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Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America Paperback – August 2, 2011
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*Starred Review* When Whitaker (Mad in America, 2002) learned that between 1987 and 2007 the number of Americans disabled due to mental illness more than doubled despite a whopping $40 billion annual psychotropic drug tab, it gave him pause. Given their widespread use—greater than even that of cholesterol-lowering drugs—he had believed that psychopharmaceuticals were magic bullets, knocking mental illness out of the game, returning formerly disabled people to the ranks of productive citizens. But the deeper he probed into clinical studies in prestigious scientific journals, some dating back more than 50 years, the more he noticed a shocking anomaly. Psychiatric drugs have repeatedly been shown to worsen mental illness, to say nothing of the risks of liver damage, weight gain, elevated cholesterol and blood sugar, and reduced cognitive function they entail. The reality, he says, is that, because no one knows what causes mental illness, there’s no cure or palliation to be found in these pills. What with the conclusions Whitaker draws from his assembled literature and the accusations he levels at those who consciously deceive consumers eager for magical cures, his book will either blow the lid off a multibillion-dollar industry or cause him to be labeled a crackpot and, perhaps, medicated into obscurity. At the very least, it should prod those who take the drugs to question those who prescribe them. --Donna Chavez --This text refers to an out of print or unavailable edition of this title.
NEW YORK TIMES BESTSELLER
“The timing of Robert Whitaker’s “Anatomy of an Epidemic,” a comprehensive and highly readable history of psychiatry in the United States, couldn’t be better.”
“Anatomy of an Epidemic offers some answers, charting controversial ground with mystery-novel pacing.” —TIME.com
“Lucid, pointed and important, Anatomy of an Epidemic should be required reading for anyone considering extended use of psychiatric medicine. Whitaker is at the height of his powers.” —Greg Critser, author of Generation Rx
“Why are so many more people disabled by mental illness than ever before? Why are those so diagnosed dying 10-25 years earlier than others? In Anatomy of an Epidemic investigative reporter Robert Whitaker cuts through flawed science, greed and outright lies to reveal that the drugs hailed as the cure for mental disorders instead worsen them over the long term. But Whitaker’s investigation also offers hope for the future: solid science backs nature’s way of healing our mental ills through time and human relationships. Whitaker tenderly interviews children and adults who bear witness to the ravages of mental illness, and testify to their newly found “aliveness” when freed from the prison of mind-numbing drugs.” —Daniel Dorman, M.D., Clinical Assistant Professor of Psychiatry, UCLA School of Medicine and author of Dante’s Cure: A Journey Out of Madness
“This is the most alarming book I’ve read in years. The approach is neither polemical nor ideologically slanted. Relying on medical evidence and historical documentation, Whitaker builds his case like a prosecuting attorney.” —Carl Elliott, M.D., Ph.D., Professor, Center for Bioethics, University of Minnesota and author of Better than Well: American Medicine Meets the American Dream
“Anatomy of an Epidemic investigates a profoundly troubling question: do psychiatric medications increase the likelihood that people taking them, far from being helped, are more likely to become chronically ill? In making a compelling case that our current psychotropic drugs are causing as much—if not more—harm than good, Robert Whitaker reviews the scientific literature thoroughly, demonstrating how much of the evidence is on his side. There is nothing unorthodox here—this case is solid and evidence-backed. If psychiatry wants to retain its credibility with the public, it will now have to engage with the scientific argument at the core of this cogently and elegantly written book.” —David Healy, M.D., Professor of Psychiatry, Cardiff University and author of The Antidepressant Era and Let Them Eat Prozac
“Anatomy of an Epidemic is a splendidly informed, wonderfully readable corrective to the conventional wisdom about the biological bases—and biological cures—for mental illness. This is itself a wise and necessary book—essential reading for all those who have experienced, or care for those who have experienced, mental illness—which means all of us! Robert Whitaker is a reliable, sensible, and persuasive, guide to the paradoxes and complexities of what we know about mental illness, and what we might be able to do to lessen the suffering it brings.” —Jay Neugeboren, author of Imagining Robert and Transforming Madness
“Every so often a book comes along that exposes a vast deceit. Robert Whitaker has written that sort of book. Drawing on a prodigious quantity of psychiatric literature as well as heart-rending stories of individual patients, he exposes a deeply disturbing fraud perpetrated by the drug industry and much of modern psychiatry—at horrendous human and financial cost to patients, their families, and society as a whole. Scrupulously reported and written in compelling but unemotional style, this book shreds the myth woven around today’s psychiatric drugs.” —Nils Bruzelius, former science editor for the Boston Globe and the Washington Post
“A devastating critique. . . . One day, we will look back at the way we think about and treat mental illness and wonder if we were all mad. Anatomy of an Epidemic should be required reading for both patients and physicians.” —Shannon Brownlee, senior research fellow, New America Foundation and author of Overtreated
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His major premise appears to be that ingesting large amounts of anti-psychotics and antidepressants can give rise to cognition impairment. On the one hand I applaud him for raising the issue: Are our medications bad for us? But on another level I feel as if he may be just giving rise to anxiety in the mental health community for no good reason.
