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.
- Kline, N. S. (1957). Foreward. In R. S. de Ropp, Drugs and the mind (p. ix). New York: Random House. ↩
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
good blog…I think the problem we have today is very difficult…
we still don’t know the CAUSES of most mental suffering…
so we can go ahead and treat the symptoms with any kind of treatment..
whether it works or not…I see another problem here…many persons
would like to throw out biology from the model of causation bio/psych/soc..
We all believe in a physical universe, Littleturtle. We all believe biology is real. I believe making someone take mind altering drugs for decades on end, destroying parts of the brain with bursts of electroshock, or whacking someone over the head repeatedly with a wooden bat effecst the biology of that person.
Until a bio-marker can be located how can any drugs or surgery help? A drug may lower the exact chemicals already in short supply and elevate those already too high. Many of us here doubt madness is caused by biology (in most cases.) But even assuming it is, until we know what parts of the brain are responsible for the inability to function, how can we justify random experimental drugs and electroshock? Would any respectable surgeon perform brain surgery in the dark–not even knowing if the cancer existed?
Thank you, sir. I sincerely believe that the average psychiatrist, even today, started out with the best intentions, even if Big Pharma’s marketing money has mostly corrupted the entire establishment and skewed their conversation, with their relentless propaganda, in the direction of pharmaceuticals. It is good to see when a psychiatrist, especially one of his apparent eminence, also realized the dangers implicit in the use of psychotropic drugs. I am not opposed to the use of drugs in all circumstances, even if I believe that their long-term use is harmful. Thank you for reminding us of this person, who clearly meant to do good, and was humble enough and cautious enough that he did the best he could with a balance of therapy and drugs. Best to you, sir.
Thank you for the comment here. I am in agreement that most psychiatrists do not enter the field with the intention of doing harm or controlling their patients. As someone who teaches psychiatry residents, I think most are sincerely looking to help the human condition. My position on drugs is simple: as long as the patient consents to them and is informed that they are not treating any known diseases, I am okay with them. In my opinion, any other position negates the patient’s autonomy and self-responsibility.
Dr. Ruffalo, although I have been badly damaged by psychiatry, in all fairness I have only known one truly evil psych doctor. She behaved in a sadistic seeming manner at times. I doubt she started out that way though. 1 out of 12. Could be a lot worse.
(I never should have been called bipolar; no mood swings till I started Anafranil and none since I tapered off my cocktail.)
“My position on drugs is simple: as long as the patient consents to them and is informed that they are not treating any known diseases, I am okay with them.” The problem is this is the opposite of what todays’ “mental health professionals” have been doing. They lie to the patients and their families claiming the patient has a “chemical imbalance in their brain” and a “lifelong incurable genetic mental illness” that mandates the drugs. Then they threaten the patient by claiming that if they do not takes all the drugs as prescribed “all the doctors will call you paranoid.” But you do make a good point, we should get rid of the DSM, so the “mental health professionals” do not have “diseases” to use to coerce and force patients into taking the drugs. Especially since the DSM was declared “invalid” years ago.
Dr. Ruffalo, You stated that “as long as the patient consents to them (drugs), and is informed that they are not treating any known diseases, I am okay with them.”
I am of the understanding that the purpose for prescribing a drug to a patient is indeed to treat an illness or disease … for example, antibiotics are prescribed to a patient who suffers from a bacterial infection … the right antibiotic that will kill that bacteria is prescribed to the patient to do just that. What is the purpose for prescribing a drug that doesn’t treat anything? As well, patients typically have faith in their doctor’s inclination to do the right thing – they trust that the doctor will give them what is needed to make them well. Why would you give them a drug that won’t cure anything? Informing the patient is your disclaimer to avoid accountability – and just because you inform them, that doesn’t make it okay to give them a drug that is useless. The only thing that comes out of that, is the money that is made selling the drug, because you have already stated it won’t do anything to make the patient better. I’m conjecturing that even if a patient is told that the drug you are prescribing them won’t cure anything, the patient likely figures there must be some reason for you prescribing it – or it wouldn’t be prescribed! I don’t comprehend how you can possibly be “okay” with giving a patient a prescription drug that you know won’t do anything, simply because you told that patient that it wouldn’t.
