Editor’s note: I had encouraged Lydia Green to write about her experience as a medical advertising writer whose work involved promoting Risperdal, and on August 9 we published her piece, which triggered several angry comments from our readers. I then asked Lydia if she would be willing to address that anger in a follow-up blog, rather than respond in the comments section, as I think this is an important dialogue for all of us at Mad in America to hear. —Robert Whitaker
When my piece on Risperdal was published on Mad in America, I didn’t expect the flood of comments that followed—many of them painful, angry, and deeply personal. At first, it was hard not to feel defensive.
Some readers called me greedy and evil because of my work in pharma advertising. I understand why. I was part of the machine that marketed Risperdal, and yes, that means I was part of the problem. I helped tell the stories Pharma wanted the world to believe, and people were harmed by those stories—people I loved, people I never met, and maybe even people reading this now. That’s not something I say lightly.
But I would like to make one thing clear. Once I became aware of being a cog in the Pharma marketing wheel, I changed direction, realizing that I wanted to be a force for change. I write looking backwards, and if I knew then what I know now, things would have turned out differently.
Several commenters asked me to apologize for what I have done. Apologies are easy. I believe in making amends. For me, that has meant trading a lucrative career for one that often leaves me broke but aligned with my values. I rent out spare rooms, check my bank balance more often than my email, and have a personal relationship with Grocery Outlet.
As for those who are curious about my car—no, it’s not a luxury model. It’s fourteen years old, dented, and the front bumper is held in place with duct tape. When I drive over a bump, the body shop guys reattach the bumper with a push and shove. Meanwhile, my roommate drives a BMW.
I say all this because it made me realize I needed to share my whole story. This is a story about the doubts I carried for years, along with the career detours and failed exits. And the harsh realities unfolding in my own family.
Here’s the story.
My Two Worlds Collide
Just as my doubts about pharma advertising were beginning, the hoopla about a new generation of psychiatric drugs was underway. It was 1987/1988, the years that Prozac—the first blockbuster selective serotonin reuptake inhibitor (SSRI)—won FDA approval and shook up the medical world. TV, books, and news stories were extolling the “chemical imbalance” theory, even though it soon seemed questionable to me.
In 1987, my seventh year after graduating from pharmacy school and becoming a medical copywriter, I was helping out on an antidepressant account. I wasn’t the primary writer, so I wasn’t familiar with all the details of the marketing strategy. My clients said the drug was a breakthrough, and I believed it.
Until things started to spiral in my own family. Suddenly, I realized that the things we were telling doctors about antidepressants were rosier than they seemed.
My older brother Michael was a brilliant attorney—smart, funny, and charming. Diagnosed with bipolar disorder at 32, after two tours in Vietnam, he managed well for many years. With medication and therapy, he always seemed to find his footing. There were one or two hospitalizations, but each time he recovered and rebuilt his life.
But that year, things spiraled out of control. Hospital stays grew more frequent, and recoveries shorter. In twelve months, he spent almost as much time in the hospital as out. A few weeks before he died, he called and asked if he could move in. I said no—unaware of how serious things had become. Not long after, when we couldn’t reach him, the Los Angeles police did a welfare check.
Michael was dead, an empty pill bottle at his side. He had taken his life with the very antidepressants that were supposed to cure him. I had no idea antidepressants could be lethal in overdose. If they were so safe, how could this be?
I felt devastated—angry, horrified, and in disbelief. And with it came doubt, cracks in the polished story we were telling doctors.
My father also struggled with severe depression; he died a year before my brother. Medication and therapy didn’t seem to help. After a suicide attempt and entering a near catatonic depression, he lost his business and spent years rarely leaving the house. The psychiatrists told us his depression was “treatment resistant.” In the end, he was hospitalized and scheduled for ECT. Ten days later, he died from undiagnosed cancer.
It was also the year I started my 37-year journey of sobriety.
Cracks in the Story
In the years that followed, my doubts continued to grow. I didn’t want to be in pharma anymore. I applied to journalism school, hoping to change careers entirely. When I didn’t get in, I moved to Montana to work on a political campaign. Four years later, I was down to my last $200. I burned through my entire 401(K) chasing that dream.
I moved back to New York City. Overnight, I went from an $11 an hour job as a pharmacy technician at a VA hospital to $100,000 a year at a Madison Avenue ad agency. My main account was Risperdal.
In my 2020 TEDx Talk, I shared how Risperdal was the straw that broke the camel’s back—what I called my “night to remember.” My agency manager came to my office one night, fearful Janssen would pull their business from our agency if we couldn’t prove Risperdal didn’t cause obesity, diabetes, and enlarged breasts in men.
The next morning, I quit.
Trying to Leave Pharma Behind
I decided to try medical device advertising, only to discover that the industry was no better. So I decided to leave advertising.
