Mineral springs and spring fever. Lithium: fact and fantasy in psychopharmacology.

Lithium salts have been employed as medical treatment for more than two thousand years. The history of lithium in medicine reveals a strictly empiricist approach to its use which has resulted in its varying popularity as a therapeutic treatment over the past century. Much of the enthusiasm about the therapeutic use of lithium has been generated by faulty scientific process. This paper reviews the scientific errors which have surrounded the medical use of lithium in history, discusses the metaphorical use of medical terminology and the problem which is posed by the literal interpretation of such terms, and challenges the currently accepted point of view that lithium is a specific treatment for mania. The scientific errors which have resulted in the introduction of lithium as a treatment for mania are reviewed, and it is proposed that lithium treatment be viewed as the paradigm of modern psychopharmacology. The author suggests that the empiricist approach in biological psychiatry requires critical scrutiny in order to avoid tragic consequences, regarding the hazards both to patients arbittrarily exposed to lithium therapy, as well as to the scientific concept of disease as it is modified by those who wish to re-define disease, empirically, in terms of response to treatment.