Lucas Richert is the George Urdang Chair in the History of Pharmacy at the University of Wisconsin, Madison, and historical director for the American Institute of the History of Pharmacy. His work explores prescription and illicit drugs, the American counterculture, and the influence of various power structures within and beyond psychiatry.
As a scholar of the pharmaceutical industry, Richert encountered a trove of historical documents that talked about the self-described radicals in mental health from the 1970s. “They cared about relevant issues, things that we talk about right now: racism, the environment, militarism, and political division. It really grabbed hold of me when I got these documents, they were a catalyst.” This project turned into his third book, Break on Through: Radical psychiatry and the American counterculture, in which he examines the tumultuous 1970s in America with a focus “not just on the elite doctors and people in positions of power, but also wider societal trends.”
In addition to Break on Through, Richert has published A Prescription for Scandal: Conservatism, consumer choice, and the food and drug administration during the Reagan era and Strange Trips: Science culture, and the regulation of drugs. His fourth book, Cannabis: Global histories, will be available later this year (2021).
In this interview, we will discuss the radical landscape of American psychiatry in the 1970s, “therapeutic” and “non-therapeutic” drugs and how they are classified as such, and feminist critiques of psychiatric institutions.
The transcript below has been edited for length and clarity. Listen to the audio of the interview here.
Richard Sears: First, I wanted to ask you about what brought you to study the history of pharmacy and psychiatry?
Lucas Richert: I really enjoy contributing to Mad in America. I respect what you guys are doing. The history of psychiatry and mental health has been a big draw for professional historians and the public, including me. The subject area is just by nature incredibly important and fascinating, especially now in the midst of this pandemic.
I started as a scholar of the pharmaceutical industry. It was around 2008 that I found some historical documents that talked about radicals in mental health. This was set in the 1960s and early 1970s and these self-described mental health radicals identified with certain counter-cultural values. They cared about relevant issues, things that we talk about right now: racism, the environment, militarism, and political division. It really grabbed hold of me when I got these documents. They were a catalyst. I was in Philadelphia at a library, and I just thought, whoa, this could make for a really intriguing project. That turned out to be Break on Through.
It was a pretty fascinating personal journey to try and develop the project and write the book. What I wanted to do was write a different kind of book. A lot of excellent authors and scholars had already written about specific treatments that have been featured in Mad in America. A lot about antidepressants, a lot about ECT, psychoanalysis, and biological psychiatry. A lot of fantastic authors have done that. I tried to write a more expansive, slightly more experimental book and try to offer a re-interpretation of medical and mental health knowledge in the seventies.
Sears: I want to talk a little bit about the turn in that period towards social, economic, and political concerns. We got the biopsychosocial model in psychology. We started asking more questions like: How do you feel? What’s going on around you? I wonder if you could speak a little bit about specific events and decisions in psychiatry that got us to that point.
Richert: Your question speaks to the complexity and change during the sixties and seventies. There was a lot happening—with different events, decisions, disagreements, and problems—within the psy-disciplines, but also outside in society. What I try to do in the book and some of my other writings is capture just how complex the era was.
Mental health knowledge and practice were highly contested. Debates about the self and techniques were supercharged at given times. The expansive approach I took to the book as a way to try and capture just how many ideas and issues were floating about in the sixties/seventies and connect what was going on with the counterculture with what was going on within the American psy-disciplines.
What I want to get across is that certain bodies of mental health knowledge, psychological or psychiatric, weren’t fixed in any sort of way. This knowledge shouldn’t be regarded as universal, atemporal, or even 100% objective. By putting a spotlight on the sixties and seventies, you can see just how fluid that knowledge was within these sciences. There were struggles over the validity of psychoanalysis. In Break on Through, some of the radicals I showcase talked about the need for more evidence-based approaches and biological approaches. At the same time, you had the emergence of slightly new, fringe maybe, mental health treatments like Arthur Janov’s primal therapy. Then, at the same time, you had the rise of parapsychology in the late sixties as a part of this bubbling ferment of ideas.
Even Raymond Wagoner, the head of the American Psychiatric Association in 1968, said that change was necessary and that the American psychiatrists ought to be more action-oriented, that they shouldn’t be afraid to be social activists. He added, and remember this is the head of the APA, that psychiatry ought to play a more constructive role in our future society.
