It is with great skill that Bergner places Caroline’s story in the context of the history of modern psychiatry. It’s hard to do justice to the scope of the larger story it tells, but probably the most shocking part is the utter randomness that has characterized much of the modern search for psychoactive drugs, combined with the absolutely devastating side effects they can have. Bergner traces the history of treatments such as lithium, SSRIs, and antipsychotics. In many cases, the researchers only stumbled upon the drugs’ potential to improve symptoms. Of lithium, he writes that 19th-century doctors used it to treat kidney stones. He later he was among the ingredients of 7-Up. Although lithium was approved by the FDA for psychiatric use in 1970, “nobody had more than a vague concept of how the drug worked neurologically,” says Bergner, and they still don’t.
Bergner interviews a group of researchers who, despite the accidental origins of numerous pharmaceutical products, are today striving to turn them into substances that really improve people’s lives. This is an interesting group of interviewees, all dedicated, hard-working, and highly trained scientists, who candidly acknowledge how poorly many drugs work, how much they can affect the people who use them, and how little we know about how drugs work. the brain really works.
Bergner’s subjects, as well as the scientists and physicians he interviews, also testify to the blurring of many diagnostic and behavioral boundaries. Standard diagnoses often combine what some scientists believe to be different conditions into one, while other diagnoses isolate conditions that may not be that different at all. Psychosis, for example, may not really be one disorder but dozens of them.
Where the history of drug development has been staggeringly messy and our understanding of brain function is worryingly low, the history of psychopharmaceutical marketing has been smart and effective. I still remember when a college friend confidently told me that her recent bout of depression had resulted from a chemical imbalance in her brain. She dazzled me with the explanation. She made her sadness cleaner, easier to resolve, less unglamorous.
It turns out that we had both subscribed to the “chemical imbalance theory,” which proposed, in the 1960s, that depression could be due to a deficiency of neurotransmitters. This eventually evolved into the idea that too many or too few neurochemicals could cause different types of mental illness, such as psychosis. Biology became ascendant in our understanding of psychiatric conditions, leading to a view of medicalized mental health that one of Bergner’s scientists calls “a house of cards.” The idea that SSRIs, for example, could improve our understanding of disorders, the scientist observed, was like saying, “I’m in pain, so I must have an aspirin deficiency.”