The New York Times Magazine published an informative article titled “Doctors Gave Her Antipsychotics. She Decided to Live With Her Voices.” The article chronicles the journey of a woman who had been hearing voices in her head most of her life. As is the common practice of the day, she was prescribed psychotropic drugs in an attempt to manage her symptoms. Over time, this grew into an ever-changing mix of antipsychotics and mood stabilizers plus an antidepressant, a benzodiazepine for anxiety and a stimulant for attention deficit.

When these pharmaceuticals failed stop the voices, she supplemented her prescriptions with street drugs including marijuana, illicitly-obtained Valium and even heroin. She was arrested more than once. Her third arrest was for stealing electronics to trade for drugs. She was ultimately sent to a high-end locked ward in the outskirts of Houston and then to a psychiatric farm in the foothills of the Appalachian Mountains where she decided to quit all her medications.

With this story as a backdrop, the article describes the growing effort to thoroughly reform how the field of mental health approaches severe psychiatric conditions. Given that addiction is currently viewed as a mental disorder for which medications may be prescribed as treatment, this article is relevant also to addiction treatment policy.

Importantly, the article cited a 2019 lead opinion piece in the New England Journal of Medicine: “We are facing the stark limitations of biologic treatments,” it argued. “There is no comprehensive biologic understanding of either the causes or the treatments of psychiatric disorders.” The Times article also quotes a Dr. Thomas R. Insel (National Institute of Mental Health Director, 2002 to 2015) as follows: “I spent 13 years at N.I.M.H. really pushing on the neuroscience and genetics of mental disorders, and when I look back on that, I realize that while I think I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs — I think $20 billion — I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness.”

Yet the evidence that the medications improve outcomes is murky. And it is countered by other studies suggesting that maintenance on the drugs may actually worsen outcomes and even cause brain atrophy, though these findings have been debated. The area is devoid of conclusive science, a failure that is a prominent part of a wider problem in biomedical psychiatry: its lack of progress in treating serious conditions, or even precisely diagnosing and comprehending them. “Something has gone wrong in contemporary academic and clinical psychiatry,” a 2019 lead opinion piece in The New England Journal of Medicine stated. “We are facing the stark limitations of biologic treatments,” it argued. “There is no comprehensive biologic understanding of either the causes or the treatments of psychiatric disorders.”