“palliative, none are even proposed as cures”… T. R. Insel and E. M. Scolnick, “Cure Therapeutics and Strategic Prevention: Raising the Bar for Mental Health Research,” Molecular Psychiatry 11 (2006): 13.
Second-generation drugs… An NIMH study, called the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE), compared older drugs with atypical antipsychotics and found that “the newer drugs were no more effective or better tolerated than the older drugs” with the exception of one, Clozapine. “Questions and Answers About the NIMH Clinical Antipsychotic Trials of Intervention Effectiveness Study (CATIE)—Hase 2 Results,” National Institute of Mental Health, https://www.nimh.nih.gov/funding/clinical-research/practical/catie/phase2results.shtml.
“the single biggest target”… Duff Wilson, “Side Effects May Include Lawsuits,” New York Times, October 2, 2010, https://www.nytimes.com/2010/10/03/business/03psych.html.
Johnson & Johnson, for example… Katie Thomas, “J&J to Pay $2.2 Billion in Risperdal Settlement,” New York Times, November 4, 2013, https://www.nytimes.com/2013/11/05/business/johnson-johnson-to-settle-risperdal-improper-marketing-case.html.
“For the past twenty-five years”… Robert Whitaker, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America (New York: Crown, 2010), 358.
“They just need to take their drugs”… Psychiatrist, in-person interview.
“your life is taken away from you”… This person prefers to remain anonymous.
I see that these drugs help many people… For a remarkable story about how the right antipsychotic medication (in this case Clozapine) helped turn a life around, see Bethany Yeiser’s Mind Estranged: My Journey from Schizophrenia and Homelessness to Recovery (2014).
a worldwide shortage of mental health care workers… Kitty Farooq et al., “Why Medical Students Choose Psychiatry—A 20 Country Cross-Sectional Survey,” BMC Medical Education 14, no. 12 (2014), https://bmcmededuc.biomedcentral.com/articles/10.1186/1472-6920-14-12.
only 3 percent of Americans… M. M. Weissman, H. Verdeli, S. E. Bledsoe, K. Betts, H. Fitterling, and P. Wickramaratne, “National Survey of Psychotherapy Training in Psychiatry, Psychology, and Social Work,” Archives of General Psychiatry 63, no. 8 (2006): 925–34, https://www.ncbi.nlm.nih.gov/pubmed/16894069.
“Before we get to that”… Allen Frances, phone interview, January 4, 2016.
27: MOONS OF JUPITER
Taunted by death… Rita Charon and Peter Wyer, “The Art of Medicine,” Lancet 371 (2008): 296–97, https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(08)60156-7.pdf.
“I think we should be honest about”… Belinda Lennox, phone interview, December 29, 2016.
Dutch psychiatrist Jim van Os, who wrote… S. Guloksuz and J. van Os, “The Slow Death of the Concept of Schizophrenia and the Painful Birth of the Psychosis Spectrum,” Psychology Medicine 48, no. 2 (2018): 229–44, https://www.ncbi.nlm.nih.gov/pubmed/28689498.
“not more than ten diagnoses”… Jim van Os, phone interview, August 3, 2017.
The research community has reached… In Japan, psychiatrists replaced the term Seishin Bunretsu Byo (mind-split disease) with Togo Shitcho Sho (integration disorder) in 2002. There’s evidence that this change in the nomenclature has opened up better communication channels between doctors and patients: Before the change, only 7 percent of psychiatrists always shared diagnosis with patients; within seven months, 78 percent of psychiatrists did.
“Is schizophrenia disappearing?”… Per Bergsholm, “Is Schizophrenia Disappearing?” BMC Psychiatry 16 (2016), https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-1101-5.
“Should the label schizophrenia be abandoned?”… A. Lasalvia, E. Penta, N. Sartorius, and S. Henderson, “Should the Label Schizophrenia Be Abandoned?” Schizophrenia Research 162, nos. 1–3 (2015): 276–84, https://www.ncbi.nlm.nih.gov/pubmed/25649288.
During his tenure as the director… My understanding of the RDoC came from a variety of sources, but was mainly compiled from an in-person interview on June 15, 2015, and “Research Domain Criteria (RDoC),” National Institute of Mental Health, https://www.nimh.nih.gov/research/research-funded-by-nimh/rdoc/index.shtml.
half of NIMH-funded studies… Sarah Deweerdt, “US Institute Maintains Support for Diagnoses Based on Biology,” Spectrum, May 9, 2018. For more on RDoC criteria, see https://www.psychiatrictimes.com/nimh-research-domain-criteria-rdoc-new-concepts-mental-disorders.
from 10 to 30 percent… Frederick J. Frese, Edward L. Knight, and Elyn Saks, “Recovery from Schizophrenia: With Views of Psychiatrists, Psychologists, and Others Diagnosed with This Disorder,” Schizophrenia Bulletin 35, no. 2 (2009): 370–80, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2659312/.
