Psychiatry today is a barren tundra, writes medical historian Edward Shorter, where drugs that don't work are used to treat diseases that don't exist. In this provocative volume, Shorter illuminates this dismal landscape, in a revealing account of why psychiatry is "losing ground" in the struggle to treat depression.
Naturally, the book looks at such culprits as the pharmaceutical industry, which is not inclined to market drugs once the patent expires, leading to the endless introduction of new--but not necessarily better--drugs. But the heart of the book focuses on an unexpected villain: the FDA, the very agency charged with ensuring drug safety and effectiveness. Shorter describes how the FDA permits companies to test new products only against placebo. If you can beat sugar pills, you get your drug licensed, whether or not it is actually better than (or even as good as) current medications, thus sweeping from the shelves drugs that may be superior but have lost patent protection. The book also examines the FDA's early power struggles against the drug industry, an influence-grab that had little to do with science, and which left barbiturates, opiates, and amphetamines all underprescribed, despite the fact that under careful supervision they are better at treating depression, with fewer side effects, than the newer drugs in the Prozac family. Shorter also castigates academia, showing how two forms of depression, melancholia and nonmelancholia--"as different from each other as chalk and cheese"--became squeezed into one dubious classification, major depression, which was essentially a political artifact born of academic infighting.
An astonishing and troubling look at modern psychiatry, Losing Ground is a book that is sure to spark controversy for years to come.

With every passing year, the mutual mistrust between doctor and patient widens, as doctors retreat into resentment and patients become increasingly disillusioned with the quality of care. Rich in anecdote as well as science 'Doctors and Their Patients' describes how both have arrived at this sad shape.

This book argues that psychiatry's love affair with the diagnosis of depression has become a death grip. Depression is a real illness, especially in its melancholic form. But most patients who get the diagnosis of 'depression' are also anxious, fatigued, unable to sleep, have all kinds of physical symptoms, and tend to obsess about the whole thing. They do not have a disorder of 'mood'. It is a travesty to call them all 'depressed.' How did this happen? How did everyone become depressed? A well-known historian, the author describes how in the 19th century patients with those symptoms were considered 'nervous,' and when they lost control it was a 'nervous breakdown.' Then psychiatry turned its back on the whole concept of nerves, and - first under the influence of Freud's psychoanalysis and then the influence of the pharmaceutical industry - the diagnosis of depression took center stage. The result has been a scientific disaster, leading to the misdiagnosis and inappropriate treatment (with antidepressants) of millions of patients. Urging that the diagnosis of depression be re-thought, the book turns a dramatic page in the understanding of psychiatric symptoms that are as common as the common cold. The book makes an immediate contribution to the debate about DSM5, which is due to be released very soon, in terms of discussing the diagnosis of depression. The author controversially proposes replacing the diagnosis of 'major depression' with 'melancholia' and 'nonmelancholia'; he argues that depression and anxiety usually occur together and are really the same disease; and he says that patients with so-called mood disorders really have a disorder of the entire body. The author's ability to make use of the enormous well of psychiatry's past history in several languages make this a unique book that contributes to the important discussions today of diagnosis and treatment.

This book describes how women's physical experience historically has affected the whole constellation of values that represents womanliness, and the constellation of power relationships that binds men and women together. It explores the role of herbs and of mechanical procedures for abortion.

The riddle of melancholia has stumped generations of doctors. It is a serious depressive illness that often leads to suicide and premature death. The disease's link to biology has been intensively studied. Unlike almost any other psychiatric disorder, melancholia sufferers have abnormal endocrine functions. Tests capable of separating melancholia from other mood disorders were useful discoveries, but these tests fell into disuse as psychiatrists lost interest in biology and medicine. In the nineteenth century, theories about the role of endocrine organs encouraged endocrine treatments that loomed prominently in practice. This interest faded in the 1930s but was revived by the discovery of the adrenal hormone cortisol and descriptions of its abnormal functioning in melancholic and psychotic depressed patients. New endocrine tests were devised to plumb the secrets of mood disorders. Two colorful individuals, Bernard Carroll and Edward Sachar, led this revival and for a time in the 1960s and 1970s intensive research interest established connections between hormone dysfunctions and behavior. In the 1980s, psychiatrists lost interest in hormonal approaches largely because they did not correlate with the arbitrary classification of mood disorders. Today the relation between endocrines and behavior have been disregarded.
This history traces the enthusiasm of biological efforts to solve the mystery of melancholia and their fall. Using vibrant language accessible to family care practitioners, psychiatrists and interested lay readers, the authors propose that a useful, a potentially live-saving connection between medicine and psychiatry, has been lost.

