GLEASON IS A BIG, lively girl with a round face, a quick wit,
and a sharp tongue. She's 13 and in eighth grade at Dessau
Middle School in Pflugerville, Texas, an Austin suburb, but
could pass for several years older. She is the second of four
daughters of Calvin and Anaka Gleason, an African American
couple who run a struggling business taking people on casino
In the early part of seventh grade, Aliah was a B and C student
who "got in trouble for running my mouth." Sometimes
her antics went overboard-like the time she barked at a teacher
she thought was ugly. "I was calling this teacher a man
because she had a mustache," Aliah recalled over breakfast
with her parents at an Austin restaurant.
School officials considered Aliah disruptive, deemed her
to have an "oppositional disorder," and placed her
in a special education track. Her parents viewed her as a
spirited child who was bright but had a tendency to argue
and clown. Then one day, psychologists from the University
of Texas (UT) visited the school to conduct a mental health
screening for sixth- and seventh-grade girls, and Aliah's
life took a dramatic turn.
A few weeks later, the Gleasons got a "Dear parents"
form letter from the head of the screening program. "You
will be glad to know your daughter did not report experiencing
a significant level of distress," it said. Not long after,
they got a very different phone call from a UT psychologist,
who told them Aliah had scored high on a suicide rating and
needed further evaluation.
The Gleasons reluctantly agreed to have Aliah see a UT consulting
psychiatrist. She concluded Aliah was suicidal but did not
hospitalize her, referring her instead to an emergency clinic
for further evaluation. Six weeks later, in January 2004,
a child-protection worker went to Aliah's school, interviewed
her, then summoned Calvin Gleason to the school and told him
to take Aliah to Austin State Hospital, a state mental facility.
He refused, and after a heated conversation, she placed Aliah
in emergency custody and had a police officer drive her to
The Gleasons would not be allowed to see or even speak to
their daughter for the next five months, and Aliah would spend
a total of nine months in a state psychiatric hospital and
residential treatment facilities, While in the hospital, she
was placed in restraints more than 26 times and medicated--against
her will and without her parents' consent--with at least 12
different psychiatric drugs, many of them simultaneously.
On her second day at the state hospital, Allah says she was
told to take a pill to "help my mood swings." She
refused and hid under her bed. She says staff members pulled
her out by her legs, then told her if she took her medication,
she'd be able to go home sooner. She took it. On another occasion,
she "cheeked" a pill and later tossed it into the
garbage. She says that after staff members found it, five
of them came to her room, one holding a needle. "I started
struggling, and they held my head down and shot me in the
butt," she says. "Then they left and I lay in my
What, if anything, was wrong with Aliah remains cloudy. Court
documents and medical records indicate that she would say
she was suicidal or that her father beat her, and then she
would recant. (Her attorney attributes such statements to
the high dosages of psychotropic drugs she was forcibly put
on.) Her clinical diagnosis was just as changeable. During
two months at Austin State Hospital, Aliah was diagnosed with
"depressive disorder not otherwise specified," "mood
disorder not otherwise specified with psychotic features,"
and "major depression with psychotic features."
In addition to the antidepressants Zoloft, Celexa, Lexapro,
and Desyrel, as well as Ativan, an antianxiety drug, Aliah
was given two newer drugs known as "atypical antipsychotics"--Geodon
and Abilify--plus an older antipsychotic, Haldol. She was
also given the anticonvulsants Trileptal and Depakote--though
she was not suffering from a seizure disorder--and Cogentin,
an anti-Parkinson's drug also used to control the side effects
of antipsychotic drugs. At the time of her transfer to a residential
facility, she was on five different medications, and once
there, she was put on still another atypical--Risperdal.
The case of Aliah Gleason raises troubling--and long-standing--questions
about the coercive uses of psychiatric medications in Texas
and elsewhere. But especially because Aliah lives in Texas,
and because her commitment was involuntary, she became vulnerable
to an even further hazard: aggressive drug regimens that feature
new and controversial drugs--regimens that are promoted by
drug companies, mandated by state governments, and imposed
on captive patient populations with no say over what's prescribed
In the past, drug companies sold their new products to doctors
through ads and articles in medical journals or, in recent
years, by wooing consumers directly through television and
magazine advertising. Starting in the mid-1990s, though, the
companies also began to focus on a powerful market force:
the handful of state officials who govern prescribing for
large public systems like state mental hospitals, prisons,
and government-funded clinics.
One way drug companies have worked to influence prescribing
practices of these public institutions is by funding the implementation
of guidelines, or algorithms, that spell out which drugs should
be used for different psychiatric conditions, much as other
algorithms guide the treatment of diabetes or heart disease.
The effort began in the mid-1990s with the creation of TMAP--the
Texas Medication Algorithm Project. Put simply, the algorithm
called for the newest, most expensive medications to be used
first in the treatment of schizophrenia, bipolar disorder,
and major depression in adults. Subsequently, the state began
developing CMAP, a children's algorithm that is not yet codified
by the state legislature. At least nine states have since
adopted guidelines similar to TMAP. One such state, Pennsylvania,
has been sued by two of its own investigators who claim they
were fired after exposing industry's undue influence over
state prescribing practices and the resulting inappropriate
medicating of patients, particularly children.
Thanks in part to such marketing strategies, sales of the
new atypical antipsychotics have soared. Unlike antidepressants--which
have been marketed to huge audiences almost as lifestyle drugs--antipsychotics
are aimed at a small but growing market: schizophrenics and
people with bipolar disorder. Atypicals are profitable because
they are as much as 10 times more expensive than the old antipsychotics,
such as Haldol. In 2004, atypical antipsychotics were the
fourth-highest-grossing class of drugs in the United States,
with sales totaling $8.8 billion--$2.4 billion of which was
paid for by state Medicaid funds.
At a time when ethical questions are dogging the pharmaceutical
industry and algorithm programs in Texas and Pennsylvania,
President Bush's New Freedom Commission on Mental Health has
lauded TMAP as a "model program" and called for
the expanded use of screening programs like the one at Aliah
Gleason's middle school. The question now is whose interests
do these programs really serve?
THE TEXAS MEDICATION ALGORITHM PROJECT got under way in the
mid-1990s just as the new generation of antipsychotic drugs
was coming on the market. For some 40 years before, medications
like Thorazine, Haldol, and Mellaril were given to patients
with schizophrenia or psychosis to silence their voices and
calm their agitation. But they caused terrible side effects,
including sedation, social withdrawal, and tardive dyskinesia,
which causes muscle and facial tics and strange jerking movements
like those in people with Parkinson's disease. Many patients
would refuse to take them--when they had a choice. Some sued
drug companies and doctors for failing to warn them about
the side effects and won large awards.
Into that environment, drug companies brought out the new
atypical antipsychotics and began describing them in almost
miraculous terms. The drugs--including Janssen Pharmaceutica's
Risperdal, Eli Lilly's Zyprexa, Pfizer's Geodon, AstraZeneca's
Seroquel, and Bristol-Myers Squibb's Abilify, as well as a
slightly older drug, Clozapine by Sandoz--were said to be
more effective than the first-generation antipsychotics and
less likely to cause motor problems and other side effects.
"A potential breakthrough of tremendous magnitude,"
Stanford University psychiatrist Alan Schatzberg gushed to
the New York Times. Laurie Flynn, executive director of the
National Alliance for the Mentally III, added that now "the
long-term disability of schizophrenia can come to an end.