When I first started taking anti-depressants in the early 1980s, several years before the advent of Prozac made these medications seem cool, I wasn’t too concerned about what was causing my deep and persistent unhappiness. My childhood had been traumatic, but I was also willing to believe that I had a “chemical imbalance” – the then-ascendant theory about the cause of depression. Perhaps I had a biological predisposition that wouldn’t have been triggered had I grown up under more benign circumstances. Whatever the source of my prolonged misery, I finally found relief with a tricyclic, a pre-Prozac class of anti-depressants – but only after more than half a dozen other medications had failed to alleviate my life-threatening condition.

I consider myself lucky to have had a positive experience of medication for a mental health condition. I am well aware that many others have not – especially those prescribed multiple psychiatric drugs simultaneously, which seems to happen with alarming frequency and with little apparent thought given to the potentially harmful effects of these combination cocktails. In any event, journalist Daniel Bergner makes a compelling case for abandoning this pharmacological approach in The Mind and the Moon: My Brother’s Story, the Science of Our Brains, and the Search for Our Psyches. This readable, well-written indictment of the field of biological psychiatry raises searching questions about the role medications should play – if any – in the treatment of psychosis, schizophrenia, bipolar disorder, and other forms of severe mental illness.

The pharmaceutical industry has frequently engaged in egregious and even fraudulent marketing strategies, and the field of psychiatry has not lagged in this respect. Psychotropic medications are blunt instruments that can tamp down some of the demons – and often some of the voices – that plague so many patients. But they have significant side effects that their enthusiastic boosters have routinely downplayed, dismissed or ignored. From the perspective of Bergner, his brother Bob, and the other patients whose experiences are recounted here with tenderness and care, the medicines once hailed as wonder drugs, and psychiatry’s insistence that the mind can be understood solely through neurological mechanisms, largely function as a form of societal control and oppression.

The Mind and the Moon consists of several interwoven narrative strands: intimate and detailed portraits of people struggling with mental illness; the Bergner family’s challenges in coping with Bob’s condition, which was diagnosed as bipolar disorder; historical sections on the search for chemical compounds to treat these diseases of the mind; and accounts of the author’s meetings with neuroscientists and others investigating the mind. In developing his themes, Bergner repeatedly invokes humankind’s successful campaign to land on the moon and suggests that scientific efforts to plumb the depths and mysteries of the mind have been much less fruitful – a comparison reflected in the book’s title.

“Science, President Kennedy was sure, would take us to ‘the remote reaches of the mind,’” he writes. “And science, he vowed, would take us to the moon…Kennedy’s ambition of reaching the moon was so swiftly accomplished while his rhetoric about making ‘the remotest regions of the mind accessible’ has proved delusional. The moon is there, physically, to be reached. With the mind, this may not be so.”

Starting with the anti-psychotics Thorazine and Haldol, which became available in the 1950s and 1960s, respectively, Bergner documents how new psychiatric drugs were introduced with great fanfare and hope. They were widely promoted and widely prescribed despite minimal understanding of what exactly they were doing in the brain, and how they were doing it, and whether any of it was harmful. Eventually, of course, the breadth and severity of the inevitable negative consequences, including sometimes irreversible neurological damage, became apparent and undeniable. In many patients, the medications caused metabolic disruptions, led to significant weight gain, and increased the risk of heart disease and diabetes.

Bergner is unsparing in his account of these and other side effects: “The drugs dimmed thinking and dulled speech,” he writes. “They obliterated sex drive, stirred excessive salivation and drooling, and caused tardive dyskinesia: unrelenting, repetitive scrunching of the eyes, puffing of the cheeks, twitching and twisting and smacking of the lips, darting, lolling, and rhythmic thrusting of the tongue, jerking of the necks, jerking and gyrating of the shoulders, rocking back and forth.” In some patients, the drugs also caused a condition called akathisia, “a feeling of overall torturous physical restlessness that begged perpetually for release.” Such devastating impacts did not appear to dim the psychiatric field’s support for the drugs, Bergner notes.

The book isn’t heavy on statistics. Its power rests on the accumulated histories of its main protagonists. Besides the author’s brother, these include, among others, Caroline, who learned to keep her voices and suicidal thoughts to herself but later found the reverse strategy to be a more effective method of dealing with her condition; and David, a successful civil right lawyer suffering agonizing physical symptoms after having stopped taking drugs for depression and anxiety. After years of complying with pharmaceutical regimens, these patients found the self-awareness and gumption to reject the labels pegged on them – and the drugs that were automatically prescribed along with their diagnoses. The goal, for Bergner’s brother and Caroline and the others, is not to eradicate or obliterate the voices and other manifestations of psychosis with drugs but to accept them, contemplate what wisdom or lessons they might offer, and learn how to make some form of relatively peaceful accommodation with them.

In general, dumping the meds has led to significant improvements in their lives. Bergner’s brother marries a level-headed woman untroubled by his idiosyncracies, finds himself drawn to religion, and pursues a career as a pastor in a small Connecticut town, often ministering to people experiencing similar mental health challenges to those he had faced. Caroline becomes a trainer with the Hearing Voices Network, an international consortium “for people who hear voices, see visions or have other unusual perceptions.” She still hears her own voices but has largely learned to navigate between this internal reality and the rest of the world.

“This was her battle,” Bergner writes. “This was her life. She did all the prescribed things, existed in relationship to her voices rather than in opposition to them…yet her burden could only be reduced, not removed. This was her extraordinary trial. This was what she bore, even as she sipped tea in a booth in our shared world, and chatted amiably, charmingly, with the café’s owner.”

These stories are powerful and inspiring. So too is Bergner’s description of Soteria houses, where patients live alongside staff and enjoy much greater freedom than generally granted to inmates warehoused in huge psychiatric institutions. In these settings, staff members focus less on categorizing patients by diagnosis and ensuring they’re medicated than on listening to them and treating them as peers. In offering these accounts, Bergner provides an optimistic vision of a possible pathway for others caught in the grip of similar struggles, whether they are currently taking medication or not.

The unanswered question – and Bergner leaves it mostly unasked – is whether this sort of approach is widely applicable even if it could be made widely available. What proportion of patients currently on doses of multiple medications would be able to wean themselves off successfully, and what proportion of prospective medication patients could do without them altogether? Could all or most patients find their own way through the darkness, as Bergner’s brother and Caroline have, or thrive in a Soteria setting? Should no one take psychotropic drugs, or might some people benefit from them? The Mind and the Moon doesn’t really address these critical angles, and Bergner provides no extended portraits of patients who found relief through medication.

But a book does not need to be exhaustive to serve a valuable purpose. Individuals and families daily confront hard choices about psychiatric medications, whether for themselves or for loved ones. To the extent that these drugs have been presented for decades as the main and often only viable options for treatment, and as largely benign, Bergner’s book offers a critical window onto other perspectives and makes a compelling case for the importance of considering non-pharmacological choices – whether as supplements or alternatives.

He also makes a compelling case for the importance of humility in the face of uncertainty – a trait that has not in general characterized the field of biological psychiatry. If the discipline wishes to serve the interests of patients rather than the interests of pharmaceutical companies, Bergner suggests, doctors need to listen more to patients instead of automatically categorizing and medicating them. The profession “would have to acknowledge to itself that, as far as science is concerned, the mind is much, much farther away than the moon ever was, immeasurably, ineffably so…It would have to reiterate, at the start of every session, some variation on We don’t know.”