Today, Edward Shorter takes us on a 200-year journey from the age of spa treatments to the birth of psychopharmacology.

Welcome to the Carlet Psychiatry Podcast, keeping psychiatry honest since 2003.

I'm Chris Aiken, the editor-in-chief of the Carlat's Psychiatry Podcast, keeping psychiatry honest since 2003. I'm Chris Aiken, the editor-in-chief of the Carlat Psychiatry Report.

And I'm Kelly Newsom, a psychiatric MP and a dedicated reader of every issue.

Edward Schorter has been documenting the history of psychiatry for nearly half a century,

sometimes writing alone,

sometimes with psychiatrists like Conrad Schwartz and Max Fink. We caught up with him from his home

in Toronto, Canada, where he shared how the disorders we call depression and anxiety were managed

long ago. I take it from reading your books and books like it, that there's been some kind of distress

that's driven people to psychiatrists for many years and that maybe the name of it has changed,

you know, anxiety, depression, neurosis, etc. But it might all be the same condition.

Distress itself doesn't really change. This is probably a constant in human affairs,

but the labels for it change and accordingly the treatments for it, what you just called distress a moment

ago used to call nerves. Nerves or nervous illness is one of the original diagnoses of psychiatry. And the

assumption is that this is an organic problem. Your nerves are organic entities, and there's something

wrong with these nerves. There's a physical disorder in the body, in other words. And that's the

term how it has gone out of style and been largely for your patients' depression. Well, the treatments for nervous illness were not wonderful in those days, but nonetheless, there were treatments.

If you were middle class and above, you'd be sent to a spa for hydrotherapy.

Bathing and spa water, drinking spa water, or having electrophotherapy, not ECT, but peripheral applications of electricity, were

seen as optimal treatments for nervous disorder. And they were very successful, actually. Going to a spa

was seen as highly therapeutic, even though we look now back at these hydrotherapy with disbelief.

How could they have imagined that bathing, potassium

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