Having ingested anti-psychotics namely Resperidone, for about three years and finding them really wonderful in terms of stopping the psychosis, I did feel a bit concerned about the potential for frontal lobe damage and loss of grey matter.
However even I with my potentially impaired brain could pick up the howler which afflicts Whitaker's major premise. On page 6 in the chapter titled A Modern Plague he notes that in 1955 there were 566,000 people in state and county mental hospitals in the USA.
"However only 355,000 had a psychiatric diagnosis". He goes on to say that in 1987 this number had grown and there were 1.25 million people in the USA receiving a disability payment because of mental illness.
He calculates this as an increase from 1 in every 468 Americans hospitalized by mental illness in 1955 to 1 in every 184 Americans on disability payments for mental health problems n 1987. Indeed if these figures are correct then there really is an epidemic.
However a bare 45 pages later he notes :
"During the war, (World War 11) psychiatrists had been charged with screening draftees for psychiatric problems and they had deemed 1.75 million American men mentally unfit for service. While many of the rejected draftees may have been feigning illness in order to avoid conscription, the numbers still told of a societal problem."
There is only slightly more than a decade between the war years and 1955 when Whitaker notes there were only half a million people in state and county mental hospitals in the USA. If there were 1.75 million men rejected from military service during the war because of mental health problems isn't it more likely that in 1955 there was a huge number of people, both men and women, who didn't fess up to mental problems?
This is the case today where comprehensive door knock studies have shown that some two thirds of people with mental health problems in Australia for example don't seek treatment.
The fact that none of the experts and opinion makers who read this book including a critique from New Scientist, failed to point out this obvious problem causes me to wonder who is potentially cognitively impaired here? I can pick this inconsistency up and I have been on anti-psychotics, anti-depressants and lithium for many years whereas all these other non-medicated people haven't spotted the problem. I leave it up to the reader to make up their own mind.
Another part of Whitaker's thesis which doesn't really hold water is when he argues that the increase in numbers on disability support is an indication that present medical treatments for mental illness are making us sicker.
The increase in those on disability pensions can be due to a number of other environmental factors other than just medical treatments .
The overall increase in numbers on disability pensions in Australia is really a function of the ageing population. In a May 2011 article in Inside Story, Peter Whiteford, Professor in Social Resarch Policy at the University of New South Wales points out that at least half of the vaunted "explosion" in disability pensioners in Australia is attributable to the gradual increase in ageing .
Stressing that disability rates are strongly related to ageing, Professor Whiteford says that the steady increase in the disability pension rates that has so alarmed Australian politicians is significantly affected by the ageing of baby boomers.
"The first of the baby boomers started to turn fifty in 1996, so from that point changes in the age structure of the population became likely to increase levels of receipt of the DSP."
This fits in with Whitaker's statement that "... during the 1990s people struggling with depression and bipolar illness began showing up on the SSI and SSDI rolls in ever increasing numbers ..."
Professor Whitford goes on to say:
"This means that about half of the total increase in numbers (on disability support pension) was the result of population ageing unrelated to any changes in the labour market, to the incidence of disability or to individual behavior."
As persons with mental health problems comprise the largest sector of those on disabilities, some 25%, this sector will naturally increase with the baby boomer effect.
Other reasons in Australia for the growth of the disability sector are the presence of people on the disability rolls who moved to the sector after other forms of support were closed. For example single mothers with mental health issues would move to the disability support pension when tougher entitlement conditions were applied to the Parenting Payment.
While this is the situation in Australia, in order to prove his hypothesis Whitaker would have had to address some of these environmental factors in the USA to disregard them, and this he has not attempted to do.
