Unshrunk - Medication, Red in Tooth and Claw

Delano is very much an example of something being wrong with psychiatry, the question is how emblematic is her experience?

Unshrunk: A Story of Psychiatric Treatment Resistance

By: Laura Delano Published: 2025 352 Pages

Briefly, what is this book about?

An autobiographical tale of Delano's experience with the mental health industry starting at the age of thirteen. Among other things, it covers her bipolar diagnosis, eating disorders, cutting, and one, nearly successful, suicide attempt. On the treatment side of the ledger she took at least a dozen drugs, engaged in constant therapy, and was committed to psychiatric hospitals and treatment programs on several occasions. In the end she decided that most of her problems stemmed from the substances she was taking, both those that are recognized as harmful, like cocaine and alcohol, and those that were supposed to help her. A major theme of the book is that the horrible withdrawal symptoms that accompany most psychiatric drugs go a long way towards creating the impression that "the drugs are helping".

Woven through all of this, Delano provides significant research illustrating the bad incentives, and shoddy testing engaged in by the pharmaceutical industry, along with critiques of the DSM, the paradigm of mental illness as a chemical imbalance, and reliance on drugs as a first line of treatment.

What authorial biases should I be aware of?

Delano includes some extensive research. This is not merely an n=1 anecdote, there are clearly a significant number of people who are taking too many psychiatric drugs, and don't have the skills to taper off those drugs. Also Delano is explicitly not "antimedication" or "antipsychiatry". Nevertheless, it is clear that she is not a neutral observer, that she is profoundly distrustful of the pharmaceutical industry, and that she came by this distrust honestly, even if it doesn't necessarily apply to everyone.

It should also be mentioned that money was never a problem for Delano, which probably meant both that she received too much care, but also that she had a large support network available during every phase of her journey.

Who should read this book?

The debate over how to care for the mentally ill is both fascinating and fraught. It sits at a convoluted nexus that includes healthcare availability, cost, worries over youth, violence, homelessness, anti- and pro- drug narratives, and a weird tangle of culture war issues. Navigating this mess is going to take as much information as we can get and this is a great book describing one of the many angles available for approaching it.

As a more specific matter I would recommend it to psychologists and psychiatrists as something of a counter-narrative/steelman for those who are wary of medications and interventions.

Finally, for those seeking to taper or get off of medication, this book is essential reading, and the idea of hyperbolic tapering may be the single most important bit of knowledge it contains.

If you want a taste of things, I read this as part of the Blocked and Reported book club, and they had an interview with Delano which was quite good.

Specific thoughts: Mental health treatment is crazy complicated