"Medicine Can Soothe a Troubled Mind, but Not Without Costs"

The world’s first transorbital lobotomy was performed in 1946 by Walter Freeman, in his Washington office. Using an ice pick from his own kitchen, he went through the eye sockets into the brain of his patient, a 29-year-old severely depressed housewife, and cut into her frontal lobes. Then he sent her home in a cab.

The history of mental illness treatments reveals medicine at its most inventive, desperate and disturbing. There have been awe-inspiring discoveries — of the healing properties of lithium, for example, a soft, silvery metal produced in the first 20 minutes after the Big Bang. But remedies generally seem to have run a narrow gamut from the unpleasant (Cotton Mather’s prescription for depression: “living swallows, cut in two, and laid hot reeking unto the shaved Head”) to the outright sadistic. Aside from Freeman’s lobotomies, there is a long tradition of poisoning patients or inducing comas to “reset” the brain. In one notorious treatment, turpentine was injected into a patient’s abdominal wall in the hope of encouraging a fever high enough to burn away her hallucinations.

We’re lucky to live in more evidence-based, scientific times. Or do we? In “Blue Dreams,” a capacious and rigorous history of psychopharmacology, the psychologist and writer Lauren Slater looks at the fact that despite our ravenous appetite for psychotropic medications (about 20 percent of Americans take some psychotropic drug or other), doctors don’t really understand how they work or how to assess if a patient needs them. In the case of antidepressants, two-thirds of patients taking an S.S.R.I. (Prozac, Zoloft, Celexa, etc.) would improve on a placebo alone.

Still the misconception that depression is a matter of “low serotonin” persists. “There is no proof that a depressed person has a chemical imbalance,” Slater writes. “When you choose nevertheless to put that person on a medication that will alter neurotransmitter levels in his or her brain, then in effect you are causing a chemical imbalance rather than curing one.”

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