A Dangerous Idea About How the Brain Works

In July 1990, President George H. W. Bush issued a presidential proclamation to mark the dawn of a new and exciting era of neuroscience. The ’90s, Bush said, would be the “decade of the brain”—a 10-year scientific blitz that promised to render the human brain, “one of the most magnificent—and mysterious—wonders of creation,” a bit less mysterious.

The implications of success were enormous. The proclamation names Alzheimer’s, stroke, schizophrenia, autism, depressive disorders, Parkinson’s, Huntington’s, and addiction as targets to study. With use of the PET scan and MRI becoming more common—creating colorful images of the brain in action—scientists were hopeful the decade of the brain would yield results for the millions of patients affected by these conditions.

But the approach to mental illness inherent in Bush’s proclamation made its way out to the public before scientists could evaluate their efforts. And a new story of mental illness would fundamentally alter the way Americans thought—and still think—about mental health.

This episode follows both this scientific saga and the story of a family of three generations dealing with one diagnosis—and the question of what it means to get better.

This is part two of a new three-part miniseries from Radio Atlantic—Scripts—about the pills we take for our brains and the stories we tell ourselves about them.

Listen to the story here:

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The following is a transcript of the episode:

Hanna Rosin: This is Radio Atlantic. I’m Hanna Rosin. Today we have the second episode of Scripts, our three-part series exploring the pills we take for our brains, the stories we tell about them, and what happens when you combine the two.

This week’s episode is about a family—three generations dealing with one diagnosis— and the question of what it means to get better.

Reporter Ethan Brooks will take it from here.

Ethan Brooks: In the mid 1990s, somewhere in central Connecticut, Cooper Davis was on a school bus headed toward New York.

Davis: We had a field trip to go see The Scarlet Pimpernel on Broadway.

Brooks: I’m not familiar.

Davis: I wasn’t, and I didn’t get to see it, because of decisions that I made.

Brooks: Cooper didn’t get to see The Scarlet Pimpernel, because of what he packed in his bag for this field trip.

In the bag were two nips of Jack Daniels. Never had a drink before but he was curious, so why not?

Davis: I brought not just those. I also brought firecrackers, a hunting knife, a survival kit with those matches covered in phosphorus so you can light a match in the rain.

I just felt very cool because I had a backpack filled with gear, you know, in case the bus flips over in the wilderness.

Brooks: I just want to repeat the inventory: That’s an eighth grader carrying two nips of Jack Daniels, firecrackers, a hunting knife, and matches. Also, a white tank top.

Davis: Because it felt like that went with the other stuff.

Brooks: Yeah, that’s the outfit for the rest of your bag.

Davis: Exactly. (Laughs.)

Brooks: Were you wearing it, or was it there in spirit?

Davis: No, no. It was there in case I needed to, like, express the whole picture.

Brooks: The whole picture ends up looking like this: Cooper pours the whiskey into a two-liter Coke bottle, passes it around the bus. At some point, he lights one of the matches because, you know, they’re cool and then struggles to put it out.

So now the school bus has a kind of speakeasy vibe, smells a bit smokey, full of tipsy eighth graders. And it doesn’t take long for the teachers to trace all this chaos directly back to Cooper.

So he spends the rest of the field trip sitting next to his teacher.

Davis: And so when we got back at the end of the night, literally my dad just physically picked me up the second I stepped off the bus. I got hit with, Why would you steal alcohol from your grandfather? Why would you bring weapons? Why would you do all of this? And for me, it was like, the reason why was because, impulsively, for one minute, I thought it would be a good idea.

Brooks: Mm-hmm.

Davis: And I said that, but no one believed me. And instead, there was sort of an insistence that I was disturbed. And that was when I sort of graduated from class clown into behavior problem.

Brooks:Class clown. Behavior problem. These are phrases people used for the better part of a century to describe what is now called ADHD.

Cooper is, and has always been, the poster child of ADHD. As a kid, he was a voracious reader, undeniably smart, but also just had rock-bottom-boredom tolerance, caused problems in class. The Scarlet Pimpernel incident is just one story of many. There’s also the Tiger Balm affair, the blue-tissue trouble, the desk debacle—the list goes on.

