Ahmad Gamal Saad-Eddin

On the strange accident that rewired the story of madness.

This piece was originally Published in Almanassa. 

Joel Elkes was born on November 12, 1913, and died on October 30, 2015. He changed the face of psychiatry forever.

It’s impossible to speak of modern psychiatry, despite all the skepticism and suspicion that still surround it, without first pausing at this man. He began his career fascinated by the chemistry of the brain, trained as a physician in one of London’s hospitals, and became the first researcher ever to conduct a controlled clinical trial on chlorpromazine, the very first drug used to treat mental illness.

At the time, the primary way of “managing” psychiatric patients was isolation. They weren’t even called “psychiatric patients” yet; they were simply the insane. These people were pushed to the margins of society, removed from its shared spaces in every possible way.

Before the 1950s, the idea of treating mental illness with medication did not even exist. This was the age of asylums. Patients were admitted and left there, to recover if they could, or to remain for life. The asylums overflowed with the chronically depressed and the incurably schizophrenic. It seemed this would never end.

In the late 1940s, a French surgeon named Henri Laborit was looking for a drug that could calm patients before surgery. He focused his search on antihistamines. The idea arose from a simple observation: patients’ bodies seemed to release large amounts of histamine before operations, likely out of fear of what awaited them under the surgeon’s scalpel. Antihistamines, then, might help ease that anxiety.

Laborit contacted several pharmaceutical companies, asking for potent antihistamines. One sent him a compound called chlorpromazine. It was everything he was looking for. When patients took it, they calmed down; they entered a state of pleasant clarity that allowed him to operate with greater ease and precision. He was so impressed that he recommended the drug to his colleagues and friends in other specialties, including psychiatry.

The drug proved strikingly effective, especially in cases of acute, not chronic, schizophrenia. At Winson Green Hospital in Birmingham, Joel Elkes, then professor of experimental psychiatry, decided to test the drug on patients considered hopeless cases, the ones the world had already abandoned.

At The Margins

They were called the burned-out. They were left behind, neglected in the most literal sense. The medical literature of the time is filled with dreadful descriptions of these people: humans forgotten because no tool could reach them, their very humanity doubted even by the most compassionate physicians. They lived amid vomit and excrement, creatures no one saw as human anymore.

Elkes tells of one patient, a 32-year-old man who had been in the hospital for six years without improvement. He suffered violent fits of rage that ended with shattered furniture. He couldn’t sleep without heavy sedation. He lived in constant terror of unseen beings, ghosts that mocked him, taunted him, urged him to die. Ghosts everywhere.

Elkes tried different doses of chlorpromazine with him and, after a period of regular use, began to notice improvement. The man could now hold conversations. He could attend therapy sessions without losing control. The violent outbursts stopped. When Elkes stopped the drug and replaced it with a placebo, the symptoms returned immediately. Chlorpromazine had worked.

Gradually, other patients improved too. They could be drawn back, at least for a time, from the worst storms of their illness. By the mid-1950s, chlorpromazine had become a cornerstone of psychopharmacology in hospital wards.

Physicians of that era described one immediate effect: the wards themselves became more humane. Doctors and nurses could finally know their patients, not as lunatics, but as people whose illnesses had been partly subdued. The aim of treatment shifted from mere control and sedation to genuine interaction and care.

By the late 1950s, the drug was being used widely across Europe and the United States. Within a decade and a half, many patients, even those once deemed incurable, were able to leave the hospitals and return to the world. The asylum, that grim monument of psychiatry’s past, had outlived its purpose.

The neglected were coming back, working again, reconnecting, or at least becoming manageable and less of a crushing burden on their families. In the U.S. alone, the number of inpatients in mental hospitals dropped by hundreds of thousands. Psychiatric care moved outside asylum walls. The era of the asylum was over.

There was, however, one small problem: no one knew exactly how the drug worked, or even how the diseases it treated came about. That didn’t stop anyone from using it, of course; the results were too clear to ignore. But it revealed something strange about modern medicine: we now had entire therapeutic fields built on success stories we didn’t fully understand.

Why should a compound that blocks histamine in body tissues have such an effect on the mind, interacting somehow with dopamine? No one knew what schizophrenia truly was, or why it occurred. There was no answer.

The End of Winter’s Snow

By the end of the 1950s, six new psychiatric drugs had entered use, many of which remain in use today. Yet it’s important to note that their discovery didn’t come from any systematic search or deep understanding of brain chemistry. It happened in reverse. The drugs were found first; only later did we notice their effects on the brain’s chemical messengers. From there, we learned to manage symptoms that had once been untouchable.

Today we know that chlorpromazine, that magical compound that opened unimaginable doors, suppresses dopamine, one of the brain’s key neurotransmitters. It seemed logical, then, to assume that schizophrenic brains must contain too much dopamine. A neat idea. We now know it’s wrong. Schizophrenic brains don’t show any consistent dopamine imbalance. We’re back at square one.

The historian Edward Shorter wrote in A History of Psychiatry: From the Era of the Asylum to the Age of Prozac:

“If there is one fundamental truth at the end of this century, it is that the biological approach to mental illness—as disorders shaped by genes and brain chemistry—has been a resounding success. Freud’s ideas, which dominated the first half of the century, are now vanishing like the last snow of winter.”

The significance wasn’t only that the drugs worked. This transformation reshaped psychiatry itself, and our relationship to its patients. By embracing the idea that genes and brain chemistry play central roles, illness ceased to look like a mysterious personal failure.

For the first time, stigma began to retreat. The drug had proved that guilt did not belong to the patient, but to a biological flaw in their wiring. And those two things are entirely different.