With every passing year, the mutual mistrust between doctor and patient widens, as doctors retreat into resentment and patients become increasingly disillusioned with the quality of care. Rich in anecdote as well as science Doctors and Their Patients describes how both have arrived at this sad shape.

What has been the source of women's oppression by men? Shorter argues that women were victimized by their own bodies. Exploring five centuries of medical records and folklore from Europe and the US, he shows how pregnancy, childbirth, and gynecological disease have kept women in positions of social

Psychotic depression is a distinct and acute clinical condition along the spectrum of depressive disorders. It can manifest itself in many ways and often induces very violent and suicidal behavior. This book aims to help clinical practitioners and trainees describe their observations of psychotic depression, formulate treatment, and express expectations of recovery from illness. It focuses on all facets of the disorder, from clinical history to coverage of diagnostic and treatment protocols. Medical readers of this book will come away able to diagnose and readily treat psychotic depression and thus will be able to serve their patients better. Non-physician readers will come away with the message that this is a terrible illness, but there is hope.

Choice Recommended Read What Psychiatry Left Out of the DSM-5: Historical Mental Disorders Today covers the diagnoses that the Diagnostic and Statistical Manual of Mental Disorders (DSM) failed to include, along with diagnoses that should not have been included, but were. Psychiatry as a field is over two centuries old and over that time has gathered great wisdom about mental illnesses. Today, much of that knowledge has been ignored and we have diagnoses such as "schizophrenia" and "bipolar disorder" that do not correspond to the diseases found in nature; we have also left out disease labels that on a historical basis may be real. Edward Shorter proposes a history-driven alternative to the DSM.

Psychotic depression is a distinct and acute clinical condition along the spectrum of depressive disorders. It can manifest itself in many ways and often induces very violent and suicidal behavior. This book aims to help clinical practitioners and trainees describe their observations of psychotic depression, formulate treatment, and express expectations of recovery from illness. It focuses on all facets of the disorder, from clinical history to coverage of diagnostic and treatment protocols. Medical readers of this book will come away able to diagnose and readily treat psychotic depression and thus will be able to serve their patients better. Non-physician readers will come away with the message that this is a terrible illness, but there is hope.

Choice Recommended Read What Psychiatry Left Out of the DSM-5: Historical Mental Disorders Today covers the diagnoses that the Diagnostic and Statistical Manual of Mental Disorders (DSM) failed to include, along with diagnoses that should not have been included, but were. Psychiatry as a field is over two centuries old and over that time has gathered great wisdom about mental illnesses. Today, much of that knowledge has been ignored and we have diagnoses such as "schizophrenia" and "bipolar disorder" that do not correspond to the diseases found in nature; we have also left out disease labels that on a historical basis may be real. Edward Shorter proposes a history-driven alternative to the DSM.

What are the real disease entities in psychiatry? This is a question that has bedeviled the study of the mind for more than a century yet it is low on the research agenda of psychiatry. Basic science issues such as neuroimaging, neurochemistry, and genetics carry the day instead. There is nothing wrong with basic science research, but before studying the role of brain circuits or cerebral chemistry, shouldn't we be able to specify how the various diseases present clinically? Catatonia is a human behavioral syndrome that for almost a century was buried in the poorly designated psychiatric concept of schizophrenia. Its symptoms are well-know, and some of them are serious. Catatonic patients may die as their temperatures accelerate; they become dehydrated because they refuse to drink; they risk inanition because they refuse to eat or move. Autistic children with catatonia may hit themselves repeatedly in the head. We don't really know what catatonia is, in the sense that we know what pneumonia is. But we can identify it, and it is eminently treatable. Clinicians can make these patients better on a reliable basis. There are few other disease entities in psychiatry of which this is true. So why has there been so little psychiatric interest in catatonia? Why is it simply not on the radar of most clinicians? Catatonia actually occurs in a number of other medical illnesses as well, but it is certainly not on the radar of most internists or emergency physicians. In The Madness of Fear, Drs. Shorter and Fink seek to understand why this "vast field of ignorance" exists. In the history of catatonia, they see a remarkable story about how medicine flounders, and then seems to find its way. And it may help doctors, and the public, to recognize catatonia as one of the core illnesses in psychiatry.

