinz Lehmann agreed to address these concerns in a public debate with the distinguished philosopher Herbert Marcuse who spoke to the motion, “Psychiatry is an agent of the Establishment.” Heinz spoke against the motion and may have relished the encounter. Marcuse, in his 70s, was a German Jew who, like Lehmann, fled Germany before World War II. Fiercely opposed to totalitarian regimes, his early work combined themes from Marx and Freud. He taught at Harvard and Brandeis where he was known as “The Father of the New Left,” believing that “technology amounted to social control of the individual.” This fit the notion that psychotropic drugs were abusive. Heinz was well equipped to negate this opinion but, while getting the best of the argument, he was attacked by a psychiatric resident armed with a spray can that covered the professor with whipped cream. Without missing a beat Heinz calmly wiped the foam from his face and concluded the debate, widely viewed as the winner.
Politics cooled, Quebec never obtained independence and Heinz emerged with his reputation intact. The Zeitgeist dissipated and Heinz went on to receive numerous awards and accolades. He was President of both the ACNP (1965) and the CINP (1970). In 1970 he became a Fellow of the Royal Society of Canada; in 1976 an Officer of the Order of Canada; and in 1988 he was inducted into the Canadian Medical Hall of Fame, in the distinguished company of William Osler. The citation reads: “He was a humble and affable man who made the world a better place.”
Later in America
Events in America in the early 1970s, also stirred up by the Scientologists lead by psychiatrist Peter Breggin, focused again on the same CIA “mind control” experiments but this time in conjunction with brain stimulation research at Yale University by Spanish psychiatrist Jose Delgado.
Delgado was born in Spain and mentored by Santiago Ramon y Cajal, 1906 Nobel Laureate, often considered “The Father of Neuroscience” (Blackwell 2013). Studying medicine and physiology in Madrid Jose’s education was interrupted when he served on the Republican side in the Spanish Civil War. After the end of the war and a brief time as a prisoner of war he returned to complete doctorates in medicine and physiology, both cum laude. From 1942 till 1950 he conducted research in neurophysiology on selective brain ablation and electrical stimulation in animals, publishing 14 articles and winning several prizes.
In 1950 he won a scholarship to Yale and worked under John Fulton whose pioneer work on prefrontal lobotomy in chimpanzees encouraged Egas Monez to perform the procedure in humans for which Monez received the Nobel Prize in 1949.
Delgado, convinced that brain stimulation was superior to chemotherapy for treating brain disorders, developed a “stimoceiver” for two-way communication with the brain in mobile animals producing changes in affect and behavior. Encouraged by these results and Monez’s treatment of humans, Delgado extended his research to patients with chronic refractory epilepsy and schizophrenia, work published in 1952, the year chlorpromazine was discovered.
In choosing electrical stimulation over chemotherapy (because drugs were metabolized by the liver and blocked by the blood brain barrier), Delgado was eventually proved wrong. The effects of stimulation were often imprecise, poorly replicated and without therapeutic benefit. Nevertheless, his enthusiasm, prolific publications and dramatic demonstration of stopping a charging bull (which made front page news) led to an invitation to write a book in a series on “World Perspectives” edited by a well-known philosopher, a series in which several of the world’s leading experts in a spectrum of topics, including three Nobel Laureates, were invited to speculate on the implication of their fields: “to extrapolate an idea in relation to life.”
Delgado chose a provocative title for his volume: “Physical Control of the Mind. Towards a Psychocivilized Society.” Although his intent was benevolent - “to encourage a future psychocivilized human being, a less cruel, happier and better man” - he extended his philosophical ideas far beyond that which his experimental results justified. In doing so he became the prime scapegoat for the Scientologist cult and their crusade against all things biological, including drugs, ECT and the CIA mind control experiments.
Disastrous for Delgado was the strategy of his detractors to lobby Congress in order to block all Federal funding for brain stimulation research. In this they succeeded. Unable to fund his research and with his reputation tarnished he accepted the offer of a Chair of Physiological Science at a new medical school in Madrid and left Yale to return to Spain in 1974.
For another quarter century Delgado continued to publish animal research in brain stimulation and books on philosophy in both Spanish and English. His final book, Happiness, achieved 14 editions. After retirement late in life, he and his wife returned to America to live in San Diego where in 2011 he died, unheralded and largely forgotten.
Despite Helmchen’s persistent and cogent opposition, a prevailing anti-psychiatrist agenda - “a state of mind of an epoch” - existed that continued to publicly oppose biological treatments including anti-psychotic medications and ECT supported by public “Tribunals” student protests, hostile media (Spiegel), politicized student bodies and a fellow psychiatrist (Peter Lehman, leader of the “crazy offensive”), all supported by political stratagems and court decisions. Although cautious, Helmchen appears to attribute this to a Zeitgeist derived from “victim identification,” presumably a prevailing public sentiment and sequel to the concentration camps and holocaust atrocities of World War II.
Beginning in the mid 1970s a complex Zeitgeist has evolved in America that is, paradoxically, not anti-psychiatric but a corrupted product of the biological revolution that began in the early 1950s influenced by political, legislative, economic and cultural changes in health care (Blackwell 2017).