but hundreds… Linda Geddes, “Huge Brain Study Uncovers ‘Buried’ Genetic Networks Linked to Mental Illness,” Nature News, December 13, 2018, https://www.nature.com/articles/d41586-018-07750-x.
a “genetic overlap” in psychiatric disorders… The Brainstorm Consortium, “Analysis of Shared Heritability in Common Disorders of the Brain,” Science 360, no. 6395 (2018), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6097237/; and Alastair G. Cardno and Michael J. Owen, “Genetic Relationship Between Schizophrenia, Bipolar Disorder, and Schizoaffective Disorder,” Schizophrenia Bulletin 40, no. 3 (2014): 504–15, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984527/.
“The tradition of drawing these sharp lines… Karen Zusi, “Psychiatric Disorders Share an Underlying Genetic Basis,” Science Daily, June 21, 2018, https://www.sciencedaily.com/releases/2018/06/180621141059.htm.
spurring studies of immune-suppressing drugs… One such example comes out of Oxford University: Belinda R. Lennox, Emma C. Palmer-Cooper, Thomas Pollack, Jane Hainsworth, Jacqui Marks, Leslie Jacobson, “Prevalence and Clinical Characteristics of Serum Neuronal Cell Surface Antibodies in First-Episode Psychosis: A Case-Control Study,” Lancet Psychiatry 4, no. 1 (2017): 42–48, https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366%2816%2930375-3/fulltext.
a third of people with schizophrenia… Moises Velasquez-Manoff, “He Got Schizophrenia. He Got Cancer. And Then He Got Cured,” New York Times, September 29, 2018, https://www.nytimes.com/2018/09/29/opinion/sunday/schizophrenia-psychiatric-disorders-immune-system.html.
reduce mania… F. Dickerson et al., “Adjunctive Probiotic Microorganism to Prevent Rehospitalization in Patients with Acute Mania: A Randomized Control Trial,” Bipolar Disorders 20, no. 7 (2018): 614–21.
the more robust symptoms of schizophrenia… Emily G. Severance et al., “Probiotic Normalization of Candida albicans in Schizophrenia: A Randomized, Placebo-Controlled Longitudinal Pilot Study,” Brain Behavior and Immunity 62 (2017): 41–45.
people born in winter months… Erick Messias, Chuan-Yu Chen, and William W. Eaton, “Epidemiology of Schizophrenia: Review of Findings and Myths,” Psychiatric Clinics of North America 8, no. 9 (2011): 14–19, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3196325/.
are more likely to be born in the summer… Thank you, Dr. William Carpenter, for the heads-up about this. Erick Messias, Brian Kirkpatrick, and Evelyn Bromet, “Summer Birth and Deficit Schizophrenia: A Pooled Analysis from Six Countries,” JAMA Psychiatry 61, no. 10 (2004): 985–99, https://jamanetwork.com/journals/jamapsychiatry/fullarticle/482066.
“What I teach my students is”… Steven Hyman, phone interview, February 10, 2017.
a highly touted paper in Nature… Aswin Ekar et al., “Schizophrenia Risk from Complex Variation of Complement Component 4,” Nature 530 (2016): 177–83, https://www.nature.com/articles/nature16549.
Drop-Seq… Lisa Girard, “Single-Cell Analysis Hits Its Stride: Advances in Technology and Computational Analysis Enable Scale and Affordability, Paving the Way for Translational Studies,” Broad Institute, May 21, 2015, https://www.broadinstitute.org/news/single-cell-analysis-hits-its-stride.
optogenetics, which manipulates brain circuits…
Stephen S. Hall, “Neuroscience’s New Toolbox,” MIT Technology Review, June 17, 2014, https://www.technologyreview.com/s/528226/neurosciences-new-toolbox.
CLARITY, which melts away the superstructure… Mo Costandi, “CLARITY Gives a Clear View of the Brain,” The Guardian, April 10, 2013, https://www.theguardian.com/science/neurophilosophy/2013/apr/10/clarity-gives-a-clear-view-of-the-brain.
a new technique… Ruixan Gao et al., “Cortical Column and Whole-Brain Imaging with Molecular Contrast and Nanoscale Resolution,” Science 363, no. 6424 (2019), https://science.sciencemag.org/content/363/6424/eaau8302.
They are in essence creating “mini-brains”… Dina Fine Maron, “Getting to the Root of the Problem: Stem Cells Are Revealing New Secrets About Mental Illness,” Scientific American, February 27, 2018, https://www.scientificamerican.com/article/getting-to-the-root-of-the-problem-stem-cells-are-revealing-new-secrets-about-mental-illness.
IBM’s Watson team told me… I visited the facility and received a tour from Guillermo Cecchi and company on November 16, 2016.