Thank you for your comment. You are right that drugs treat disease. But drugs have also been used for thousands upon thousands of years to ease suffering. I never said that psychiatric drugs “do nothing.” To the contrary, many people seem to find relief in them, although the reasons for this are complicated. Unlike many associated with “anti-psychiatry,” I believe in an unregulated free market in psychiatric drugs. If a person wants Prozac or lithium, he should be able to walk to the pharmacy and buy it without a prescription. The reason for this is simple: I believe in freedom. This is the view of Thomas Szasz, who said the same thing for electroshock, lobotomy, etc. Any other view infantilizes the patient (person) and limits his autonomy even further. There are no psychiatric diseases, and psychiatric drugs don’t treat diseases. But this is not sufficient justification for restricting them from people.
I certainly wouldn’t be out to excuse the so-called father of psycho-pharmacology. Nathan Kline’s scientism reminds me of the scientism of B. F. Skinner. In one version, you’ve got rewards and punishments behind behaviors, in another, chemistry. While humanity is in no danger of “tranquilizing” itself out of existence, it has come a long way towards “tranquilizing” particular, and unwanted, segments of that humanity out of existence.
The good news is that the reason I’ve never had ECT, nor a lobotomy, might have something to do with Nathan Kline’s work. Shock treatment in institutions, for diagnoses other than simply depression, was much more common prior to the introduction of neuroleptics. Also, not to downplay the efforts of many many people to end the practice, chemical lobotomy basically did in the perceived necessity for having surgical lobotomies.
This is where the numbers start to tell a different story. I wouldn’t say the numbers of the casualties (non-survivors) declined after Nathan Kline’s work. All you have to do is read Peter Breggin or Robert Whitaker to get the other side of the picture. Treatment since has gotten more, rather than less, deadly, and this is alarming for another reason. Once society had a tendency to needlessly lock some individuals up for life. When it was doing so, the life expectancy of the person in the institution wasn’t so foreshortened as it is today. I don’t really consider early death an improvement over life imprisonment when it comes down to it. The death rate among people in the mental health treatment is alarming, an international scandal and tragedy, and this death rate is a direct result of the work of the likes of Nathan Kline.
Thank you for your comment. We may disagree here. I would much rather have outpatients who are free to refuse medications than inpatients who are civilly committed and unable to refuse drugs, electroshock, etc. While Kline’s work opened up the door for what later became an out-of-control biological psychiatry, he alone cannot be blamed for this, as he was very clearly cautious about the widespread use of psychotropics.
If anybody is to practice psychiatry, I’d like to see more non-drug docs in the practice. Just as we’ve got shock docs, we’ve got drug docs. Generally it boils down to how little or how much of a drug doc do we have. There aren’t a lot of non-drug docs out there. Were patients given an option, there would be a few fewer patients maintained, at the expense of their overall health, on neuroleptics. Although Szasz, whose book you cite, could be referred to as a non-drug doc, I don’t think the same could be said for you or Dr. Kline. Thomas Szasz does spotlight the morality of the issue, and in that sense, I guess the four of us are in agreement. Harming people through the excessive use of neuroleptics is not the way to go if we can do anything else.
We are in agreement there that most “anti-medication” psychiatrists are actually just “anti-excessive medication.” I am not a drug doc. In fact, I am not even a psychiatrist–I am a psychoanalyst. What you say about Szasz is actually mistaken. He believed people should be free to seek psychiatric drugs, just as they should be free to seek alcohol, cocaine, or marijuana. He just did not want any part in prescribing them. I am of a similar belief. Some people may find some relief in medication, and who am I to keep that from them? Szasz had no interest in banning psychiatric drugs, unlike some of the others associated with “anti-psychiatry.” His book Antipsychiatry: Quackery Squared reveals these beliefs.
He just did not want any part in prescribing them.
I rest my case.
As you are a social worker, and not a psychiatrist, my apologies. I did get that wrong.
Szasz also justified shock on the same grounds. What a shot in the arm given ‘direct to consumer advertising’? In other words, his view was that if a person thinks he or she would be helped through the harm he or she received, he or she should be able to get the harm he or she sought. He was against coercive non-consensual treatment. I can’t say that I myself would be so quick to encourage self, or other, harm, but that is that.
I think it’s fairly clear that though Kline appeared at the beginning of the drug era, he was not totally responsible for the disaster of today’s somatic psychiatry. I was working in psychiatry from 1969, and the `tranquillisers’ were seen as the saviour of the` mental patient’. The tormented back ward patient, locked up, restrained, at the mercy of his/her hallucinations and delusions was able to go home for weekends, walk the grounds, go shopping or even to the races. They even meant that ECT was used far less to the point where it was being phased out altogether. We all, including many patients looked on them with great hope.
