The Mind and the Moon: My Brother's Story, the Science of Our Brains, and the Search for Our Psyches by Daniel Bergner is a well-written book about mental illness. It tells the story of Bergner's brother, who was diagnosed as bipolar. The author explores psychiatry, the pharmaceutical industry, and other treatment options. This book was extremely in depth, but it was still easy to understand. Thanks to NetGalley for the free digital review copy. All opinions are my own.

The Mind and the Moon by Daniel Bergner is an exploration into the experience of schizophrenia in the modern medical system. Bergner also explores themes of family, friendship, and the pitfalls of the mental health care system.

Bergner’s brother David was diagnosed with schizophrenia at a young age. Bergner discusses his experience as a family member of someone diagnosed with schizophrenia as well as the history of psychiatric care.

This is a topic that I usually enjoy, unfortunately, Bergner’s clunky writing distracted from the main messages of the book. There were many times where the narrative seemed irrelevant or overly descriptive and I found myself skimming the page to find the narrative thread. His sentences were often long and I had to reread them several times to understand his meaning.

The Mind and the Moon is a scathing takedown of Big Pharma and the role of the psychiatric profession in overmedicating and frankly abusing those labelled mentally ill or neurodivergent. It is also a personal story, including the author’s brother as one of the three individuals whose tales of suffering from psychiatric medications, diagnosis, and institutionalization he interweaves with a comprehensive history of how drugs targeting the brain were developed, sold, and approved despite limited knowledge of how they work and known severe side effects.

While many of us are aware of the limits to scientific understanding of the brain, as well as the fact that antidepressants and other psychiatric medications are overprescribed in the United States, this book illuminates those facts and their context in a way that I found frankly a little terrifying. This book shocked out of the general attitude of “sigh, yeah, this isn’t great, but there’s not much we can do,” as I realized that maybe doctors know quite a lot less than we assume.

While the neuroscientists studying ways to target these conditions remain doggedly optimistic, the fact that there is no structural indication of difference in neurodivergent and mentally ill brains raises some questions: why do we pathologize people who think differently? To what extent does environment play a role in mental health? Do these drugs really have an effect, or is it mostly placebo?

What Bergner does particularly well is weave together different factors at play so the reader can get a clearer sense of why these drugs are so widely used and not questioned more than they are. I was surprised to learn that the “chemical imbalance” theory has pretty much no actual evidence, despite being confidently shared by any doctor I’ve spoken with about depression and anxiety. While the theory that some brains need drugs to “rebalance” their chemistry makes logical sense, the actual science is still pretty much a crapshoot—researchers don’t know why certain drugs work, and many in fact don’t work any better than placebo, but are still prescribed.

Monetary interests are a big part of the picture, unsurprisingly, alongside a fair bit of cultural inertia. Other factors the book exposes include lax FDA regulation, straight-up corruption, a diagnostic model that has more to do with psychiatrists trying to prove their professions’ worth and give it scientific-sounding appeal than the actual needs of patients, family members looking for a simple explanation that takes the blame aware from their own behavior or genetics, and the impact of pharmaceutical direct advertising as well as advertising to doctors.

In other words, there is a man behind the curtain who has no idea what he’s talking about, and the emperor is very, very naked.

This isn’t a quick read, though given its broad scope I found it a compelling one. The three individual stories featured each have a particular lens that allow Bergner to discuss a different angle of this multi-layered problem, and that personal aspect keeps the writing from being too dry while also humanizing the arguments presented.

My favorite “character” was a roller derby enthusiast and psychiatric survivor who has taken a major role in creating self-advocacy groups that avoid institutionalization and allow those who hear voices to actually talk about those voices without stigma. Bergner’s narrative shows that this approach to psychosis is actually much less likely to result in violence and harm than the standard of care that encourages patients to hide what they hear and take damaging medications to suppress their voices and sedate their bodies.

I suspect many readers will relate to the way members of these support groups point to how fear of institutionalization prevents talking about suicidal thoughts—the very thing that is most likely to actually help a person having them. The aim of suicide prevention, especially within institutions, is so centralized that staff effectively torture people who might do just fine in another setting, in the name of avoiding suicide whether or not there is even a clear risk. Bergner showcases a few alternatives to this model and while none is perfect, perhaps, they do seem promising to further explore.

The other two featured stories present similarly relatable themes. In one, a man put on anti-depressants for mild symptoms goes through absolute hell from the withdrawal symptoms, his narrative framed in time by its connection to the Trump debacle. Despite years of success as a civil rights attorney, withdrawal from a commonly-prescribed medication results in years of torment where he is unable to practice at the time he feels most needed, watching the country fall apart. The other, centered on Bergner’s brother, considers the relationship between artistic talent and mental illness as well as the role of the family environment. In doing so it really debunks the myth of the simple binary I grew up not questioning: treatment and mental health on the one hand vs. creative ability on the other.

In all three of these stories, as well as others explored at less length, there is a sense that being odd or disruptive is dangerous, and nowhere more so than within a psychiatric institution. In an evidence-based world, there is no tolerance for perceptions that can’t be scientifically proven, and in a world obsessed with simply keeping people alive there’s no space for empathy or root cause investigation. Actual human strength and resilience is ignored, as casting patients as fragile serves the narrative. Similarly, the actual experiences of unmedicated patients are seen as irrelevant. Bergner’s writing brings a few of these patients metaphorically back to life as he wrestles with questions of the authentic self, decouples the brain and the mind, and considers neurodivergence as a kind of self-understanding that is denied by psychiatry (and institutions where neurodivergent friendships are seen as dangerous).

I would recommend this book to anyone who wants a clearer and more comprehensive understanding of mental health in the United States, especially the use of psychiatric drugs, though with the word of caution that you’re likely to find yourself both moved and a little freaked out if you or someone you love has been prescribed drugs like these or placed in an institutional setting. For policy makers, it’s a must-read.