“Digital phenotyping”… Thomas R. Insel, “Digital Phenotyping: A Global Tool for Psychiatry,” World Psychiatry 17, no. 3 (2018): 276–78, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6127813/.
More medical students are pursuing careers… Mark Moran, “U.S. Seniors Matching to Psychiatry Increases for Sixth Straight Year,” Psychiatric News, American Psychiatric Association, March 29, 2018, https://doi.org/10.1176/appi.pn.2018.4a.
the average psychiatrist’s salary increased… Carol Peckham, “Medscape Psychiatrist Compensation Report 2018,” Medscape, April 18, 2018, https://www.medscape.com/slideshow/2018-compensation-psychiatrist-6009671#8.
“We have never seen demand”… Peckham, “Medscape Psychiatrist Compensation Report 2018.”
decreasing its flow to those areas… Mary O’Hara and Pamela Duncan, “Why ‘Big Pharma’ Stopped Searching for the Next Prozac,” The Guardian, January 27, 2016, https://www.theguardian.com/society/2016/jan/27/prozac-next-psychiatric-wonder-drug-research-medicine-mental-illness.
“It is to be hoped that”… David Cunningham Owens and Eve C. Johnstone, “The Development of Antipsychotic Drugs,” Brain and Neuroscience Advances, December 5, 2018, https://journals.sagepub.com/doi/full/10.1177/2398212818817498#articleCitationDownloadContainer.
psychedelic revival… Matt Schiavenz, “Seeing Opportunity in Psychedelic Drugs,” The Atlantic, March 8, 2015, https://www.theatlantic.com/health/archive/2015/03/a-psychedelic-revival/387193.
Even brain stimulation… For more on deep brain stimulation, past and present, see Frank, The Pleasure Shock.
Some techniques involve implanting electrodes… Thank you to Columbia psychiatrist Cheryl Corcoran, who shared some details about her work with deep brain stimulation in our phone interview on April 11, 2017.
a variation of the anesthetic ketamine… Benedict Carey, “Fast-Acting Depression Drug, Newly Approved, Could Help Millions,” New York Times, March 9, 2015, https://www.nytimes.com/2019/03/05/health/depression-treatment-ketamine-fda.html.
being touted on all the morning shows… “What to Know About Ketamine-Based Drug for Depression and More,” Today, March 6, 2019, https://www.today.com/video/what-to-know-about-ketamine-based-drug-for-depression-and-more-1452994627709.
therapy creates profound changes… Eric Kandel, “A New Intellectual Framework for Psychiatry,” American Journal of Psychiatry 155, no. 4 (1998): 457–69, https://www.ncbi.nlm.nih.gov/pubmed/9545989; and Louis Cozolino, The Neuroscience of Psychotherapy: Healing the Social Brain, 2nd ed. (New York: W. W. Norton, 2010).
“Psychotherapy is a biological treatment”… Eric R. Kandel, “The New Science of the Mind,” New York Times, September 6, 2013, https://www.nytimes.com/2013/09/08/opinion/sunday/the-new-science-of-mind.html.
“One sees as far as one is limited”… Niall Boyce, phone interview, April 19, 2016.
“It’s true, [it’s like having] a microscope”… Matthew State, phone interview, March 13, 2017.
“You’re going to see the whole thing”… E. Fuller Torrey, phone interview, January 14, 2016.
“In spite of the fact that state hospitals”… Joel Braslow, phone interview, March 10, 2015.
The late neurologist Oliver Sacks agreed… Oliver Sacks, “The Lost Virtues of the Asylum,” New York Review of Books, September 24, 2009, retrieved from https://www.nybooks.com/articles/2009/09/24/the-lost-virtues-of-the-asylum.
Three University of Pennsylvania ethicists… Dominic Sisti, Andrea G. Segal, and Ezekiel J. Emanuel, “Improving Long-Term Psychiatric Care: Bring Back the Asylum,” JAMA 313, no. 3 (2015): 243–44.
“a disgrace”… confirmed via emails provided to me by Dominic Sisti on April 29, 2019.
“The debate boils down to one question”… Dominic Sisti, phone interview, July 6, 2017.
“The brain is extremely plastic”… Maree Webster, interview at the Stanley Medical Research Institute Laboratory of Brain Research, January 14, 2016.
Environmental factors… For a great breakdown of the environmental factors associated with developing severe mental illness, see Joel Gold and Ian Gold, Suspicious Minds.
antibodies directed against a common feline parasite… E. Fuller Torrey and Robert H. Yolken, “Toxoplasma Gondii and Schizophrenia,” Emerging Infectious Diseases 9, no. 11 (2003): 1375–80, https://wwwnc.cdc.gov/eid/article/9/11/03-0143_article.
schizophrenia found in the Caribbean population… Rebecca Pinto and Roger Jones, “Schizophrenia in Black Caribbeans Living in the UK: An Exploration of Underlying Causes of the High Incidence Rate,” British Journal of General Practice 58, no. 551 (2008): 429–34, https://bjgp.org/content/58/551/429.