But before long the nasty side of them appeared, the horrible movement disorders, the suppression of emotion etc, and some of us began to try to work without them. These social, psychological interventions were possibly the forerunners to programs like Open Dialogue.
Sadly with the psychiatric pharmaceutical alliance that really gathered pace in the mid to late 1970s, this approach was abandoned. The other push towards bio-psychiatry was the fact that they were no match for psychologists, mostly women, in their training and ability to use psychotherapy techniques. As a result, when they set up in private practice they were not the preferred source for patients. The resultant threat to their income and the fact that they were not respected as `doctors’ by the rest of the profession meant they doubled down and with the help of the pharmaceutical industry, very good PR and the DSM 3 – somatic psychiatry as we know it today was built.
I believe psychiatry from 1965 on will be marked in history as one of the great tragedies of humanity.
Tranquilizing is what drugs are for, its what talk therapy is for, all designed to politically neutralize survivors.
The goal of any ethical psychotherapy is not to tranquilize the patient but rather to free him or her, to support and expand the patient’s autonomy and self-determination. This is in stark contrast to the biological approach. See The Ethics of Psychoanalysis by Szasz (1965).
“The goal of any ethical psychotherapy is not to tranquilize the patient but rather to free him or her”
But this is the opposite of what psychotherapy does. Rather, it continues to make people believe that their aggression and sexuality are wrong, and that these are the source of the problem.
Psychotherapy teaches people to submit to an unjust world without complaint. It teaches them to believe that anytime there is a problem, it is they themselves who are at fault.
Your psychotherapist is not your friend, they are a secondary abuser. Your psychotherapist has not put abusers into prison, sued them for their last dollar, or hunted them down across continents and across oceans to bring them to justice. Your psychotherapist is not going to inflict penalties on the abusers or obtain reparations for the survivors.
Right now, if educated middle-class parents are abusing their child about all they have to fear is that the child will spend the rest of their life on the therapist’s couch confessing about how angry they are.
Okay. So therapists are not attorneys/trans-continental bounty hunters turned vigilante?
If you have the financial resources to pull off such a scheme good luck!
Well it is simply a matter of survivors starting to stand up for themselves, instead of allowing themselves to be prey for therapists, the Recovery Movement, life-coaches and motivationalists.
How many Americans have been through a divorce from a spouse?
Well how many Americans have cause to seek redress from abuser parents? How many have actually tried this? How many have prevailed?
The road to justice is long. But every day standing up for yourself is better than living by seeking pity.
From what I can see Psychiatry creates diagnoses and illnesses that cost the taxpayer an awful lot of money.
I would say that at least 50 percent of UK Mental Health Expense is created by White Collar Professional Fraud.
The psychiatric illnesses are longterm because nobody gets better by taking tranquillisers regularly.
Psychotherapy, Recovery, and Motivationalism also treats survivors as thought they suffer from some sort of a malady or character disorder, like they need to be fixed.
So the first step in standing up for ourselves is simply to take a zero tolerance position with regard to any healers, fixers, or motivators.
I’m sure this is true about Norman Kline, but for an indication of just how early the drug companies were pushing substances that would “tranquilize us into oblivion,” as Kline says, see these ads from the 50s from Smith, Kline, and French for Thorazine. Good for, let’s see: arthritis, menopause, “senile agitation,” “hyperactive” children, cancer, bursitis, alcoholism, pain (wouldn’t want any pain…), and, of course psychosis and scizophrenia. My mother was given the stuff for several years as an alternative to being committed. It “became necessary” shortly after her parents told her they would not support her in any way if she left a bad marriage. So, you know, bad marriage + thorazine or mental institution, take your choice. Anyway, I would imagine Kline had things like this in mind when he said that about tranqulizing ourselves into oblivion.
Interesting point Kline made about the drugged monkey. By chemically disabling the monkey for his own (Kline’s) comfort and convenience he ruined its hope for surviving in the wild. A valid point for consideration when we view how psych drugs alter those deemed “mentally ill.”
Dear Dr Ruffalo,
Thanks for the informative Article.
“…psychiatry of today—one marked by its emphasis on diagnosis and medication, and its seeming repudiation of psychotherapy….:
The Reality of Life is, that if a person gets Better, then they get Better.
