The Science Behind Our Mental Health Failures

Over the past few years, the number of Americans taking psychiatric drugs and in particular antidepressants, has steadily increased, only growing with the onset of the COVID-19 pandemic. As more and more individuals are prescribed psychiatric drugs, there has been a reckoning on the efficacy of these medications. In this extended Q&A from The Fifth Draft in March 2022 — the National Fellows Program newsletter — New America National Fellow Daniel Bergner previews his forthcoming book, The Mind and the Moon, focusing on the science behind mental illness medication, and why we are falling so far behind in these efforts. Sign up for The Fifth Draft to hear how the world's best storytellers find ideas that change the world.

Your Fellows project, The Mind and the Moon, is a work of both autobiography and science writing. Can you tell us about the origins of the project?
In the early 1960s, President John F. Kennedy promised that science would take us to the moon, and, just weeks before his death, he declared that science would make “the remote reaches of the mind accessible” and cure psychiatric disorders with breakthrough medications. We were on the moon within the decade. But today, psychiatric cures continue to elude us — as does the mind itself. Leading neuroscientists have told me that we’ve made no true progress in medicating mental illness in half a century. Why? And what alternative approaches to understanding and treatment might we take? My book is an exploration of these questions through three personal stories, one of them the story of my little brother, who was put on a locked ward when we were in our early 20s.

The book is centered around your own brother’s experiences with mental health problems and its various treatments. He was diagnosed with manic depression near the forefront of what you call psychiatry’s “third revolution.” Can you explain this era and its significance in the history of mental health?
By the early 80s, the idea that the brain and the mind are synonymous took full hold. Psychiatric troubles were purely a matter of neurology; if we could just adjust and fix the physical stuff of the brain, we would fix our depressions, our anxieties, our manias, our breaks from shared reality into the hallucinations of psychosis. This was the so-called third revolution. It was defined by a kind of triumphal rationalism. This is the source of the common wisdom that mental illness is like diabetes; you take psychiatric drugs like you take insulin — straightforward as that. But it’s not even remotely as straightforward as that. The brain and the mind, neurology and consciousness, wiring and emotion, are vastly, perhaps infinitely divergent things. Science may well never take us from one to the other. And this is where, though I’m a fairly rational person, the book takes a slow spiritual turn.

One facet of your book will look at how other cultures differ in method and outcome when comprehending, diagnosing, and controlling disorders. What is it about mental illness that causes such a disconnect in diagnosis and treatment methods among cultures?
Maybe the quickest way to answer this infinitely complex question is to think about Abraham. He hears God telling him to sacrifice his son. If I told a psychiatrist that God was commanding me to bind my son on an altar of stone and slaughter him, I'd be rushed to a locked ward. But the authors of Genesis thought completely differently. And even without the distances of millennia, divergent cultures can have dramatically different perspectives on the mind and mental health. One of my main characters, Chacku, learns to live with his voices and value his unshared realities through the lens of Buddhist and Hindu perspective. That last sentence might sound impossibly romantic, given that we're talking about psychosis, but stories like Chacku's have a lot to teach all of us about existing in our subjective, private realities, and about what it means to be human. If that doesn't come through in the book, then I've failed as a writer.

Your past work has covered topics as diverse as female desire, opera, and antiracism training. What draws you to a subject? How do you know when a story warrants a longer-form treatment?
It’s funny. People often say that I write about a wide array of subjects. But I feel like I keep returning to two topics: psychology and race. My books are inevitably about one or the other. (In a way, my two books about desire led straight into the neuroscience of this book.) I’m obsessive. Fitzgerald once said that writers keep writing about the same things and have to hope no one notices. I wish I could write like Fitzgerald, but I’m thankful that at least no one’s noticing my repetitions.

You also work with high school students, one of whom had an op-ed published in the New York Times last year. What advice do you have for young writers?
I was so thrilled when that student, Elijah Megginson, published that opinion piece. I was just then finishing a draft of this book, but I could barely think about anything besides Elijah getting his ideas heard. He really had something to say, something that needed saying. But you're asking about general advice. I'm not sure I have that. Well, there's one story I tell students from high school on up to grad school. Back when I was bartending and utterly unpublished, a drunk customer, hearing that I wanted to be a writer, decided to tell me that I would fail miserably unless I could summarize my novel-in-progress in a single sentence, two at most. Even Crime and Punishment, he argued, could be summed up in a line or two. I've never forgotten that. He may have had too many drinks, but he was right.

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