I was lucky to land a job at a healthcare technology start-up—a company dedicated to improving medication safety by giving doctors access to mobile drug information. From 2000 to 2015, I worked with medical information specialists, professors, software engineers and government agencies in various communication roles, including Director of Corporate Communications. It was the first time I felt I was helping to fix a problem instead of fueling it.
I loved working at Epocrates. I collaborated with journalists, federal agencies, state Medicaid offices, pharmacy benefit managers, retail pharmacies, scientific publishers, medical educators, medical schools, and professional associations. It opened my eyes even wider.
I saw that greed reaches into every part of the healthcare system: medical education, policy, publishing, and research. No one seemed immune. Academic physicians making $350,000 called me on the phone asking for free premium software rather than pay a reasonable $79 subscription fee. Medical school professors—running clinical trials—naively hired large healthcare consulting firms to help with communications on NIH trials, only to get fleeced. And the company’s business model was based on delivering Pharma’s ad messages to doctors’ phones.
Healthcare, I realized, wasn’t about healing. It was about finding ways to extract money from the suffering of others.
Pharma People Are Nice—So Why Do They Do Harm?
If you met a pharmaceutical executive at a barbecue or church supper, they’d probably seem warm and likable. Yet the same person who would give you the shirt off their back will stretch the truth without regard for the public’s welfare.
Denial is a powerful force.
Most colleagues pushed back when I expressed my doubts about medical advertising, insisting our client’s claims were factual, rigorously reviewed, and accurate. Others seemed insulted, as if I was questioning their integrity.
Feeling uneasy, I kept searching for answers.
Reading Reinhold Niebuhr’s Moral Man and Immoral Society was an epiphany. Niebuhr wrote that well-intentioned individuals, once inside an organization, can behave in ways they would never consider as individuals. Later, hearing Harvard professor Max Bazerman speak at a conference on the corporate psychology of ethical dilemmas was another wake-up call. Bazerman explained how “ethical blind spots” lead people to act unethically even when they know better, because humans have an enormous capacity to rationalize bad behavior. He told us that this is why corporate compliance programs often fail.
Suddenly, I had a framework for what I’d been struggling to understand for years. My clients weren’t bad; they were just unaware. The harm wasn’t caused by personal evil, but by a system that put profit ahead of moral behavior and normalized the compromises needed to keep it going—a system I was still complicit in.
My anger and frustration now had a purpose—I would work for change.
Starting RxBalance
In 2014, I launched RxBalance when a Stanford professor invited me to collaborate on an NIH-funded study. She had noticed some of our work hanging in another professor’s cubicle.
Her study would explore whether ad-style messaging could make dry, technical information memorable—and actionable—for doctors and patients, competing with Pharma’s slick promotions.
Today, my goal is twofold: to demonstrate how advertising can promote evidence-based medicine and to expose the hidden sides of Pharma—things people rarely see.
Consider the FDA’s Form 2253 process. Officially, every new promotional piece must be submitted electronically to the division responsible for overseeing accuracy in drug marketing. For years, even I—an insider—believed that FDA experts carefully evaluated claims before doctors or patients ever saw a word.
Only recently did I learn the truth. Pharmaceutical companies submit up to 80,000 promotional pieces a year. The FDA requires it. However, with only 60 to 70 reviewers in the Office of Prescription Drug Promotion, most are never reviewed. They remain in the cloud—officially “filed,” but rarely examined.
From RxBalance’s beginning, I also drew a hard line: we would never take pharma money. That boundary isn’t easy, but it matters. You can’t promote rational drug use if you’re financially entangled with the very system you’re trying to question. Unfortunately, virtually every healthcare stakeholder—including patient advocacy groups, medical associations, and even the FDA—takes money from industry.
Anger Feels Good, Strategy Gets Results
Outrage at the pharmaceutical industry may feel satisfying, but outrage alone won’t change the system. Excessive use of medicines may look like a problem to you, but to the pharmaceutical industry, it’s a revenue stream.
Pharma doesn’t just have deep pockets. It has a strategy.
We need one too.
Pharma is deliberate, disciplined, relentless. It shapes opinion, bypasses regulations, and neutralizes anything in its way. My clients slipped past every hurdle and every safeguard—that’s what they do. You try to rein them in, and they find another way to bend the rules.
Pharma wants us tangled in the weeds—debating every data point, every statistic, every so-called finding—because that’s where they hold the upper hand. They have entire medical affairs departments of PharmDs and physicians whose full-time job is to churn out “evidence” that backs their story. Add to that their consultants, PR firms, and communication specialists, and they can shape the news, journals, and even medical education.
If we want to counter pharma’s influence on the “medical information pipeline,” we can’t just resist their claims. We need to offer better ways to understand and treat severe mental illness and its root causes—and back them with solid evidence showing they work as well as, or better than, medication.
