Since the advent of the first anti-psychotic, Largactil (chlorpromazine), drug treatment has overshadowed any other therapeutic intervention in British mental hospitals. Since the 1950s myriad drugs with severe side effects have been introduced and continue to be prescribed today. Some advocates therefore went as far as identifying the advent of drug treatment uncritically as the third revolution in psychiatry (Swazey, 1974).
The calming effect of chlorpromazine was discovered in 1950 by French scientists searching for an anti-histamine to treat cardio-respiratory shock. Despite its severe side effects on motor functions (leading to, amongst others, the well described ‘Largactil shuffle’), the drug was widely used in the DCMH soon after it was marketed as an anti-psychotic in 1954. Irrespective of their diagnoses, patients seemed to benefit from the drug’s calming effects that could make a patient more sociable and accessible to other therapies, as the following quote by a former hospital employee illustrates: ‘We had one gentleman that was in his shirt and bare legs in a side room for many a year. He used to shout out the bottom of windows at us when we were working outside, and even Dr […] used to walk on the other side of the ward as he came through. A big man like Mr […], he had a black eye one day from him. So, he was a bit of a character. Now when he had taken [chlorpromazine], I was walking up one of the corridors one day and this fellow came towards me dressed in a suit, and I couldn’t believe my eyes, and he said good morning to me and I said good morning, but I was rather dubious. After that he came and helped us with our stuff. He went in our stores and worked and he took over the cricket scoring. He was quite a gentleman. He had served a lot of time abroad and he was a member of our set-up cricket team from then on until he died’ (Interview with WS). Consequently, case notes reveal that in some instances Largactil could be used to facilitate the management of the patient rather than for medicinal purposes. Similar to the early sedatives, patients did not have to take psychotropic drugs as long as they were ‘quiet and co-operative’ – any instance of disruptive or noisy behaviour, however, was swiftly followed by a course of Largactil, or later its successors. To achieve this, doses administered to severely disturbed patients could exceed the recommended daily dose of 150 to 200 mg (Baker, 1955) by three or four times. Since the development of Largactil numerous psychoactive drugs were introduced to the DCMH. Very few were completely new drugs, most were modification of existing medication with a view to reduce side effects and improve efficacy.
By 1960, Devon used 11 antipsychotics, 6 antidepressants, and 5 anxiolytics (anti-anxiety drugs). Anxiolytics in particular were regarded as extremely safe when first introduced. They have more recently been referred to ‘as one of the greatest menaces to society in peacetime, as coming off them is harder than coming off heroin’ (Healy, 2003). Although psycho-pharmacotherapy seemingly benefited patients as well as nursing staff through enhancing patients’ social capabilities, reducing expensive, long-term hospitalisation, and avoiding damage through invasive surgery, some patients showed minimal or no improvement at all, and others were not always happy with the drug regime. It was observed that while in hospital, ‘they hide it under their pillows, spit it out when unobserved, beg to have it discontinued. They argue it makes them feel sleepy, feel sick, gain weight […]’ (Slear, 1959). The Devon case files provide ample evidence of patients’ expressing their concerns about drugs and sometimes their refusal to take them. In many cases staff responded to this refusal by changing medication from tablets to injections. It is interesting to note that, contrary to the shock treatments and psychosurgery, no specific consent from either the patient or a relative was sought before drug therapy was started, which was usually immediately after arrival at the hospital.