According to Edward Shorter, just forty years ago the institutions housing people with mental retardation (MR) had become a national scandal. The mentally retarded who lived at home were largely isolated and a source of family shame. Although some social stigma still attaches to the people with developmental disabilities (a range of conditions including what until recently was called mental retardation), they now actively participate in our society and are entitled by law to educational, social, and medical services. The immense improvement in their daily lives and life chances came about in no small part because affected families mobilized for change but also because the Kennedy family made mental retardation its single great cause.

Long a generous benefactor of MR-related organizations, Joseph P. Kennedy made MR the special charitable interest of the family foundation he set up in the 1950s. Although he gave all of his children official roles, he involved his daughter Eunice in performing its actual work -- identifying appropriate recipients of awards and organizing the foundation's activities. With unique access to family and foundation papers, Shorter brings to light the Kennedy family's strong commitment to public service, showing that Rose and Joe taught their children by precept and example that their wealth and status obligated them to perform good works. Their parents expected each of them to apply their considerable energies to making a difference.

Eunice Kennedy Shriver took up that charge and focused her organizational and rhetorical talents on putting MR on the federal policy agenda. As a sister of the President of the United States, she had access to the most powerfulpeople in the country and drew their attention to the desperate situation of families affected by mental retardation. Her efforts made an enormous difference, resulting in unprecedented public attention to MR and new approaches to coordinating medical and social services. Along with her husband, R. Sargent Shriver, she made the Special Olympics a international, annual event in order to encourage people with mental retardation to develop their skills and discover the joy of achievement. She emerges from these pages as a remarkable and dedicated advocate for people with developmental disabilities.

Shorter's account of mental retardation presents an unfamiliar view of the Kennedy family and adds a significant chapter to the history of disability in this country.

The Age of Psychopharmacology began with a brilliant rise in the 1950s, when for the first time science entered the study of drugs that affect the brain and mind. But, esteemed historian Edward Shorter argues that there has been a recent fall, as the field has seen its drug offerings impoverished and its diagnoses distorted by the "Diagnostic and Statistical Manual of Mental Disorders." The new drugs, such as Prozac, have been less effective than the old. The new diagnoses, such as "major depression," have strayed increasingly from the real disorders of most patients. Behind this disaster has been the invasion of the field by the pharmaceutical industry. This invasion has paid off commercially but not scientifically: There have been no new classes of psychiatry drugs in the last thirty years. Given that psychiatry's diagnoses and therapeutics have largely failed, the field has greatly declined from earlier days. Based on extensive research discovered in litigation, Shorter provides a historical perspective of change and decline over time, concluding that the story of the psychopharmacology is a story of a public health disaster.

This is the first historical dictionary of psychiatry. It covers the subject from autism to Vienna, and includes the key concepts, individuals, places, and institutions that have shaped the evolution of psychiatry and the neurosciences. An introduction puts broad trends and international differences in context, and there is an extensive bibliography for further reading. Each entry gives the main dates, themes, and personalities involved in the unfolding of the topic. Longer entries describe the evolution of such subjects as depression, schizophrenia, and psychotherapy. The book gives ready reference to when things happened in psychiatry, how and where they happened, and who made the main contributions. In addition, it touches on such social themes as "women in psychiatry," "criminality and psychiatry," and "homosexuality and psychiatry." A comprehensive index makes immediately accessible subjects that do not appear in the alphabetical listing. Among those who will appreciate this dictionary are clinicians curious about the origins of concepts they use in their daily practices, such as "paranoia," "selective serotonin reuptake inhibitors" (SSRIs), or "tardive dyskinesia"; basic scientists who want ready reference to the development of such concepts as "neurotransmitters," "synapse," or "neuroimaging"; students of medical history keen to situate the psychiatric narrative within larger events, and the general public curious about illnesses that might affect them, their families and their communities-or readers who merely want to know about the grand chain of events from the asylum to Freud to Prozac. Bringing together information from the English, French, German, Italian, and Scandinavian languages, the Dictionary rests on an enormous base of primary sources that cover the growth of psychiatry through all of Western society.

