In the preface to his new book, David Healy, chronicler of the evolution of psychopharmacology and fearless critic of the pharmaceutical industry, offers some playful remarks about writing history. He points out that as a ‘player’ in the debate about the role of medication in mental illness, he inevitably has his own agenda. He asks the reader to decide whether this agenda distorts the story he tells. The warning is an apt one, because Healy's book, rather than being a short history of mania, is actually more concerned with recent developments in pharmacotherapy. The book races through two millennia to arrive at the 1950s and the advent of lithium. One senses that Healy is really more interested in recent events than the distant past. This is a pity, because his account of medical ideas about mania in classical Greece is revealing. He points out that many clinical accounts of manic–depressive illness begin by claiming an ancient lineage for the condition, reaching back to Hippocrates. By looking at the original documents, Healy convincingly shows that other authors have quoted selectively from Hippocrates and omitted the crucial detail that symptoms suggestive of ‘mania’ occurred in individuals who were also experiencing ‘fever’. He suggests that what was actually being described was some kind of organic, confusional state. Healy refers to that master of the linguistic archaeology of psychiatric terminology, German Berrios, who emphasised that the meaning of clinical terms can change over time and we cannot assume that when the ancient Greeks used the word ‘mania’, they meant the same as we do.

Thereafter, Healy proceeds to 17th-century England to consider Thomas Willis' work on the brain, before travelling to Paris in the 1850s where the new category of folie circularie was being outlined independently by Jules Baillarger and Jean-Pierre Falret. This concept was taken up by Karl Kahlbaum and then Emil Kraepelin who by the end of the 19th century was delineating a condition he called ‘manic–depressive insanity’. According to Healy, the disease remained a rarity until the 1960s when clinicians began to ask whether it might respond to lithium. Healy devotes nearly two-thirds of the book to subsequent developments in psychopharmocology. He is clearly fascinated by the subject and over the years has interviewed many of the leading figures in the field, the fruits of such labour being published in his three volumes of The Psychopharmacologists (Altman, Chapman & Hall, 1996). This has been a valuable and illuminating project in oral history, but do we need quite so much of this material in a short book on bipolar disorder? The average reader may find accounts of who said what to whom at a succession of medical conferences and what happened behind drug company walls a bit wearying.

Nevertheless, what Healy has to say about recent trends in the treatment of mood disorders is deeply disturbing, particularly the case of ‘Alex’, a 2-year-old baby girl who was treated with antipsychotic medication for a supposed bipolar condition and subsequently dropped dead. Hers was not an isolated case: Healy reveals that in the USA young children and infants are routinely being treated with antipsychotic medication for psychiatric conditions they almost certainly do not have. In the final section entitled ‘Coda’, Healy strikes an apocalyptic note which veers between the allusive and the opaque. The pharmaceutical companies' push to sell their product, Healy asserts, has transformed the way we see ourselves and how doctors practise medicine. We are at risk from what Healy styles a ‘pharmaceutical Pied Piper’ who connives to have our children administered unnecessary and potentially fatal doses of psychotropic medication. Despite the imbalances in the book, Healy continues to provide a probing and challenging commentary on the state of contemporary psychiatry.