page_title: Mad in America
section_title: Part Three: Back to Bedlam (1950–1990s)
hierarchical_section_title: Mad in America / Synopsis / Part Three: Back to Bedlam (1950–1990s)
caption_attribution_description: Ball-and-stick model of the chlorpromazine molecule. X-ray diffraction data from H. S. Yathirajan, M. A. Ashok, B. Narayana Achar and M. Bolte (April 2007). "Chlorpromazinium picrate". Acta. Cryst. 'E63' (4): o1795-o1797. DOI:10.1107/S1600536807011555.
context_page_description: Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill is a 2002 book by medical journalist Robert Whitaker, in which the author examines and questions the efficacy, safety, and ethics of past psychiatric interventions for severe mental illnesses, particularly antipsychotics. The book is organized as a historical timeline of treatment development in the United States.
  Mad in America received positive reviews from the general public and mixed reviews from the medical community, which criticized some bias in sourcing but nonetheless acknowledged the need to address the critical questions raised by the book regarding modern psychiatry.
context_section_description: Part Three describes the invention of the neuroleptic drug chlorpromazine (Thorazine) by Rhône-Poulenc in France, and its purchase by Smith, Kline & French (today known as GlaxoSmithKline). The drug "produced an effect similar to frontal lobotomy", according to early reports by the company's lead investigator.  Whitaker says that pharmaceutical advertising, articles published in the scientific literature, and stories in the media of "miracle drugs" transformed Thorazine into a healing drug.
  Whitaker says that marketing money from pharmaceutical companies began to flow to the American Medical Association in 1951, a year after Thorazine was synthesized, because of the Durham-Humphrey Amendment to the Federal Food, Drug, and Cosmetic Act which "greatly expanded the list of medications that could only be obtained with a doctor's prescription".
  In Part Three, Whitaker also describes the American (but not for example British) propensity to classify patients as "schizophrenic", as well as the error (confusion of schizophrenia with the yet-to-be-discovered encephalitis lethargica) in the original classification by Emil Kraepelin, which psychiatry chose to not revisit and fix. Whitaker then describes three pathways that dopamine may take in the human brain, and quotes first-person accounts of the effects of antipsychotic drugs on individuals.
  He calls a 1996 New York Times advertisement by a consortium of pharmaceutical companies a "bald-faced lie": the group sought to say that the cause of psychosis and schizophrenia is an abnormal dopamine level and that their drugs worked by altering the level of dopamine. Whitaker then criticizes some American studies, and points out the work of George Crane at the National Institute of Mental Health to get tardive dyskinesia recognized, and he contrasts the dosages that British doctors were comfortable in prescribing (300 milligrams per day of Thorazine) with what American psychiatrists prescribed (1,500 up to perhaps 5,000 milligrams per day).
  He sees irony in the fact that The New York Times reported on Soviet forced use of neuroleptic drugs (which Florida Senator Edward Gurney called "chemicals which convert human beings into vegetables") in "psychiatric jails", but called the same drugs "widely acknowledged to be effective" when reporting on American schizophrenic patients.
  Whitaker describes the demise of modern-day moral treatment in a short history of Loren Mosher's Soteria Project, funded by the U.S. while Mosher was chief of schizophrenia at NIMH. He attributes the results in a World Health Organization 1979 study of outcomes for schizophrenia patients (which found better outcomes in undeveloped countries like India, Nigeria and Colombia than in developed countries like the United States, England, Denmark, Ireland, Russia, Czechoslovakia and Japan) to doctors in the developed world who maintained their patients on medications.
  He then describes 50 years of American scientists doing experiments on schizoprenia patients: to intentionally exacerbate their symptoms and study the results. He compares the doctors' behavior, unfavorably, to 1947 after American trials of Nazi doctors ended in the Nuremberg Code for ethics in human experimentation.
caption: Chlorpromazine, marketed in the U.S. as Thorazine, was first synthesized by Rhône-Poulenc in 1950.[1]:142
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