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Or later, because certain antidepressants increase levels of the neurotransmitter serotonin in the brain, it was postulated that depression is caused by too little serotonin. (These antidepressants, like prozac or Celexa, are called selective serotonin reuptake inhibitors (ssris) because they prevent the reabsorption of serotonin by the neurons that release it, so that more remains in the synapses to activate other neurons.) Thus, instead of developing a drug to treat. That was a great leap in logic, as all three authors point out. It was entirely possible that drugs that affected neurotransmitter levels could relieve symptoms even if neurotransmitters had nothing to do with the illness in the first place (and even possible that they relieved symptoms through some other mode of action entirely). As Carlat puts it, by this same logic one could argue that the cause of all pain conditions is a deficiency of opiates, since narcotic pain medications activate opiate receptors in the brain. Or similarly, one could argue that fevers are caused by too little aspirin. But the main problem with the theory is that after decades of trying to prove it, researchers have still come up empty-handed.

Some brief—and necessarily quite simplified—background: the brain contains billions of nerve cells, called neurons, arrayed in immensely complicated networks and communicating with one another constantly. The typical neuron has multiple filamentous extensions, one called an axon and the others called dendrites, through which it sends and receives signals from other neurons. For one neuron to communicate with another, however, the signal must be transmitted across the tiny space separating them, called a synapse. To accomplish that, the axon of the sending neuron releases a chemical, called a neurotransmitter, into the synapse. The neurotransmitter crosses the synapse and attaches to receptors on the second neuron, often a dendrite, thereby activating or inhibiting the receiving cell. Axons have multiple terminals, so each neuron has multiple synapses. Afterward, the neurotransmitter is either reabsorbed by the first neuron or metabolized by enzymes so that the status quo ante is restored. There are exceptions and variations to this story, but that is the usual way neurons communicate with one another. When it was found that psychoactive drugs affect neurotransmitter levels in the brain, as evidenced mainly by the levels of their breakdown products in the spinal fluid, the theory arose that the cause of mental illness is an abnormality in the brains concentration of these. For example, because Thorazine aspiring was found to lower dopamine levels in the brain, it was postulated that psychoses like schizophrenia are caused by too much dopamine.

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And in 1957, marsilid (iproniazid) came on the market as a psychic energizer to treat depression. In the space of three short years, then, drugs had become available to treat what at that time were regarded as the three major categories of mental illness—psychosis, anxiety, and depression—and the face of psychiatry was totally transformed. These drugs, however, had not initially been developed to treat mental illness. They had been derived from drugs meant to treat infections, and were found only serendipitously to alter essay the mental state. At first, no one had any idea how they worked. They simply blunted disturbing mental symptoms. But over the next decade, researchers found that these drugs, and the newer psychoactive drugs that quickly followed, affected the levels of certain chemicals in the brain.

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Book review : 100 Best First Lines from novels

But despite their differences, all three are in remarkable agreement on some important matters, and they have documented their views well. First, they agree on the disturbing extent to which the companies that sell psychoactive drugs—through various forms of marketing, both legal and illegal, and what many people would describe as bribery—have come to determine what constitutes a mental illness and how the disorders should. This is a subject to which Ill return. Second, none of the three authors subscribes to the popular theory that mental illness is caused by a chemical imbalance in the brain. As Whitaker tells the story, that theory had its genesis shortly after psychoactive drugs were introduced in the 1950s. The first was Thorazine (chlorpromazine which was launched in 1954 as a major tranquilizer and quickly found widespread use in mental hospitals to calm psychotic patients, mainly those with schizophrenia. Thorazine was followed the next year by miltown (meprobamate sold as a minor tranquilizer to treat anxiety in outpatients.