By that time each of the novel drugs effective for all the major psychiatric disorders had been discovered. The Federal Government closed the Early Clinical Drug Evaluation Units, the NIMH moved from funding psychopharmacology to genetics and a Republican Congress passed legislation encouraging “information transfer” from academia to industry. Despite collaboration with industry innovative drug development dwindled and Big Pharma switched its resources from creative research to aggressive marketing of “me too” products supported by seductive TV advertising yielding vast profits. Its lobbying force increased to more than 350 and beginning in 1980 Congress passed legislation that mandated the FDA charge higher costs for approving new drugs amounting to 50% of its budget. Meanwhile no changes were made to the outdated statutory requirements for approval since the mid-1960s. Double-blind controlled trials were still against placebos, not cheaper generic drugs, and statistical significance was often achieved before rare but serious side effects became apparent.
In 1980 DSM III was introduced, a symptom-based program that was easily manipulated by industry and complicit academics - Key Opinion Leaders (KOLs) - to identify novel drug-responsive syndromes. A climate had now developed that allowed the industry to further use its vast profits to infiltrate academia and its professional organizations establishing an economic hegemony over the entire educational and drug testing process (Ban 2006). Conflicts of interest were rampant, glibly admitted but never penalized. Prominent psychiatrists were bribed to “ghost write” research reports and publications, as well as sitting on FDA approval panels, Best Practice Drug and Journal review committees. The ACNP, originally a seed bed for innovative academic psychopharmacology, now had fewer and fewer members involved with less and less dialog between clinical and basic neuroscientists - a founding principle of the organization.
Meanwhile the entire mental health system was moving toward a system of “for profit” health care and medicine as a whole turned from a profession into a business. Large, allegedly “not for profit” health corporations kept an eagle eye on the bottom lineand were run by well-paid administrators with large advertising budgets. Increasing numbers of psychiatrists gave up individual practice to become employees subject to “productivity” requirements and without autonomy or political influence.
Stimulated by Professor Helmchen’s concerns about the situation in Germany this essay pursues the topic of the anti-psychiatry influences in depth across four cultures from1952 to the present: America, France, Canada and Germany.
Each culture presents a differing picture of the prevailing Zeitgeist, its origins and countering forces displayed in a chronological framework. It begins with America in1952 where Catholic concern over psychiatry competing with religion was quickly disposed of by constructive dialogue between the Papacy and leading psychopharmacologists. A far bigger and longer adverse Zeitgeist was created by psychoanalytic hegemony over biological psychiatry that lasted two decades into the late 1960s and was resolved by the manifest therapeutic superiority of psychopharmacology and an influx of experts from other countries.
Nineteen-sixty-eight was a pivotal year in the evolution of ant-psychiatric movements in all four countries, triggered by Trotskyist, Marxist and Scientology ideologies that viewed psychotic and delusional persons as victims of totalitarian regimes with psychiatry as the agent of suppression through the use of toxic and dangerous biological treatments. Despite their common origin the duration and outcome of each Zeitgeist differed.
France came first when a Trotskyist revolution ousted Jean Delay and the team that discovered chlorpromazine. This provoked an abrupt and complete collapse of the existing French tradition due in part to Delay’s age, ill health, decline in stamina but also an eager exit to pursue his first love in literature and occupy his lifelong seat in the Academie Francaise. According to his biographer (Moussaoui, 2002), the lack of an energetic successor at a time when French Psychiatry was ready to pursue a less biologic direction and the absence of a presence on the international stage contributed to Delay’s departure.
Canada followed almost immediately in 1970 due to a Marxist and Scientology element in the context of Quebec’s Quiet Revolution and attempt to secede from Canada. Much of the anti-psychiatry sentiment was directed at Heinz Lehmann whose robust, energetic resistance and sterling reputation quickly suppressed dissent and sustained a strong and lengthy psychopharmacology tradition in collaboration with Tom Ban and the ECDEU program. (Blackwell 2015).
Immediately following this the Scientologists, under psychiatrist Peter Breggin and opponents of the CIA “mind control” program, attacked Jose Delgado, his brain stimulation research at Yale and his philosophical writings. Their lobbying Congress succeeded; his funding was cut off; and he as forced to return to his native Spain in 1974 where he was able to continue his research in animals.
Germany has had an active and by far the most sustained anti-psychiatric movement beginning in 1968, strongly opposed by Professor Helmchen but still influential perhaps due to a sustained Zeitgeist that obtains its energy from deep-seated feelings derived from the evils of the Nazi totalitarian regime during the Second World War, still expressed in contemporary elements of German culture.
Finally, the current sustained Zeitgeist in America is an amalgam of several cultural changes that have evolved over almost four decades beginning in the mid 1970s. While not overtly anti-psychiatric they have profoundly altered the nature of the profession, virtually extinguished the academic discipline of psychopharmacology and contributed to a sterile epoch in innovative drug development. Paradoxically, due to malign commercial interests, treatment has tilted in a chemophilic direction at the expense of psychosocial interventions (Blackwell 2016) and the profession is mired in an atmosphere of profound pessimism and powerlessness to create change.
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March 7, 2019