Edward Shorter

A History of Psychosomatic Illness in the Modern Era

From Paralysis to Fatigue

Max Fink

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.

A History of Catatonia

The Madness of Fear

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.

The Rise and Fall of the Age of Psychopharmacology

"PPPP . . . To compress 200 years of psychiatric theory and practice into a compelling and coherent narrative is a fine achievement . . . . What strikes the reader [most] are Shorter's storytelling skills, his ability to conjure up the personalities of the psychiatrists who shaped the discipline and the conditions under which they and their patients lived."--Ray Monk The Mail on Sunday magazine, U.K. "An opinionated, anecdote-rich history. . . . While psychiatrists may quibble, and Freudians and other psychoanalysts will surely squawk, those without a vested interest will be thoroughly entertained and certainly enlightened."--Kirkus Reviews. "Shorter tells his story with immense panache, narrative clarity, and genuinely deep erudition."--Roy Porter Wellcome Institute for the History of Medicine. In A History of Psychiatry, Edward Shorter shows us the harsh, farcical, and inspiring realities of society's changing attitudes toward and attempts to deal with its mentally ill and the efforts of generations of scientists and physicians to ease their suffering. He paints vivid portraits of psychiatry's leading historical figures and pulls no punches in assessing their roles in advancing or sidetracking our understanding of the origins of mental illness. Shorter also identifies the scientific and cultural factors that shaped the development of psychiatry. He reveals the forces behind the unparalleled sophistication of psychiatry in Germany during the eighteenth and nineteenth centuries as well as the emergence of the United States as the world capital of psychoanalysis. This engagingly written, thoroughly researched, and fiercely partisan account is compelling reading for anyone with a personal, intellectual, or professional interest in psychiatry.

From the Era of the Asylum to the Age of Prozac

A History of Psychiatry

Hannah Chair in the History of Medicine and Professor of Psychiatry Edward Shorter

ward Shorter

Placing the physical symptoms of stress in a historical and cultural context, the author shows how patients through the centuries have produced symptoms in tandem with the cultural shifts of the larger society

The book argues that the diagnosis of depression has been bent greatly out of shape through misuse and needs to be replaced by other concepts that correspond more closely to what people actually experience. The sturdy term "nerves" from the past is a ready candidate, and "nervous breakdown" is still meaningful to many people. book in this field has such scope, nor such a deeply learned ability to use the past in service of the present.

The Rise and Fall of the Nervous Breakdown

How Everyone Became Depressed

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.

Medicine at the University of Toronto and Academic Hospitals

Partnership for Excellence

David Healy

Shock therapy is making a comeback today in the treatment of serious mental illness. Despite its reemergence as a safe and effective psychiatric tool, however, it continues to be shrouded by a longstanding negative public image, not least due to films such as the classic One Flew over the Cuckoo's Nest, where the inmate of a psychiatric clinic (played by Jack Nicholson) is subjected to electro-shock to curb his rebellious behavior. Beyond its vilification in popular culture, the stereotype of convulsive therapy as a dangerous and inhumane practice is fuelled by professional posturing and public misinformation. Electroconvulsive therapy, or ECT, has in the last thirty years been considered a method of last resort in the treatment of debilitating depression, suicidal ideation, and other forms of mental illness. Yet, ironically, its effectiveness in treating these patients would suggest it as a frontline therapy, bringing relief from acute symptoms and saving lives. Shock therapy is making a comeback today in the treatment of serious mental illness. Despite its reemergence as a safe and effective psychiatric tool, however, it continues to be shrouded by a longstanding negative public image, not least due to films such as the classic One Flew over the Cuckoo's Nest, where the inmate of a psychiatric clinic (played by Jack Nicholson) is subjected to electro-shock to curb his rebellious behavior. Beyond its vilification in popular culture, the stereotype of convulsive therapy as a dangerous and inhumane practice is fuelled by professional posturing and public misinformation. Electroconvulsive therapy, or ECT, has in the last thirty years been considered a method of last resort in the treatment of debilitating depression, suicidal ideation, and other forms of mental illness. Yet, ironically, its effectiveness in treating these patients would suggest it as a frontline therapy, bringing relief from acute symptoms and saving lives. -- Provided by publisher.

A History of Electroconvulsive Treatment in Mental Illness

Shock Therapy

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.