Living in cities is linked… One of many studies that have shown a correlation between urban life and schizophrenia is James Kirkbride, Paul Fearon, Craig Morgan, Paola Dazzan, Kevin Morgan, Robin M. Murray, and Peter B. Jones, “Neighborhood Variation in the Incidence of Psychotic Disorders in Southeast London,” Social Psychiatry and Psychiatric Epidemiology 42, no. 6 (2007): 438–45, https://link.springer.com/article/10.1007%Fs00127-007-0193-0.
A two-year government-funded study… John M. Kane et al., “Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes from the NIMH RAISE Early Treatment Program,” American Journal of Psychiatry 173, no. 4 (2016): 362–72, https://www.ncbi.nlm.nih.gov/pubmed/26481174.
“comprehensive, multi-element approach”… Thank you to Dr. Robert Heinssen, Dr. Lisa Dixon, and Dr. John Kane for your perspectives on RAISE and early intervention. For more information, see Robert K. Heinssen, Amy B. Goldstein, and Susan T. Azrin, “Evidence-Based Treatment for First Episode Psychosis: Components of Coordinated Specialty Care,” National Institute of Mental Health, April 14, 2014, https://www.nimh.nih.gov/health/topics/schizophrenia/raise/evidence-based-treatments-for-first-episode-psychosis-components-of-coordinated-specialty-care.shtml.
people who are troubled by hearing voices… For a wonderful examination of voice-hearing, see Charles Fernyhough, The Voices Within: The History and Science of How We Talk to Ourselves (New York: Basic Books, 2016), 4.
Yale researchers found that a key difference… Albert R. Powers, Megan S. Kelley, and Philip R. Corlett, “Varieties of Voice-Hearing: Psychics and the Psychosis Continuum,” Schizophrenia Bulletin 43, no. 1 (2017): 84–98, https://academic.oup.com/schizophreniabulletin/article/43/1/84/2511864.
compared the experience of auditory hallucinations… Tanya Marie Luhrmann et al., “Culture and Hallucinations: Overview and Future Directions,” Schizophrenia Bulletin 40, no. 4 (2014): 213–20.
“Are those cultural judgments”… Joseph Frankel, “Psychics Who Hear Voices Could Be onto Something,” The Atlantic, June 27, 2017, https://www.theatlantic.com/health/archive/2017/06/psychics-hearing-voices/531582.
One popular therapy that takes these cultural judgments… For more on open dialogue therapy, see Tom Stockmann, “Open Dialogue: A New Approach to Mental Healthc
are,” Psychology Today, July 12, 2015, https://www.psychologytoday.com/us/blog/hide-and-seek/201507/open-dialogue-new-approach-mental-healthcare.
I saw McLean’s version… I visited McLean Hospital in August 2017. Thank you to Dr. Dost Ongur and Dr. Joseph Stoklosa for allowing me to visit and for taking time to show me their techniques.
You’ve heard of the placebo effect… For a great discussion of the placebo effect and history, see Jo Marchant, Cure: A Journey into the Science of Mind Over Body (New York: Crown, 2016); Melanie Warner, The Magic Feather Effect: The Science of Alternative Medicine and the Surprising Power of Belief (New York: Scribner, 2019); and Gary Greenberg, “What If the Placebo Effect Isn’t a Trick?” New York Times, November 7, 2018, https://www.nytimes.com/2018/11/07/magazine/placebo-effect-medicine.html.
with the psalm Placebo Domine… Daniel McQueen, Sarah Cohen, Paul St. John-Smith, and Hagen Rampes, “Rethinking Placebo in Psychiatry: The Range of Placebo Effects,” Advances in Psychiatric Treatment 19, no. 3 (2013): 171–80.
to attend funerals to “sing placebos”… C. E. Kerr, I. Milne, and T. J. Kaptchuk, “William Cullen and a Missing Mind-Body Link in the Early History of Placebos,” Journal of the Royal Society of Medicine 101, no. 2 (2008): 89–99, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2254457/.
The word made its way… Kerr, Milne, and Kaptchuk, “William Cullen and a Missing Mind-Body Link.”
By the 1960s, the FDA had set… Suzanne White, “FDA and Clinical Trials: A Short History,” U.S. Food & Drug Administration, https://www.fda.gov/media/110437/download.
saline solution that you believe is morphine… J. D. Levine, N. C. Gordon, R. Smith, and H. L. Fields, “Analgesic Responses to Morphine and Placebo in Individuals with Postoperative Pain,” Pain 10, no. 3 (1981): 379–89.
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