And what about the drugs that are now the mainstay of treatment? If they do, shouldnt we expect the prevalence of mental illness to be declining, not rising? These are the questions, among others, that concern the authors of the three provocative books under review here. They come at the questions from different backgrounds—Irving Kirsch is a psychologist at the University of Hull in the uk, robert Whitaker a journalist and previously the author of a history of the treatment of mental illness called. Mad in America (2001 and Daniel Carlat a psychiatrist who practices in a boston suburb and publishes a newsletter and blog about his profession. The authors emphasize different aspects of the epidemic of mental illness. Kirsch is concerned with whether antidepressants work. Whitaker, who has written an angrier book, takes on the entire spectrum of mental illness and asks whether psychoactive drugs create worse problems than they solve. Carlat, who writes more in sorrow than in anger, looks mainly at how his profession has allied itself with, and is manipulated by, the pharmaceutical industry.

The Epidemic of Mental Illness: Why?

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by marcia angell The

Nowadays treatment by medical doctors nearly always means psychoactive drugs, that is, drugs that affect the mental state. In fact, most psychiatrists treat only with drugs, and refer patients to psychologists or social workers if they essays believe psychotherapy is also warranted. The shift from talk therapy to drugs as the dominant mode of treatment coincides with the emergence over the past four decades of the theory that mental illness is caused primarily by chemical imbalances in the brain that can be corrected by specific drugs. That theory became broadly accepted, by the media and the public as well as by the medical profession, after Prozac came to market in 1987 and was intensively promoted as a corrective for a deficiency of serotonin in the brain. The number of people treated for depression tripled in the following ten years, and about 10 percent of Americans over age six now take antidepressants. The increased use of drugs to treat psychosis is even more dramatic.

The new generation of antipsychotics, such as Risperdal, zyprexa, and Seroquel, has replaced cholesterol-lowering agents as the top-selling class of drugs in the. What is going on here? Is the prevalence of mental illness really that high and still climbing? Particularly if these disorders are biologically determined and not a result of environmental influences, is it plausible to suppose that such an increase is real? Or are we learning to recognize and diagnose mental disorders that were always there? On the other hand, are we simply expanding the criteria for mental illness so that nearly everyone has one?

Read Full Interview mystery homage with a twist Just after. On a bright spring morning, wealthy widow diana cowper waltzes into the london funeral home of Cornwallis and Sons to plan her own funeral service. Six hours later, shes found strangled to death in her terraced Chelsea home. The Emperor's New Drugs: Exploding the Antidepressant Myth by Irving Kirsch, basic books, 226.,.99 (paper). Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by robert Whitaker, crown, 404.,.00, unhinged: The Trouble with Psychiatry—a doctor's revelations About a profession in Crisis by daniel Carlat.


Free press, 256.,.00, an advertisement for Prozac, from, the American journal of Psychiatry, 1995. It seems that Americans are in the midst of a raging epidemic of mental illness, at least as judged by the increase in the numbers treated for. The tally of those who are so disabled by mental disorders that they qualify for Supplemental Security Income (SSI) or Social Security disability Insurance (ssdi) increased nearly two and a half times between 19—from one in 184 Americans to one in seventy-six. For children, the rise is even more startling—a thirty-five-fold increase in the same two decades. Mental illness is now the leading cause of disability in children, well ahead of physical disabilities like cerebral palsy or Down syndrome, for which the federal programs were created. A large survey of randomly selected adults, sponsored by the national Institute of Mental health (nimh) and conducted between 20, found that an astonishing 46 percent met criteria established by the American Psychiatric Association (APA) for having had at least one mental illness within four. The categories were anxiety disorders, including, among other subcategories, phobias and post-traumatic stress disorder (ptsd mood disorders, including major depression and bipolar disorders; impulse-control disorders, including various behavioral problems and disorder (adhd and substance use disorders, including alcohol and drug abuse. Most met criteria for more than one diagnosis. Of a subgroup affected within the previous year, a third were under treatment—up from a fifth in a similar survey ten years earlier.

