[The Pill Battle in psychiatry; past, present and future of the medication revolution in mental health care].

Abstract

Background: The explosive growth after 1945 in the production and use of substances that act on the central nervous system. The possibilities for drug intervention on mood, cognition and behaviour became much greater. Meanwhile, the non-medical use of psychoactive substances also increased. Alcohol consumption tripled after 1960 and drug use increased.

Aim: Sketching the impact of these developments on the field of work of Dutch mental health care.

Method: Analysis of historiography of psychotropic drug use and its broader social context; supplemented with primary source material, mainly psychiatric medication narratives.

Results: The medication revolution in mental health care led to therapeutic optimism, but also to conflict. Patients struggled with the profound physical and emotional side effects of psychotropic drugs. They also experienced problems with dependency and discontinuation of medication. Within the counterculture of the 1960s and 1970s, psychiatric medication was seen as an oppression of the free individual. Practitioners struggled with patients’ lack of medication adherence and their self-medication with alcohol and drugs.

Conclusion: It is argued that the tension in the past and present of mental health care around the use of substances for the mind could possibly be alleviated in the future through the practice of autonomous medication management.