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By Yair Oded
May 8, 2025
We sat down with author and journalist Daniel Bergner, who recently joined the Bazelon Center’s board, to discuss his writing on mental health, his views on the mind and modern psychiatry, and the use of institutionalization as a response to mental health needs.
The views expressed in this interview are the interviewee’s and do not necessarily reflect the position of the Bazelon Center for Mental Health Law.
Daniel Bergner
Bazelon Center: We’re joined today by author and journalist Daniel Bergner. Daniel is a contributing writer for the New York Times Magazine and the author of six books of nonfiction and one novel. His writing has also been featured in The Atlantic, Harper’s and Mother Jones, among other publications.
Daniel, you’re also a new Bazelon board member, welcome! We would love our audience to get to know you a little, and learn about your work. You’ve done a significant amount of writing about mental health issues. Can you tell us what drew you to this subject matter? Where did that journey start for you and what’s the lens through which you approach this topic?
Daniel Bergner: It’s always hard to say exactly what gets one started, but certainly a big reason for my writing about mental health is my brother. When we were in our early twenties, he was diagnosed with what would now probably be called schizoaffective disorder, and was put on a locked ward. He was told he would be on quite strong medication for the rest of his life. But he is an artist, he’s a pianist. He couldn’t really play with this medication due to its side effects. That began a journey which has resulted in a really flourishing life of outreach, of leading a church as a pastor, doing all kinds of good works through that position.
And so his life just raises all kinds of questions about locked wards, about diagnoses, about the permanence of those diagnoses. About how we should think about our minds, and even our souls, our psyches. It’s his story that really spurred me to think deeply over time about these issues.
Speaking of your brother’s story – in 2022 you released your most recent book. It’s titled The Mind and the Moon: My Brother’s Story, the Science of Our Brains, and the Search for Our Psyches. It provides a broad overview of modern psychiatry and weaves research with the personal stories of a number of individuals living with mental illness, including your brother. For someone who hasn’t read the book: Can you explain what “the mind” vs. “the moon” stands for, and what’s the core claim you’re making there about how we’ve been thinking about mental health?
Back in the early sixties, president Kennedy made two big promises: One, American science would get us to the moon. Two, that the power of American science would take us to what we called the far reaches of the mind and would be able to cure serious mental health challenges (of course he would call them ‘illnesses’). Now we all know we reached the moon and many of us may know we didn’t really reach the farthest reaches of the mind, and certainly did not find the cure for serious mental illnesses. And so I called the book ‘the mind and the moon’ as a way to contrast what’s material from what’s much less tangible. We got to the moon really fast because it is there physically. It’s not clear that the mind is there physically as the brain is. Is there a difference between the brain and mind? I would strongly argue, yes. I think that the researchers who were very patient with me, over years of my working on the book, and who are very committed to a biomedical vision of psychiatry, taught me the difference between brain and mind, or brain and consciousness.
And if I can take one more minute on this: we’re so involved in the AI conversation right now, and I think pretty much everyone would agree these days that as powerful as AI is, we’re not quite ready to say that AI is sentient; that it’s conscious the way our minds are. And that should give us some pause when we start thinking about our brains as the paramount vehicle to understanding our psyches. There is a difference there, just as there is a difference on the side of AI, and we all ought to take a pause.
Since 1980, more or less, psychiatry has said, ‘mind is brain.’ No, not really. And that’s what allows for these really unpredictable moving stories, like my brother’s.
You write extensively about this shift from the 1980s onwards, when psychiatry took on a more confident biomedical story. Can you expand on what you think is lost when we look at mental health from a purely physiological perspective, focusing exclusively on the brain? What are the scientific gaps in this approach? It seems like scientists have so far failed to provide conclusive evidence that the roots of mental illness are fundamentally physiological.
So to go back a ways pre-1980, the legacy of psychoanalysis was still fairly strong in the way psychiatry was thinking of its mission. But around 1980, that shifts, and then there is a gathering of momentum as two things happen. One, antidepressants are developed – Prozac and its close cousins. What are known as the second generation, or atypical antipsychotics, are also developed, beginning toward the end of the 1980s.