Sears: You mention this fluidity of the time period. I wonder if you could speak to the influence of the counterculture on the Psychiatric Survivors Movement and Judi Chamberlin.
Richert: It’s Important. More people need to be engaged with this sort of history and work. More can be written about this in the future. Other people need to work more closely with these movements to tell their stories better in the future.
The countercultural movement, the protests, and the activism definitely influenced the psychiatric survivor movement. You see ex-mental patient interest groups emerging that organized all sorts of demonstrations. They circulated petitions. They had all sorts of awesome lobbying activities. They initiated legal proceedings against different mental health groups and institutions. There’s a real connection institutionally between the counter-culture, anti-war, civil rights activism, and psychiatric survivor movement activism. It’s important to think of them as part of a whole.
The psychiatric survivor movement didn’t necessarily achieve the level of support of African-American civil rights or anti-Vietnam protestors. But they still exerted a very real, very tangible influence on mental health policy and terminology. I look forward to reading more in the future about this. I don’t think “the” book has been written on the psychiatric survivor movement’s influence. I’m looking forward to learning more myself.
Sears: You write that, in the seventies, radical ideas either matured, faded away, or became mainstream. I’m wondering if you could give us an idea about what a radical idea maturing looks like versus becoming mainstream.
Richert: The debate over cannabis is a good example of an idea maturing. Cannabis, in 2021, is placing pressure on public health officials, on politicians, on psychiatrists, psychologists, small business owners, and marginalized groups. This is the same as 50 years ago. Nowadays, we’ve got this high intensity increased marketing, more availability of CBD, super high THC content products that are synthetic. We’ve got more and more consumer demand.
What I try to do in the book is understand the links between cannabis and mental health policy and connect the past and the present. I sketch some of the theories and debates about cannabis and mental health in the 1930s and 1940s and then focus on the sixties and seventies.
For the longest time in the U.S. and other places, cannabis was thought to drive you totally nuts. Public announcements and posters suggested that a single puff would turn you into some sort of ax-murderer or some sort of sexual deviant. Many mental health specialists supported that idea in the courts and beyond. There was a bit of a shift in the sixties and seventies where you see some of the radicals suggesting it’s time to look a lot more closely at causal links between “mental illness” and cannabis use. They said that psychiatrists and psychologists shouldn’t just say cannabis will make you go bonkers. If you smoke a joint, you’re not going to become a murderer. You’re not going to become a prostitute. You’re not going to have a schizophrenic break. Let’s look at the evidence.
These radicals weren’t really proposing anything all that radical. They’re saying let’s actually study this and not just make these huge leaps. This idea has matured over time. The mental health establishment has called for more science, and you see the studies growing. I’m hesitant to say that cannabis medicine has become mainstream since it is still under schedule one of the controlled substances act and federally illegal. Still, the idea that it is going to always cause mental health breakdowns has matured since the sixties and seventies.
Sears: What about an idea becoming mainstream?
Richert: Pushing for more evidence around certain mental health disorders, one was homosexuality. The radicals said we need to think more seriously about how we’re creating these disorders and diagnosing certain people. The radicals suggested that they needed a more biological approach. You shouldn’t label someone without thinking seriously about how that happens.
You begin to see a shift towards biological psychiatry and a move away from psychoanalytic approaches. I would go out on a limb and say that the biological approach has become mainstream, which is rooted obviously much further back than the sixties and seventies. But this is something that the radicals were talking about.
Sears: Why have we considered certain drugs therapeutic, like antidepressants and antipsychotics, and not other “indigenous drugs” like cannabis, psilocybin, and mescalin?
Richert: I work at a school of pharmacy in Madison. Within the building, we have some researchers who are studying psilocybin for treatment-resistant depression. Drugs become therapeutic or not because we decide that. How do we decide what’s legitimate and illegitimate, legal and illegal? It has to do with risk-reward calculations and the safety involved.
You have a process that involves doctors and scientists like the ones at my building. Then you have political actor champions, and you have movements like the psychiatric survivor movement, police chiefs, and police forces, agencies such as the DEA and the FDA that all work within this melting pot. There are obviously innate power differentials within that melting pot. The decision-making has to do with a complex way of understanding safety and risk.
The relationship between humans and drugs is overwhelmingly dependent on context. Shanghai is not the same as San Francisco, which is not the same as the Andean mountains in Mexico or the Plains of Oklahoma, where indigenous groups have used mescalin and psilocybin for hundreds, if not thousands, of years as a way of connecting with their gods. Other white settler-colonists might say we want to use this plant and its derivatives for purely medical purposes and divorce it from these religious uses.