It was the mid 1990s, and everybody knew that Cooper had ADD. And a few years after this field trip, he would be put on a stimulant, Ritalin. But when Cooper took this drug, he also took in a story about how his own brain worked and who he was—an idea that, for Cooper, would eventually prove disastrous, an idea that is still very much with us, the millions of Americans who take medications for mental health.

This is Cooper’s story and the story of that idea.

When he was a kid, Cooper was always reading. If his parents wanted to punish him, they’d take away his books. Teachers too. But reading is reading, and he eventually found his way into a gifted-and-talented program at school.

Davis: And I loved it. I mean, I loved it. And it was all—it was just me and a little room of, like, mostly horse girls. There were a lot of them.

Brooks: You mean, like, just girls who love horses?

Davis: Exactly. I just have such a deep affinity for that particular type of person, and so that was a bright spot. Other than that, I was mercilessly bullied. I would’ve given it as hard as I got if I sort of had a crew to back me up, but I really didn’t.

Brooks: Where were the horse girls?

Davis: Yeah, they were galloping in a different part of the playground.

Brooks: Cooper’s time in the gifted-and-talented program didn’t last. He moved schools a lot because school was tough for Cooper. His grades were bad. His teachers disliked him because, as he describes it, he was exceptionally unhelpful in the classroom.

The teachers would send him to the principal, who would make him write sentences like, “I will not disrupt class,” over and over and over again like a real-life Bart Simpson.

And it wasn’t always the principal. Sometimes they’d send him to the nurse—just anything to get him out of the classroom. And the nurse’s office is where he notices something: There were a lot of kids in there picking up their meds.

Brooks: And the meds, in your understanding at the time, were stimulants?

Davis: Yeah. One hundred percent.

Brooks: How common was that?

Davis: I mean, anecdotally, to my very young mind, I would say in a class of 20 kids, maybe five—four or five.

Brooks: One of Cooper’s teachers thought he had ADD and told his parents he should get evaluated for Ritalin. Here’s Cooper’s mom, Trish.

Trish: Say there were eight boys in the class and, say, I don’t know how many girls, but there were eight boys. And she said, Well, six of these boys are already on Ritalin, and they’re fine.

Davis: Really? Six?

Trish: And in my head, it was like, Six boys out of eight? Like, I just couldn’t believe that statistic.

Brooks: If you look at the big-picture numbers from this time, they’re not as extreme. But they’re not not extreme. One study has prescriptions for Ritalin more than doubling between 1990 and 1995. The DEA had estimated a six-fold increase in that time period.

This is the period in American history when ADD is becoming an extremely popular diagnosis for kids. The 1.5 million kids being prescribed Ritalin then, leading the way to where we are now: As of 2022, over one in 10 kids in the U.S. has received an ADHD diagnosis. For boys, it’s 15 percent.

But something else was happening alongside those numbers. At the start of the ’90s, a new idea was taking hold in the field of psychiatry, an idea that would inform Trish’s decision whether or not to medicate Cooper—the same idea that would come to haunt Cooper 20 years later.

On July 17, 1990, President George H. W. Bush issued a presidential proclamation. The 1990s, Bush said, would be the “decade of the brain.”

Benjamin Fong: The decade of the brain, it’s a really terrifying declaration looking back at it.

Brooks: (Laughs.) The decade of the brain.

Brooks: This is Benjamin Fong, a professor at Arizona State University. Fong says the decade of the brain started off with one very specific goal.

Fong: The hope was that with the development of these new drugs, we would start to tackle the different mental-health conditions that had so far eluded psychiatric practice.

Brooks: By 1990, psychiatry was at the tail end of a coup, and it was not bloodless. On one side, the psychoanalysts: disciples of Freud, who had dominated the field since World War II with ideas like the unconscious, repression, Oedipus complex—all the classics.

On the other side were the medical psychiatrists, who were tired and maybe a little embarrassed by all this Freudian stuff. They were doctors, after all. Psychiatry should be rooted in scientific rigor, in biology—not some Austrian guy’s ideas.

So by the time Cooper was noticing all the Ritalin kids in his class, the biology crowd had already won. The psychoanalysts lost standing, and the medical psychiatrists announced it would be the decade of the brain.

