The doctor gave her antipsychotic medication. She decided to live with her voice.

In affirming its position, WHO highlights clear words from Thomas R. Insel, who from 2002 to 2015 was head of the National Institutes of Mental Health, the largest funder of mental health research Psychiatry in the World: “I spent 13 years at NIMH really advancing the neuroscience and genetics of mental disorders, and when I look back on that, I realize that although I thought I had succeed in getting a ton of really interesting papers published by interesting scientists at a pretty hefty cost – $20 billion I think – I don’t ‘don’t think we’ve hit the mark in reducing suicides, reducing hospitalizations, and improving resilience for tens of millions of people with mental illness. “

Better outcomes “will depend on a re-evaluation of the many assumptions, norms and practices currently operating, including a different perspective on what ‘expertise’ means when it comes to health,” WHO predicts. mental health.” Michelle Funk, a former clinician and researcher who is leading WHO work on mental health policy, law and human rights and the report’s lead author, has told me about the need to fundamentally change common clinical assumptions: “Doctors cannot put their expertise above the expertise and experience of the people they are trying to support.” Current approaches can damage and impair outcomes not only through psychotropic side effects, and not only through power imbalances of locked areas and outpatient care. court-ordered residency and even a seemingly benign physician-patient relationship, but through a singular focus on symptom relief, a Professional thinking makes people feel that they are seen as a checklist of diagnostic criteria, not as people. “Many people in the medical profession believe that people with mental health conditions have brain defects or brain disorders,” adds Funk, “which leads to a loss of power, a loss of identity, a loss of hope, a stigma and isolation. ”

In demanding a “fundamental paradigm shift” in the field of mental health, WHO is calling for a history of psychiatry spanning nearly half a century. In the early 1960s, a few weeks before his assassination, President John F. Kennedy signed a mental health bill into law and declared that “under the present conditions of scientific achievement, it would be possible to there is a country rich in human and material resources like ours. to make the long-range of the mind accessible. He pledged that American science would not only put a man on the moon, but also defeat mental illness.

This confidence stemmed from psychiatry’s first pharmaceutical breakthrough a decade earlier, the discovery of chlorpromazine (marketed in the United States as Thorazine), the primary antipsychotic drug. head. The drug causes debilitating side effects – unsteady gait, facial stiffness, persistent seizures, stupor – but it has difficulty regulating behavior and seems to reduce false beliefs. The Times praised the drug’s “social and humanitarian significance,” and Time magazine compared Thorazine to “germicidal sulfas,” a breakthrough drug developed in the 1930s and 1940s to fight infections. by bacteria. But patients do not seem convinced that the benefits outweigh the harms; they often quit smoking.

Followed by Thorazine is Haldol, a stronger antipsychotic with no better side effects. However, each drug contributed to the release of residents from mental institutions to a large extent, and by the 1970s crude concepts had emerged about how these drugs worked. Overactive systems of dopamine, a neurotransmitter, are believed to be the culprit in psychosis, and antipsychotics inhibit these systems. The problem is that they deplete dopamine networks throughout the brain, including in ways that lead to dyskinesia and dyskinesia.

By the 1980s, however, biological psychiatrists believed they would fill this gap by creating better-regulated antipsychotics. Joseph Coyle, then professor of psychiatry and neuroscience at Johns Hopkins School of Medicine, was quoted in a 1984 Pulitzer Prize-winning Baltimore Sun series heralding new and ingeniously targeted brain research to antipsychotics and other psychotropic drugs: “We went from ignorance to almost complete knowledge in just 10 years. One Coyle’s defender, Donald Goff, now a professor of psychiatry at New York University’s Grossman School of Medicine and one of the country’s leading researchers on mental disorders, told me, in the late 1980s, “Those were tough years. Every day, as he approached a Boston clinic he directed, he saw Haldol’s marks on some of the people he passed on the sidewalk: “As you approached, there were patients from the clinic with strange movements, bending over. their bodies, their tremors. Not only debilitating disease; The medication made them very physically miserable. “However, he sensed, he said, “the possibility of infinite progress.”

What are dubbed “second-generation antipsychotics” — among them Risperdal, Seroquel, and Zyprexa — primarily came on the market in the 1990s. In addition to attacking dopamine, they appear to act. less to other neurotransmitters, and they seem to have fewer side effects. “There was a lot of optimism,” Goff recalls. “We’re sure we’re improving people’s lives.” But soon worries arose, and eventually Eli Lilly and Johnson & Johnson, the makers of Zyprexa and Risperdal, would pay out billions of dollars — a fraction of the drug’s profits — in lawsuits over illegal marketing. methods and effects of the drug on the user’s metabolism. Zyprexa poses a high risk of diabetes and serious weight gain (Eli Lilly hid internal data showing that 16% of patients gained more than 66 pounds using Zyprexa). Some boys and young adults taking Risperdal have been affected by gynecomastia; they develop swinging breasts. In 2005, the NIMH published a study of 1,460 subjects looking at whether the new antipsychotic was actually better, in terms of efficacy or safety, than one of the first-generation drugs. The answer is no. “It was a resounding disappointment,” says Goff, although he advocates that long-term and possibly lifelong medication, in balance, is the best way to protect against mental devastation. .

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