In the early 1950s, with chlorpromazine just making its first rounds, none of the doctors, scientists, psychiatrists or researchers involved knew a thing about psychopharmacology. In fact, the word barely existed in the normal lexicon. Jacques Lh.’s doctors saw his illness go away, and they had no reason to think anything but that the drug had cured him, just as penicillin cures the patient of strep and, once cured, the patient can cease the medication. Jacques Lh. himself probably thought he was cured, and while there is no record of his response to the clarity that came with his particular drug cocktail, we can imagine he must have experienced it as a real relief, because psychosis is a dreadful state in which a person is hounded by hallucinations, the head crammed full of squeals and screams, the body wracked by daytime dreams of steep stairs and burning bonfires and pitiless gods who demand idiosyncratic sacrifices at altars no one can see. Jacques Lh. trudged out into the world with his head mercifully emptied of the cruel chaos that constitutes a psychotic illness, having been briefly blessed with a state of ‘normal’ calm that must have made his symptoms, when they returned, as they were bound to, that much sharper, fiercer, hotter, harder – the sanguine self a dim memory if even that.
Sainte-Anne
Less than a mile from the Val-de-Grâce military hospital, where Laborit laboured in search of the safest anaesthetics, stood another imposing institution, right in the heart of Paris, surrounded by city streets to which vendors flocked on market days to sell their wares – buckets of bright flowers, fish, their silver scales aglitter in the sun, laid out on beds of ice, oranges stacked in pretty pyramids, and healthy rotund watermelons, their thick rinds striped with the palest seams of green. This institution was called Hôpital Sainte-Anne, one of Paris’s only mental hospitals, housing in the early 1950s over five thousand patients who crowded its dimly lit halls, who crouched in corners or paced the corridors talking to invisible rivals. These five thousand patients were divided into wards – locked and open, male and female – all of which were presided over by one thousand nurses and other staff members, and then, supervising the nurses, the junior psychiatrists, and supervising the junior psychiatrists the senior psychiatrists, and, sitting at the helm, a deeply intelligent and fiercely hierarchical patrician named Jean Delay, considered one of the most brilliant doctors of his generation.
Delay’s father had been a respected surgeon in the south of France who wanted his son to follow in his footsteps, which Delay did, passing all of his examinations with perfect or near-perfect scores, despite realising, at some point in his medical education, that surgery did not interest him half as much as the human head. Diverting from the path his father had laid out for him, Delay veered into neurology while also studying psychiatry at the Sorbonne, with a thesis on memory and its pathology. Unlike Laborit, who abhorred hierarchy and who would, after sharing the Lasker Prize in 1957 for his role in the discovery of chlorpromazine, set up his own private lab in which he could pursue his own interests unencumbered by the daily demands of life on the medical fast track, Delay thrived on the rat race, keen to prove his considerable merits and, in the process, to earn his seat at the tip of the top. Thus, when he was appointed full professor and head of the department of psychiatry at the University of Paris, which was housed within the Sainte-Anne complex, Delay easily and keenly took this coveted position, overseeing the jam-packed wards from a benevolent distance, always with his assistants, Pierre Deniker and Pierre Pichot, by his side.
Perhaps in part because of Delay’s wide and learned mind (he read deeply in diverse subjects and had a love of literature), Sainte-Anne, despite its wretched patients and mediocre resources, attracted many talented psychiatrists and researchers. For a time Jacques Lacan came there to give weekly seminars, which drew audiences much larger than Delay’s, a fact that bothered Delay so much he eventually sent Lacan across town, to opine elsewhere. He was that sort of man, grandiose but benevolent, full of himself and hitched to his hierarchy but prone to jealousy, and yet so smart, so superbly educated, that it was hard to quibble with his position.
Yet despite Delay’s stature, the breadth and depth of his mind and his education, Sainte-Anne in the early 1950s was like any other insane asylum of its time. Patients were treated in the typical manner, with enemas given in the hope of detoxifying their colons and emptying their innards of illness, electroconvulsive shock therapy performed minus the muscle relaxants, so that the patients’ entire bodies were wracked with current, and lobotomies practised, going in through the eye sockets, with an ice pick, or in through the skull, into which two holes were drilled before inserting the knife blade or spatula, a quick swish swish and it was done. Baths were drawn in attempts to soothe manic agitation, with water rumbling into ancient claw-foot tubs and the tiled rooms dense with steam, the moist mirrors dripping and distorting in a Dalí-esque way. One female patient in Sainte-Anne suffered second-degree burns because she was tied into her bath and the cold water pipe ceased working, scalding her, the nurses ignoring her screams as they were so used to such sounds.
People walking to and fro on the busy city streets below Sainte-Anne regularly heard the wails and slams and tilted laughter of the madmen and women behind those brick walls. Not even a man as learned as Delay could do much to help his charges, and this may be why he kept a careful distance between himself and the patients, seeing only the most difficult cases and only on occasion. His aristocratic bearing was entirely at odds with the reality of the hospital he had to run. He ran it by delegating, by sealing himself inside his well-appointed office, where he received the crème de la crème of the psychiatric, scientific and artistic community. He was close friends with André Gide and received visits from the poet Henri Michaux, who regularly used psychedelic mushrooms to stimulate his muse.