The idea was simple: In this decade, psychiatry would join up with the rest of medicine and discover the biology of mental illness. They would be able to look at something in your blood or your urine, or whatever, and say, See that? That’s your depression. That’s your ADD.

Anne Harrington: There was enormous optimism.

Brooks: This is Anne Harrington, history professor at Harvard.

Harrington: Sort of like, you know, a cardiologist can take an angiogram that they would be able to look at, like the brain of a schizophrenic person, and say, Aha!

Brooks: That aha moment, in 1990, felt inevitable. The PET scan and the MRI were becoming more common, creating detailed, colorful images of the brain in action. It felt like the biological basis for mental illness was just around the corner. And scientists figured that basis would be chemical. People have been taking chemical compounds for decades, and there was a theory about how they worked.

Harrington: There was often a comparison made between taking, say, an antidepressant if you have suffered from depression and taking insulin if you suffer from diabetes, and it’s simply correcting the chemical imbalance.

Brooks: Simply correcting the chemical imbalance—this was an idea with obvious appeal, and the start of the story that would change Cooper’s life.

Compared with old-school psychoanalysis, the idea of a chemical correction feels chiropractic—the same satisfaction, the same instant relief as a cracked neck. Soon enough, this idea was everywhere.

The FDA made it easier for prescription-drug makers to advertise directly to consumers. On TV, that rapid-fire list of side effects and phrases like “ask your doctor” began to feel normal, even though this type of advertising is not normal. To this day, it’s only the U.S. and New Zealand that allow this. It’s banned pretty much everywhere else on earth.

Anyway, it was, in part, through TV ads that the chemical-imbalance idea reached the public.

Advertisement:  You know when you feel the weight of sadness, you may feel exhausted, hopeless, and anxious.

Brooks: Take, for example, ads for the antidepressant Zoloft, which showed up a few years after the advertising rules were eased. The ads are in black and white, hand-drawn, simple animation. The ad opens with what can only be described as a sad blob groaning as rain pours down from a blob-sized cloud.

Advertisement:  These are some symptoms of depression, a serious medical condition affecting over 20 million Americans.

Brooks: Then the ad cuts to a new shot, this one of two synapses, one on each side of the frame, labeled nerve A and nerve B. Chemicals float between the two but drift decisively toward nerve A.

Harrington: But then they say, while they’re showing you this, the actual cause of depression is unknown.

Advertisement:  While the cause is unknown, depression may be related to an imbalance of natural chemicals between nerve cells in the brain. Prescription Zoloft works to correct this imbalance.

Brooks: The chemicals even out. Then the ad cuts back to the sad blob. The rain has stopped. A flower has sprouted next to the blob, who bounces along with a singing bluebird for company.

Advertisement: Talk to your doctor about Zoloft.

Zoloft. When you know more about what’s wrong, you can help make it right.

Brooks: “When you know about what’s wrong, you can help make it right.” Zoloft could have shared that tagline with the new psychiatry, or at least their aspiration to find the biological basis of mental illness.

The Zoloft ads have been credited with bringing mass awareness to the symptoms of depression. Some people saw themselves in that sad blob and decided to get help. But the ads also helped solidify this mechanistic picture of mental health, something that just needed a few tweaks.

Back in Connecticut, by the time Cooper’s teacher is telling his mom about all the boys on Ritalin, the chemical-imbalance idea had arrived. Cooper’s teacher knew what was wrong. It was up to his mom, Trish, to help make it right.

Trish: And it was, you know, during conference, and she just suggested it, strongly. So I think I probably talked to the other moms that had the kids on Ritalin. But you had to be careful because the teacher shouldn’t have said, you know, who was on Ritalin. So it was complicated, and it was very lonely. I will tell you that it was a very lonely thing to go through.

Davis: Why?

Trish: Because I had a different perspective.

Brooks: Trish’s perspective was that she didn’t want Cooper on meds. She didn’t really even want him on sugar, so methylphenidate was sort of a stretch.

Instead, she moved him around: a brief stint in private school, another in catholic school, then back to public school. But as Cooper got older, into his teenage years—as the decade of the brain progressed and the chemical-imbalance idea found greater purchase—as doctor after doctor told her Cooper fit the bill for ADD, it wore her down.