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Sweeping fantasies are this years biggest trend in childrens and homework teen literature—think breathtaking action, complex world building, magical abilities and bands of young heroes who must save the day. Read Full essay feature feature by jon Little, two new young adult novels open in boulder, colorado, and find their teen protagonists in the wilderness—struggling to save themselves or someone they love. Read Full feature feature by sarah McCraw Crow, summertime means travel—family travel, solo journeys, finding lost places. Two new books take on these concepts in distinctive ways. Read Full feature an apt surname for the self-described "world's uncoolest artist". In her memoir, old in Art School, nell painter surprises everyone by returning to college in her 60s to earn degrees in one of her passions: painting. Read Full Interview feature by barbara Clark secrets make for good reading in three new cozy mysteries set against colorful backdrops, from 1913 prewar New York city and Bostons lively north End in 1937 to an abandoned mansion in present-day maryland. Read Full feature a study in justice margalit Fox vividly remembers the day she first read about a case she could hardly believe: Arthur Conan doyle personally investigated and helped commute the sentence of Oscar Slater, a wrongfully imprisoned 36-year old immigrant in Glasgow, Scotland.

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About something odd that happened when I was very young. Read Full Essay theres no going back in this apocalyptic home-invasion thriller. Praised by horrormeister Stephen King, paul Tremblays shocking new novel, The cabin at the End of the world, is an often graphic account of one familys ordeal when their vacation is shattered in a cult-like home invasion. We asked Tremblay about the books origins, its dark path and his inner fears that helped forge the novel. Read Full Interview feature by julie hale, these rollicking picture books feature animals who get mixed up in some outrageous situations. High jinks and humor ensue in five slapstick stories for young readers. Reading has never been more uproarious! Read Full feature feature by hilli levin and savanna walker.

of humor and an abiding love of movies, and though her new novel proves that she knows how to tell a great story, she also has a serious bit of advice: Dont become a novelist. Read Full Essay a particularly potent brew, i was seven years old the first time my uncle poisoned. The first sentence of Sam Hawkes. City of lies lets the reader know exactly what theyre in for. A deliciously tense, well-crafted start to a new fantasy series, city of lies follows jovan and Kalina, two young nobles who have been raised to detect poisons and prevent them from harming the ruling family of Sjona. When their father and the monarch are assassinated, jovan and Kalina have to protect the new ruler—their close friend tain—from threats both within the city and outside its walls. We talked to hawke about devising fictional poisons, creating a magic system based on emotion and the real-world parallels in her fantastic new world. Read Full Interview behind the book by dervla McTiernan. Much of, the ruin is inspired by real life, and Id like to tell you about one experience in particular.

assistant Editor Hilli levin speaks with the author-illustrator. Read Full Interview feature by Chris Pickens, no doubt there are a multitude of mystery readers out there who love digging into classic spy stories from the golden age of espionage. Filled with ritzy postwar ballrooms, foggy alleyways and the smell of gunpowder, these stories conjure up boatloads of thrilling nostalgia, one swishing trench coat at a time. But have you ever imagined a cold War that plays out in both this life and the afterlife? Or contemplated world powers vying for demonic runes in their quest for influence? Both of these supernatural mysteries excel at taking a familiar genre and time period and augmenting them essay with just enough otherworldly elements to make each page feel new and exciting. Read Full feature behind the book by Elizabeth leiknes.

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Unfortunately, our website is currently unavailable in most European countries. We are engaged on the issue and committed to looking at options that support our full range of digital offerings to the eu market. We continue to identify technical compliance solutions that will provide all readers with our award-winning journalism. It deepens like a coastal shelf. In his deeply personal and compassionate collection of essays, Criminals, robert Anthony siegel explores his unusual upbringing as the son of a charming, erratic criminal defense attorney, whose ethically dubious practices eventually send him to prison, and a culturally eloquent mother who was always reaching. I asked siegel a few questions about his family, the hells Angels world and the unexpected solace he found in Eastern traditions. Read Full Interview "Kids bring people together.


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  1. It seems that Americans are in the midst of a raging epidemic of mental illness, at least as judged by the increase in the numbers treated for. Are we learning to recognize and diagnose mental disorders that were always there? What a child saw, and what you'd never believe behind the book by dervla McTiernan mystery & Suspense / Mystery much of The ruin is inspired by real life, and Id like to tell you about one experience in particular.

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  5. Book reviews, news, interviews and features. Covering bestselling fiction and non-fiction, essays, lists and more from the. The allies are looking with dread to this weeks summit as President Trump continues his campaign to undermine a decades-old partnership. The years notable fiction, poetry and nonfiction, selected by the editors of The new York times book review.

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