And these kind of give a resurgence of that Kennedy-like optimism: we’ve got this figured out, and our work as psychiatrists can be seen as medical, can be seen as scientific, the way, let’s say, a cardiologist’s work would be seen.
And that, I think, was a boost to the field of psychiatry.
But what psychiatry soon ran into was that the medications we had – and still have – can really, at best, be categorized as uncertain in their efficacy. In the case of antipsychotics, they can have very serious side effects – movement disorders that are like having Parkinson’s, and a real dulling of thinking. So you’re really dealing with a tradeoff. You may quiet the voices, but you’re also very likely going to have some real adverse effects.
So by now, I think psychiatry, for the most part, has begun to acknowledge its limitations. When I worked on The Mind and the Moon, I was meeting regularly with two of the absolutely leading researchers who had committed their entire careers – 40-plus years – to pinpointing causes and finding medications to address those causes. These were hardcore scientists. And I think I found them at the point where they were ready to talk candidly about the frustrations of their search.
In fairness to them, I want to stress that I think both of them would say, often: take your medication – it’s better than not taking it. So in some ways our views diverge, but they were tremendous teachers, and tremendously candid about the limitations they had run into.
We really haven’t made much, if any, progress at all. You’re not seeing miraculous developments that build on Prozac, and you’re certainly not seeing breakthroughs building on Risperdal or Zyprexa or other antipsychotics. The mind is an elusive thing.
And it’s something that’s proving difficult for science to grapple with.
I think it’s very difficult for some scientists to fully acknowledge – and really for all scientists to grapple with. Steve Hyman, for a long while, ran the National Institute of Mental Health, and now runs a huge enterprise at the Broad Institute – probably the best-funded effort to find genetic causes for psychiatric conditions.
He too had reached a point of candor and said, I’m paraphrasing, ‘you know, when I entered this, I was so optimistic. Now I’m overwhelmed. It’s like entering a sort of Borges story – a maze that’s almost infinite. I thought I would have five genetic causes, now I’m at 300 and counting.’
I’d like to pivot a bit and get your take on institutions. You describe multiple visits you’ve made over the years, as part of your reporting, to psychiatric wards. What are some of the patterns you see that keep showing up? And, in your view, what does that environment do to a person’s sense of self and control? I’m asking because I think most people don’t really have a clear sense of what it’s like to be held on a ward.
So that’s an important question, particularly because so much of The Mind of the Moon is about my brother, a woman named Caroline, and one other person.
This is a very intimate, narrative book, but the science is an important part of it, and I want to talk about some recent large-scale studies that have looked at a straightforward question: does being institutionalized help people in the medium or long-term?
And it can seem intuitive that it would help. Like, how could it not help if someone is living on the street, refuses help, doesn’t want to take medication, and seems to be at least entering – if not locked into – alternate realities? How could it not help to get that person institutionalized and on medication?
It’s important to look at the effects of involuntary institutionalization itself.
I know this intimately from my brother. I know it intimately from Caroline. I know it intimately from others. And you’ll hear, over and over again – you may hear some stories of people saying it did help them. I want to be clear about that, and acknowledge there are objections to what I’m about to say.
But what these large-scale studies are consistently showing now is that, sure, you’re not going to commit suicide – or likely hurt anyone else – while you’re on that ward. It’s a controlled environment. But once you leave, your odds of self-harm or harming others may actually increase. Why? Because that experience of having all agency taken away is harmful.
You have to really put yourself in the place of someone who has already been put in a box – labeled as psychiatrically ill, labeled as unable to take care of themselves, or as a threat. They’re already feeling isolated from society, and now you’ve locked them up.
If you think about it with empathy, you can imagine why it may not help – and why, in some cases, it may make things worse. There was a large study done in Pennsylvania showing that the risk of harm can actually increase, because people feel even more isolated and even more out of control of their own situation.