Trish: I just didn’t know what to do. I was so tired of the pressure. And then I remember telling Cooper, When you’re 18, you can make that decision for yourself because I’m done.

Brooks: So around the time he turned 18, Cooper drove over to the doctor on his own and asked for meds.

Davis: And then he said, Well, I have a friend who’s a psychiatrist. I’m just going to give him a quick call. He calls the psychiatrist. Psychiatrist said whatever he said. He gets off the phone and says, Well, he says you fit. That should probably help you. So I’m gonna start you at 5 milligrams twice a day.

Brooks: That quick.

Davis: Bada bing. You know, he just did it cowboy style and just kind of got it done.

Brooks: Did anyone ever talk to you about coming off or how long you would be on stimulants?

Davis: No.

Brooks: Did you ever think about it?

Davis: Not really.

Brooks: Cooper left the doctor with his prescription in hand. But it’s important to say, I think, he wasn’t really expecting much. He didn’t think of himself as having any sort of deficiency. Then he starts 5 milligrams of Ritalin twice a day, and that skepticism vanishes.

Davis: My initial experience with taking the drugs was revelatory. It did feel profound, and if I was a different type of a person, it would have brought me to tears. I had been, for years and years, sort of beleaguered by people telling me, Why can’t you just do what you’re supposed to do? You have so much intelligence. You have so much potential. Why do you choose to not do this?

And I never had a good answer for that. The drug gave me, sort of, freedom from that question. Like, I no longer have to be that way.

That was an enormous relief.

Brooks: This shift for Cooper, from having explainable deficiencies, like, I have ADD, but I don’t take meds, so be gentle, to simply not have those deficiencies—that is a profound change, a cure for unrealized potential.

And when you think about those terms it’s like, Who cares about the biology of mental illness? The treatment works, and that’s what matters.

Davis: So I will say that my grades—I do have the report card somewhere that shows the low B’s and mostly C’s one quarter, and then the next: straight A’s across the board.

Brooks: Wow. Really? You know, if you read about ADD and about medication, there are these phrases that come up, or metaphors that people use to kind of describe the experience of getting medicated for the first time.

Davis: Mm-hmm.

Brooks: People will say it feels like putting on glasses for the first time. There’s the thought of: This is how normal people feel. Did you have those thoughts? Did you think about it in those terms at all?

Davis: That thought entered my mind but was more like, Is this how normal people feel? Is this how the horse girls are able to just do their work and not to suffer through school? But even at that time, I did not have the sense that, like, This is correcting something for me.

It was more like a superpower. Like, it wasn’t fixing my brain; it was making my brain even better than the average brain. That was sort of my conception.

Brooks: As far as Cooper was concerned, his chemicals didn’t need rebalancing. Instead, the Ritalin was a tool—not a corrective, not glasses; more like X-ray vision. And by the time he’s starting on stimulants at the end of the decade of the brain, the idea of superpowers via psychiatry was gaining speed.

Fong: The phrase, “better than well” became commonplace in psychiatry circles.

Brooks: Again, historian Benjamin Fong.

Fong: The idea that you could be your optimized self, that was very much part of the dream as well.

Freud’s old dictum was that the whole point is to turn hysterical misery into common unhappiness. Well, that’s not a very American goal.

Brooks: Imagine if, at the end of that Zoloft commercial, after getting his chemicals rebalanced, if the blob was just a little less wet. No flowers. No bluebird. Just common unhappiness. I don’t think that would sell much Zoloft.

Fong: There’s a sort of culture of self-optimization, to be your best possible self at all times, and it’s a really difficult thing to do. It’s a really difficult thing to live up to. It’s an unrealizable ideal in a lot of ways.

Brooks: Whether the drugs were stimulants or antidepressants or anything else, the message was the same: that with the right balance of chemicals, you can be better than well. Cooper felt it too.

Davis: I became hyper-focused on inventorying how I’m feeling and, What can I do to adjust that or optimize it? It was not: What do I change externally? It’s: How do I change me?

Brooks: The Ritalin, though, came with a crash. So in high school, he smokes and drinks to take the edge off that crash, even though he didn’t really like being drunk or high. In college, he starts having anxiety, which led to a prescription for Ativan.