Shock therapy is making a comeback today in the treatment of serious mental illness. Despite its reemergence as a safe and effective psychiatric tool, however, it continues to be shrouded by a longstanding negative public image, not least due to films such as the classic One Flew over the Cuckoo's Nest, where the inmate of a psychiatric clinic (played by Jack Nicholson) is subjected to electro-shock to curb his rebellious behavior. Beyond its vilification in popular culture, the stereotype of convulsive therapy as a dangerous and inhumane practice is fuelled by professional posturing and public misinformation. Electroconvulsive therapy, or ECT, has in the last thirty years been considered a method of last resort in the treatment of debilitating depression, suicidal ideation, and other forms of mental illness. Yet, ironically, its effectiveness in treating these patients would suggest it as a frontline therapy, bringing relief from acute symptoms and saving lives. In this book, Edward Shorter and David Healy trace the controversial history of ECT and other "shock" therapies. Drawing on case studies, public debates, extensive interviews, and archival research, the authors expose the myths about ECT that have proliferated over the years. By showing ECT's often life-saving results, Shorter and Healy endorse a point of view that is hotly contested in professional circles and in public debates, but for the nearly half of all clinically depressed patients who do not respond to drugs, this book brings much needed hope.

A Practical Guide

The Historian and the Computer

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.

Historical Mental Disorders Today

What Psychiatry Left Out of the DSM-5

Thomas A. Ban

This series covers in autobiographical accounts the first fifty years in the history of neuropsychopharmacology. The autobiographies in Volume I, (The Rise of Psychopharmacology and the Story of CINP) are from psychopharmacologists who began their professional careers in the 1950s and 1960s; in Volume II (The Triumph of Psychopharmacology and the Story of CINP), from those who started in the 1970s; in Volume III (From Psychopharmacology to Neuropsychopharmacology in the 1980s and the Story of CINP), who started in the 1980s; and in Volume IV (Reflections on Twentieth-Century Psychopharmacology), who started in the 1990s. At the core of each volume are personal accounts in which the contributions of the scientists, are at the center of the reflections, but also include several sections in which the reflections are focused on the mainstream of events, particular areas of research, individuals and organizations. The series was the extension of an effort by CINP's History Committee, during the chairmanship of Tom Ban, to document both the history of the College and the enire field. It was co-edited by Ban, David Healy and Edward Shorter. Its publication was supported by the College primarily from non-restricted publication grants received from Pierre Fabre, Janssen Pharmaceutica and Research Foundation,Inc., and Janssen Phamaceutica International in Collaboration with Organon International.

From Psychopharmacology to Neuropsychopharmacology in the 1980s and the Story of CINP, as Told in Autobiography

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

A Social History of Women's Encounter with Health, Ill-Health and Medicine

Women's Bodies

Hugh E. Scully

Bernard S. Goldman

Great innovations take place within great institutions. Founded in 1819, Toronto General Hospital (TGH) is one of Canada’s oldest hospitals and has created a nurturing environment for early Canadian innovations in heart surgery. The Heartbeat of Innovation tells the story of the brilliant surgeons who worked there and the hospital environment that provided an incubator to the many people – skilled perfusionists, dedicated nurses, and pioneering cardiologists – who participated in the revolution in heart surgery that took place along University Avenue in Toronto. Supported by historical records, hospital archives, personal memoirs, and interviews, this book is an extensive and descriptive account of the seemingly inexorable development of cardiac surgery at this leading academic health science centre. It pursues several themes: the complexity of this surgical specialty, its generally male-dominated nature, the trend toward teamwork in practice, and the evolution and incorporation of original research into this branch of healthcare. These strands are woven together to demonstrate how the TGH has evolved into such a dominant leader in the competitive and demanding field of cardiac surgery. Canadian hearts may beat with pride at the knowledge that one of the major stories in modern medicine took place here – and continues here.

A History of Cardiac Surgery at the Toronto General Hospital

The Heartbeat of Innovation

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.

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 powerful people 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. Author note: Edward Shorter is a Professor at the University of Toronto where he holds the Hannah Chair in the History of Medicine. He is the author of A History of Psychiatry from the Era of the Asylum to the Age of Prozac, as well as many other books in the fields of history and medicine.

The Kennedy Family and the Story of Mental Retardation

Laurence Shorter

Traces and assesses the discernible factors and determinants of the gradual transformation of the Western family, over the last three hundred years, from extended to nuclear.

Edward Shorter

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