To back its position, the WHO highlights stark words from Thomas R. Insel, who from 2002 to 2015 was the head of the National Institute of Mental Health, the largest funder of mental-health research in the world: “I spent 13 years at NIMH. Really pushing on the neuroscience and mental disorders of genetics, and when I look back on that, I realize that while I think I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs – I think $ 20 billion – I don “Don’t think we need to move into reducing suicide, reducing hospitalizations, improving recovery for the millions of people who have mental illness.”
Better results, the WHO predicts, “will depend on a re-evaluation of many of the assumptions, norms and practices that currently operate, including a different perspective on what ‘expertise’ means when it comes to mental health.” Michelle Funk, a former clinician and researcher who is leading the WHO’s work on mental-health policy, law and human rights and is the primary author of the report, spoke about the need for a radical change in prevailing clinical presumptions: “Practitioners They cannot put their expertise above the expertise and experience they are trying to support. ” Present methods can not only do harm and undermine the consequences of psychotropic side effects, and not only the power imbalances of locked wards and court-ordered outpatient care and even seemingly benign practitioner-patient relationships, but also through reducing symptoms on a singular focus. A professional mind-set that leaves people feeling that they are seen as a diagnostic type of checklists, not as human beings. “The widespread belief that many in the health sector that people have a mental-health condition has a brain defect or disorder of the brain,” Funk added, “so easily leads to overwhelming disempowerment, loss of identity, loss of hope, self- stigma and isolation. “
In demanding a “radical paradigm shift” in the field of mental health, the WHO has been calling for a close half-century of psychiatric history. In the early 1960s, weeks before his assassination, President John F. Kennedy signed a mental-health bill into law and declared that “under current conditions of scientific achievement, it would be possible for a nation as rich in human and material resources as ours. to make the remote reactive of the mind accessible. ” American science, he pledged, would not just land a man on the moon but would triumph over mental illness.
This confidence stemmed from psychiatry’s first pharmaceutical breakthrough a decade ago, the discovery of chlorpromazine (marketed in the United States as Thorazine), the original antipsychotic. The drug brought debilitating side effects – a shuffling gait, facial rigidity, persistent tics, stupor – but it becalmed difficult behavior and seemed to curtail aberrant beliefs. The Times hailed the drug’s “humanitarian and social significance,” and Time magazine compared Thorazine to “germ-killing sulfas,” groundbreaking drugs developed in the 1930s and 1940s to fight off bacterial infections. But patients didn’t seem to persuade that the benefits were outweighed the harm; They often abandoned their medication.
Thorazine was followed by Haldol, a more potent antipsychotic whose side effects were no kinder. Yet each drug contributed to a sweeping release from residents of psychiatric asylums, and by the 1970s, crude concepts emerged about how these medications work. Overactive systems of dopamine, a neurotransmitter, were thought to be the culprit in psychosis, and antipsychotics inhibited these systems. The problem was that they impaired dopamine networks all over the brain, including in ways that led to movement disorders and torpor.
By the 1980s, though, biological psychiatrists believed they would solve this flaw by creating more finely tuned antipsychotics. Joseph Coyle, then a professor of psychiatry and neuroscience at the Johns Hopkins School of Medicine, was quoted in a 1984 Pulitzer Prize-winning Baltimore Sun series that heralded new brain research and deftly targeted antipsychotics and other psychotropics on the horizon: “We’re gone from ignorance to almost a surfeit of knowledge in only 10 years. ” A protégé of Coyle’s, Donald Goff, now a psychology professor at New York University’s Grossman School of Medicine and one of the decades pre-eminent researchers in psychosis, told me about the end of the 1980s, “Those were heady years. ” Every day, as he neared a Boston clinic he directed, he saw the marks of Haldol in some of the people he passed on the sidewalk: “As you approached, there were patients from the clinic with their strange movements, their bent-over. bodies, their tremors. Not only was the illness debilitating; The medications were leaving them physically so miserable. ” Yet he sensed, he said, “the possibility of limitless progress.”
What were christened the “second-generation antipsychotics” – among them Risperdal, Seroquel and Zyprexa – came on the market in the 1990s. In addition to their attacks on dopamine, they seem to act, in lesser ways, on other neurotransmitters, and they have less side effects. “There was so much optimism,” Goff remembered. “We were sure we were improving people’s lives.” But quickly worries arose, and eventually Eli Lilly and Johnson & Johnson, makers of Zyprexa and Risperdal, would pay out billions of dollars – a fraction of the drugs’ profits – lawsuits over illegal marketing and the effects of drugs’ users’ metabolisms. General Chat Chat Lounge Zyprexa has a significantly elevated risk of diabetes and severe weight gain (Eli Lilly concealed internal data showing that 16 percent of patients gained over 66 pounds on Zyprexa). Some boys and young men who took Risperdal were affected by gynecomastia; They grew pendulous breasts. In 2005, the NIMH published a study with 1,460 subjects looking for new antipsychotics in fact better, in efficacy or safety, than one of the first-generation drugs. The answer was no. “It was a resounding disappointment,” Goff said, though he advocates long-term and perhaps lifelong medication as, on balance, the best way to guard against psychiatric devastation.