Perspectives in Biology and Medicine

MENTAL DISEASE AND DRUGS AFFECTING IT F. M. BERGER* Drugs affecting the mind have been used by man since time immemorial . Among these are drugs that produce a sense ofwell-being, drugs that relieve pain and produce a feeling ofdetachment, drugs that distort perception and cause hallucinations, and drugs that alter consciousness and produce sleep or anesthesia. In recent years, a new and diffèrent class of mind-affecting drugs has come into widespread use—drugs diat relieve or cure mental disease. These drugs, which differ from other substances affecting the mind, were not introduced until the middle 1950s. In this paper, after reviewing the nature, prevalence, and causes of mental disease, I will present some reasons why the new drugs were not discovered earlier and describe their history, usefulness, and impact on our society. Psychopharmacology Although psychopharmacology—die scientific discipline that studies how drugs affect the mind—did not evolve until the middle of this century, die world psychopharmacon (a drug affecting tie mind) from which the namepsychopharmacology was derived, was first used as early as 1548 as the title of a book ofprayers written to give consolation to die dying [1]. Until recently it was not thought possible or even reasonable to treat mental disease with drugs. Frequendy insanity and mental disease were not evenrecognizedasmedicalproblems, and therewasalack ofunderstanding ofthe nature ofthese conditions. To the layman, many manifestations of mental disease are frightening, incomprehensible, and repulsive. This * Wallace Laboratories, Cranbury, NewJersey. This paper was presented as the eighth Paul K. Smith Memorial Lecture, January 1969, Department of Pharmacology, George Washington University School ofMedicine, Washington, D.C. 31 emotional attitude and our lack ofunderstanding ofthe nature and origin ofdisturbed and disturbing behavior perhaps explain why mental disease has not been subjected to study by the scientific method until relatively recently. As a result ofthis, even today there is a good deal ofuncertainty not only about the prevalence but also about the cause, diagnosis, and treatment ofmental disease. The Nature ofMental Disease Mental disease seems to differ from other diseases in several respects. Such disorders areprimarily disturbances ofbehavior, mood, and thought, which are manifested as exaggerations of these personality attributes. Evenanormal person may at times display socially unacceptable behavior, become unduly depressed, or suffer disturbances of his thinking. We speak ofmental disease when these disturbances become excessive, when they occur too frequently, and when they seriously interfere with a person's ability to adjust to his environment. In this sense, symptoms of mental disease only reflect subjective evaluations ofthe behavior ofsome individuals relative to the behavior of other individuals. Thus, the term mental disease still remains an operational concept based on social judgment . The term does not as yet imply understanding of the underlying biological disturbance responsible for the manifestations ofthe disease. In mental disorders that do not have a known organic basis, diagnosis and evaluation oftreatment, to a large extent, can still be made only by subjective means. As a rule, psychiatric conditions are not associated with easily elicited and objectively measurable physical signs. Diagnosis and evaluation of the patient depend to a large extent on the observation, critical judgment, and nosological orientation of the clinician. Thus, psychiatrists, even when they have been working together in the same institution, differ in their diagnoses inan appreciablepercentage ofpatients. In one study wherepatients were independently evaluated by two different psychiatrists, using an agreed list ofeleven possible diagnoses, agreement in specific terms was reached in only about 65 percent ofpatients [2]. Thus it is not surprising that even eminent psychiatrists will often offer sharply opposing opinions before court. If, instead of insanity, the diagnosis of typhoid fever or syphilis were at issue, there would be no difference of opinion. Yet fifty years ago the diagnosis ofsyphilis and typhoid was as open to uncertainties as is the diagnosis ofinsanity today. 32 F. M. Berger · Mental Disease and Drugs Affecting It Perspectives in Biology and Medicine · Autumn 1969 The Prevalence ofMental Disease Mental disease is more common than other illness. It may be more incapacitating and cause more suffering to the individual and society than any other disease. It has been estimated that more than 50 percent ofpatients who visit a doctor suffer from mental disturbances...