Blaming the Brain: The Truth about Drugs and Mental Health

In the past 25 years, theories of mental illness have shifted from blaming mother to blaming the brain. While the prevailing view is that ""mental illnesses are medical illnesses just like diabetes, high blood pressure or heart disease,"" and it's estimated that 30 million people worldwide have taken Prozac, the truth, argues Valenstein, a professor of psychology and neuroscience at the University of Michigan and the author of Great and Desperate Cures, is that we are only at the dawn of an understanding of mental illness. The studies he reviews indicate that a combination of medications and therapy offers the best chance of success at treating common disorders, although no one knows exactly why. Valenstein does a fine job of illuminating the various interests at work behind the ascendancy of purely biological hypotheses. They appeal to pharmaceutical companies, he suggests, for all the obvious reasons, and he details the impact that these companies have, at every level, on today's psychiatric landscape: from sponsoring research and colloquiums to lobbying government to marketing directly to both consumers and primary-care physicians--the largest prescribers of psychiatric drugs. The companies also, he reports, pressure editors of psychiatric journals, in which they also advertise, to downplay studies that cast doubt on the safety or usefulness of their drugs. Families and patients, meanwhile, embrace biological theories because they relieve them of the burden of blame, and physicians, he says, neglect their responsibility to report side effects to the FDA. This meticulously researched, evenhanded work deserves a large audience. Unfortunately, it's about as exciting to read as the fine print in your HMO contract; Valenstein, who comes out with both guns blazing, concentrates more on clearly digesting the data than on giving the story a human face. (Oct.)