Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker
Brave New World.2
At 14, Melissa Sances was overweight, acned, and socially awkward. Life at home with her brothers and single mother wasn’t easy. She took a handful of Benadryl and Valium to escape. She entered, instead, the world of biological psychiatry.
It may well have destroyed her.
The doctors at the hospital told Melissa she had a mental illness, that it was due to problems with her neurotransmitters, and that she would need drugs the rest of her life. She wept. They put her on Zoloft.
For a while, that was nice. But as so often happens, Zoloft quit working. Switch to Paxil, at massive doses. “I felt like a zombie,” Melissa says.
Her early adult life became a series of drug experiments, one psychiatric med after another, one on top of another. Despite academic success—Melissa graduated UMass Dartmouth—and a promising beginning to her career, she ended up on Social Security Disability (SSD).
Twenty-five years ago, Melissa’s life would have gone very differently. Two things given her by doctors who treated her as a teenager were rare: a lifetime of psychiatric drugs, and an ideology that taught her to think of her distress as an incurable biological disorder.
Twenty-five years ago, psychotherapy, not drugs, dominated mental health care. In the mid-1970s, non-medical practitioners commanded about 70 percent of the market. Most psychiatrists (the other 30 percent) practiced talk therapy as well, using medication as an adjunct. Nearly all mainstream mental health doctrines attributed mental health problems to psychological or social factors. Very rarely—and certainly not with distressed teenagers—did clinicians presume patients’ problems irresolvable.
Today? Psychopharmacology rules the roost. Under the influence of pharmaceutical advertising, vigorous propagandizing by biological psychiatrists, and the oh-so-current writings of credulous journalists, the American public interprets more and more distress as mental disorders – as ‘medical conditions.’ Medical conditions obviously need treatment by medication.
Nearly 60 percent of mental health consumers receive medications alone – with no therapy. At least one state, New York, forbids mental health counselors to see depressed or anxious patients, or those who suffer from other ‘major’ mental disorders, unless they first refer the patient to a psychiatrist for medication evaluation. In just 10 years, from 1998 to 2007, the number of people seeking mental health care rose by about 50 percent, almost entirely from people seeking meds.
At the same time, psychotherapy lost ground, with expenditures on psychotherapy falling by more than a third. Therapeutic goals became less ambitious, aimed mostly at manipulating moods and teaching coping skills, not at understanding clients and resolving their issues. Today, psychotherapy tends to involve fewer sessions, with less frequency, than ever before.
Dozens of good books (and hundreds of less good ones) argue that science doesn’t show what psychiatrists and drug companies claim it does, that meds are neither as effective nor as safe as interested parties contend, that the whole mess has been fueled by a fair amount of outright corruption. The good books point out how relying on medications has a variety of moral and social consequences we really shouldn’t applaud.
With Anatomy of an Epidemic, Robert Whitaker has written the scariest, and maybe the best, of the good books. If Whitaker is right, biological psychiatry treats – and benefits from – an epidemic that it has caused.
Whitaker, a journalist, has won a number of major awards for writing about mental illness. In 1998, he coauthored a series of articles for the Boston Globe uncovering serious misuse of psychiatric patients for “scientific” purposes. That series began with the idea—which Whitaker believed at the time—that biological psychiatry’s conventional wisdom is correct. The series was a finalist for the Pulitzer Prize.
“I believed that psychiatric researchers were discovering the biological causes of mental illnesses and that this knowledge had led to the development of a new generation of psychiatric drugs that helped ‘balance’ brain chemistry. . . . I believed that to be true because that is what I had been told by psychiatrists while writing for newspapers.”
He was troubled, though, by a couple of research findings he stumbled across while writing that series: that schizophrenics in underdeveloped countries fare much better than schizophrenics in the industrialized West, and that schizophrenia treatment outcomes in America had worsened in the 1970s and ‘80s. Indeed, outcomes for schizophrenia were as bad as at the beginning of the twentieth century.
How could this be? Since the mid-1950s, we’d had a steady stream of wonderful drug discoveries that made schizophrenia so much more manageable, right? Isn’t that why we closed the asylums? How could these wonderful developments not have resulted in better outcomes? How could poor countries, where a very small minority (about 16 percent) of schizophrenics get meds at all, do better?
Following that puzzle led to Whitaker’s Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill. By “mistreatment,” Whitaker means that the accepted treatments for severe mental illness—the medically practiced, societally endorsed, often legally enforced regimens claimed to cure, ameliorate, or manage suffering— have often been inhumane and destructive.
Now, in Anatomy of an Epidemic, Whitaker moves beyond “severe” mental illness to assay mental health care more generally. He works from another disturbing set of data: Disability due to mental illness has jumped drastically since the advent of psychotropic drugs.
In 1987, the year before Prozac was introduced, 1 in 184 Americans received SSI or SSDI disability payments due to mental illness. In 2007—after all manner of other, supposedly even better, miracle drugs had been introduced, and as drastically more Americans availed themselves of these wonderments—1 in 76 Americans were on SSI or SSDI for mental disability.
The disability numbers are not Whitaker’s topic. The puzzle Whitaker wants to solve is this:
“Why are so many Americans, while they may not be disabled by mental illness, nevertheless plagued by chronic mental problems—by recurrent depression, by bipolar symptoms, and by crippling anxiety? If we have treatments that effectively address these disorders, why has mental illness become an ever-greater health problem in the United States?”