Delay and his main assistant, Pierre Deniker, who oversaw the male locked wards, knew nothing about chlorpromazine, even after Rhône-Poulenc released samples of it into the medical community. They did not know about patient Jacques Lh.; they had not read Laborit’s published paper in which he ended by suggesting that the compound might have a place in psychiatry. They did not know about Cornelia Quarti or about psychiatrists Jean Sigwald and Daniel Bouttier, who had successfully used the drug – alone, rather than as part of a blend – on Madame Gob, a fifty-seven-year-old psychotic patient at the Hôpital Paul Brousse, also in Paris, in December 1951. Sigwald and Bouttier were the first ever to use chlorpromazine on a patient for psychiatric purposes (as opposed to Laborit’s surgical, anaesthetic use), but they did not publish their results until 1953, while Colonel Hamon and his colleagues released their results on Jacques Lh. in March 1952, making them the first psychiatrists to publish an account of chlorpromazine’s psychiatric use, with barbiturates.
Delay and Deniker first learned about chlorpromazine at the end of 1951, when Deniker’s brother-in-law, an anaesthetist – who had himself heard of Laborit’s use of chlorpromazine with artificial hibernation and had tried the drug on his own patients – suggested to Deniker that he might be interested in it for its tranquillising properties. Thus, on 2 February 1952, at Deniker’s request, Rhône-Poulenc sent to Sainte-Anne some samples of chlorpromazine. Deniker, who had tried all sorts of somatic treatments on his patients, with no luck, was likely not expecting much. He chose a group of six male patients, in whom he would induce a kind of artificial hibernation while simultaneously administering the drug, much like Laborit. At this point chlorpromazine had been in circulation for several months and a number of psychiatrists had tried it, many with good, if not outstanding, results, but none of the psychiatrists, except Sigwald and Bouttier, had tried chlorpromazine alone. All of them had used it in conjunction with other drugs. Deniker set out to use chlorpromazine all by itself, although he did request, and receive, slabs and buckets of ice from the hospital pharmacy. The patients were packed in these cold cubes and then shot up in an arm or a buttock while Deniker sat by their side and nurses rushed to and fro, replacing melted ice with more and more i
ce until at last the pharmacy could not keep up with the demand and the frozen component was abandoned and the drug administered entirely alone.
Here is what happened. Although science and magic are exactly the opposite of each other, the latter accomplished through impenetrable mystery or miracle, the former undergirded by replicable results that prove to have relevance and validity in the material world, chlorpromazine’s effects on the minds of the mad, while clearly rooted in the science of pharmacology, nevertheless had a distinctly magical feel. This was made all the more so because in 1952, little was known about the biochemistry of the brain; no one knew about serotonin, dopamine, noradrenaline or the synaptic cleft. So when chlorpromazine worked – and work it did, extraordinarily well – it seemed less like a drug had been given and more like a wand had been waved, all the junk and rumble and static and screams stuffed inside the wracked minds of the insane just emptying out, leaving in their wake the tender but beautiful fabric of cogent thought, of untainted language, of intact memory, longing and love. Nameless patients suddenly had names. They had histories and hopes their illness had smothered but not snuffed, and now the hope was here again. They had humour and abilities of which their doctors had had no idea.
There was, for instance, the case of Phillippe Burg. Burg had been enveloped in a deep psychotic state for years, utterly unreachable. He hadn’t walked, or even talked. Nothing had helped him, and every treatment had been tried. Once given chlorpromazine, however, and over a series of weeks, Burg began to emerge from his madness. The torpor that had trapped him diminished and then disappeared. The man began to move about, to stretch, to place one foot in front of the other, carefully, cautiously, as if to test that the floor beneath his feet was real. It was. He walked, for the first time in more years than anyone could count. And then, after he began to walk, he started, also, to talk. He said his name –Phillippe Burg – and then he asked his doctors what their names were, and suddenly a real relationship began where before there had been only handling. Burg progressed so rapidly on chlorpromazine that eventually the hospital staff allowed him to attend an outing with his mother. The pair went to dinner at Hemingway’s favourite haunt, the Closerie des Lilas.
Other patients, too, in other hospitals around France, began to emerge from their murk as news of chlorpromazine spread. Catatonic patients tended to respond almost immediately, whereas others needed days or weeks to stabilise. Either way, the responses were often incredible. One newly awakened patient in an asylum near Lyon had a severe sickness that had kept him cloudy for years. But now, on chlorpromazine, he told his doctor, Jean Perrin, that he knew who he was and where he was. He reported that he was a barber from Lyon and that now, well, he would like to go back to work. His psychiatrist responded with a challenge. ‘Give me a shave,’ the doctor suggested intrepidly to the barber, whose skills must have been at the very least rusty, dulled from years of disuse and disease. Nurses produced a bowl of warm water, a stack of clean and folded towels, some soap and an unsheathed blade, which was placed in the barber’s hand. The doctor sat in a seat while the recently revived patient smocked him with the towels and soaped up his chin and cheeks. Then, with sane and steady hands, the barber raked the razor over the iron filings of stubble until the psychiatrist’s skin was perfectly smooth and satiny.
