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"It seems that Americans are in the midst of a raging epidemic of mental illness, at least as judged by the increase in the numbers treated for it. The tally of those who are so disabled by mental disorders that they qualify for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) increased nearly two and a half times between 1987 and 2007-from one in 184 Americans to one in seventy-six. For children, the rise is even more startling-a thirty-five-fold increase in the same two decades. Mental illness is now the leading cause of disability in children, well ahead of physical disabilities like cerebral palsy or Down syndrome, for which the federal programs were created. A large survey of randomly selected adults, sponsored by the National Institute of Mental Health (NIMH) and conducted between 2001 and 2003, found that an astonishing 46 percent met criteria established by the American Psychiatric Association (APA) for having had at least one mental illness within four broad categories at some time in their lives. The categories were "anxiety disorders," including, among other subcategories, phobias and post-traumatic stress disorder (PTSD); "mood disorders," including major depression and bipolar disorders; "impulse-control disorders," including various behavioral problems and attention-deficit/hyperactivity disorder (ADHD); and "substance use disorders," including alcohol and drug abuse. Most met criteria for more than one diagnosis. Of a subgroup affected within the previous year, a third were under treatment-up from a fifth in a similar survey ten years earlier. Nowadays treatment by medical doctors nearly always means psychoactive drugs, that is, drugs that affect the mental state. In fact, most psychiatrists treat only with drugs, and refer patients to psychologists or social workers if they believe psychotherapy is also warranted. The shift from "talk therapy" to drugs as the dominant mode of treatment coin

"A few months after the World Trade Center attacks, a strange message appeared on a U.S. Army computer: "Your security system is crap," it read. "I am Solo. I will continue to disrupt at the highest levels." Solo scanned thousands of U.S. government machines and discovered glaring security flaws in many of them. Between February 2001 and March 2002, Solo broke into almost a hundred PCs within the Army, Navy, Air Force, NASA, and the Department of Defense. He surfed around for months, copying files and passwords. At one point he brought down the U.S. Army's entire Washington, D.C., network, taking about 2000 computers out of service for three days. U.S. attorney Paul McNulty called his campaign "the biggest military computer hack of all time." But despite his expertise, Solo didn't cover his tracks. He was soon traced to a small apartment in London. In March 2002, the United Kingdom's National Hi-Tech Crime Unit arrested Gary McKinnon, a quiet 36-year-old Scot with elfin features and Spock-like upswept eyebrows. He'd been a systems administrator, but he didn't have a job at the time of his arrest; he spent his days indulging his obsession with UFOs. In fact, McKinnon claimed that UFOs were the reason for his hack. Convinced that the government was hiding alien antigravity devices and advanced energy technologies, he planned to find and release the information for the benefit of humanity. He said his intrusion was detected just as he was downloading a photo from NASA's Johnson Space Center of what he believed to be a UFO. Despite the outlandishness of his claims, McKinnon now faces extradition to the United States under a controversial treaty that could land him in prison for years-and possibly for the rest of his life. The case has transformed McKinnon into a cause célèbre. Supporters have rallied outside Parliament with picket signs. There are "Free Gary" websites, T-shirts, posters. Rock star David Gilmour, the former guitarist for Pink Floyd, even recorded

"FOR a brief, heady period in the history of autism spectrum diagnosis, in the late '90s, I had Asperger syndrome. There's an educational video from that time, called "Understanding Asperger's," in which I appear. I am the affected 20-year-old in the wannabe-hipster vintage polo shirt talking about how keen his understanding of literature is and how misunderstood he was in fifth grade. The film was a research project directed by my mother, a psychology professor and Asperger specialist, and another expert in her department. It presents me as a young man living a full, meaningful life, despite his mental abnormality. "Understanding Asperger's" was no act of fraud. Both my mother and her colleague believed I met the diagnostic criteria laid out in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The manual, still the authoritative text for American therapists, hospitals and insurers, listed the symptoms exhibited by people with Asperger disorder, and, when I was 17, I was judged to fit the bill. I exhibited a "qualified impairment in social interaction," specifically "failure to develop peer relationships appropriate to developmental level" (I had few friends) and a "lack of spontaneous seeking to share enjoyment, interests, or achievements with other people" (I spent a lot of time by myself in my room reading novels and listening to music, and when I did hang out with other kids I often tried to speak like an E. M. Forster narrator, annoying them). I exhibited an "encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus" (I memorized poems and spent a lot of time playing the guitar and writing terrible poems and novels). The general idea with a psychological diagnosis is that it applies when the tendencies involved inhibit a person's ability to experience a happy, normal life. And in my c