Whitaker writes Anatomy of an Epidemic in the style of, “Let me show you what I found out . . . “ We visit mental illness support groups with him, talk with patients and former patients, peruse the stacks of medical libraries, talk with scientists and doctors. He walks us through a process of discovery.
Of necessity, Whitaker covers ground familiar to scholars of psychiatric history (and aficionados of anti-psychiatry diatribes). Whitaker shows, as others have, that psychiatrists’ claims to have discovered brain abnormalities and chemicals that correct or compensate for them are simply false.
Time after time, a chemical being developed for some other purpose turns out to have an effect on mood or behavior. “Hm,” some scientist or physician thinks, “I wonder what would happen if we gave this to psychiatric patients?” When the chemical has an effect that someone in power likes, they call it a treatment. They manufacture an explanation for why it works and call that a discovery. In every single case so far, the putative explanations have proven untrue or unsupportable.
Whitaker’s prose is unusually graceful and engaging. He weaves medical, cultural, commercial, and scientific trends and concerns to show how biological psychiatry arose, why its limitations were overlooked from the first, and how the supporting myths thrive. Unlike some anti-psychiatry crusaders, he doesn’t come across as unhinged and self-righteous. If Whitaker has an axe to grind or a score to settle, it doesn’t show. Whitaker’s ability to tell such a complex, multifaceted story so calmly, clearly, and accessibly is a marvel.
He tells the story to make a point that no one before has had the research, ingenuity and intellectual horsepower to make so well: that biological psychiatry does grave harm. Whitaker’s great achievement isn’t simply to raise dark alarms. He’s done the work to show the harm.
He shows that psychiatrists have quite literally rewritten the descriptions of mental illness to fit contemporary practice.
For instance, well into the 1970s, professionals understood major depression to be rare, self-limited, and episodic. About 1 in 1,000 Americans suffered a bout of major depression. Left untreated, it almost always cleared up in six months to a year. Half the people who suffered a bout of major depression never suffered another. Only about 20 percent suffered more than two bouts in a lifetime.
Now, psychiatrists routinely tell us what they told Melissa Sances: Depression is a brain disease, chronic and recurrent. We are apt to need meds forever, if we once suffer an episode of depression, ‘like insulin for diabetes’— as the psychiatrists cannot seem to stop saying. It’s said in spite of the fact that the analogy is completely wrong: We know exactly what insulin does. We know why it’s needed. We know how it helps, unlike every psychotropic drug.
Whitaker argues that depression has become chronic and recurrent because antidepressant medications themselves damage the brain. Despite billions of dollars of research, we have never been able to discover brain abnormalities that cause depression in the first place. But antidepressants do cause changes in the brain changes we have good reason to believe lead to chronic, recurrent depression. ‘Natural’ depression isn’t chronic, and it’s highly unlikely to be recurrent. Medication-induced depression may well be both, because it damages the brain.
“In the short span of forty years, depression had been utterly transformed. Prior to the arrival of the drugs, it had been a fairly rare disorder, and outcomes were generally good. Patients and their families could be reassured that it was unlikely that the emotional problem would turn chronic. It just took time—six months or so—for the patient to recover. Today, the NIMH [National Institute of Mental Health] informs the public that depression is ‘appearing earlier in life’ than it did in the past, and that the long-term outlook for those it strikes is glum.”
So it is with one sort of suffering after another, according to Whitaker. We interpret certain suffering as a sign of underlying brain abnormality, even though no one has ever discovered the putative abnormality. We think that medications correct or compensate for that abnormality, though no one has ever shown this to be the case. We take the meds, which cause perturbations in the brain and, quite often, changes in brain wiring. Those perturbations and alterations lead to more problems. We then rewrite the description of the illness to ascribe to it the damage treatment itself has caused.
By the time Whitaker has led us through his remarkable research, we—like him—may find ourselves no longer puzzled but angry.
“As a society, we put our trust in the medical profession to develop the best possible care . . . We expect that the profession will be honest with us. . . .For the last twenty years, the psychiatric establishment has told us a false story. It has told us that schizophrenia, depression, and bipolar illness are known to be brain diseases, even though . . . it can’t direct us to any scientific studies that document this claim. It told us that psychiatric medications fix chemical imbalances in the brain, even though decades of research failed to find this to be so. . . . Most important of all, the psychiatric establishment failed to tell us that the drugs worsen long-term outcomes.”
Whitaker doesn’t deny that medications have their uses, and that for most people they don’t become problematic. Medications with bad side effects generally only do grave damage in a small percentage of cases. Vioxx, for instance, killed only a fraction of a percentage point of the people who took it. The damage psychiatric drugs do to brains will not become chronic, disabling, or irreversible for most people. Still, we have very good reasons to think they’re very bad for a significant number of souls.
Much of Whitaker’s evidence is circumstantial. The argument isn’t airtight, though the case is clear and compelling. One simply cannot read this book with an open mind and not be terrified.
Anatomy of an Epidemic is probably a manifesto in a losing battle. The mental health industries possess far too much money, power, political influence, and prestige to be upended by the likes of Robert Whitaker. Besides, it’s really cool these days to ‘know’ that problems are ‘really’ your brain.
But maybe there’s change here. Whitaker has done a better job than those before him. Perhaps his book will galvanize the misgivings and outrage of enough people to counter the legal drug trade – psychiatry. Is there a pill for hope?
Bob Fancher is the author of Health and Suffering in America: The Context and Content of Mental Health Care and Pleasures of Small Motions: Mastering the Mental Game of Pocket Billiards. He maintains a counseling practice in Portland, Oregon.