Friday, October 31, 2008

Before Prozac

Edward (Ned) Shorter, an historian who has written a number of books
on the history of psychiatry, has now thrown his opinions into the
growing debate on the influence of antidepressants and the concept of
depression on psychiatry in particular and on American life in
general. His new book Before Prozac:: The Troubled History of Mood
Disorders in Psychiatry is in some ways a companion to Wakefield and
Horwitz's The Loss of Sadness. Both attack the DSM category of Major
Depression--though for somewhat different reasons-- for dumping too
many different states into the same pot. Shorter also takes aim at the
FDA's process for vetting antidepressants, where his central critique
is that the FDA refused to allow head to head comparisons between
newer antidepressants and older ones, leading to a deterioration in
the pool of antidepressants. As in his other books, Shorter is never
short on indignation. In this book his primary complaint is that
psychiatry has failed to evaluate its treatments with sufficient
rigor. This line of attack is, however, somewhat muddled by his lack
of regard for Randomized Clinical Trials and his willingness ot accept
almost anyone's opinion that older drugs like meprobamate were really
quite wonderful. Whatever the shortcomings of this book, it is an
important one, both for giving a detailed overview of the history of
the mood disorders in the second half of the 20th century and for
setting out a framework in which this period in the history of
psychiatry can be discussed.

1 comment:

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