The American Brain Disease Cult: When Prophecy Fails

After devastating data have shown that America is leading the world in a failed approach to combating mental illness and addiction, Nora Volkow comes out firing.

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When Prophecy Fails

What to do when you stake your life on a bizarre set of beliefs that is proven to be delusional? Three social psychologists studied this critical question in the 1956 classic, When Prophecy Fails. The psychologists infiltrated a doomsday cult that expected to be transported by a flying saucer on a specific date in advance of the earth’s being deluged by floods.

The cult members had divergent reactions to disconfirmation of their belief system. Less committed adherents sidled off into the sunset. Those who had done the most in anticipation of leaving earth and who were most embedded with other true believers, however, had a paradoxical reaction. They began proselytizing more actively for the cult in order to offset their cognitive dissonance.

Nora Volkow, long-time director of the National Institute on Drug Abuse, has seemingly undergone a similar transformation.

In 2011, the New York Times published an adoring profile of Volkow, titled “A General in the Drug War,” amidst accelerating American drug-use deaths. At the time Volkow was eight years into her post with over a $billion annual budget. 

Volkow has has since been routed in the drug war. But her command is unchallenged, along with her mantra, which Volkow spouted “a dozen times a day” according to the Times: “Addiction is all about the dopamine.”

Volkow and the dopamine and “chronic brain disease” theory of addiction she has embraced and propagated have been a disaster for America. When her predecessor at NIDA, Alan Leshner, pronounced in Science in 1997 that “addiction is a brain disease” fewer than 10,000 Americans were dying each year due to drug use. In 2021 the figure was 107,600— a full order of magnitude greater. 

Mightn’t we have expected some diminution in drug problems based on Volkow and her colleagues’ brilliant brain and neuroscience discoveries? Volkow still predicts that futuristic interventions will alter the brain’s addictive chemistry. In fact, after 20 years and billions of dollars spent annually, Volkow and NIDA have developed no useful diagnostic or treatment tools or techniques. 

With this record one might think that Volkow would have been declared a failure and fired long ago. Instead, she is the undisputed arbiter of addiction in America, even as we have been shown to be the nation just about the worst afflicted by drugs in the world. The World Health Organization conducted an international study of the impacts of diseases. The Global Burden of Disease research measured per capita disability and death experienced in 196 countries. The US was the world’s second worst in its drug use burdens. We lost five times more disability-adjusted life years from drugs per capita than Europe as a whole did.

Volkow is unconcerned about her agency’s and her program’s monumental failure. She promulgates the brain disease theory more ardently than ever. In doing so she resembles  the cult members who reacted to the failure of a flying saucer to appear by redoubling their proselytizing about their mass delusion.

How Thomas Insel Explains His Failure

Volkow was joined in espousing brain disease fantasies by Thomas Insel, the director of the National Institute of Mental Health from 2002 to 2015. (Volkow became head of the NIDA in 2003.)

Insel’s applecart was upended when American researchers in the Global Burden study found that mental health outcomes have plunged precipitously in the US since 1990, just as our drug outcomes had. This disaster occurred despite the US spending billions of dollars— more than the rest of the world combined— on neuroscience and brain research.

Insel conceded in his 2022 memoir “that advances in neuroscience have yet to benefit patients.” But Insel still believes mental disorders are coded in the brain. He blames a failed American healthcare system for our psychiatric abyss. This explanation for the decline of mental health under his regime as director of NIMH enables him to continue to grasp his reductive, delusional way of conceiving mental disorders. 

So Insel is only marginally better than Volkow, who enthusiastically continues to throw money and lives away on her disproved, dysfunctional vision of addiction.  Volkow is followed in this disastrous plunge off the drug and addiction cliff by the large majority of American psychiatrists, politicians, public health leaders and mental health workers. This group is as unable to be deprogrammed of their mass delusion as Trump’s supporters who believe en masse that he won the 2020 election.

Searching “drug overdose” in the Times we find over the last decade:

2013 Rise in drug overdose deaths

2016 How the epidemic of drug overdose deaths rippled across America 

2018 ‘The numbers are so staggering’: overdose deaths set a record last year

2020 In shadow of pandemic U.S. drug overdose deaths resurge to a record 

2021 ‘It’s huge, it’s historic, it’s unheard of’: drug overdose deaths spike

In June 2022, a massively long article in the Times announced: “Experts say we have the tools to fight addiction. So why are more Americans overdosing than ever?” It focused on Harris Marquesano, a young man who died at 19 using drugs despite having undergone multiple bouts of disease treatment for addiction and mental illness (another epidemic among America’s young that the Times identified in 2022).

The final sentence of the Times piece is “Harris needed to know how not alone he was and that he could learn to manage these things in time.” This message is the opposite of the chronic, relapsing brain disease mantra he was repeatedly taught as a teen in the rehabs he attended and that the article’s experts universally espouse. The Times’ cult consensus for remedying the drug death epidemic is to combine failed mental illness and addiction disease treatments throughout America.

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