BALANCEE SHEET ON TRANQUILIZERS

...But while they obviously constitute a potent and revolutionary tool, the new drugs have stirred up a far-flung controversy and raised a number of disturbing questions...

...Other observers are inclined to take a less charitable view of the situation...

...The American Medical Association, the state and local medical societies, and the^lil|H censing boards supposedly have'.stag control over what doctors do...

...The federal government is charged with passing on drugs to make sure that they are safe for use as directed on the label," commented one expert...

...These are milder relaxants that are not chemically related to the tranquilizers but act in a somewhat similar manner in relieving tension...

...By calming the patient without knocking him out, they facilitate a curative approach, even though they do not actually cure anything...

...Many thousands of previously unreachable patients in the mental hospitals are now clamoring to "talk to somebody...

...One medical authority told me recently that "not only are there few well-authenticated studies evaluating the effects of the tranquilizing drugs, particularly when used outside of the mental hospital, but the average doctor is usually too busy to read up carefully on the professional literature, supplied by the drug houses...

...The American Psychiatric Association has warned that the excessive use of the tranquilizing drugs "for the relief of common anxiety, emotional upsets, nervousness, and the routine tensions of everyday living" is "medically unsound and constitutes a public danger...

...They caution that before a general practitioner prescribes tranquilizers for a mental or emotional condition he should consult with a psychiatrist on diagnosis and the patient's outlook for recovery...

...Both reserpine and chlorpromazine can cause a drop in blood pressure, nausea, and allergic reactions...

...But even group psychotherapy requires many more psychiatrists...

...For regardless of how effective psychotherapy can be for acutely ill mental patients, there is lktle doubt that intensive treatment can bring about a much higher proportion of so-called "social recoveries" enabling the patients to return to society, even if they are not completely cured...

...They say that, in dispersing tons of the psychiatric drugs without knowing too well what they are doing, many doctors are behaving irresponsibly, cashing in on a dangerous fad...

...Under the calming impact of these drugs, wards kept in an uproar by violently disturbed and destructive patients have quieted down...

...In view of what the tranquilizers have shown (hey can do, Dr...

...The tranquilizing drugs have given new impetus to investigation of the chemistry of the brain in an attempt to discover why some of us break down under the same stresses that others manage to weather...

...With the new means of managing unruly patients, hospitals have virtually discarded the use of strait jackets and given up such other restraints as continuous tubs and wet packs...

...The drugs make many severely ill patients responsive to psychotherapy by enabling them to emerge at least to some degree from the grotesque world of their delusions and to think more clearly...

...But it has no authority over the practice of medicine...

...Aside from the question of the advisability of the prolonged use of medication for relatively mild neurotic complaints and for ordinary tension, this poses the threat of hazardous side effects...

...As the controversy over the valnj and safety of the tranquilizing drug in non-hospital use goes on, scien tists in many laboratories are hunt ing for answers regarding their pre cise mode of action and for still mow effective chemicals...

...This would open up dramatic possibilities for treating many mental patients without any hospitalization at all or after only a short hospital stay...

...Reserpine in daily doses of from one-half to one milligram, the agency reported, "produces severe depression in a significant number of individuals, and has precipitated a very considerable number of suicidal attempts, some of them successful...

...Chlorpromazine also appears to slow reflexes and to inter-, fere with the ability to maintain sustained attention...

...dealing adequately with psycMiagSi illness...

...The tranquilizers, used in the treatment of severe mental illness and even more widely to tone down ordinary tension, have put on a truly remarkable performance since they first became generally available early in 1954...

...The frenzied popularity of the so-called aspirins of the soul has underscored the fact that millions of Americans are anxiety-ridden, jittery, and in need of a crutch to keep going...

...Clearly they hold out the promise of a breakthrough in the battle against the scourge of mental illness...

...This is a challenge which will tax our social conscience and our resources...

...The custodial problem has been considerably simplified, and fewer attendants are needed merely to keep order...

...The physician inevitably feels that if he doesn't accede to a request for a prescription for reserpine, chlorpro-mazine, or one of the meprobamates, the patient will go to another doctor and get it...

...The new atmosphere in the disturbed wards not only means more humane treatment of the patients and paves the way for possible recovery of some of them but also has improved the morale of hospital personnel...

...Such medication has air ready proved of immense practical value in the bedlam atmosphere of the back wards of mental hospitals...

...James A. Shannon, director of the National Institutes of Health, the significance of these drugs goes far beyond their practical value in calming violently disturbed psychotics...

...Then there is the pressure exerted by countless neurotic patients...

...It's hard to say...

...The use of electric and insulin shock, which at best brings about a temporary improvement, has been sharply reduced...

...No such controls are generally possible when the drugs are prescribed for unhospitalized patients...

...While the sedatives depress mental func...

...Food and Drug Administration...

...Under the mounting clamor by many thousands of persons for serenity pills for whatever ails them, numerous general practitioners are prescribing tranquilizers without regard to their side reactions and long-range effects and without any knowledge as to how psychiatric illness should be handled...

...In the nation as a whole, there was a drop of 7,000 patients in the mental hospital population in 1956, the first in many years, instead of the expected increase of about 12,000...