To your point, we have the question: How do you medicalize a given substance? Does it begin as a medical substance? Does it begin as a sort of multi-use substance? Ayahuasca, cannabis, mescaline, and psilocybin began as substances that served multiple purposes and had multiple meanings. In contrast, antidepressants and antipsychotics were a product of Western medicine and emerged as part of a pharmaceutical process.
Sears: I’m wondering if you yourself faced any obstacles in writing critically about the discipline? Any significant pushback you can recall?
Richert: I faced obstacles and push back. They were both external and internal. Self-doubt, can I get this project done? Am I good enough to do this project? There’s that sort of nagging self-doubt that hangs around all of our heads. Was this project feasible? Was it something that was achievable, and does it really make a mark?
I think it is important that we think about psychiatry, psychology, and mental health knowledge from different perspectives. That’s what I was trying to do with my book. It focuses not just on the elite doctors and people in positions of power but also on wider societal trends. I think that it is ultimately valuable to have that sort of approach.
Then externally, I did have issues getting ahold of the records. You can do interviews, and you can mine other sorts of data, but the American Psychiatric Association simply didn’t want to play ball. That is perfectly up to them to share their records and their documents. I don’t think that hindered the book too much, but it definitely leaves the door open for other writers and scholars in the future to build on what I’ve done if they can get access to APA records.
Sears: Can you tell us about something you learned while you were working on Break on Through that most of us probably don’t know? Something you think might be important for us to know?
Richert: There are all sorts of power structures in psychiatry/psychology and especially in mental health more generally. I think about the power structures within the institution of psychiatry, but it’s also important to recognize the power structures outside of psychiatry and how it reinforces them.
How does mental health knowledge reinforce or challenge existing hierarchies and power differentials in society? Nowadays, gender, feminism, and sex are very important. Like with the Black Lives Matter movement, it is so important that we think about divisions within society.
One thing that I learned is just how much psychiatry itself underpinned traditional definitions of gender and how psychiatry was challenged by feminism and sexual politics in the 1960s and 1970s. Ultimately you begin to see a reassessment of certain sexual and gender-based hierarchies throughout the seventies. It was a real learning experience for me. As an undergrad, I barely scratched the surface. Later, I learned about “mother’s little helpers,” the idea of women taking benzodiazepines, and how the drugs functioned essentially to reinforce the nuclear family, the traditional family setup.
In writing the book and learning more about radicalism and mental health, I found that pushing back against these practices and pushing back against “mother’s little helpers” actually challenged notions of the “dutiful mother and the obedient housewife.” A lot of people felt that the mental health establishment was a means to control women. Mental health was a way to police or surveil propriety.
I also learned that the ethical codes around patient and provider sexual contact didn’t change until the 1970s. These ethical codes in the American Psychiatric Association finally declared sexual activity with patients unethical in 1973. The American Psychoanalytic Association declared that sexual activity with patients was not allowed in 1975. The American Psychological Association said it was unethical in 1977. This is incredibly late, in my view.
I didn’t know a ton about this when I started off reading and researching. All these changes in the 1970s are a direct result of women radicals in mental medicine pushing back against the establishment and pushing back against the patriarchy.
Sears: You talk a bit about how psychiatry and psychology were seen as something that kept women “in their place,” so to speak. Others have written similar accounts about minority communities and a resulting reluctance to go to medical doctors and psychiatrists. Is there anything the discipline can do to heal those wounds? Is it a good idea for those groups that have been oppressed by psychology in the past to embrace it now?
Richert: Psychology should own its past for all its strengths and weaknesses, be ready to collaborate, and try to work as much as they possibly can with different populations while being as frank as possible. I have some colleagues in the school of pharmacy who work with different marginalized populations in Milwaukee, Madison, and elsewhere. It’s not easy to make progress and build trust. Focus groups and conversations have to happen.
Trust isn’t earned overnight. There’s a real legacy of oppression of certain groups by mainstream medicine. There’s a lot of mistrust, and I’m not sure if I’m the guy to answer how to overcome that. In their writings, the radicals in the sixties and the seventies suggest that it was important to embrace what was happening and not be as neutral about outside forces.
MIA Reports are supported, in part, by a grant from the Open Society Foundations