"Scientists who scanned the brains of men convicted of murder, rape and violent assaults have found the strongest evidence yet that psychopaths have structural abnormalities in their brains. The researchers, based at King's College London's Institute of Psychiatry, said the differences in psychopaths' brains mark them out even from other violent criminals with anti-social personality disorders (ASPD), and from healthy non-offenders. Nigel Blackwood, who led the study, said the ability to use brain scans to identify and diagnose this sub-group of violent criminals has important implications for treatment. The study showed that psychopaths , who are characterised by a lack of empathy, had less grey matter in the areas of the brain important for understanding other peoples' emotions. While cognitive and behavourial treatments may benefit people with anti-social personality disorders, the same approach may not work for psychopaths with brain damage, Blackwood said. "To get a clear idea of which treatments are working, you've got to clearly define what people are like going into the treatment programmes," he said in a telephone interview. Essi Viding a professor in the psychology and language sciences department of University College London, who was not involved in Blackwood's study, said it provided "weighty new evidence" about the importance of distinguishing psychopathic from non-psychopathic people rather than grouping them together. The findings also have implications for the justice system, because linking psychopathy to brain function raises the prospect of arguing a defence of insanity. Interest in what goes on inside the heads of violent criminals has been sharpened by the trial of Anders Behring Breivik, the Norwegian who massacred 77 people last July. Two court-appointed psychiatric teams who examined Breivik came to opposite conclusions about his mental health. The killer himself has railed being called insane."

"An army hospital in Tacoma, Wash. is under fire for reneging on mental health care for troops diagnosed with post-traumatic stress disorder. Since 2007, more than 300 soldiers under consideration for medical retirement because of PTSD had their diagnoses reversed by a screening team at Madigan Army Medical Center -- a move criticized for putting costs before care. "Over 40 percent of those service members who walked in the door with a PTSD diagnosis had their diagnosis changed to something else or overturned entirely," Sen. Patty Murray said at a Defense Appropriations Subcommittee hearing Wednesday. "In light of all the tragedies we have seen that stem from the untreated, invisible wounds of war, I'm sure that you would agree that this is very concerning." PTSD is an anxiety disorder brought on by a traumatic event. The symptoms -- from anger and hypervigilance to numbness and avoidance, not to mention recurrent nightmares and terrifying flashbacks -- can wreak havoc on a person's personal and professional life. A 2010 study by Walter Reed Army Institute of Research found up to 30 percent of Iraq war veterans have symptoms of PTSD. The diagnosis can cost taxpayers as much as $1.5 million per soldier, according to an Army Medical Command memo obtained by the Seattle Times. "The challenges of PTSD and mental health care are real. And no one -- no one -- should be denying any service member purely because of a question of cost," said Murray. "That is something the tax payers of this country bear the burden of providing. We will provide it." Madigan is currently under investigation by the U.S. Army Medical Command for the reversed diagnoses. But Murray argued the investigation should be military-wide. "I want to make sure that we are really looking not just at Madigan… but system-wide," she said, adding that cost should not stand in the way of soldiers getting "the care that they have earned and they deserve and that this country expects them to have." Army

