The doctors gave her antipsychotics. She has decided to live with her voices of hers.

In support of its position, WHO underlines the strong words of Thomas R. Insel, who from 2002 to 2015 was the head of the National Institute of Mental Health, the largest mental health research funder in the world: “I spent 13 years at NIMH really pushing on neuroscience and the genetics of mental disorders, and when I look back on it, I realize that while I think I’ve managed to get a lot of really cool articles published by fantastic scientists at pretty high cost – I think $ 20 billion – not “I don’t think we’ve moved the needle in reducing suicides, reducing hospitalizations, improving recovery for the tens of millions of people with mental illness.”

Better outcomes, the WHO predicts, “will depend on a re-evaluation of many of the assumptions, norms and practices currently in place, including a different perspective on what” competence “means when it comes to mental health.” Michelle Funk, a former clinic and researcher who is leading WHO’s work on mental health policy, law and human rights and is the lead author of the report, told me about the need for a radical change in clinical presumptions. prevalent: “Practitioners cannot put their experience above the competence and experience of those they are trying to support.” Current methods can cause harm and undermine outcomes not only through psychotropic side effects, and not just through the power imbalances of closed wards and court-ordered outpatient care and even seemingly benign doctor-patient relationships, but also through singular attention. symptom reduction, a professional mindset that leaves people with the feeling that they are seen as checklists of diagnostic criteria, not as human beings. “The widespread belief by many in the healthcare industry that people with a mental health condition have a brain defect or a brain disorder,” added Funk, “so easily leads to overwhelming helplessness, loss of identity, loss of hope. self-stigma and isolation “.

In calling for a “fundamental paradigm shift” in mental health, WHO is calling for nearly half a century of psychiatric history. In the early 1960s, weeks before his assassination, President John F. Kennedy signed a mental health bill and declared that “under the current conditions of scientific achievement, it will be possible for a nation rich in human and material resources. like ours to make the farthest corners of the mind accessible. ”American science, he promised, would not only take a man to the moon, but triumph over 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 original antipsychotic. The drug produced debilitating side effects – a shuffling gait, facial stiffness, persistent tics, stupor – but it became difficult behavior and seemed to limit aberrant beliefs. The Times hailed the drug’s “humanitarian and social significance” and Time magazine compared thorazine to “germ-killing sulfites,” innovative drugs developed in the 1930s and 1940s to fight bacterial infections. But the patients did not seem convinced that the benefits outweighed the harms; they often gave up their medications.

Thorazine was followed by Haldol, a more potent antipsychotic whose side effects were no longer gentle. Yet each drug contributed to a radical release of residents from psychiatric asylums, and crude concepts emerged about how these drugs work in the 1970s. Overactive systems of dopamine, a neurotransmitter, were thought to be the culprits of psychosis, and antipsychotics inhibited these systems. The problem was that they damaged dopamine networks throughout the brain, including in ways that led to movement disorders and numbness.

In the 1980s, however, biological psychiatrists believed they would fix 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 series about the Baltimore Sun announcing new brain research and cleverly targeting antipsychotics and other psychotropics on the horizon. : “We’ve gone from ignorance to near-excess knowledge in just 10 years. Coyle’s protege, Donald Goff, now a professor of psychiatry at New York University’s Grossman School of Medicine and for decades one of the country’s foremost researchers on psychosis, he told me, in the late 1980s: “Those were exciting years.” Every day, as he approached a Boston clinic he directed, he saw Haldol’s marks in some of the people he met on the sidewalk. : “As you approached, there were the patients of the clinic with their strange movements, their bending bodies, their tremors. Not only was the disease debilitating; the drugs were leaving them physically so miserable. Yet he perceived, he said, “the possibility of unlimited progress”.

What have been dubbed the “second generation antipsychotics” – including Risperdal, Seroquel and Zyprexa – arrived on the market mainly in the 1990s. In addition to their dopamine assault, they appeared to act less on other neurotransmitters and appeared to have fewer side effects. “There was so much optimism,” Goff recalled. “We were sure we were improving people’s lives.” But concerns soon surfaced and eventually Eli Lilly and Johnson & Johnson, makers of Zyprexa and Risperdal, would pay several billion dollars – a fraction of the drug’s profits – in lawsuits over illegal marketing and the effects of drugs on users’ metabolism. . Zyprexa caused a greatly increased risk of diabetes and severe weight gain (Eli Lilly withheld internal data showing 16% of patients gained over 66 pounds with Zyprexa). Some boys and young people who have taken Risperdal have experienced gynecomastia; pendulous breasts grew. In 2005, the NIMH published a study with 1,460 subjects to see if the new antipsychotics were actually better, in terms of efficacy or safety, than one of the first generation drugs. The answer was no. “It was a resounding disappointment,” Goff said, even though he advocates long-term and probably life-long medications as, on balance, the best way to protect himself from psychiatric devastation.