When the first Academy Awards were held in 1929, effective depression treatments did not exist.
Today dozens do, and millions have benefited.
Yet the image of psychiatry in cinema still mirrors that shown in Cuckoo’s Nest.
The therapies have changed.
The story has not.
#Psychiatry
#Oscars
In a 1987 interview, Kalinowsky was asked whether he still subscribed to the view expressed in this formulation.
“Yes, I do,” he replied.
This was a psychiatrist who had lived through a remarkable arc of discovery: ECT, lithium, chlorpromazine, imipramine, and the dawn of the SSRI era.
And yet …
His is a threefold posture: meet the mystery unruffled, pursue its solution, and treat to the limits of our knowledge.
Humility about causes; boldness in practice.
(Continued.)
This state of affairs makes it all the more gratifying that active application of so many different therapeutic methods can restore the functioning of an increasing number of psychiatric patients.
Kalinowsky then speaks of “constant progress” in therapeutics.
Psychiatry is still – exactly as at the time of the first writing of this book in 1946 – limited to purely empirical treatments of diseases whose origin remains shrouded in mystery.
(Quotation continues in the next post.)
In the 1969 edition of "Pharmacological, Convulsive and Other Somatic Treatments in Psychiatry", the textbook he co-authored with Hanns Hippius, Kalinowsky repeated a formulation he had first set out in 1946:
But Kalinowsky draws the opposite conclusion.
At first glance, this sounds like a familiar critique of psychiatry:
that its diagnoses are social constructs, and its treatments little more than pharmacological accidents whose mechanisms remain unknown.
Some critics take this to undermine the field's legitimacy.
Quote card with cream background and black serif text reading: "Psychiatry is still … limited to purely empirical treatments of diseases whose origin remains shrouded in mystery." Attributed to Lothar Kalinowsky & Hanns Hippius (1969).
Lothar Kalinowsky (1899–1992) was a doyen of 20th-century psychiatry, a pioneer of somatic treatments, and co-author of a major clinical textbook. He was not shy about biological therapies.
#Psychiatry · #PsychShelf
I'll be looking at how the mood disorders volume frames TCAs, MAOIs, and lithium. I love to explore how psychopharmacology treatment logic differs among various psychiatric traditions.
I don't know Turkish, so I'll be using DeepL – slowly and carefully.
In today's mail: five psychopharmacology monographs from Turkey. They cover mood disorders, anxiety disorders, psychotic disorders, addiction, and general psychopharmacology.
What are you curious to learn from them?
Assumptions, treatment logic, clinical pearls?
Taking requests.
Cover of Duygudurum Bozukluklarının Psikofarmakolojisi (Psychopharmacology of Mood Disorders), 2nd edition, edited by Kürşat Altınbaş, Sinan Gülöksüz, and E. Timuçin Oral. Published by the Turkish Psychiatric Association. White cover with red title text and a stylized outline of a human head containing a maze-like brain illustration. A bookseller's label has been obscured.
#Psychiatry #PsychShelf #booksky
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→ Marginalia:
Five psychiatry textbooks, five different conceptions of where the field begins. Each revealed by a single choice: what to put first.
What do you think should come first – and why?
a) The patient
b) The encounter
c) The examination
d) The diagnosis
e) The brain
#Psychiatry
→ Marginalia:
Five psychiatry textbooks, five different conceptions of where the field begins. Each revealed by a single choice: what to put first.
What do you think should come first – and why?
a) The patient
b) The encounter
c) The examination
d) The diagnosis
e) The brain
#Psychiatry
Source for the main quotation
Wilson – “A Plan for Refining the Nosology of Mental Illness,” in Martin M. Katz, ed., The Role and Methodology of Classification in Psychiatry and Psychopathology (1965), p. 53.
Only the first editor is cited here.
Sources
DSM-II (1968) – acknowledgement page
Wilson obituary – Legacy.com (Washington Post notice)
Bayer – Homosexuality and American Psychiatry (1987), pp. 123–124
Wilson obituary – Columbia University Medical Center Archives
Archived at Perma.cc [https://perma.cc/9HBW-V44T]
Wilson also served on the APA’s Nomenclature Committee during the DSM-II era and drafted a discussion paper supporting the declassification of homosexuality from the diagnostic nomenclature. In 1986 he published a survival manual for medical students.
Paul T. Wilson (1932–2020) was a psychiatrist on the staff of the American Psychiatric Association during the preparation of DSM-II. The manual’s acknowledgement page credits him with “extensive editorial revision of the original manuscript” that clarified and added precision to its definitions.
No single part can advance far without similar growth in the other parts. And so the act of improving a nosology is inseparable from the other acts that help the profession to grow. — WILSON, PAUL T. (Washington, DC, 1965)
#Psychiatry #PsychShelf
– – –
Refining a nosology involves much more than just renaming illnesses from time to time. The nosological system of any healing profession is an integral part of its structure, tradition, philosophy, and practice. »
#Psychiatry #PsychShelf
– – –
Wilson also served on the APA’s Nomenclature Committee during the DSM-II era and drafted a discussion paper supporting the declassification of homosexuality from the diagnostic nomenclature. In 1986 he published a survival manual for medical students.
Paul T. Wilson (1932–2020) was a psychiatrist on the staff of the American Psychiatric Association during the preparation of DSM-II. The manual’s acknowledgement page credits him with “extensive editorial revision of the original manuscript” that clarified and added precision to its definitions.
[8/4] Sources 4 — California & Limerick:
Stahl – Essential Psychopharmacology (2nd ed.), cited in:
Jordan – ‘Running Low on Rocket Fuel’ (2019)
Meagher – ‘The case for Limerick “rocket fuel”’ (2006)
[7/4] Sources 3 — London:
Currie – ‘Treatment Resistant Depression Pharmacology’ (citing Hale et al., 1987)
Only source attesting to the name “London cocktail.”
[6/4] Sources 2 – Dalhousie:
Dursun – ‘Dalhousie Serotonin Cocktail’ (2001)
Bird – ‘Treatment-Resistant Depression’ (2002)
Chehil – ‘Pharmacologic management of refractory depression’ (2001)
[5/4] Sources 1 – Newcastle:
Barker – ‘The Newcastle Chronic Depression Study’ (1987)
McKeith – ‘Donald Eccleston’ (2018)
Gardner – ‘Competent Psychopharmacology’ (2014)
Ayd – Lexicon of Psychiatry (1995)
Formulations differ across sources; I follow the original trial.
[4/4]
This information is shared for general and historical purposes. It is not medical advice.
[3/4] Tiki edition …
California rocket fuel: venlafaxine, mirtazapine
Limerick rocket fuel: duloxetine, mirtazapine
The former has become a textbook staple.
The latter was proposed in a 2006 case report, but never caught on.
Any others I’m missing?
[2/4] A few combinations that earned names of their own …
Newcastle cocktail: phenelzine, L-tryptophan, lithium
Dalhousie cocktail: nefazodone, pindolol, L-tryptophan
London cocktail: clomipramine, L-tryptophan, lithium