Courtwright D T
Department of History, University of North Florida, Jacksonville, 32224-2645, USA.
Addiction. 1997 Mar;92(3):257-65.
Marie Nyswander was the co-discoverer of methadone maintenance. In the 1960s she and Vincent Dole carried out clinical trials and established the first officially sanctioned methadone clinics, which became models for maintenance programs throughout the world. In 1967 she and Dole theorized that heroin addicts had undergone a permanent metabolic change. They needed narcotics in a visceral way, which explained why abstinence was not a realistic goal-a claim that remains hotly disputed. Nyswander's work in the 1960s marked an abrupt shift in her thinking about addiction. Her previous approach had been centered on psychoanalysis. Her embrace of methadone maintenance and the metabolic theory amounted to an intellectual conversion. Nyswander was prepared for that conversion by years of patient relapse; she was frustrated with orthodox therapy. At the same time the success of such drugs as chlorpromazine suggested that psychiatric disorders might yield more readily to chemotherapy than talking therapy. Her own heavy smoking may have led her to question whether addiction was a psychiatric disorder in the first place. Finally, Nyswander had a long history of self-reinvention, having previously changed her politics, her medical specialty, and even her name. She was temperamentally suited for a conversion experience.
玛丽·尼斯万德是美沙酮维持疗法的共同发现者。20世纪60年代，她和文森特·多尔进行了临床试验，并建立了首个官方批准的美沙酮诊所，这些诊所成为了全球维持治疗项目的典范。1967年，她和多尔提出理论，认为海洛因成瘾者经历了永久性的代谢变化。他们内心极度需要麻醉品，这就解释了为什么禁欲并非现实目标——这一观点至今仍备受争议。尼斯万德在20世纪60年代的工作标志着她对成瘾问题的思考发生了突然转变。她之前的方法以精神分析为中心。她对美沙酮维持疗法和代谢理论的接受相当于一次思想转变。多年来患者的复发让尼斯万德为这次转变做好了准备；她对传统疗法感到沮丧。与此同时，氯丙嗪等药物的成功表明，精神疾病可能比谈话疗法更容易通过化疗得到治疗。她自己大量吸烟可能使她首先质疑成瘾是否是一种精神疾病。最后，尼斯万德有着长期自我重塑的经历，此前她曾改变自己的政治立场、医学专业，甚至自己的名字。她的性格适合经历一次转变体验。
