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The trouble with medicating mental illness

The standard of care for the severely mentally ill in the United States has drastically changed since the 1950s, when more than half a million patients resided in enormous state hospitals. As pharmaceutical firms developed new antipsychotic medications, national policy shifted such that most of the old hospitals have now closed. Today, the majority of US patients, even those with serious mental illnesses such as schizophrenia, bipolar syndrome and major depression, receive only short-term, in-patient medical treatment to quell symptoms before being sent home.

The old asylums were the scenes of some well-publicized abuses and poor conditions. Yet their closures and the parallel embrace of medications did not solve the issue of how to best care for people. The current mental-health system leaves many mentally ill patients no better off, says Joel Braslow, a historian and psychiatrist at the University of California, Los Angeles. In some cases, the situation has grown worse.

In the 2019 Annual Review of Clinical Psychology, Braslow and UCLA colleague Stephen Marder argue that our current “age of psychopharmacology” has shrunk society’s sense of responsibility toward the mentally ill. Whereas most psychiatrists once viewed mental illness as a complex interaction between a patient’s biology and social context, Braslow and Marder contend, it is now often seen more narrowly as merely symptoms to be medicated.

Braslow blames this shift for what he calls our society’s “total failure” in caring for its most vulnerable members: Roughly 140,000 seriously mentally ill people are now homeless on city streets, while 350,000 others are serving time in prisons and jails, where their illnesses get little treatment.

Knowable Magazine is an independent journalistic endeavor from Annual Reviews.

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