Nathan S. Kline, MD, is widely heralded as the father of American psychopharmacology and the discoverer of the original antidepressant and antipsychotic drugs. His discoveries in the 1950s and 1960s ushered in a new era in American and global psychiatry and sparked the transition from a psychoanalytically-inclined psychiatry to a field dominated by biology, neuroscience, and psychopharmacology. Historians of psychiatry note that it is largely because of Nathan Kline’s early research that we have the psychiatry of today—one marked by its emphasis on diagnosis and medication, and its seeming repudiation of psychotherapy.
Throughout his long and accomplished career as a researcher and psychiatrist, Kline asserted that a more complete understanding of psychoactive substances and their effect on human functioning could forever change the landscape of psychiatry—and mankind in general. In a quote widely attributed to Kline, he submitted:
“Those of us who work in this field see a developing potential for a nearly total control of human emotional status, mental functioning, and will to act. These human phenomena can be started, stopped or eliminated by the use of various types of chemical substances. What we can produce with our science now will affect the entire society.”
Clearly, Kline recognized the vast influence that his discoveries would have, not only for psychiatry but for the future of humanity.
I once treated a patient in psychotherapy who had seen Dr. Kline many years earlier, in the 1960s. The patient paid $900 for a consultation with Dr. Kline at his private office in Manhattan—a small price to pay given that the patient’s life was being completely overtaken by his extreme mood swings, and no treatment up to that time had been able to help him. At a time when most psychiatrists were psychoanalysts, Kline was investigating with psychotropic drugs, and the patient was desperately seeking relief. For the first time in his life, the patient was diagnosed with manic-depression and started on a new drug called lithium. To this day, the patient credits Dr. Kline with saving his life and giving him hope for a meaningful and productive existence.
Despite Kline’s widespread success and optimism regarding the promise of psychopharmacology, he frequently warned of the misuse and overuse of psychiatric medications. In 1957, Kline wrote:
“The tranquilizing drugs, as I have repeatedly and strongly urged, should be used only for the treatment of those whose mental and emotional state disables them… The picture of the snarling vicious dangerous monkey transformed by a few milligrams of a chemical into a friendly ‘tranquil’ and ‘happy’ animal fascinates me in a horrendous way. Such a creature is a pleasure to have around the laboratory, but he would not last ten minutes in his native jungle. Similarly, mankind is perfectly capable of tranquilizing itself into oblivion.“1 [emphasis added]
Kline himself was trained as a psychotherapist, having Paul Schilder, the famous Austrian psychoanalyst, as his mentor. At the Rockland State Hospital in New York, where Kline conducted his research, he kept psychoanalytic psychiatrists and psychologists on staff to provide psychotherapy. Kline insisted that his discoveries were adjunctive to psychotherapy, not replacements, and that there was no inherent antagonism between his biological approach and a more traditional psychotherapy-based approach. Kline was clearly friendly towards his psychotherapist colleagues, and although he may have disagreed with them regarding the nature of mental disorder, he saw psychotherapy as serving a very useful role in many, if not all, forms of psychopathology.
This is, of course, in sharp contrast with the psychopharmacology of today. Modern psychopharmacology operates with a hubris and certainty that the solution to all psychiatric conditions—and life problems—is a pill, and that psychotherapy may provide some relief from suffering but does not really “treat” mental disorder. This belief is based on the flawed assumption that mental disorders are brain diseases and that psychiatric medications treat diseases, not symptoms. (See my article on the myth of the chemical imbalance here.) Psychotherapy is seen as a “second-class” treatment, its practitioners as “less than” the medically credentialed biological psychiatrists. But this is a complete reversal of the psychopharmacology of Kline’s era which, despite its successes, recognized that medications are a blunt instrument—methods of changing experience but useless in changing people.
Modern psychiatry would be wise to heed Kline’s warning on tranquilizing itself—and the world—into oblivion. Psychiatric medications can certainly help some people, but there is vast agreement that they are grossly overprescribed, do not treat any known diseases, and provide only superficial relief. Thankfully, a number of well-respected psychiatrists have recently begun to speak up about the limitations of a strictly biological approach, among them Allen Frances and Daniel Carlat. One can only hope that the psychiatry of tomorrow places medication into its appropriate context and heeds Dr. Kline’s wise—and ominous—warning.