Rauwolfia serpentina is an evergreen shrub with large leaves and flowers and tiny fruit that turn purple-black when ripe. It grows wild in India and is mainly found on the slopes of the Himalayas. The first recorded mention of rauwolfia roots (known as snakeroot or "sarpagandha" in Indian medicine) was in 600 BC although oral tradition describes it as a mainstay of Indian Avuredic medicine for thousands of years before that. Snakeroot gained its name as a treatment for the effects of snake venom but it was also used for treating insomnia, diarrhea, dysentery and uterine complications. Traditional healers also used it for the sedation of mental disturbances and it became known as the "insanity herb" for that reason. Rauwolfia serpentina was given its scientific name in the 17th century by a French botanist who named the shrub in honour of 16th century botanist and physician Leonhard Rauwolf. Still, its medical properties weren't formally identified until 1933 when Rauwolfia's value in combating hypertension was first discovered. The active alkaloids derived from the rauwolfia root (more commonly known as reserpine) were first isolated and synthesized in 1952 and research into reserpine began in earnest. Researchers found that reserpine affected norepinephine uptake, activated dopamine receptors and depleted brain serotonin. The calming effect that reserpine had on patients suffering from acute psychosis was first identified in 1954 and the psychopharmacological revolution in psychiatry was on.

It was reserpine, along with chlorpromazine (which was actually first used in psychiatric patients) and haloperidol that triggered the massive deinstitutionalization of psychiatric patients that followed. In the United States alone, the number of hospitalized psychiatric patients went from 500,000 in 1960 to an estimated 100,000 at present. While the introduction of psychiatric medications gave rise to an irrational optimism about the treatability of mental illness in the community, the reality proved to be considerably bleaker for all too many psychiatric patients. Sadly, while psychiatric medications prove useful in controlling mental illness in institutions, using them for outpatient treatment is far more problematic. I won't go into the various economic, social and political dimensions of the tragedy but the end result has been a widescale shift in patients from psychiatric hospitals to homeless shelters, prisons and alleyways throughout most of the industrialized world. Ironically, reserpine has long since been phased out as a treatment for mental illness in favour of more effective medications due to the serious side effects associated with it (including neuroleptic malignant syndrome and parkinsonian symptoms). It's mainly used as a treatment for hypertension these days (except by traditional healers). The social upheaval that it helped spark is still unfolding though and the political and social will to deal with this health care crisis is sorely lacking.

The intricate details of how Indian herbal medication led to this current situation mean little to the former mental patients who find themselves locked in prisons or freezing on the streets this winter. All that I can say is that I am thinking about them this holiday season. I wish there was an answer for them.