Customer Reviews

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

5 star:		(91)
4 star:		(9)
3 star:		(1)
2 star:		(2)
1 star:		(5)

 

 

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.

Whitaker and many of Amazon's reviewers have a lot to say about psychiatric drugs, most of them virulently negative. As someone who actually is mentally ill and takes some of these drugs, I see things very differently and I want to share my story and my point of view.

I have schizoaffective disorder (a combination of schizophrenia and bipolar disorder). I developed this disease in my early 20s. I was beset by mania, depression, and psychosis. The mania and depression were bad but easier to manage than my psychosis. I heard loud, terrifying voices which threatened to kill me and worse. They sounded just as real as any voice I had ever heard in my life. They tortured me morning, noon, and night without interruption. I was completely disabled by them.

I was a bright young woman with a good education but I could barely leave my house, let alone work. I could not even have a meaningful conversation with anyone because the voices were too loud. My parents became my caretakers and my friends disappeared completely. Despite my family's support, I felt utterly alone in the world.

This went on for years as I tried different antipsychotics. They worked to a degree but the voices simply would not go away. I certainly did not get better or "heal" on my own--despite my family's love and support. No words can describe how hellish and worthless my life felt. I thought about killing myself but my parents helped me hold on to what seemed like a very slim hope that the voices would be stilled one day.

Geodon, the last antipsychotic I had settled on, began to give me symptoms of dyskinesia and my doctor made me stop taking it right away. The symptoms went away and I began to take a new drug: Seroquel.

Within weeks of starting on Seroquel, the voices dropped off and virtually disappeared. They are very few and far between now and they no longer seem real. It took me a while to adjust to the absence of the voices. I did so rather slowly and with cautious optimism--what if this freedom didn't last?

It lasted. Several years have passed and the Seroquel is still working. It can be very sedating, which is why I take it bedtime. It really wasn't such a bad side effect--my body eventually adjusted and in the meantime I just learned to love my morning coffee. All drugs have possible side effects: Seroquel's most dangerous one is that it can cause high blood sugar which can lead to diabetes.

I have a battery of blood tests done every year to be cautious. Anyone on medication (psychiatric or otherwise) should. I am in fine shape physically and mentally. I don't have cognitive problems and I am certainly not subdued or "drugged into a stupor."

I am happier and more productive than I have ever been before in my life.

The pharmaceutical industry, which Whitaker and so many reviewers here look askance at, restored my sanity and saved my life. It didn't work on the first try or even the second, but my doctor and I persevered and did not give up. I am no longer afraid to leave my house and I have a good job. I have a great relationship with my family and I can talk to anyone at anytime without being interrupted by voices. I have friends and a social life again.

This may not sound exceptional to a normal person, but it means the world to me. None of it would be possible without the drugs I take. I take them every day--happily and with more gratitude than Whitaker or his acolytes will or could ever understand.

I realize that my experience is not everyone's. Like "normal" people, the mentally ill are quite different from each other and we respond differently to different drugs and therapies. Whitaker would have you believe that psychiatric drugs are useless and even detrimental to people like me, though, and that is simply not the truth--not my truth, anyway.

I should mention that I work in NYC. The streets are full of unmedicated schizophrenics. Some of them beg for money but others are too out of it to do even that--they are completely absorbed in their fights with their voices. Some are loud and menacing, others just sit in silence looking terrified.

It breaks my heart to see them because I could have wound up like them. I would have had it not been for my parents, my doctor, and my drugs.

I'd like to bring Whitaker along with me one morning so he could see them, too. Would he really tell me that they're better off than I am? Happier? Healthier?

I give them food and money (I want to make them feel better even if it's only temporarily) but most people hurry away from them without even trying to hide their fear and disgust.

I would never, ever want to trade places with any of them. Neither would Whitaker or anyone else.

(You may have noticed that I wrote the same review for Whitaker's "Mad In America." This is because I have the exact same problem with both books. People with mental illnesses like mine who benefit greatly from medication are not represented. Mr. Whitaker, we do exist!)

***One of the fundamental differences between Whitaker and myself is what constitutes a "positve outcome" for people like me. I believe that the most (if not only) positive outcome for someone with schizophrenia or schizoaffective disorder is that the voices and any other delusions GO AWAY. I've never met anyone for whom this has happened without drugs.

I want to take my drugs and live independently. Others seem to think that living in a group home with a kind caretaker is a positive outcome. I do not see that as a positive outcome, though it could be used as a temporary stepping stone for people who are recovering and learning to be independent.

Don't get me wrong--of course it is better to be treated kindly than it is to be treated cruelly. But all the kindness in the world will not put an end to psychosis or silence the voices.