...A broad research program, to assess more fully what the new drugs can and cannot do and how they might be improved, is now being launched under a $2,000,000 appropriation voted by Congress last year...

...One researcher has described this action of the new drugs as a sort of "chemical lobotomy...

...tions, the new compounds appear to* bring relaxation without material loss of alertness...

...Suffee none of the chronic patients have actually been cured by the tran-wplizers, many of them have become puch more amenable to treatment...

...Their biggest •contribution probably will be in bringing out into the open the manner in which the emotions are manipulated biochemically...

...They are the ^opening wedge into an organic approach to mental diseases...

...About 35,000,000 prescriptions were written by doctors last year for the various tranquilizers now being marketed under some 40 trade names, and the number of such prescriptions is expected to skyrocket this year to more than 40,000,000...

...The tranquilizing drugs now offer some hope for the first time that the huge prison-like warrens for the mentally ill can be transformed into real hospitals...

...But it is reported that some patients develop withdrawal symptoms and feel let down when the medication is discontinued...

...The discharge rate in the New York state mental hospital system has increased by 25 per cent in the last two years...

...In doing so, "physicians in general practice are taking the easiest course," according to Dr...

...Each big firm is vigorously pushing its own products and is flooding physicians with free samples and with summaries of so-called scientific articles that are often based on scanty or questionable clinical trials...

...In many such patients, these drugs somehow produce a detached serenity without clouding of consciousness or impairment of memory and judgment...

...He is the winner of the Associated Press Managing Editors' Association Award for his series of articles on the problems of the aged...

...By a process which still remains to be clarified, they bring about a blunting of emotion, so that the patient does not seem to care what is happening to him...

...And how safe is it to have the tranquilizers dispensed mostly by general practitioners, who know little about the properties of these compounds or about SELIG GREENBERG, writer on medical theories for the Providence Journal and Evening Bulletin, has twice been honored by the Lasker Foundation for distinguished writing on medicine...

...What can be done about it...

...Medical authorities have become increasingly concerned over indications that the tranquilizers are often used indiscriminately, without adequate medical supervision or understanding of what they can and cannot do and what their adverse side-effects might be...

...The two compounds used in the preparation of the tranquilizers are reserpine, which is derived from the snake-like roots of a small shrub found in India, and chlorpromazine, a synthetic product developed by French chemists...

...Unlike narcotics, prescriptions for tranquilizers can be refilled, not only by the patient but by his relatives and friends as well...

...Although Miltown and Equanil are best known and most extensively resorted to for milder emotional upsets, their sales are still nowhere as large as those of reserpine and chlorpromazine...

...Is it desirable to resort so widely to compounds which reduce only the symptoms of anxiety without doing anything to solve the basic problems that cause the symptoms...

...Frontal lobotomy, the personality-mutilating form of brain surgery, has been nearly abandoned...

...When such Saowledge is obtained, it will enrich ptr understanding of the chemical Inundations of human behavior and of the underlying causes of mental disorders...

...Apparently not much, under the prevailing system of free enterprise in medicine...

...Reserpine may also produce intestinal hemorrhage, diarrhea, nasal congestion, dizziness, fatigue, and headaches...

...They have provided the drug industry with one of its richest bonanzas in many years and now make up four of the ten leading prescription items sold by druggists...

...It might then be possible for a large proportion of the mentally ill to get along with psychiatric supervision in the community, just as persons with chronic arthritis, nephritis, or heart conditions do if they see their doctors regularly...

...In some forms of mental or emotional disorders, these drugs can boomerang to dangerous depression and have even been known to lead to suicide...

...Noisy, confused, and agitated men and women—some of them naked, incontinent, and soiled, many of them kept under heavy sedation or under restraint for months and years—have been turned into quiet, reasonably cooperative patients who can dress and feed themselves and often can take part in various hospital activities...

...With the multi-million dollar bonanza provided by the tranquilizers, there is already a tremendous variety of such preparations and stiff competition among the drug manufacturers for the business...

...Doctors, nurses, and attendants can now devote more time to a hospital's real job—trying to get the patients well...

...But what is perhaps likely to be even more important in the long run, the tranquilizers promise to become a valuable tool in the investigation of the nature of the organic defect causing disturbance of the mind...

...They quiet the patient's tension but do so without making him groggy or actually putting him to sleep...

...which reserpine and chlorpromazinel are able to quiet agitation in the mentally ill...

...Shannon told me, "provide us with a clue to the biochemical structures upon which our emotions depend...

...But such warnings have been widely disregarded...

...Among the serious side effects known to result at times from the use of chlorpromazine are liver damage, a form of jaundice, and agranulocytosis, in which some white blood cells are depleted and the throat and digestive tract become ulcerated...

...By being able to calm down intensely disturbed schizophrenics through specific localized effects upon the central nervous system, they have produced the first definite clue that mental disease involves some sort of chemical disturbance in the brain...

...The tranquilizers, Dr...

...Another obstacle to the recruitment of the right kind of employes has been the unpleasantness of the work...

