What Tranquilizers Have Done

Little more than ten years has passed since two psychiatrists first gave North American patients the new drugs that were soon to be widely known as tranquilizers. In so doing, they started the most dramatic and hopeful revolution in the long, dolorous history of mental illness. They are still at it. Berlin-born Dr. Heinz Edgar Lehmann, who introduced chlorpromazine at Verdun Protestant Hospital outside Montreal, is barnstorming at meetings called to find ways of developing still more and better drugs. New York's Dr. Nathan S. Kline, who introduced reserpine at Rockland State Hospital, is in Iran, fomenting a psychiatric revolution there. Just before he left the U.S., Dr. Kline told the New York Academy of Medicine what has been wrought in these ten years. It is impressive indeed.

Savings in Billions. Most notable, of course, has been the reversal of a once seemingly inevitable annual increase in the number of mental patients. If their numbers had continued to mount since 1956--when use of the drugs became widespread and fairly systematic--at the same rate as in the pre-drug years, there would now be 82,000 more patients confined in mental hospitals. "Instead," said Dr. Kline, "there has been an actual decrease of 54,000 patients, giving a difference of 136,000 persons." The care of these might-have-been patients over eight years would have cost more than $1 billion, Dr. Kline estimates; building hospitals to house the newcomers would have cost $2 billion more. Alongside such figures, the cost of the drugs and of drug research is "very modest indeed."

Anybody admitted to a mental hospital today has twice as good a chance of getting out as he would have had before the drugs. Therefore, said Dr. Kline: "Public-mental-hospital patients now come with an expectation of improvement, and they come earlier--when treatment is more apt to be successful."

Accepted as Illness. The drug revolution, said Dr. Kline, has opened up broad new avenues for the treatment of many patients formerly considered untreatable. Most important, perhaps, "it has begun to change centuries-old public attitudes toward mental disease."

Dr. Kline pointed out that today there is much "greater acceptance of patients back into the community, since psychiatric disorders are now much more-looked upon as illnesses, and as illnesses that can be treated. The fact that a condition is treated with medication somehow guarantees, in the public mind, that it is a genuine illness." One measure of this change is that one-third (by his estimate) of all packages passing across druggists' prescription counters today are for drugs that influence the mind.

Drug treatment Dr. Kline said, constitutes direct action on many patients for whom all other methods of treatment have failed. True, many patients nowadays are further benefited by other methods, but the important thing is that they would not have responded at all to any treatment without the drugs. "Disturbed behavior is reduced so that the staff is able to concentrate on those who will benefit, rather than, as in the past, having to spend almost all its time managing assaultive patients. And there is now more personnel available because the work is no longer so hazardous or distasteful." The family physician, said Dr. Kline, should take much more responsibility for treating depression ("far and away the most common of the emotional disorders") and refer only the stubborn cases to psychiatrists.

Problems from Solutions. Dr. Kline attacked the common misconception that the neuroses are "less severe" than the psychoses. "Both the diagnosis and treatment of the psychotic are simpler and more effective than those of the neurotic patient," he said. "With adequate drug treatment, plus a few basic psychiatric skills, the family physician would be able to handle the bulk of psychiatric patients and thereby free the psychiatrist to work with the more difficult disorders--such as neurosis."

So little is known about how the drugs work that selecting the right one for a particular patient often takes precious time. And although there seem to be so many drugs, there are really not enough. "New drugs are badly needed to treat conditions which are not yet treatable. These include mental deficiency, diseases of aging, certain types of juvenile delinquency, and psychopathic personality." Even without these, psychiatric services must be reorganized to take full advantage of what the drugs have made possible. "There is nothing more productive of problems," Dr. Kline concluded, "than a really good solution."

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