American doctors dispense approximately 230 million antidepressant prescriptions every year, more than any other class of medication. Charles Barberexplores this disturbing phenomenon, examining the ways in which pharmaceutical companies first create the need for a drug and then rush to fill it. Most importantly, he convincingly argues that, without an industry to promote them, non-pharmaceutical approaches are tragically overlooked in favor of an instant cure for all emotional difficulties. Compulsively readable and urgently relevant,Comfortably Numbis an unprecedented account of the impact of psychiatric medications on American culture and on Americans themselves.

Charles Barber was educated at Harvard and Columbia and worked for ten years in New York City shelters for the homeless mentally ill. The title essay of his first book, Songs from the Black Chair, won a 2006 Pushcart Prize. His work has appeared in The New York Times and Scientific American Mind, among other publications, and on NPR. He is a lecturer in psychiatry at the Yale University School of Medicine and lives in Connecticut with his family.


From the Hardcover edition.

In 1988, almost by accident, I began working with homeless people suffering from mental illness in New York City. This was meant to be a short-term vocation, a year at most. But for the next fourteen years, I worked with the homeless mentally ill in Manhattan in a variety of settings–first on the streets, then in shelters, then in supportive residential programs. All of my clients suffered from, as the psychiatric textbooks put it, “severe and persistent mental illness.” That is, they were diagnosed with various forms of schizophrenia, extreme mood complications such as bipolar disorder and major depression, and a range of personality disorders. Most of my clients had been or were addicted to some combination or other of alcohol, heroin, crack, cocaine, benzodiazepines, and PCP. A very large percentage had chronic physical ailments like diabetes, HIV, and hepatitis. Despite the rather remarkable burden of their collective afflictions, my clients were also often engaging, interesting, and without exception astonishingly resilient.

To quell their unruly moods and their troublesome delusions and hallucinations, my patients were taking all manner of psychiatric medications. Some of these medications had been around since the 1950s and 1960s–mood stabilizers like lithium, antipsychotics such as Haldol and Thorazine–while others, at the time, were brand-new, with strange and exotic names like Prozac, Paxil, and Zoloft. Each year over the course of the 1990s, new psychiatric medications were introduced and consumeden masseby my clients. Some of these new medications arrived with great fanfare and extremely high expectations. In particular, a class of agents called “atypical antipsychotics”–Risperdal, Clozaril, and Zyprexa are the best known–had been shown in early clinical studies to be far superior to the Haldols and the Thorazines. Overnight, it seemed, almost all patients were converted to these new drugs, as well as new-generation antidepressants and mood stabilizers. It was not at all unusual for my clients to be taking three, four, five, or six different types of psychiatric drugs in a given day–a combination not unlike the number of street drugs many of them had once been addicted to.

I am not a psychiatrist. My job was first as a counselor and then director of a number of clinical and residential programs, and finally as a researcher at medical schools. But I became oddly enthralled by the ongoing parade of medications that entered my clients’ mouths (and sometimes their arms, via injection). I became deeply immersed in the sheerzeitgeistof all that was involved in their ever more complex pharmacological regimens: from the monthly filling of their multiple prescriptions (which would have cost hundreds and hundreds of dollars if not paid for by Medicaid); to the cheerful colors and happy-sounding, near-poetic names of the drugs (and the colors become more vibrant and the names more poetic as the 1990s wore on); to the regular visits of perky drug reps ready to hand out free meals, pens, calendars, and coffee cups to anybody who would listen; and, not least, to the complicated and broadly variable impact of the drugs on my clients’ symptoms, personalities, and physical health. The influence of the drugs ranged greatly: from near-miraculous apparent “cures”; to therapeutic numbing, to no effects whatsoever; to, in one case, a near-fatal attack.

In the late 1980s, when I told people outside the field about my work–say, friends at cocktail parties in suburban, upper-middle-class Connecticut, where I grew up–no one seemed to quite comprehend what I did for a living. The prevailing tenor of these conversations was one of confusion. It would require real effort on my part to explain to these highly educated, eminently bourgeois people the nature of the problems which m clients faced. Sipping white wine, m

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Excerpted from Comfortably Numb: How Psychiatry Is Medicating a Nation by Charles Barber
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