...While there are no ready answer* to these questions and experts agree that it is far too early to try to assess fully the long-range value of the tranquilizing drugs, the significant and tremendously hopeful point is that, for the first time in history, medication is now available which can temporarily turn off some psychotic symptoms...

...Unlike the sedatives and the narcotics, the tranquilizing drugs are not simple painkillers...

...But there is evidence indicating that the meprobamates can likewise cause undesirable psychological effects and may in some cases lead to addiction...

...This has gone a long way toward producing a more relaxed and hopeful atmosphere in the back wards, which have traditionally been regarded as the end of the line in mental care...

...Nearly one-half of the 750,000 patients in the state and municipal mental hospitals in the United States are now being treated with tranquilizers...

...Probably even more widely used on an ambulatory basis for ordinary tension are the mepro-bamates...

...So he might as well collect the fee himself...

...But is it advisable for people who are not sick in the ordinary sense of the term to try to get rid of their tensions, which up to a point are a perfectly normal stimulant to peak performance under pressure, and to seek to achieve a synthetic peace of mind by gulping pills...

...Group psychotherapy is one possible way of attempting to meet the problem and is now being intensively developed...

...In mental hospitals the tranquilizers are used under qualified professional supervision, which means that reactions can be carefully watched and dosages adjusted accordingly...

...The agency cautioned doctors that the drug "is not the innocuous substance it was first thought to be, that there are contraindications, and that the safe level for long-term outpatient maintenance is lower than the originally recommended dosage schedule...

...Even if it were assumed that psychotherapy can cure many chronic patients, which is an assumption still to be proved, it would take many more psychiatrists than are now Available to try to do the job...

...The most popular meprobamates are Miltown and Equanil, identical substances under different trade names...

...They have brought about a profound change for the better in our public mental hospitals, and are given credit for the first signs of a reversal in the steady rise of the population of such institutions...

...Also needed are more nurses, occupational and recreational therapists, psychiatric social workers, and other trained employes to do a curative rather than a custodial job, which in the long run would reduce the patient load and mean lower costs...

...Poor pay has not been the only factor in the crippling shortages of personnel in many mental hospitals...

...A Psychopharmacology Service Center has been established in the National Institute of Mental Health at Bethesda, Md., to make grants for research on the tranquilizers and to coordinate all such studies...

...A warning regarding the "potential hazards" of reserpine was issued some time ago by the U.S...

...Experts stress that the use of the tranquilizing drugs is just as sensitive and skilled a procedure as the use of insulin for diabetics, of anticonvulsants for epileptics, and of digitalis for cardiac patients...

...The new psychiatric drugs should make it easier to attract and hold better staff—a consideration of yital importance in securing more effective treatment for the patients...

...But psychotherapy takes a lot of time...

...Closely linked with this line of investigation is the intensive quest l&r drugs that are safer and more specie in their action on various mental ind emotional ailments...

...There is a strong possibility that they will pave the way for better and more specific drugs which will not only calm down psychotics but actually cure mental illness...

...Some of them have improved to such an extent that it has been possible to discharge them...

...Observation of the properties of both the tranquilizers and the meprobamates is making it increasingly clear, according to leading authorities, that they are not always as harmless as they have been represented to be...

...It might even be possible to nip in 'the bud burgeoning outbreaks of emotional disturbance...

...uncovered regarding the means by...

...The tranquilizers have not been used long enough to determine whether they have habit-forming properties...

...Balance Sheet On Tranquilizers by SELIG GREENBERG FEW developments in medicine have raised such an hullabaloo as have the tranquilizing drugs, which within less than four years have soared to the forefront of pharmaceutical best sellers and are expected to account in 1957 for sales of about $200,000,000...

...Ijjjjj you don't see such control exercise too often...

...BPP more information ' is still BBfcotd determine just how and where the tranquilizers act in the staim and nervous system...

...According to Dr...

...The tranquilizers act in an entirely different manner from the barbitu-ates, such as phenobarbital, and other sedatives...

...Shannon declared, it # not at all fantastic to conceive that *t may eventually be possible to correct chemical defects in the brain, slWt as medicine can now use drugs Jtp, correct many defects in other Ifegans...

...Being milder relaxants, Miltown and Equanil are not quite so dangerous as the more powerful tranquilizers...

...Some persons taking the drugs develop symptoms similar to those of Parkinson's disease, in which there is uncontrolled shaking...

...Important clues already have been...

...He can thus get hold of himself again and is more amenable to outside influences...

...Other reactions occasionally provoked by this drug are skin rashes, fever, constipation, and drowsiness...

...Who does...

...But while the tranquilizers open up encouraging possibilities for curative treatment, they also confront the mental hospitals with new and challenging problems...

...Knight Aldrich, chairman of the department of psychiatry at the University of Chicago...

...Most authorities feel that the tranquilizers now available are only the advance guard of more effective drugs which are certain to be developed within a few years...

...Psychiatric investigators theorize that the tranquilizers block out the brain mechanism governing the emotions, as if it were done surgically with a knife...

...This in itself would be a ffemendous accomplishment, ranking l^ith the greatest discoveries in medicine...