It’s taking away agency in a profound way.
There may be situations where it’s necessary, but if I were shaping policy, I would be very wary of forced institutionalization or mandatory care. It’s not the way to go.
At Bazelon we focus a lot on personal autonomy and living in the community with the right supports so people don’t end up warehoused in hospitals or jails. When you zoom out, what changes would make the biggest difference to help people live full lives outside institutions?
First, let me talk about Caroline’s work now, both with the Hearing Voices Network and in suicide prevention. In both cases, she’s working in ways that are quite counterintuitive.
With the Hearing Voices Network, there’s no effort to judge, categorize, or even correct people’s alternate experiences of reality. The goal is to create a sense of inclusion. Picture, just for shorthand, something like an AA meeting – it’s not a perfect analogy – but you’re gathered in a room, and really, you’re just listening. And listening becomes support.
The more dramatic example of this counterintuitive approach – something Caroline has been spearheading and teaching around the world – is in how she approaches suicide. When we hear someone talk about suicide, our instinct is to call 988, to get someone to intervene immediately, to have that person taken somewhere and prevented from acting. And she teaches against that instinct. Her approach is to listen, to empathize, to acknowledge – and not to hit the panic button.
Why? Because hitting the panic button – if it results in a few days in the hospital – may seem to control the situation temporarily. Of course, the person is unlikely to harm themselves during those few days. But afterward, they may feel even more diminished and helpless, as we were talking about earlier.
Instead, what she’s trying to do is create a feeling of connection. And if you pause and think about it, when people are in their darkest place – when they’re asking whether ending their life is the only solution – it’s often because they feel completely alone, without any sense of recourse.
What she’s offering is an alternative to that aloneness. It sounds simple, but it’s actually quite profound. I’ve been in those circles – it’s powerful to witness.
You asked about alternatives – those are two. There are also peer respite houses, which are still far too few across the country, but she’s involved in expanding them. These are places where people can go for a week or two, come and go as they please, and be supported by others who have lived through similar experiences.
And the track record is quite strong, because people are being embraced, rather than told they are the problem.
Your writing has an undertone of hope. If readers take one or two constructive lessons from your reporting on mental health issues, what do you hope they would be? Particularly family members who are trying to help someone they love and feel they have no good options.
So family members play a big part, of course; my family went through this. When my brother was in his early twenties, going through what he would now call a kind of spiritual crisis rather than a psychiatric one, my parents were afraid – terribly afraid. They wanted to control the situation. They made sure my brother was on a locked ward, and everything that followed came from that. I completely empathize with that parental fear.
But what I would say to parents is: take an infinite number of deep breaths and know that you actually can’t control the situation.
I think it was Caroline who gave me this motto: when you’re controlling, you’re not connecting. And that’s worth remembering. It’s just so true – you can’t do both at the same time. And what will increase your odds of things turning out okay is connection. Control will probably not get you there.
Connect. Don’t control.
That’s so hard. It’s so hard. I completely understand. I can still see my parents trying to explain what was happening with my brother, handing me a book they wanted me to read. It was a big bestseller at the time that promised that with medication, everything would be better. I can still feel their desperation. But when you’re controlling, you’re not connecting.
And I think that never fully went away. For my brother, it’s been so many years – he’s accomplished so much – but some part of him still carries that. He’s still pushing back against that labeling, and against that effort to control rather than to understand and connect.
Finally, are there any upcoming projects you’re excited about and that people should keep an eye out for?
I’m almost certainly moving forward with a story for The New York Times Magazine about involuntary commitment. And then I’ve also got some long-shot theatrical projects that are closely adjacent to this topic, which I hope will let me get even more intimately engaged and offer an even more intimate picture of what people like my brother and Caroline have gone through.
Daniel, thank you so much for taking the time to chat today. We’re looking forward to working together and learning from your perspective on these issues.
Thanks, it’s great to talk with you and I’m really honored to be involved with the Bazelon Center.
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