The Hunt For Cures: Mental Illness

Asked once what makes people happy, Sigmund Freud replied, "Work and love." A strange answer from the man who invented the psychoanalyst's couch? Perhaps, but in his day, doctors could offer little more for patients suffering from anxiety or depression. And when faced with intractable mental illnesses like schizophrenia, they had to resort to brute force: inducing seizures and comas with chemicals and electric shocks, infecting patients with malaria to provoke brain-clearing fever, or slicing away parts of the brain's prefrontal cortex. In general, desperation guided treatment of the deranged.

The accidental discovery in the 1950s of the first synthetic tranquilizer, chlorpromazine (Thorazine), ushered in a gentler age of psychopharmacology. As other feel-good pills followed--Tofranil (imipramine) for depression, Miltown and Equanil (meprobamate) for psychosis, Valium (diazepam) for severe anxiety and lithium for manias--no mental illness seemed beyond their reach. Governments began emptying mental wards on the assumption that madness could be medicated--ignoring the fact that thousands of former inmates ended up living, and suffering, in the streets.

By the time Prozac (fluoxetine) swept onto the stage in 1988, the new drugs had wrought a revolution in psychiatry. Long-drawn-out talking cures were shortened or replaced by prescription pills, and some doctors found their offices filled with grateful patients. "All of a sudden, we were being told, 'Gee, doc, you're great,'" recalls Dr. Samuel Barondes, a psychiatrist and medical historian at the University of California, San Francisco. No one really understood how the wonder pills worked. Nor were they always free of distressing side effects--such as the "Thorazine shuffle," the stumbling, zombie-like gait that often accompanies this treatment for schizophrenia.

Still, the message out of the bottle was clear: Forget the couch; there is no psychiatric ill that cannot be chemically controlled. Even hyperactive youngsters were caught up in the pharmacological whirlwind, given daily doses of Ritalin to tame their excess energies. Critics such as Dr. Thomas Szacz worried loudly about an overly medicated, drug-dependent society. But with more than 50 million Americans suffering from mental illnesses of varying degrees of severity, doctors in the clinical trenches felt they had no choice but to employ the best weapons at their disposal. Says Dr. Sophia Vinogradov, Barondes' UCSF colleague and a specialist in schizophrenia: "We now have a much more vigorous armamentarium for our patients."

Her armamentarium will soon grow. No fewer than 103 new psychoactive drugs are currently undergoing testing, including clinical trials, according to the Pharmaceutical Research and Manufacturers of America. These include 26 drugs for depression, a disease that affects 19 million Americans each year and costs the country more than $23 billion in lost work days and decreased productivity. Other drugs in the pipeline target schizophrenia, anxiety phobias and various forms of senile dementia, most notably Alzheimer's. All told, drug companies are betting $6 billion a year on R. and D. in hopes of creating new blockbuster drugs like Eli Lilly's Prozac, whose patent expires in 2003.