Mania: A Short History of Bipolar Disorder (review)

In the mid-1990s, Healy notes in this absorbing, often disturbing book, American psychiatry entered a brave new medical world. "No one listened to or looked at patients anymore," he writes of those creating and marketing blockbuster pharmaceuticals. "If large randomized trials showed the drugs 'worked,' what was the point in talking to people?" This and other blunt questions, made rhetorical to stress the extent of its author's dismay about the fads and trends now governing his profession, orient Healy's fascinating, nearly exhaustive history of bipolar disorder. As he shows with impressive clarity and care, diagnoses of the disorder took off in the 1990s, rising at rates of 4,000 percent, partly because patent cycles and canny marketing gave extraordinary prominence to Seroquel, Risperdal, and other antipsychotic medication. Influential psychiatrists, accepting large honoraria from the same corporations that make those drugs, added loudly that large numbers of American teens and preteens, previously diagnosed with ADHD, were in fact bipolar and in need of treatment at ever younger and younger ages.

Healy takes the reader through not only the lithium wars of the 1960s but also the diagnostic wrangles of the last two centuries, when mania and agitated overactivity were sometimes classed as "moral insanity," sometimes as tristimania, and later as folie alterne, before clinicians settled (for much of the twentieth century) on "manic-depressive illness." Still, at all points the condition was viewed as exclusively an adult phenomenon, given its complex shading. Since the 1990s, however, with the renaming of the condition as "bipolar disorder," best sellers such as The Bipolar Child, pastel-colored children's books such as Brandon and the Bipolar Bear, and a phalanx of researchers, trade journals, and marketing agencies, often ghostwriting scholarly articles and cherry-picking evidence, have coaxed large numbers of Americans, in particular, into believing that bipolar disorder is a hidden epidemic afflicting children as young as two years, and sometimes even less than one.

"The brain of modern neuroscience risks disappearing behind a pastiche generated in company marketing departments," Healy warns, in a book alarmed by the overmedication of Western children, hungry to restore psychiatry's scientific bona fides, and weary of the extent to which drug companies, sponsoring vast amounts of psychiatric research, routinely — and with impunity — withhold data that do not favor their products. "We are losing sight and sense of health," he concludes. "The fact that pharmaceutical companies are now sequestering data is a profound threat to our modernity." Well paced, judicious, and extremely well researched, Healy's powerful book deserves a wide readership in and far beyond psychiatry.