Everyone who reads this book, whether they like it or not, must give some serious thought to what truly constitutes a "positive outcome." You all know my opinion and you need to form your own by thinking critically about the information you read--don't just accept the words blindly.

edit: Whitaker mentions that atypical antipsychotics (such as Seroquel, Risperdal, and Zyprexa) can cause severe weight gain. This is certainly true, but he fails to mention that a diabetes drug called metformin (brand name: Glucophage) can be used in addition to diet and exercise to help people on these drugs lose weight and maintain a healthy weight. It has been very helpful to me personally in this regard.(You do not have to be diabetic to use metformin for this purpose--I'm not.)

For myself, someone who has been taking various psych med cocktails for twenty years, to read Robert Whitaker's "Mad In America" and "Anatomy of an Epidemic" is both heartbreaking and intoxicatingly delightful. To know that I am not alone in wondering why I never seem to get any better, to know that there are others who say, "Enough!"; this is empowering stuff.

I cannot recommend this book highly enough. My family is rife with these types of illnesses and I am telling all of them to read it. It may not be what certain people want to hear, but the ideas in "Anatomy" ring true.

Please read this book to get a glimpse into how American health care works. You will be angry but also maybe a bit hopeful, just like me, when you finish.

Whitaker's investigative account of the lack of scientific evidence for (a) the "diseases" or chemical imbalances claimed to underlie mental illnesses and (b) the efficacy of the medicines promoted as cures for (a) is worthy of a Pulitzer. Anatomy of an Epidemic is exceedingly well written, exceedingly well researched and documented and its topic could not be more important. For purposes of both work and general interest I have tried to read every general book on psychopharmacology published since Listening to Prozac and I would place Whitaker's book only behind Moncreiff's recent The Myth of the the Chemical Cure and almost anything by David Healy on my list of books everyone with a stake in the mental health arena should be required to read. In fact, I think there's one area in which Anatomy of an Epidemic may be the best, as it presents the most complete and accessible scientific account of the process by which, rather than curing chemical imbalances, psychopharmaceuticals actually create them, and in doing so it presents the most comprehensive account of why the number of mental patients in America continues to increase despite a parallel increase in the use of allegedly effective psychotropic medications.

This is a well-documented, interesting book, which should be read by psychiatrists and clinical psychologists. Whitaker examines current clinical Literature from a special position, that of not being a medical doctor, nor a psychiatrist, thus avoiding professional bias, which is by the way analysed in some of the book chapters.

I find particularly intriguing the concept that antipsychotic and antidepressant drugs act by inducing contropolar symptoms to the primary mental disease, but also may provoke a iatrogenic disease which then might be even more difficult to treat. This is quite well documented on every clinical pharmacology textbook, in my experience.

The Author never assumes that mental disease do not exist, as stated in one of the one-star reviews, nor refuses the use of psychotropic drug or underestimates the risk of fatal outcomes in untreated patients or in those who suddenly stop their therapies. On the contrary, he points to the benefits of a less simplicistic workup for people with mental disorders, based on a biological, psychological and social assessment and intervention, like that described in the chapter concerning Finland.

Background: I'm a clinical pharmacologist, working in addiction medicine.

Anantomy of an epidemic is such an alarming book that is full of so much data and references that it would take me too long to write a thorough review of it but there is one part of the book that had me walking around all day with a look like I had seen a ghost after having read it.

I will review that part of the book, The Bipolar Boom:
In the beginning of this chapter, Whitaker writes about his attendance at the 2008 anual meeting of the American Psychiatric Association and first told of how reporters and science writers were urged to assist them in getting their message out that 1) Psychiatric treatment is effective and 2) That psychiatric illnesses are real biological diseases like cardiovascular disease and cancer. To which they were told that the public was vulnerable to misinformation. That all seems O.K., so far. But then he goes on to describe what can only be imagined as a circus.

He notes that the best attended conferences were the drug industry sponsored symposiums. They heard from academic speakers who due to recent policies at the time were forced to have to disclose their financial ties to drug companies - as if anyone there might have even cared. Often the members of the audience, sitting at tables eating gournmet free meals, were given handheld devices to answer question while game show type jepaordy music would play and when the answer was provided and shown to simply just be a test of whose paying attention since it was a reiteration of the presentation, one speaker would declare "Wow, you guys are so smart." and then the show moves on to the celebrities, to which Patty Duke declares in a seemingly incoherent blather that psychiatric drugs have made her "Marriage material." and that when she speaks to patient groups across the country she tells them "Take your medicines!" and then finally to her speech getting a standing ovation. Throughout this experience (some of them written about in other chapters) he hears from more non-medical speakers who are applauded, including a man who travels the country giving talks to patient groups regarding bipolar disorder and the necessity to take drugs to which he claims to respond to skeptics who challenge that assertion by telling them to sit down and shut up because "You don't know what you're talking about", another standing ovation from the crowd. Meanwhile, doctors are playing carnival games in the hallways, rapidly mashing buttons on arcade styled computer machines to see how quickly they can pass a test written by the manufacturer of Geodon to which personalized, ego stroking prizes are awarded.


