Malady of the Mind: Schizophrenia and the Path to Prevention

Of the many myths and misconceptions that obscure our understanding of schizophrenia, the most pernicious is that there is no effective treatment or cure. Though that may have been true in the past, the current reality couldn’t be more different: today’s treatments have the potential to be game-changing—and often lifesaving.

This powerful portrait of schizophrenia, the most malignant and mysterious mental illness, by renowned psychiatrist Jeffrey Lieberman, interweaves cultural and scientific history with dramatic patient profiles and clinical experiences to impart a revolutionary message of hope. For the first time in history, we can effectively treat schizophrenia, limiting its disabling effects—and we’re on the verge of being able to prevent the disease’s onset entirely.

In this rigorously researched, profoundly compelling biography of schizophrenia, Dr. Jeffrey Lieberman draws on his four-decade career to illuminate the past, present, and future of this historically dreaded and devastating illness. From his vantage point at the pinnacle of academic psychiatry, informed by extensive research experience and clinical care of thousands of patients, Dr. Lieberman explains how the complexity of the brain, the checkered history of psychiatric medicine, and centuries of stigma combined with misguided legislation and health care policies have impeded scientific advances and clinical progress. Despite this, there is reason for optimism: by offering evidence-based treatments that combine medication with psychosocial services and principles learned from the recovery movement, doctors can now effectively treat schizophrenia by diagnosing patients at a very early stage, achieving a mutually respectful therapeutic alliance, and preventing relapse, thus limiting the progression of the illness. Even more auspiciously, decades of work on diagnosis, detection, and early intervention have pushed scientific progress to the cusp of prevention—meaning that in the near future, doctors may be able to prevent the onset of this disorder.

A must-read for fans of medical histories, psychology, and those whose lives have been affected by schizophrenia, this revelatory work offers a comprehensive scientific portrait, crucial insights, sound advice for families and friends, and most importantly, hope for sufferers now and in the generations to come.

“A renowned psychiatrist explains the process and history of a debilitating, pervasive mental illness [and] argues persuasively that the public understanding of schizophrenia is limited… As he did in Shrinks, the author presents an informative, authoritative package. A compelling and engaging story that shines much-needed light into a dark corner of modern society.”
—Kirkus

“In this penetrating, important book—at once scholarly and highly readable, authoritative and anecdotal—Jeffrey Lieberman introduces us to the strange and frightening world of schizophrenia, charting its history, its treatments, its highly varied manifestations and insidious causes.  He writes with compelling optimism about psychiatry’s great leaps forward; explains when, how, and why the antipsychotics work; and allows us to glimpse the future possibility of prevention.  He is perhaps the leading authority working on this topic today, and here he makes the complex science he has mastered fully accessible.  If someone I know were diagnosed today, this is the volume to which I would immediately turn, and copies of which I’d distribute to the patient’s friends and family.  It will spare such people from anguish and perhaps save their lives.”
—Andrew Solomon, author of The Noonday Demon and Far from the Tree

“Lieberman’s book is one of the deepest and most comprehensive explorations, yet, of schizophrenia, perhaps the most mysterious among the maladies of the mind. Replete with stories of patients and researchers, he writes with that rare combination of authority, empathy and curiosity that makes this an incredibly captivating book.”
—Siddhartha Mukherjee, author of The Emperor of All Maladies and The Gene

“In Malady of the Mind, Dr. Lieberman tackles one of the most complex and misunderstood mental health conditions with precision, compassion, and grace. Grounded in historical context and Lieberman’s own rich clinical expertise, the book offers readers a meaningful understanding of the past, present, and promising future of schizophrenia treatment.”
—Former U.S. Congressman Patrick J. Kennedy, founder of The Kennedy Forum

“As he did in his previous book, Shrinks: The Untold Story of Psychiatry, Dr. Lieberman skillfully renders a complex disease accessible to all while telling a spellbinding story. The great strength of this book is its clear, compelling exposition of how schizophrenia can and should be successfully treated. In doing so, Lieberman confronts us with the fact that “we know what to do but we just don’t do it,” and audaciously brands this a “social injustice.” The book will enlighten and inspire all who encounter schizophrenia, either personally or professionally, and is highly recommended.” 
—E. Fuller Torrey, MD, author of Surviving Schizophrenia and founder of the Treatment Advocacy Center

“Malady of the Mind is the most important book about schizophrenia in decades, and perhaps ever. In addition to telling schizophrenia’s fascinating history, Dr. Lieberman gives readers a new scientific understanding of the disease and an evidence-based protocol for its diagnosis and management. Equally important, he challenges policymakers to provide the standard of care that current and future patients have the right to expect. Focused on early, effective intervention and preventing damage, approaches modern medicine has long since adopted for other illnesses, he has written a total game-changer.”
—Sylvia Nasar, author of A Beautiful Mind

Over his forty-year career, world-renowned psychiatrist Dr. Jeffrey A. Lieberman’s groundbreaking research has pioneered a transformative strategy for the early detection and prevention of schizophrenia. A member of the National Academy of Medicine and recipient of the Lieber Prize for Schizophrenia Research, the APA’s Adolf Meyer Award, and NAMI Scientific Research Award, Dr. Lieberman served as American Psychiatric Association (APA) president in 2013 and 2014). He has contributed to federal legislation to improve mental health care access and quality while reducing stigma associated with mental illness, and is also the author of Shrinks: The Untold Story of Psychiatry, which became the basis for the four-part PBS series, Mysteries of Mental Illness.

Chapter 1: From the Ancient World to Father Amorth

Chapter 1 FROM THE ANCIENT WORLD TO FATHER AMORTH
There are more things in heaven and earth, Horatio,

Than are dreamt of in your philosophy.

—William Shakespeare, Hamlet

A FRAMEWORK FOR REALITY
On the afternoon of July 7, 2016, I received a call from William Friedkin, director of the 1973 supernatural thriller The Exorcist. The critically acclaimed film earned ten Academy Award nominations and won two, including Best Screenplay. It seemed that Billy, as he insisted I call him, had retained an interest in spiritual possession since working on the movie, in which the young daughter of a film star becomes ill and undergoes all manner of medical and psychiatric tests and procedures to diagnose her condition. When all medical science’s tests and treatments fail to reveal the reason for her increasingly bizarre and aggressive behavior, including some bodily maneuvers that defy the natural laws of physics and biology, the desperate mother appeals to the Catholic Church and a wizened exorcist is summoned, pitting the forces of evil against a mortal agent of God. In May of 2016, Billy told me, he had traveled to Rome, where the Vatican’s ninety-one-year-old chief exorcist, Father Gabriele Amorth, had allowed him to witness his first real exorcism—a woman named Rosa. Not only had Billy attended the event, he had filmed it. He was planning to produce a documentary sequel to The Exorcist.

Billy had already shown the footage to two physicians at UCLA Medical Center. Neil Martin, the chief of neurosurgery, didn’t think it looked like schizophrenia or epilepsy, though it could be some form of delirium. He had performed thousands of brain surgeries—on tumors, traumatic injuries, ruptured aneurysms, none of which had produced symptoms like Rosa’s. Itzhak Fried, an epilepsy specialist, was equally mystified, though he regarded what he was seeing as authentic: Rosa wasn’t fabricating her symptoms. He’d mentioned hyper-religiosity and said he doubted you would see such behavior in someone with no religious background.