The University of Toronto's Faculty of Medicine is North America's largest medical school and a major health consortium, boasting nine affiliated teaching hospitals and a network of research institutes. It is where insulin was pioneered, stem cells were first discovered, and famous physicians from Vincent Lam to Sheela Basrur began their careers. But despite all its major accomplishments, the faculty's impressive history has never before been comprehensively documented. In Partnership for Excellence, senior medical historian and award-winning author Edward Shorter details the Faculty of Medicine's history from its inception as a small provincial school to its present day status as an international powerhouse. Deeply researched through front-line interviews and primary sources, it ties the story of the faculty and its teaching hospitals to the general history of medicine over this period. Shorter emphasizes the enormous concentration of intellectual energy in the faculty that has allowed it to become the dominant force in Canadian medicine, home to a legion of medical pioneers and achievements.

Volume 1 of the series The History of Psychopharmacology and the CINP, As Told in Autobiography. It covers the rise of psychopharmacology and traces the history of the new field and of the CINP to about 1970. This is a source book, based on a collection of memoirs of those who were there.

THE SERIES The 10 volumes in this series record a fifty year history of neuropsychopharmacology related by 213 pioneer clinical, academic, industrial and basic scientists in videotaped interviews, conducted by 66 colleagues between 1994 and 2008. These volumes include a preface by the series editor placing its contents in an historical context and linking each volume to the next. Each volume is dedicated to a former President of the ACNP and edited by a distinguished historian or Fellow of the College who provides an introduction to its themes and a biography of each scientist's career. The series provides insights into a half century of discovery and innovation with its rewards and disappointments, progress and setbacks, including future expectations and hopes for the field as a whole and the ACNP as an organization. IN THIS VOLUME Volume I, "Starting Up" is dedicated to Heinz Lehmann, President, 1965 and edited by Edward Shorter, a distinguished historian and professor of the history of medicine and psychiatry. -The 22 pioneers, all men and predominantly Americans, include trialists, pharmacologists and clinical scientists. From 1952 to the mid 1960s the earliest clinical trials of the first psychotropic drugs took place in the V.A., private practice and State hospitals. -Thousands of people with untreated mental illness benefited for the first time. Psychoanalysis dominated academia, the pharmaceutical industry had barely awakened to the potential for treatment of mental illness and clinical pharmacology was an infant discipline. But the NIH and NIMH expanded dramatically, funded by an enthusiastic Congress and the FDA was empowered to insist on drug efficacy as well as safety. Basic scientists began to make the first linkages between serendipitous clinical efficacy and putative neurochemical mechanisms of action.

This is volume 2 of the series The History of Psychopharmacology and the CINP, As Told in Autobiography. It covers the triumph of psychopharmacology in the 1970s and traces the story of the CINP during that period. This is a source book, based on a collection of memoirs of those who were there

This is volume 3 of the series The History of Psychopharmacology and the CINP, As Told in Autobiography. It covers the transformation of psychopharmacology to neuropsychopharacology in the 1980s and traces the story of the CINP during that period. This is a source book, based on a collection of memoirs of those who were there.

This is volume 4 of the series The History of Psychopharmacology and the CINP, As Told in Autobiography. The series covers in autobiographical accounts the fifty years that laid the foundation of neuropsychopharmacology In this fourth volume the story of the 1990s is complemented by reflections on twentieth-century psychopharmacology by the few of those who actively participated throughout the development of the field. The series represents the first source book for a field that has been virtually undocumented. Many of the stories have relevance to current research.

This is volume 5 of the series The History of Psychopharmacology and the CINP, As Told in Autobiography. It is a comprehensive cumulative index, and an appendix which includes a biographic register of all the contributors to the four main volumes.

In the 19th century, when gender roles were more confining, the dominant forms of psychosomatic illness were paralysis and hysteria. Today, when people experience confusion about the abundant possibilities available to them, when all is permitted, the dominant complaint is fatigue. Edward Shorter's history shows how patients throughout the centuries have produced symptoms in tandem with the cultural shifts of larger society. He argues that newly popularized diseases such as chronic fatigue syndrome are only the most recent examples of patients' ailments that express the deepest truths about the culture in which we live.