But this isn't the scary thing, no. This just speaks of people caring more about money, fun and friendship than they do about science. What is scary comes around when reputable professionals within that field bring about skepticism or tell a story that the audience doesn't want to hear. Such people included Frederick Goodwin, Robert Post, Martin Harrow and Nassir Ghaemi. The response? Boo's were heard throughout the auditorium. Hecklers were present. And some people just got up and left back to the party in the hallways.


This is not how authorities of a supposed scientific medical speciality are supposed to behave.

I have been waiting for this title for a long time, and it does not disappoint. On the contrary, this extensively researched and annotated book makes me feel a lot LESS crazy. I have believed for a long time the most "ill" I ever was, was when I was prescribed 13 psychotropic meds, and that I have never been the same since- which was 20 years ago. Plus, I transitioned off psychiatric medications completely two years ago, and have been flummoxed by previously unexplained issues- issues that this book SCIENTIFICALLY explains. This book SCIENTIFICALLY explains a lot of things. I can hardly wait for some beleaguered psychiatrist to start whining about these outcomes! I almost feel sorry for them, wanting to be real doctors and all SO BAD, but not I don't feel THAT sorry, seeing as how they ruined my life for decades, refusing to acknowledge these very clear and rigorous studies they didn't like. My copy of Mad in America is dog-eared, beat-up, loaned out all the time, and I see that Anatomy will be the same. Thrilling reading AND extensive research & citation references- can't go wrong there!

"You can't know what you have not experienced personally."
"I don't think you can have an opinion on the subject until you've been in our shoes."

The two above quotes are from commentators who heartily agreed with the numero uno critic who disliked Robert Whitaker's new book, "Anatomy of an Epidemic." Their point is, if you haven't been mentally ill yourself, you can't condemn the medications that mental patients take.

I have studied drugs extensively for over forty years. Currently I am a Psychology Professor, but for decades worked in various capacities as a Drug Addiction Counselor. Prior to that I was a mental patient. I personally have been there, done that, and got the ECT-shirt.

If personal experience is the criterion for determining the merits of "Anatomy of an Epidemic," then I am uniquely qualified to pass such judgment. And I say Robert Whitaker has not only bravely attacked institutional Psychiatry, but that he has accurately reported the truth too many of us do not want to hear. His should be a clarion call to wake up America that the decades-long ultimately futile War on Drugs, that is illegal drugs, ignores the reality of the consequences when millions of Americans are prescribed legal mood-atering drugs that are potentially just as harmful and just as addicting, if not more so. "Anatomy of an Epidemic" does for institutional Psychiatry, what the "Pentagon Papers" did for the Vietnam War. It speaks the truth.

Yet, only the first of the two leading quotes is true. You cannot know what you have not experienced personally. This creates a dilemma in any investigation of drugs. As one author of a book on LSD wrote many years ago, there are two types of investigators; those who have taken LSD and are so biased by their personal experience, that they have lost all objectivity; and those who have not taken LSD and, lacking personal experience, have no idea what they are talking about.

But Whitaker is not writing about what it feels like to be mentally ill, nor does he deny that medications often produce improvements. To thus conclude he can't have an intelligent opinion, is a little like saying, if you haven't had a baby yourself, you can't be a good obstetrician.

In fact, it is his impartial objectivity and investigative journalism that makes him a far better critic than myself, who has had personal experience of the harm inflicted by the psychiatric establishment. At age nineteen, I was given the first of several damning diagnoses. Although my close friends who knew me (the first to call me crazy when they disagreed with me,) steadfastly maintained there was nothing wrong with me mentally, the psychiatrists loaded me up on Thorazine, lithium, tranquilizers, anti-depressants, and anti-psychotics. When these mood-distorting cocktails failed to squash my passionate idealism and obstinate intellectual criticism of their profession, they finally defeated me soundly with three episodes of brain-damaging, memory obliterating shock treatments. After the shock treatments plunged me into depression, I was released from the hospital, and declared "better." In time, I gradually recovered, not from mental illness but from the treatment for mental illness! I refused to take any further medication, decided I was master of my own mental health, and avoided any behavior that could get me sent back to the mental hospital.

As a psychiatric survivor, I realize how lucky I am. Had I remained on medication, I believe I would have been much worse off today. I have been "pretending to be normal" for so long, I sometimes forget how far I had to climb back. Yet I feel a close affection and affinity for friends and strangers, who, like me, still struggle with, or have struggled with, various aspects of mental well-being. Many of my friends still use medication. I feel all adults should have that choice, but that far too many have been coerced into taking psychiatric medications. I personally feel I made the right choice to be drug-free. I am happier and more productive than I have ever been before in my life. As for Robert Whitaker's bold books exposing the abuses of shock treatments and disabling medications, I have only two words: Thank you.