Leaving aside the questions of whether there is an epidemic or not Whitaker poses some important questions. Among these questions is the leading one; are our psychotropic medications hurting us? He provides some interesting research including that by Dr Martin Harrow.
Harrow enrolled 64 young schizophrenics in a long term study. Some of this cohort were using medication anti-psychotics and others were not. Harrow published saying that "At the end of two years, the group not on antipsychotics were doing better on a "global assessment scale" than the group on the drugs."
By the end of 4.5 years 39% of the off-medication group were "in recovery" and more than 60 % were working.
"In contrast, outcomes for the medication group worsened during the thirty month period. At the 4.5 year mark, only 6 percent were in recovery and few were working.
At the 15 year follow-up, 40 % of those off drugs were in recovery, more than half were working, and only 28% suffered from psychotic symptoms. In contrast only 5% of those taking antipsychotics were in recovery, and 64% were actively psychotic.
I can hear what you are thinking and in fact Dr Harrow said exactly that when interviewed by Whitaker about his study.
"Afterward I asked Dr Harrow why he thought the nonmedicated patients did so much better. He did not attribute it to their being off antipsychotics, but rather said it was because this group "had a stronger internal sense of self".
Harrow said exactly what the average reader would think, that as it was a "free choice" experiment, those who did better initially went off the medication. In other words the less sick people ditched the medication leaving the "sicker" group on the medication and subsequently doing worse in the study. However Whitaker seems to not take this logical interpretation on board.
He describes Dr Harrow as becoming "testy" when he pressed on with questions about whether there could be a different interpretation - that the antipsychotics were making the on-medication group sicker.
Harrow rejected Whitaker's suggestion and said the data of his study proves that people who experience psychotic symptoms need not be on anti-psychotics all their lives. This is the take home message from this study for people who experience psychosis rather than that the anti-psychotics were making people sicker.
Whitaker's book is still a must-read however and his passionate plea for less emphasis on drugs and more people centred therapies at the end of the book makes for great reading. His indictment of the treatment of children with psychotropic medication is also right on target. His mention of the fact that schizophrenia researcher and author of The Broken Brain, Nancy Andreasen has said that she has unpublished findings from MRI scans that the more drugs taken the bigger loss of brain tissue is indeed a wake up call.
"Another thing we've discovered is that the more drugs you've been given, the more brain tissue you lose." Andreasen said in an article in the New York Times in September 2008.
She did clearly say this in an interview therefore I think we need a lot more research, preferably comparing the brain images of those who have been on anti-psychotics and the brain images of people with psychosis who have not been on any anti-psychotics at all in order to evaluate these findings.
She says she has not released the data because she fears people may go off their medication. It is quite possible that Dr Andreasen has herself experienced a "quick rush of blood to the head" or cognitive impairment (I say this tongue in cheek as I was getting rather sick of Dr Andreasen and her concentration on "disease" and "cognitive impairment" in people with "schizophrenia") as she has not published her findings.
Indeed her stated reason for not publishing her findings - that people might go off their medication - appears a trifle illogical as more people on psychiatric medication would read her interview in the New York Times than would find it in a scholarly journal.
While Andraesen might have data that shows a trend towards greater loss of brain tissue with a longer time on medication the damage might be arising from the "disease" itself. Indeed Andraesen has previously argued ad nauseum that schizophrenia is a "disease" because of changes to the brain. To prove damage conclusively, and also to prove disease, she would need to compare brain scans of psychotic people on long term medication with those people on no medication at all.
Unfortunately this type of research into whether anti-psychotics can hurt us would be research that Big Pharma would probably not undertake, therefore Governments need to step in and make sure this essential research is carried out.
Consumers should really get together and push for a study on antipsychotics and loss of brain tissue. Perhaps those consumer/survivors with long term psychotic symptoms who don't take medication could volunteer for such a comparative study.
As far as antidepressants and antipsychotic medications making us sicker, I think we are not being told enough about potential side effects. For example I took Effexor because essentially a side effect of the anti-psychotic was making me depressed. I did end up with an elevated blood pressure which was, unknown to me, a potential side effect of Effexor for some people. At no stage was I ever told about potential side effects of these medications by any medical practitioner.
Whitaker covers these issues very well with some illuminating case histories and also a comprehensive history of the development of the major psychotropic drugs.
Robert Whitaker's book is available on Amazon for the very low price of $10.
However the sections on alternative treatment methods is really interesting. I thought it was well worth the money.
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.)