Davis: So I have this ability to really modulate exactly where I’m at, internally, to meet the moment.

Brooks: For Cooper, in an uncomplicated way, this rocks. He wants to go through life energized, confident, focused.

Brooks: In college, Cooper spends countless hours in the studio creating works that are detailed and impressive. He paints mandalas: intricate, radiating patterns rendered in minute detail. His teachers see energy, confidence, focus.

After college, there is an internship at a stop-motion studio in New York—more work in obsessive detail—then some time as a production assistant.

Over these years, the medications change but not too much. There are extended-release and immediate-release formulations of the stimulants. He tries out different stimulants—generic versions of Ritalin, Adderall, Dexedrine, Desoxyn—and in the sampling, the prescribed doses increase.

With the stimulants for focus and the Ativan for relaxing, Cooper is better than well.

Brooks: By his mid 20s, Cooper is working at a local paper on Martha’s Vineyard, and this job is tough. It’s stressful with constant deadlines but not unmanageable with the stimulants.

And it’s here, on this island, that things start to unravel. At the newspaper, it’s Cooper’s job to report on culture.

Davis: So the big part of my job was just, like—the whole cultural calendar for the entire island is my responsibility. It’s not my favorite part of the job, but it’s important.

Brooks: One day, when he makes the calendar, he forgets to include a local gallery’s event. The gallery calls him to complain, and he loses his temper. So Cooper is freaking out, yelling at this watercolor gallery over the phone. They call his boss, who calls Cooper into her office.

Davis: And all of a sudden, it’s a flashback to elementary school, like I’m getting called into the office, and she’s basically saying to me, like, I don’t know what the deal is with you, but you cannot do this. Something has happened to you.

And it feels like, you know, I’m in trouble.

Brooks: Cooper didn’t quite know it, but this was not the first time he had messed up in this job. And pretty soon after, he was fired.

When he looks back at this moment now, none of it really makes sense. Why was managing the cultural calendar on Martha’s Vineyard a high-stress job? How did he end up screaming at someone over the phone about watercolors?

Davis: Local watercolors—local.

Brooks: It was like he left the real world and instead was living somewhere much more bizarre.

Davis: I had created an alternate reality for myself where I had way more stress and pressure than I actually had. What I really had was a lack of maturity and an inability to manage my time. And that was partly because my attitude was, I don’t need to manage my time, because I have superpowers.

Brooks: And so it was at this point, after more than a decade of medication, it was clear that Cooper’s superpowers weren’t superpowers at all. The X-ray vision was, instead, something closer to a kaleidoscope: colorful, interesting, but also distorting his experiences.

Brooks: Without a job, Cooper eventually moved back to Connecticut and found himself lost. He tried freelancing and struggled to do it. He tried a lot of new prescriptions—mood stabilizers, sleeping pills, antidepressants. Those he could do.

The new medications came with side effects. His memory suffered. He went to bed at night and woke up feeling like a completely different person. He slept odd hours, made odd phone calls. His family told him they didn’t recognize this person he had become.

Years passed like this: unable to work, relationships falling away, living on unemployment and a bit of money his grandfather left him. For Cooper, there would be no rock bottom—just a gradual erosion until it felt like all the meaning had disappeared from his life.

Brooks: And then, suddenly, there was meaning. One day, his partner at the time told him that she was pregnant. Cooper was going to be a father.

Davis: And it was at that moment that, all of a sudden, the facts of my life became abundantly clear to me for the first time.

Brooks: Why do you think that was?

Davis: Because I was suddenly not the main character in my story. This baby, this child, this person, What kind of dad are they gonna have? What kind of dad do I want them to have?

And then, sort of looking at myself, appraising myself, through that lens, like, I am a drug-addled, unemployed mess with no friends, no real contacts, no prospects, I think my first thought was, Whatever it’s going to take to get past this is probably going to involve cutting back on the amount of drugs that I’m taking.

Brooks: Over the next year, Cooper would come off everything. What had started with 5 milligrams of Ritalin had ended up as a lot of a lot of stuff.

As it happened, Cooper wasn’t the only one getting away from psych drugs. Major drug manufacturers were making their exit too. According to Anne Harrington, around 2010, companies like AstraZeneca and GlaxoSmithKline moved their focus away from psychiatric medications.

