Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America [Englisch] [Taschenbuch]

Robert Whitaker's Anatomy of an Epidemic reveals the damage that can and very often does result from long-term use of psychotropic drugs, and, along with it, the alarming rise in chronic mental illness in this country since such drugs as Thorazine were introduced in the 1950s. Because this drug could cause tardive dyskinesia and other permanent nervous system damage, the pharmaceutical industry got to work on new generations of drugs that are being used now.

The rise in drug use corresponds with psychiatry staking a renewed claim to therapeutic expertise and market share, which had begun to erode due to competition from counselors, social workers and others (see the Selling of DSM by Kirk and Kutchins -- [...]-- and Making Us Crazy by the same authors). The prescription pad, and the power of academic psychiatry in collaboration with Big Pharma, allowed psychiatry to open up a very large market, one that today seems to encompass the entire population.

Whitaker documents the alarming rise of disability and increasing number of people on SSI and SSDI due to mental illness over the last 50 years, including the increase since the 1980s, when serotonin reuptake inhibitors such as Prozac were introduced, and again, with the introduction of what are called atypical antipsychotics (e.g., Risperdal, Zyprexa), and reliance on drugs in the benzodiazepine family (Valium). But perhaps the most tragic of all cases with drugs used to treat what were once considered within the range of "normal" behavior (e.g., shyness) is the prescribing of amphetamine-like agents such as Ritalin or Adderall for so-called attention deficit disorder (ADHD) in children, and, even worse, powerful psychotropic drug cocktails to treat a newly introduced category of illness, childhood-onset bipolar disorder. In all of these cases, Whitaker documents how long-term use of such drugs can lead to severe debilitating effects and what may be irreversible brain damage. He also reveals that there is no scientific evidence, none whatsoever, for the psychiatric storyline that psychotropic drugs compensate for chemical imbalances in the brain.

Impeccably researched and documented, Whitaker's book is based on long-term outcome studies that have received almost no publicity from psychiatry and other guardians of the psychiatric establishment, including, of course, the pharmaceutical companies that keep churning out new generations of magic bullets. It's a multibillion dollar industry with a lot to lose were the full truth about the drug risks disclosed and understood.

While far from an anti-psychiatry or anti-drug polemic, Whitaker's interviews with patients who are on psychiatric medications are nonetheless heartrending. Also revealing is his disclosure of the brutal treatment meted out to maverick doctors like Peter Breggin, David Healy and Loren Mosher, who all questioned the efficacy of pharmaceutical treatment of mental disorders, from schizophrenia to bipolar disorder and other maladies. Harvard Medical School-trained Breggin was in effect blacklisted. Mosher lost his position with the NIMH over his successful drug-free treatment of patients through the Soteria project he founded. And Healy promptly lost a job offer after publicizing his criticism of SSRIs and their possible relation to suicide.

In a TLS April 2009 review of Healy's book Mania, the reviewer says Healy "goes on to describe how Big Pharma has captured almost total control over the research process, to say nothing of buying up academic experts and turning them into marketing shills." Whitaker essentially reports the same thing; especially telling is the chapter titled Tallying Up the Profits, including a subsection titled the Money Tree.

On top of this, there is the DSM, or Diagnostic and Statistical Manual (the fifth edition soon to be released; see Ofer Zur's critique at the Zur Institute site), with its ever-expanding list of disorders. No longer are only those thought to be suffering from schizophrenia or bipolar disorder entreated to take their medication, without which, they are told, they would be like a "diabetic without insulin." Now everyone suffering from problems such as grief or the blues or any number of things -- in the case of children, ADHD, "oppositional defiant disorder" or childhood-onset bipolar disorder -- are also told they should take drugs, as if they needed the psychological equivalent of insulin. The tragedy in the case of children is that often, after taking stimulant drugs, they begin to experience psychotic symptoms. Then, more drugs are used to treat the additional symptoms, a fact that accounts for more and more young people ending up on disability rolls.

I hope everyone who sees a primary care doctor or counselor or any kind of therapist will read this book and think twice or a dozen times before attempting to solve any type of emotional problem or bedeviling symptoms with Big Pharma remedies. While Whitaker does explain how such medicines can be useful in taking down severe symptoms on a short-term basis, this book sounds the alarm to proceed with caution. Once "treatment" is begun, brain chemistry is altered, and an insidious dependence on the drugs can develop. Withdrawal from the drugs also sounds as if it might be more challenging than withdrawal from heroin or cocaine.

On a positive note, Whitaker has started a blog that accompanies description of this book at his Mad in America book site. Here, he not only lists results of the long-term studies he documents, but also lists promising alternative treatments, including exercise, that are helping people. I admire Whitaker's courage in writing this book, which can give hope to all the people psychiatry may have condemned to chronic illness. Disclosure: After meeting Robert Whitaker for the first time and hearing him speak about his book last week, we are now friends on Facebook.

As others have stated, this book is impeccably researched and the author presents his argument in a very thoughtful, careful way, with a lot of compassion for the individuals whose stories he tells to illustrate his point.

However, as I reach the end of the book, I find myself wondering whether it is fair to implicate only Big Pharma and the proponents of biological psychiatry in this scandal. I find myself wondering about the roles of shareholder value in the decision making process in the pharmaceutical industry, and of teachers and parents who would rather think that their children's behavior is due to "chemical imbalance" than to psychosocial issues like peer pressure, unavailable parents, overwhelmed teachers, and the like.

While the lopsided presentation of psychotropic drugs by the media certainly is part of the picture (and the problem), the truth is, I think, that we as a society would much prefer the idea of mental illness as a biological problem. It relieves us from personal responsibility, for our financial investments, our children, our students. To me, the most striking part of the book is the description of the callous use of psychotropic drugs to control children and pathologize perfectly normal childhood behaviors, based on the short-term efficacy of the drugs and with no regard for the long-term consequences. I'm a little disappointed that Whitaker doesn't even comment on the wider ethical implications of the problem he is addressing!

The point of psychiatric drugs is to improve the lives of people living with mental illness. Therefore people who take psychiatric drugs should do markedly better than their peers who do not take medication, right? Wrong. Long term studies show over and over again that people do worse on medication than off. In fact, medication may be responsible for a great increase in psychiatric disability since the introduction of medication.

If you find this fact shocking or preposterous this book is for you. If you suspected this all along, this book is for you, too. It is calm and scientific. Whitaker works from the psychiatric literature to do a review of evidence from within the field. He explains how the illusion that the drugs work and are needed is maintained: in short trials (usually six weeks) the drugs do provide some improvement in symptoms. In trials of abrupt withdrawal of drugs, patients do worse due to withdrawal effects, since their brains have adjusted to some interruption in neurotransmitter function and need time to adjust back. In clinical work doctors can see this: the drugs do some good at first, and when a patient stops taking them they usually do worse. While poor long term outcomes are deplorable, they are seen as first and foremost caused by the illness itself. Whitaker's thesis is that this is not the case: the increasingly poor long term outcomes are iatrogenic, caused by medication.

If that is the case, this is a huge scandal, so huge it is hard to get a grasp on it. And after reading this book, I am convinced that it is the case. I hope that many will read this book and take its message seriously, and I hope that it provokes productive dialogue. This would not be the first time that medicine got something this wrong. This book is difficult medicine to swallow, but it is so well researched and well argued that perhaps it will set the conversation on a healthier footing. Everyone who is involved in psychiatry in any way, as a doctor, a patient, or a family member of a patient, should read this sobering book.