"Nothing is more morbidly intriguing, more chillingly compelling than an account of a malfunctioning mind, as medical writers have learned to their great profit. The victims of mental disease or brain damage are fascinating, not simply as exhibits in a neurological sideshow but also as stark demonstrations of how fragile reality can be. Most people agree, within limits, on the objective character of the world around them. Yet while the victims of mental disorders are certainly conscious and aware, their worlds are profoundly different from those of most of us. What can it possibly feel like, we wonder, to live without emotion, to be crippled without realizing it, to re-experience an event from the distant past complete with the fears that originally surrounded it? As neurologists, psychologists and biologists have zeroed in more and more precisely on the physical causes of mental disorders, they have found themselves addressing a much deeper mystery, a set of interrelated conundrums probably as old as humanity: What, precisely, is the mind, the elusive entity where intelligence, decision making, perception, awareness and sense of self reside? Where is it located? How does it work? Does it arise from purely physical processes-pulses of electricity zapping from brain cell to brain cell, helped along their way by myriad complex chemicals? Or is it something beyond the merely physical-something ethereal that might be close to the spiritual concept of the soul?"

"In my article in the last issue, I focused mainly on the recent books by psychologist Irving Kirsch and journalist Robert Whitaker, and what they tell us about the epidemic of mental illness and the drugs used to treat it.1 Here I discuss the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM)-often referred to as the bible of psychiatry, and now heading for its fifth edition-and its extraordinary influence within American society. I also examine Unhinged, the recent book by Daniel Carlat, a psychiatrist, who provides a disillusioned insider's view of the psychiatric profession. And I discuss the widespread use of psychoactive drugs in children, and the baleful influence of the pharmaceutical industry on the practice of psychiatry. One of the leaders of modern psychiatry, Leon Eisenberg, a professor at Johns Hopkins and then Harvard Medical School, who was among the first to study the effects of stimulants on attention deficit disorder in children, wrote that American psychiatry in the late twentieth century moved from a state of "brainlessness" to one of "mindlessness."2 By that he meant that before psychoactive drugs (drugs that affect the mental state) were introduced, the profession had little interest in neurotransmitters or any other aspect of the physical brain. Instead, it subscribed to the Freudian view that mental illness had its roots in unconscious conflicts, usually originating in childhood, that affected the mind as though it were separate from the brain. But with the introduction of psychoactive drugs in the 1950s, and sharply accelerating in the 1980s, the focus shifted to the brain. Psychiatrists began to refer to themselves as psychopharmacologists, and they had less and less interest in exploring the life stories of their patients. Their main concern was to eliminate or reduce symptoms by treating sufferers with drugs that would alter brain function. An early advocate of this biological

"Jeffrey Mitchell, a volunteer firefighter in the suburbs of Baltimore, came across the accident by chance: A car had smashed into a pickup truck loaded with metal pipes. Mitchell tried to help, but he saw at once that he was too late. The car had rear-ended the truck at high speed, sending a pipe through the windshield and into the chest of the passenger-a young bride returning home from her wedding. There was blood everywhere, staining her white dress crimson. Mitchell couldn't get the dead woman out of his mind; the tableau was stuck before his eyes. He tried to tough it out, but after months of suffering, he couldn't take it anymore. He finally told his brother, a fellow firefighter, about it. Miraculously, that worked. No more trauma; Mitchell felt free. This dramatic recovery, along with the experiences of fellow first responders, led Mitchell to do some research into recovery from trauma. He eventually concluded that he had stumbled upon a powerful treatment. In 1983, nearly a decade after the car accident, Mitchell wrote an influential paper in the Journal of Emergency Medical Services that transformed his experience into a seven-step practice, which he called critical incident stress debriefing, or CISD. The central idea: People who survive a painful event should express their feelings soon after so the memory isn't "sealed over" and repressed, which could lead to post-traumatic stress disorder. In recent years, CISD has become exceedingly popular, used by the US Department of Defense, the Federal Emergency Management Agency, the Israeli army, the United Nations, and the American Red Cross. Each year, more than 30,000 people are trained in the technique. (After the September 11 attacks, 2,000 facilitators descended on New York City.) Even though PTSD is triggered by a stressful incident, it is really a disease of memory. The problem isn't the trauma-it's that the trauma can't be forgotten. Most memories, and their associated emotion