Harrington: The National Institute of Mental Health invested billions. Billions. But the breakthroughs never happened.

There may have been some amazing research. There was some amazing research, but it didn’t translate into the kinds of material gains for patients that the public had been promised.

Brooks: In her book, Harrington writes about Tom Insel, the man who had been the director of the National Institute of Mental Health. In 2017, after he had retired, he said this:

“I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness. I hold myself accountable for that.”

The goal that psychiatry had set at the start of the ’90s, to map the biological basis of mental illness, never came to pass. Patients never got the benefits that were promised in the decade of the brain. What they got, instead, was a story—a story about chemical imbalance that never quite passed muster but grew deep roots into the American understanding of mental illness anyway. The science fell away, but the story remains.

[Music]

Brooks: Cooper Davis’s kid, the one whose existence inspired him to come off his meds, is now 10 years old. They live in a house not far from Cooper’s old high school. There’s a sign outside of his room that says no parents allowed.

Recently, the school psychologist devised a jar of interesting facts for him: Behave well, and you get a fact.

Davis: So these would be rolled up like scrolls.

Brooks: Like Cooper, he’s struggling in school—sometimes daydreaming, sometimes misbehaving. In any case, it’s hard. He needs help, which is why Cooper took him in for a psychological evaluation. At the eval, he met with doctors.

Davis: Saying, okay, This is what he has, and these are our recommendations. Medication is the first one that is named, and then they tell me, The way these medications work is they correct a chemical imbalance in the brain.

Brooks: They said that?

Davis: Yes.

Brooks: The first time I spoke to Cooper, when he told me that he’d need to decide whether or not to put his kid on stimulants, I had a lot of questions. Here was a person for whom stimulant medication had been both wonderful and terrible now, through his son, getting the opportunity to go back and decide again: Yes or no?

Cooper told me he was wracked with guilt and doubt over this decision, not unlike his mom 30 years ago—the same decision around the same drug made across three generations of one family. And in all that time, very little has changed.

We often tell the same simplified story about chemical imbalances and deficiencies. And our scientific understanding also hasn’t changed meaningfully. What has changed is the sheer number of people taking these medications. From 2018 to 2022, prescriptions of stimulants rose 30 percent for people aged 20 to 39. There is plenty of evidence that stimulants make people feel better. There’s a reason they are so popular.

But for so many people to be starting life-changing medications with ideas that aren’t clearly supported by evidence, like the chemical-imbalance theory or the expectation to be “better than well,” that distorts our expectations and sets us up to struggle more than we need to.

After his kid’s psych eval, Cooper made the same decision his mom did when he was 10: His son won’t get stimulants. And when Cooper explains this decision to his son, he tries to tell him a different story, maybe a complicated one for a 10-year-old but closer to true.

Davis: What I tell him that I, like you, was diagnosed even younger than you with this. And in my own case, they were very helpful to me at first in certain ways. But the ways in which they changed me over time started to take me to a life that I didn’t feel like I had a lot of control over, and that, When you don’t feel like you have control over your life, your life is out of control.

I thought the only tool that I had, really, to control what was happening around me was drugs that allowed me to change how I showed up for the world, and that actually wasn’t true and was never true.

The villain in that story is not the drugs; it was the way I was thinking about them and maybe the way that other people in my life were encouraging me to think about them. The drugs were not the villain.

Brooks: Mm-hmm. What does he think about that story?

Davis: I mean, this is one area where he has unlimited attention.

Brooks: Cooper Davis helps run the Inner Compass Initiative, a nonprofit that helps people make informed choices about taking and withdrawing from psychiatric medications.

Scripts is produced and reported by me, Ethan Brooks. Editing by Jocelyn Frank and Hanna Rosin. Original music by Rob Smierciak, Engineering by Erica Huang. Fact-checking by Sam Fentress. Claudine Ebeid is the executive producer of Atlantic audio. Andrea Valdez is our managing editor.

If you want to learn more on this topic, Benjamin Fong’s book is called Quick Fixes; Anne Harrington’s book is called Mind Fixers.

Next week: a story about the highs and lows of being prescribed ketamine online. See you then.