To support his position, WHO Thomas R. Insell, who was head of the National Institute of Mental Health from 2002 to 2015, the world’s largest funder of mental health research, said: When I look back at it, I realize that while I think I’ve managed to get a lot of really great papers published by great scientists at a fairly high cost – I think 20 billion – I don’t think we can reduce suicide, in the hospital. To reduce admissions, we need to focus on improving the recovery of millions of people with mental illness. “
Good results, the WHO predicts, will rely on a re-evaluation of many of the assumptions, rules and practices currently in place, including a different perspective on what is meant by ‘skills’ in mental health. Michelle Funk, a former physician and researcher who leads WHO’s work on mental health policy, law and human rights and the lead author of the report, spoke to me about the need to radically change the prevailing clinical hypotheses: “Practitioners are trying to support those The current methods are not only about psychotropic side effects, but also about reducing symptoms, not only through locked ward power imbalances and court-directed outpatient care and even seemingly benign practitioner-patient relationships. , A professional mindset that makes people feel that they are seen as a checklist of diagnostic criteria, not as human beings. ” , Losing identity, losing hope, self-breathing Leads to loss of health. Stigma and isolation. “
Calling for a “fundamental paradigm shift” in the field of mental health, the WHO has called for almost half a century of psychological history. In the early 1960’s, just weeks before his assassination, President John F. Kennedy signed a mental-health bill into law, declaring that “in the current state of scientific success, it will be possible for a nation as rich in human and material resources as ours.” To make remote places accessible. ” American science, he promised, would not only land a man on the moon but also triumph over mental illness.
This confidence stemmed from the first pharmaceutical breakthrough in psychiatry a decade ago, the discovery of the original antipsychotic chlorpromazine (marketed in the United States as Thorazin). The drug had weak side effects – a random gait, facial rigidity, constant ticks, stupidity – but it turned out to be difficult behavior and seemed to reduce misleading beliefs. The Times welcomed the “human and social significance” of the drug, and Time magazine compared thorazin to the “germ-killing sulfas”, a groundbreaking drug developed in the 1930s and 1940s to fight bacterial infections. But patients do not feel that the benefits outweigh the disadvantages; They often give up their drugs.
After Thorazin was Haldol, a more potent antipsychotic with no side effects. Yet each drug contributed greatly to the liberation of residents from mental asylum, and in the 1970s, crude ideas about how these drugs worked emerged. An overactive system of dopamine, a neurotransmitter, is thought to be the culprit of psychosis, and antipsychotics inhibit these systems. The problem was that they weakened dopamine networks throughout the brain, leading to mobility disorders and torpedoes.
However, in the 1980’s, biological psychiatrists believed that they could fix this defect by developing more precisely protected antipsychotics. Joseph Coyle, then Professor of Psychiatry and Neuroscience at the Johns Hopkins School of Medicine, was quoted in the 1984 Pulitzer Prize-winning Baltimore Sun series that initiated new brain research and set the horizon for antipsychotics and other psychiatrists. Has almost gone to the storehouse of knowledge. ” One of Coyle’s parents, Donald Goff, now a professor of psychiatry at the Grossman School of Medicine at New York University and one of the country’s leading researchers on psychiatry for decades, told me in the late 1980’s, “those were the years of headaches. “Every day, as he walks to a clinic in Boston, he sees signs of hallowing in some of the people walking on the sidewalk:” As you approached, the patients at the clinic were in a strange state of movement, their curves. Their bodies, their tremors. ; The drugs made them so miserable physically. ” Yet he felt, he said, “the possibility of unlimited progress.”
Named “Second Generation Antipsychotics” – including Rispardal, Serokel and Gyprexa – most came on the market in the 1990s. In addition to their attacks on dopamine, they seemed to work in other ways, on other neurotransmitters, and they seemed to have fewer side effects. “There was a lot of optimism,” Gough recalled. “We were convinced that we were improving people’s lives.” But worries arose quickly, and eventually Eli Lilly and Johnson & Johnson, the makers of Zyprexa and Rispardal, would pay billions of dollars – a fraction of the drug’s profit – in lawsuits against illegal marketing and the effects of drugs on users’ metabolism. . Xyprex increases the risk of diabetes and severe weight gain (Eli Lilly concealed internal data showing that 16 percent of patients gained more than 66 pounds in Xyprex). Some boys and adolescents who took risperdal had gynecomastia; They pendant breast growth. In 2005, NIMH published a study of 1,460 subjects that looked at whether the new antipsychotics were actually better than first-generation drugs in terms of efficacy or safety. The answer was no. “It was a great frustration,” Goff said, although he recommends long-term and possibly lifelong medication, on a balanced basis, the best way to avoid emotional distress.