"rom heroin and cocaine to sex and lies, Tetris and the ponies, the spectrum of human addictions is vast. But for Dr. Nora D. Volkow, the neuroscientist in charge of the National Institute on Drug Abuse, they all boil down to pretty much the same thing. She must say it a dozen times a day: Addiction is all about the dopamine. The pleasure, pain and devilish problem of control are simply the detritus left by waves of this little molecule surging and retreating deep in the brain. A driven worker with a colorful family history and a bad chocolate problem of her own, Dr. Volkow (pronounced VOHL-kuv), 55, has devoted her career to studying this chemical tide. And now, eight years into her tenure at the institute, the pace of addiction research is accelerating, propelled by a nationwide emergency that has sent her agency, with a $1.09 billion budget, into crisis mode. The toll from soaring rates of prescription drug abuse, including both psychiatric medications and drugs for pain, has begun to dwarf that of the usual illegal culprits. Hospitalizations related to prescription drugs are up fivefold in the last decade, and overdose deaths up fourfold. More high school seniors report recreational use of tranquilizers or prescription narcotics, like OxyContin and Vicodin, than heroin and cocaine combined. The numbers have alarmed drug policy experts, their foreboding heightened by the realization that the usual regulatory tools may be relatively unhelpful in this new crisis. As Dr. Volkow said to a group of drug experts convened by the surgeon general last month to discuss the problem, "In the past, when we have addressed the issue of controlled substances, illicit or licit, we have been addressing drugs that we could remove from the earth and no one would suffer." But prescription drugs, she continued, have a double life: They are lifesaving yet every bit as dangerous as banned substances. "The challenges we face are much more complex," Dr. Volkow said, "becau

"As neurologists, psychologists and biologists have zeroed in more and more precisely on the physical causes of mental disorders, they have found themselves addressing a much deeper mystery, a set of interrelated conundrums probably as old as humanity: What, precisely, is the mind, the elusive entity where intelligence, decision making, perception, awareness and sense of self reside? Where is it located? How does it work? Does it arise from purely physical processes-pulses of electricity zapping from brain cell to brain cell, helped along their way by myriad complex chemicals? Or is it something beyond the merely physical-something ethereal that might be close to the spiritual concept of the soul? Great thinkers have had no shortage of ideas on the subject. Plato was convinced that the mind must be located inside the head, because the head is shaped more or less like a sphere, his idea of the highest geometrical form. Aristotle insisted that the mind was in the heart. His reasoning: warmth implies vitality; the blood is warm; the heart pumps the blood. By the Middle Ages, though, pretty much everyone agreed that the mind arose from the brain -- but still had no clear idea how it arose. Finally, in the 17th century, the French philosopher Rena Descartes declared that the mind, while it might live in the brain, was a nonmaterial thing, entirely separate from the physical tissues found inside the head. Furthermore, said Descartes in one of history's most memorable sound bites, "Cogito, ergo sum" (I think, therefore I am). His point: consciousness is the only sure evidence that we actually exist. Until just a few years ago, unraveling the relationship of mind and brain was beyond the realm of observation and experimentation. But science has finally begun to catch up with philosophy. Using sensitive electrodes inserted deep into the gray matter of test animals, researchers have watched vision as it percolates inward from the eye's retina to the inner brain. Powerful te

"A technology that monitors electrical activity in the brain could help identify infants who will go on to develop autism, scientists say. The technology, known as electroencephalography, or EEG, is also providing hints about precisely how autism affects the brain and which therapies are likely to help children with autism spectrum disorders. "Right now, the earliest we can reliably identify a child is, say, three years of age," says Charles Nelson, a professor of pediatrics and neuroscience at Children's Hospital Boston and Harvard Medical School. "Our work is designed to see [if we] can we do that in early infancy, long before any signs or symptoms of autism are apparent in the child's behavior." If EEG lives up to its early promise, Nelson says, children with autism might start getting therapy before their first birthday. "