A Black and White History of Psychiatry in the United States

The History of Drug Development in Psychiatry: A Lesson in Serendipity

The goal of this book is to provide a guide on modern day drug development in psychiatry. However, in order to understand current practices in drug development, it is important to first understand the history of psychiatry including early attempts at drug discovery and develoment. The early history of psychiatry is mired with the use of inhumane experimental treatments and the institutionalization of patients in asylums. Some of the earliest drugs used in these asylums were meant to sedate patients rather than treat underlying mental disorders. The earliest identified drugs treating mental disorders were born out of serendipitous discoveries which later led to their clinical effects being demonstrated through clinical trials and case studies. This is evident from the history of chlorpromazine, monoamine oxidase inhibitors, tricyclic antidepressants, lithium, and others. We discuss in detail about each of these psychotropic drugs, the events leading up to their discovery, and their role in formulating the biological basis of mental disorders including schizophrenia, depression, and bipolar disorder. Psychiatry, it seems has worked its way backwards from first identifying treatments before understanding the biological basis of mental disorders, in a sharp contrast to the other fields of medicine. With our growing understanding of the etiopathogenesis of mental disorders, drug development in psychiatry is evolving to develop treatments that target the underlying physiology of mental disorders.

Mental health in medical and biomedical doctoral students during the 2020 COVID-19 pandemic and racial protests

Concerns about the mental health of students, trainees and staff at universities and medical schools have been growing for many years. Recently, these have been exacerbated by the COVID-19 pandemic and a period of heightened reckoning and protests about systemic racism in the United States in 2020. To better understand the mental health of medical students and biomedical doctoral students at the University of North Carolina at Chapel Hill during this challenging period, we performed a cross-sectional study (n=957) using institutional annual survey data on measures of depression, anxiety, hazardous alcohol use, problems related to substance use, and suicidal ideation. These data were collected in 2019 and 2020, and were analyzed by type of training program, race/ethnicity, gender, sexual orientation, and survey year. Results indicated significant differences for rates of depression, anxiety, and suicidal ideation, with biomedical doctoral students showing greater incidence than medical students, and historically excluded students (e.g., people of color, women, LGBQ+ trainees) showing greater incidence compared to their peers. Of note, mental health remained poor for biomedical doctoral students in 2020 and declined for those belonging to historically excluded populations. The high rates of depression, anxiety, and suicidal ideation reported suggest that training environments need to be improved and support for mental health increased.