A Dr Wray at my GP Surgery, Newton Medical Centre, in Central London told me in 2012 that if someone “has a diagnosis of Schizophrenia” then, they would remain “Mentally Ill”.
I reported myself during the interview as WELL and the doctor recorded “..mildly agitated but no sign of thought disorder no sign of self neglect ..currently functioning….down for a blood cholesterol test….”
I had become consistently well and functional, when I stopped consuming neuroleptics in 1984 (and this is clear from my history).
(I had been disabled and suicidal and in and out of hospital between 1980 and 1984, while I consumed neuroleptics – because I had suffered very badly from the Ill effects of neuroleptics).
Newton Medical were Gaslighting!
By having the audacity to recover without the neuroleptics they prescribed you were a threat to the way they viewed the world. (Not to mention their livelihoods.)
Cognitive dissonance is a bear!
Isn’t it interesting that psychiatry is the only medical specialty that doesn’t promote the recovery of its patients and doesn’t even believe in the possibility of such a thing happening. Even cancer doctors work their hardest to help their patients towards at least a possible recovery. Not psychiatry. Something is badly wrong here!
If a person recovers from heart disease or diabetes through lifestyle change – the doctors will be interested in finding out why.
But, with “Mental Health” the doctors will attempt to pull a recovered person back into sickness. Recovery is factual though – It has nothing to do with opinion.
The Doctors at my GP Surgery, Newton Medical were dishonest – but this type of dishonesty I’d imagine is Commonpractice.
My psychiatrists would attribute all improvement I made to med compliance and all set backs to missing doses or on rare occasions some admitted “maybe they aren’t working.” This was especially funny when a psychiatrist noted my “improved effect” or natural smiling and said the drugs she prescribed must be just right. I had been tapering off my abilify unbeknownst to her and getting better despite her course of treatment!
My original GP ‘Gaslighter’ endorsing “get rich quick” schemes:-
I gave him a thumbs down for you Fiachra!
He was very ‘nice’, but I had the feeling that he wasn’t genuine. He eventually became mentally unstable, and was asked to leave!
Haldol affects 2 dopamine receptor subtypes ( it took me 10 years to finally get off of a 2mg. prescription of haldol alone )
Abilify affects 10 different receptor subtypes
Zyprexa affects approximately 17 different subtypes of receptors
When these “meds” are lowered the body has to adapt to the number of receptors that become unblocked.
Reading between the lines- it appears thought leader psychiatrists are so optimistic about the future of their “field”- because they understand – their own suppliers the pharmaceutical cartel are in effect entirely unrestrained as to their right to invent- label -and have distributed -as “medicine” any substance or mixture of substances (poisons of all types or whatever)- to shut down/ or retard any human brain function or body function, targeting any place within the brain or human body as they see fit . While psychiatrists themselves can label people for life -via the DSM- and increasingly force medicate and monitor human beings with a growing rigor-and apply to them a growing ever more deadly arsenal of “meds” – ever more difficult to withdraw from- plus higher voltage electric shock if the psychiatrist wishes . Even if we think we left psychiatry behind the nursing homes which many humans hope not to enter is a world of unrestricted psychiatric, pharma and “medical” oppression . And the Hospice – we will get morphine whether we want it or not .
There are ethical practitioners that can help people ease withdrawal even at MIA’s own list of resources.Take the time to investigate thoroughly and choose wisely . Tools for a withdrawal tool box are not all in only one place . Don’t forget survivors that have come out the other end of it may have self developed first do no harm withdrawal and survival techniques which are not respected sufficiently by “professionals” “academics” or anyone else that make them reluctant to cast their pearls into the public arena only to be laughed at . Do we really think that big-pharma think tanks are short the funds to counter anything they hear about ?
Psychiatric drugs are popular for the same reasons that street drugs and alcohol are.
And our world does not want to face the systemic abuse which is the middle-class family. Rather, the survivors side with the abusers, as they see the way forward as living via denial and dissociation.
Abuse occurs among lower-class and upper-class families too. Among the lower-class they are sometimes taken out of a bad situation and put into one worse. With upper-class families they can pay hush money to authorities.
To be middle-class in America is not to be of a middle income level. To be middle-class is to be of a mind set, to have accepted a set of values and standards.
At this point, there is no other class than the middle-class.