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The TRUTH About Drugs and Mental Health ELLIOT S. VALENSTEIN, Ph.D. GREAT AND DESPERATE CURES AUTHOR OF U.S. $25.00 Can. $36.00 Over the last thirty years, there has been a radical shift in thinking about the causes of mental illness. The psychiatric establish ment and the health care industry have shifted 180 degrees from blaming mother to blaming the brain as the source of mental disorders. Whereas experi ence and environment were long viewed as the root causes of most emotional problems, now it is com mon to believe that mental disturbances—from depression and anxiety to schizophrenia— are determined by brain chemistry. And many people have come to accept the broader notion that their very personalities are determined by brain chem istry as well. In his award-winning, meticulously researched, and elegantly written history of psychosurgery, Great and Desperate Cures, Elliot Valenstein exposed the great injury to thousands of lives that resulted when the medical establishment embraced an unproven approach to mental illness. Now, in Blaming the Brain he exposes the many weak nesses inherent in the scientific arguments support ing the widely accepted theory that biochemical imbalances are the main cause of mental illness. Valenstein reveals how, beginning in the 1950s, the accidental discovery of a few mood-altering drugs stimulated an enormous interest in psy chopharmacology, resulting in staggering growth and profits for the pharmaceutical industry. He lays bare the commercial motives of drug companies and their huge stake in expanding their markets. Prozac, Thorazine, and Zoloft are just a few of the psychoactive drugs that have dramatically changed practice in the mental health profession. Physicians today prescribe them in huge numbers even though, as several major studies reveal, their effectiveness and safety have been greatly exaggerated. (continued on back flap) Other Books by Elliot S. Valenstein: Great and Desperate Cures Brain Control The Psychosurgery Debate BLAM ING THE B R A IN THE TRUTH ABOUT DRUGS AND MENTAL HEALTH S. Ph.D. Elliot Valenstein, /p THE FREE PRESS New York loiulon Toronto Sydney Singapore THE FREE PRESS A Division of Simon & Schuster Inc. 1230 Avenue of the Americas New York, NY 10020 Copyright © 1998 by Elliot S. Valenstein All rights reserved, including the right of reproduction in whole or in part in any form. The Free Press and colophon are trademarks of Simon & Schuster Inc. Designed by MM Design 2000 Inc. Manufactured in the United States of America 10 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data Valenstein, Elliot S. Blaming the brain: the truth about drugs and mental health / Elliot S. Valenstein. p. cm. Includes bibliographical references and index. 1. Mental illness—Pathophysiology. 2. Mental illness-Etiology- Physiological aspects. 3. Brain—Effect of drugs on. 4. Psychotropic drugs—Marketing—Moral and ethical aspects. 5. Medical misconceptions. 6. Deceptive advertising. 7. Pharmaceutical industry—Moral and ethical aspects. I. Title. RC455.4.B5V35 1998 616.89Ό71—dc21 98-27346 CIH ISBN 0 684 84964 X To Paul and Marcia, Carl and Susan, Clara and Helen, Max and Laura— just in case I don’t write another book. Contents Acknowledgments ix Chapter 1 Introduction 1 Chapter 2 Discoveries of Psychotherapeutic Drugs 9 Chapter 3 Theories of Drug Action and Biochemical Causes of Mental Disorder 59 Chapter 4 A Closer Look at the Evidence 95 Chapter 5 The Interpretation of the Evidence 125 Chapter 6 How the Pharmaceutical Industry Promotes Drugs and Chemical Theories of Mental Illness 165 Chapter 7 Other Special Interest Groups 203 Chapter 8 Reprise, Conclusions, and Reflections 221 Notes 243 Index 285 vii