on April 17, 2010
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.
on April 27, 2010
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!
on May 10, 2010
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.)
on April 18, 2010
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.
on November 21, 2015
This is an amazing work. I was a practicing psychiatrist for 40 years and wrote 1,000,000 Rx for 25,000 patients, but had no idea what I was actually doing until the last decade of practice. I have never met another psychiatrist who knew what he or she was actually doing to the neuro-chemistry of his or her patients. Drug companies, "Big Pharma", utterly control the willy-nilly distribution of these potentially harmful, or, at least, un-helpful biochemicals. The drug companies make-up thinly researched "just so" stories to rationalized the widest possible distribution of these agents and medical schools indoctrinate medical students with these make-believe stories. I've very rarely met another physician who continued to study the basic sciences of neuro-chemistry after the initial indoctrination in academia. The entire system is rigged by Big Pharma. To the patients I warn: caveat emptor! Whitaker's book should be mandatory reading for anyone allowed to prescribe the psychotropic medications, before they are allowed to do so!
on August 5, 2014
Just finished this. It's devastating.
Every psychoanalyst/therapist in the country should read it. They should buy a copy for each and every one of their patients, too, and insist that they read it. Change will happen then, I hope. We'll collectively begin to wake up from the long, strange trip that many of us have been on while taking these "medications"--the great majority of us not really sick; we were simply trying to escape the killing inhuman influences of living in the modern world. (Yes, I realize that's an over-simplification; this is a review, not a dissertation.)
Once we collectively know the truth about psychiatric medications after reading this book, we can begin the shift from popping a pill for our ills to a therapy that focuses alternatively on a harder but more effective course: talking; conversing; attending to others. Face to face. Talking to each other is messy, hard work; attending to each other requires people skills and to have those skills you really have to like helping others; empathy is not "Here, take this pill and let's see how you feel." It's getting to know the other.
I have GAD, so I suppose I'm one of the walking wounded that bought into the idea that SSRIs were "just like insulin for diabetics"--my proscribing doc actually said that to me (he no doubt heard it from a drug rep). After 16 years on paxiI I tried to kick it cold turkey but had to switch to celexa, a milder SSRI, just to save my sanity. I'm addicted to celexa. It's a bitter irony for me that something I take to help with my anxiety has ended up no longer effective and that, if I try to stop taking it, makes me profoundly depressed. I don't think I was ever really "sick" to begin with--just overwhelmed. Somewhere I read that celexa was easier to kick; I'm hoping that one day I'll be able to taper off altogether. However, Whitaker's book convinces me that once that happens, if it ever does, if I'm ever off this stuff, my damaged brain (hyperbole, perhaps) from my chronic SSRI use will force me back. Back to the loving arms of big pharma.
Thank you, Mr. Whitaker, for a very important book.
on May 1, 2010
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.
on May 27, 2010
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.
on August 10, 2015
As a physician with 30 years experience I have found modern psychiatry to be a throwback to mediaeval obeisance — its practitioners are white-robed ‘priests’ who practice a religion whose bible is scripted by pharmaceutical firms and whose raison d’être is profit.
The strength of this analysis comes from his contrasting the treatment of mental illness (schizophrenia, depression, mania) in the pre-mediation era (1920-1950) by examining the metrics of severity, relapse, chronicity etc with that of the post-medication era (1965-today). Comparing the two databases is telling. In summary, pharmaceutical treatment has clearly worsened all these illnesses. I, as a physician who treated mental illness, was rocked back on my heels upon examination of this information. How hoodwinked I have been by both the medical profession and the pharmaceutical firms ... as are most other M.D.'s. We have met the enemy and they are us.
According to this religion every child is mentally imbalanced and must be medicated by drugs whose long term consequences cause untold harm and an epidemic of future psychiatric diseases, expense and even death. Great-&-wonderful — a growing congregation for the religion!
Even the FDA and NIMH have become fellow travelers and promoters of this cult.
Contrary to the “one-star” reviews this book is solidly referenced, explores its material in both depth and breath and pursues all angles of numerous topics. If you have a loved one taking a neuroleptic (Ritalin, SSRI, tricyclics etc) you must read this book to find out the longterm consequences of these drugs for I assure you the federal government, pharmaceutical firms and the practitioners of this theology will withhold and deny all contrarian data — instead they will attack your sanity and integrity for even questioning them.
Additionally, if an informed loved one confronts any member of this theology with hard data and requests that these questionable drugs be discontinued — they will be accused of child endangerment, criminal neglect and even report you to Children’s Services as being reckless. Why the hardball? Look — this is a religion and heretics threaten their priesthood and this is intolerable.
This book is a must read for any parent whose child is placed on the conveyor belt of endless medications. Stop sitting on your hands, educate yourself & stop being passive.
Congratulations to author Robert Whitaker for confronting a wall of corruption (MD’s, FDA, NIMH, AMA, pharmaceutical firms etc) knowing full well that he would, in turn, get a tsunami of vitriol … and do it anyway.
This book is a winner!
on May 1, 2013
As a physician who has long been suspicious of the collusion between the Americian Psychiatric Association and Big Pharma, this book has confirmed those suspicions and has revealed a very sad and frightening story of bad drugs, bad studies and the horrifying results. I have practice Emergency Medicine for the last 20 years and have witnessed the growing mental health crisis in this conuntry. This book explains at least a part (probably a large part) of the underlying cause of this apparent iatrogenic crisis. The book is often repetitive and occasionally preachy - but the reasearch for this book seems solid. I have looked up some of the studies he quotes and he has presented them honestly - if somewhat simplistically. If you or any family member or friend have taken or are taking any antidepressants, benzodiazepams, or antipsychotics - which includes probably 90% of the US population you should read this book.