Smash Notes

Back to #502 – Psychiatry, Insane Asylums, Mental Illness, ECT, Lobotomies, Freud & Jung, with Andrew Scull.

Why Does England Recommend Therapy Before Antidepressants?

Andrew Scull says the picture with psychiatric drugs is mixed, which is why groups like NICE in England recommend CBT as the first treatment, not drugs. Patients often stay trapped on the drugs for a long time, and nobody knows what the long-term effects will be.

A recent Lancet study found the same split for both antipsychotics and antidepressants. One group responds pretty well, and the side effects are bearable or absent. With depressed patients, north of 40% are not responding, so the drugs do nothing for them while they still run a risk. A middle group gets some improvement and also gets side effects, and weighing the benefit against the harm is very difficult. Going in, the patient does not know which group they will fall into, and the doctor does not know either.

The drug revolution also moved diagnosis and prescribing away from psychiatry alone. Antidepressants in particular are often dispensed by primary care doctors, not psychiatrists.

Grokipedia·Andrew Scull·England

Transcript

#502 – Psychiatry, Insane Asylums, Mental Illness, ECT, Lobotomies, Freud & Jung ·

Lex Fridman Podcast

More from this episode

  1. How Much Progress Has Psychiatry Made?Andrew Scull says there is no question that psychiatry has made some limited progress over at least the last three-quarters of a century in dealing with the…
  2. What Is Mindless Psychiatry?Andrew Scull calls mindless psychiatry the field Leon Eisenberg found at the end of a long Harvard career that began in brainless psychiatry.
  3. How Much Earlier Do People With Serious Mental Illness Die?Andrew Scull says a person with serious mental illness will die on average 15 to 25 years before everyone else, and the gap has been growing rather than…
  4. When Did Neurosis and Psychosis Swap Meanings?Andrew Scull says neurosis and psychosis crossed over sometime in the late nineteenth century.
  5. Did Early Asylums Do Good Work?Andrew Scull believes the early asylums did good work and that some patients recovered during their stays. They were not discharging 80% of their patients.
  6. Who Were the First Victims of the Nazi Final Solution?Andrew Scull says the mentally ill were the first people to suffer the Nazi Final Solution, that the gas chamber and the disguise of gas chambers as showers…
  7. How Did Ice Pick Lobotomies Fade in America?Andrew Scull says ice pick lobotomies in America died away through generational change, and he is sure the Nobel Prize in medicine that Moniz won in 1949 for…
  8. How Does Syphilis Damage the Brain?Andrew Scull says syphilis damages the brain in its tertiary stage, when the organism that causes syphilis resides in the brains of people suffering from GPI.
  9. Why Was Malaria Used to Treat Syphilis?Andrew Scull says doctors infected asylum patients with malaria because general paralysis of the insane, the tertiary stage of syphilis, was invariably fatal…
  10. What Is Insulin Coma Therapy?Andrew Scull says insulin coma therapy put people with schizophrenia into comas with extra insulin.
  11. Why Is Electroconvulsive Therapy Still Controversial?Andrew Scull says electroconvulsive therapy is still controversial because it only eases severe depression for a time, can damage memory, and draws legal…
  12. Are Ketamine and Psychedelics a Miracle Cure for Depression?Andrew Scull says ketamine and psychedelics are being put forward as a miracle cure for depression, and the evidence for that claim is enormously weak.
  13. How Did World War Two Change American Psychiatry?Andrew Scull says American psychiatric casualties among the troops in World War II were two to three times as high as in World War I.
  14. Was Electroconvulsive Therapy Used as Discipline?Andrew Scull says electroconvulsive therapy was used in the 1950s and 1960s as a tool of discipline in the hospitals.
  15. Why Does Electroconvulsive Therapy Still Get Used?Andrew Scull says electroconvulsive therapy still gets used because patients on the brink of suicide, with long-running depressions, have described it as…
  16. Did Andrew Scull Write Desperate Remedies Right Away?Andrew Scull did not write Desperate Remedies right away.
  17. When Did Neurology Emerge in America?Andrew Scull says neurology emerged in America after the Civil War.
  18. Why Did Freud and Jung Split?Andrew Scull says Carl Jung was anointed the crown prince who was supposed to inherit psychoanalysis, then the two men had a serious falling out in 1913 and…
  19. Who Was Anna O in Psychoanalysis?Andrew Scull says Anna O was the foundation patient of psychoanalysis, and she was Joseph Breuer's patient, not Sigmund Freud's.
  20. How Many Psychoanalysts Were in North America Around 1930?Andrew Scull says North America had probably 300 psychoanalysts around 1930.
  21. Did Screening Recruits Stop Shell Shock After Pearl Harbor?Andrew Scull says psychiatric screening before America entered the war failed because the breakdowns came back after psychiatrists removed the recruits they…
  22. How Strong Is the Evidence for Cognitive Behavioral Therapy?Andrew Scull says the evidence that cognitive behavioral therapy works in cases of schizophrenia is pretty poor.
  23. Why Weren't Drugs Used to Treat Mental Illness?Andrew Scull says hardly anybody had conceived of using drugs to treat mental illness.
  24. How Was Chlorpromazine First Tested?Andrew Scull says chlorpromazine was first tested by handing the drug to doctors with no controls and asking them to see whether it worked.
  25. Were Newer Antipsychotic Drugs More Effective?Andrew Scull says a 2005 National Institutes of Mental Health study, published in the New England Journal of Medicine, found that newer antipsychotic drugs…
  26. How Did Prozac Arrive by Accident?Andrew Scull says the second generation of antidepressants, Prozac, Zoloft, and Paxil, arrived by accident.
  27. Have Drug Companies Quit Mental Illness Research?Andrew Scull says major drug companies have abandoned research on serious mental illness.
  28. What Is Andrew Scull's Hope for Psychiatry?Andrew Scull says a real hope for psychiatry is that it can actually help people who suffer.

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