At the Bassens Hospital, in Rhône-Alpes, was another patient about whom nothing was known. Like the barber from Lyon, this patient also had been stuck in an interminable series of rigid postures, and, also like the barber, had been failed by all the treatments the doctors had tried. As with the barber, this patient responded to chlorpromazine in a single day. After receiving an intramuscular injection, he suddenly began greeting the nurses, calling each one by name, correctly, as if, over all these years, facts had indeed seeped beneath the snow of his psychosis, and the real world, the nominal world, had made its way into his scrambled mind even as his mouth was unable to articulate what he had absorbed. After he’d greeted the nurses, he had an odd request: some billiard balls, please. Billiard balls? Yes, billiard balls. With some misgivings the staff produced for the now walking and talking patient three bright billiard balls, which the patient began to juggle expertly, keeping up a steady tempo as the balls rose and fell into his cupped and careful palms, managing it all with elaborate and expert finesse. He had been a juggler in his former life, it turned out, before insanity had come to claim him, and now, like the barber, he wanted to return to his vocation.
On wards all across France, scenes like this played out as papers were published and word spread through the psychiatric grapevine. There was a drug! At last there was a drug! It really worked! Patients who’d been cast for years in catatonic postures were dusting themselves off and walking away into the world, whistling. Many French psychiatrists looked and listened with a deep and tired scepticism, because for years they’d been trying this and that and that and this, going so far as to drill holes into the sides of their patients’ skulls and cut the connections, bringing the wires down. Other psychiatrists, however, especially the younger ones, were quicker to believe that this new drug might be a brew worth trying. In fact, in Sainte-Anne and other psychiatric institutions, the younger psychiatrists started to appear in the admissions centres, offering to bring the trickiest and most troubled patients back to their floors because, well, there was a drug!
Nurses crushed capsules of chlorpromazine into patients’ food, or doctors injected it into their striated muscles, and everywhere across France patients responded by waking up and looking around, oftentimes with as much confusion as relief. The world was not as they recalled it. Some of these patients had been sunk in inaccessible psychoses for decades. Now they looked outside the barred windows of their wards and saw streets full of cars and no horse-drawn carriages anywhere – where had they gone? The cars whizzed by, their horns tooting, their colours all gloss and glow. The patients were allowed to go on outings and discovered that prices were so much higher than they remembered. It was a world of quickened time and tempo. It was a world where electric lights lit the streets at night, casting shadows on the floors of the patients’ hospital rooms. It was a world that was in many ways as strange as their psychoses, as if they’d been kissed by a prince or a princess, or been the unwitting subject of some chemical abracadabra.
With so many patients awakening within the walls of their asylums, screams replaced with coherent speech, crazed laughter now hushed, one imagines that the streets around asylums quieted. Outside of Sainte-Anne’s, for instance, there was a busy market that sold produce and fish and fresh eggs and cream. Jean Thuillier, the psychiatrist who had treated Phillippe Burg, would sometimes leave his office and wander the open-air market to shop for his family. ‘During the spring and summer the windows of the hospital would be open on to the street and you could hear the wailing and the screaming of the patients,’ he said. ‘But the first year of the neuroleptics I remember one fish dealer who knew me well pulling me aside and asking me with wonder, “Doctor, what are you doing with the patients up there? We don’t hear them any more.” “I’m not killing them,” I told him.’ The fish dealer was not the only one to notice the sudden silence that had come over the wards. The glaziers, called in to replace the panes of glass that were so frequently smashed, also found themselves with far less work to do.
Rhône-Poulenc took note of the psychiatric success stories and began issuing what they called ‘provisional notes’ with each new batch of the drug. These notes suggested that the drug might have uses beyond being an anaesthetic potentiator and an anti-emetic, that, specifically, it might have uses in psychiatry as well. Laborit suggested that Rhône-Poulenc give the drug the name Largactil, meaning ‘large action’, a drug appropriate for many different needs and states, and thus chlorpromazine became known, in France (and the UK), as Largactil, chosen to express ‘the extreme diversity of the drug’s psychodynamic activities’. The company decided to market the drug not only to psychiatrists and surgeons but also to anaesthet
ists, obstetricians and gynaecologists.
Chlorpromazine in the United States
As all across France, and then Europe more generally, patients locked inside psychotic states were beginning to wake up and psychiatrists, who had often previously felt marginalised, were tasting their triumph, finally possessing a drug that made their fringe status in medicine more a thing of the past (or so they hoped), Rhône-Poulenc was thinking about how to maximise profits not just in Europe but worldwide. In 1952 the French pharmaceutical company approached Smith, Kline & French, a US pharmaceutical firm, about licensing chlorpromazine. The president of Smith, Kline & French responded to Rhône-Poulenc’s inquiry by writing, ‘The compound is exceedingly interesting at first glance and I wonder if you could arrange to send us, as soon as possible, 500 grams of the pure substance for our use in tests here.’
The Drugs That Changed Our Minds Page 4
