Reviewer: Alan Lippman, MD.        April 30, 2025

The Latin phrase, Ut est rerum omnium magister usus, (actual translation, “Experience is the teacher of all things,”)—now expressed as the aphorism, “Experience is the best teacher”—is commonly attributed to Julius Caesar, who wrote about his military and political leadership in his book, Commentarii de Bello Gallico (Commentaries on the Gallic War), justifying his actions during a nine-year campaign in Gaul around the years 49-48 BCE.¹

After reading Laura Delano’s (first!) book about her experience as a psychiatric patient for 13 years, I was struck by the insights she had gained during a period of her life that was severely impacted by irrational behavior, self-harm, occasional stays in psychiatric institutions, disruption of family relationships and support, and unintended adverse effects of a slew of psychopharmaceutical agents.

Highly intelligent and studious, Laura was educated at Harvard, but had no formal medical or psychological training.  For her, Caesar’s adage is poignant: Her experience as a psychiatric patient was indeed the best teacher.

The author describes, in compelling narrative and intimate detail, her journey beginning as a confused and rebellious 13-year-old, progressing through defiance and rage, soon involving alcohol and drug abuse, and later at least one (nearly successful) suicide gesture.  She is given a diverse spectrum of diagnoses: bipolar disorder, major depression, social anxiety disorder, eating disorder, substance use disorder, borderline personality disorder.  During the next 14 years, she pursues—willingly and unwillingly—formal psychotherapeutic interventions, with a series of psychiatric professionals, advisors, and counselors.  Laura is placed, at various times, on a wide variety of psychopharmaceutical agents: mood stabilizers, antidepressants, antipsychotics, and others.  She learns, painfully, that withdrawal from many of these dependency-inducing medications is an extraordinarily difficult and prolonged process.  Her doctors refer to her as “treatment resistant.”

By the time she is in her mid-twenties, Laura has frustratingly become resigned to a lifetime of what she calls “psychiatric patienthood.”  One day, in a bookstore, she discovers Robert Whitaker’s Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America.  In this book, Whitaker notes an alarming increase in the incidence of mental illness and in the frequency of American adults receiving government disability payments due to diagnoses of mental illness.    

Laura notes that she herself “never actually felt lasting positive change” as a result of taking any of the myriad medications prescribed over the years.  She embarks on a quest of self-discovery, endeavoring to gain control over her personal demons.

Laura does find value in working with others in Alcoholics Anonymous, where she gains insight and self-confidence.  She wonders: “Is it possible that psychiatry’s medication-based standard of care is actually causing people to become psychiatrically disabled?”  After further consultation with professionals and peers and a personal meeting with Whitaker, Laura concludes that, for her, the psychiatric drugs are causing iatrogenic harm, and she determines she must stop taking them.

But Laura finds that these medications generate dependency, and that withdrawal from them is not a simple matter.  Nevertheless, for her, this is a turning point that leads her on a journey toward healing and to navigating her way to a more productive and rewarding life.

Laura’s story raises fundamental issues regarding the biological nature of mental illness and the role of psychopharmaceutical agents in patient management.  The constellation of psychiatric conditions exhibited by Laura Delano could arguably be subsumed under the designation, “manic-depressive illness,” the pathophysiology of which is not yet fully understood, but rests on hypotheses based on genetic vulnerability, biochemistry, and environmental influences.² Until the underlying cause is established, psychopharmacologic therapy represents merely symptom management.  And although psychopharmacology offers benefit for some, years of research have not, to date, yielded any novel therapy.³

Disclosure: I am a medical oncologist who has had no advanced training in psychiatry.  But, as an oncologist, I am aware that the treatment of cancer today is becoming more rational.  Based on an increasing appreciation of genomics, it is now possible to identify specific “targeted” therapies with curative potential.  This approach has come to be known as “disease-modifying therapy,” meaning treatments that aim to alter the course of a disease by targeting its underlying cause.⁴  It could be argued that antibiotic therapy represents disease modification in specific infectious diseases.  Nevertheless, until the underlying cause of disorders like manic-depressive illness becomes defined, treatments will necessarily remain largely symptomatic. And experience may be considered a reasonable teacher of symptom palliation.      

           

¹Caesar’s Gallic War, trans. W. A. McDevitte and W. S. Bohn. 1^st Edition. New York: Harper & Brothers, 1869.

²Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, Frederick K. Goodwin and Kay Redfield Jamison.  2^nd Edition. New York: Oxford University Press, 2007.

³H. Christian Fibiger, “Psychiatry, the Pharmaceutical Industry, and the Road to Better Therapeutics.” Schizophrenia Bulletin 38 (2012):649-650.

⁴Greenfield, DP et al, “Disease Modification in Medical Care: A Twenty-First Century Paradigm Shift.”  MDAdvisor (Spring 2018):30-32.