Anger has its place. But it’s most powerful when you channel it into action.
What You Told Me
In the comments to my article in Mad in America, certain topics came up repeatedly: drug risks and the lack of informed consent, frustrations of doctors not listening to you, and the desire for alternatives to antipsychotics. I want to share my thoughts on these issues
The Illusion of Consent
Informed consent should mean that patients know what they’re agreeing to. But over time, it has devolved into paperwork: forms, signatures, and fine print. What was meant to be a safeguard has become a box-checking exercise that prioritizes protecting institutions over people.
Valid informed consent isn’t just handing over information. It means making sure that information is actually understood. And that’s not easy. When you’re in crisis, it can feel impossible to take in everything being thrown at you. That’s why patients, families, and caregivers need information that’s clear—so they can be well-informed and make the right decisions.
I saw this firsthand while working with medical school faculty on a project for heart patients who had received medical device implants. Doctors insisted they had explained the risks, but many patients were still misinformed—some only learning about serious complications after the fact.
Even more troubling, many overestimated the benefits of the device and didn’t understand the trade-offs or how it could impact their daily lives.
That gap—between what doctors say they told patients and what patients actually grasped shows just how fragile “consent” really is.
Being Heard
Doctors are trained to respond to data. If you want to get your points across, do your homework. Be confident, ask questions, and stand up for yourself or your family members. Trust your instincts and what you observe—the doctor isn’t there day to day, you are.
While Wikipedia, YouTube, and social media can be tempting shortcuts, most doctors won’t take them seriously—and you risk losing credibility fast. Trusted sources are a stronger way to make sure your voice is heard.
The good news is you don’t have to become a medical librarian to get there. Reliable resources outside of Mad in America include:
- MedlinePlus (National Library of Medicine) — plain-language information on drugs and treatments
https://medlineplus.gov/ - Google Scholar — access to the same studies your doctor reads
https://scholar.google.com/ - NIH Fact Sheets — evidence-based information on dietary supplements
https://ods.od.nih.gov/factsheets/list-all/ - NHS (UK National Health Service) — clear overviews of psychiatric conditions; compared with U.S. sources, it gives more attention to talking therapies and community care, not just medication
https://www.nhs.uk/mental-health/
NOTE: Some readers may wonder why I left the US National Institute of Mental Health off the list. While the NIMH offers decent information on general mental health topics, it has been criticized for its close ties to industry and for overstating the results of trials like STAR*D.
Beyond Medication: The Alternatives
There are proven models of care for severe mental illness that don’t center on medication, but most people never hear about them. And count me in—as a medical ad writer interested in psychiatry, I know little about anything beyond drug therapy.
This is why I was intrigued by the mention of Open Dialogue in the comments section. I was surprised to learn how much research supports it.
Open Dialogue demonstrates that treating someone with psychosis at home, rather than rushing to hospitalization, can lead to better outcomes. After five years of Open Dialogue treatment, a remarkable 81 percent of people had no remaining psychotic symptoms and 84 percent were back in full employment—that’s striking. Even more so because it doesn’t rely heavily on antipsychotics—only 33 percent had used them. That’s not wishful thinking; that’s data.
The problem is that doctors and the public mostly hear about drugs. During medical training onward, physicians are taught to see medication as the bedrock of treatment for mental illness. This entrenches a system where non-pharmacologic alternatives, no matter how strong their evidence, remain sidelined.
When a new drug is launched, pharmaceutical companies make sure it’s everywhere: mainstream news, magazines, medical conferences, and professional journals. But non-pharmacologic alternative treatments don’t get the airtime, the headlines, or the marketing push.
We need to make sure that the psychiatric community—especially residents entering practice—are exposed to alternative treatments.
Building a Movement for Change
The problems with consent, the struggle to be heard, and the lack of visibility for alternatives all point in the same direction: the current system will not change unless we organize and change it in ways the system can’t ignore. That’s why communities like Mad in America matter. They create space for truths most institutions won’t touch.
But truth-telling alone isn’t enough.
I believe that many psychiatrists feel conflicted about psychiatric medications and the biomedical model. Some, though, are hesitant, cautious, and reluctant to question the status quo. We need to reach out to them because, right now, pharma companies only fund those who represent their interests.
If we want real change, we have to be as deliberate as pharma. That means putting emotions in their place—not erasing them, but channeling them—so we can stay clear-eyed, conserve energy, and act with strategy.
We’ll never be able to outspend Pharma. But we can outmaneuver them—not by playing their game, but by changing it. Because in the end, the only power strong enough to counter their grip on psychiatry is an informed public that refuses to play by their rules—and starts making its own.
That’s the kind of power money can’t buy.