America’s real drug epidemic

In ANATOMY OF AN EPIDEMIC: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America Robert Whitaker, an award-winning science journalist, argues that the increasing use of psychiatric drugs has not only failed to stem a huge increase in mental illness in the United States, but that the drugs themselves may be a factor—maybe the main factor—in that increase.

This is an astonishing claim, but he backs it up with scientific evidence and illustrates it with heart-breaking accounts of people who’ve struggled with debilitating addiction to psychiatric drugs.  I am surprised that Whitaker’s book has not gotten more attention than it has.  It ought to have the impact of Rachel Carson’s Silent Spring or Ralph Nader’s Unsafe at Any Speed.

If psychiatric drugs were as effective as antibiotics or insulin, you would expect mental illness to be declining.  But the reverse is true.  Conditions that once were rare and temporary are now common and long-lasting.  In the past 30 years, the number of disabled mentally ill in the United States has tripled.

Psychiatric drugs are sold based on the claim that they correct chemical imbalances in the brain.  But according to Whitaker, there is no evidence that mental illness is linked to chemical imbalances, nor do psychiatric drugs correct chemical imbalances.  Rather the drugs alter brain function, sometimes permanently.

Some people undoubtedly are helped by psychiatric drugs, Whitaker wrote.  He believes drugs have their place.  But he cited studies show that in the long run, patients on psychiatric drugs don’t fare any better than patients on placebos or unmedicated patients, and sometimes do a lot worse.

Long-term recovery rates are higher for unmedicated schizophrenia patients than for medicated patients.  Taking an anti-depressant increases the risk that the person will become disabled by the disorder.  Bipolar disorder was once rare and short-lived; now it is common and long-lasting.  Long-term studies of children with ADHD (attention deficit / hyperactivity disorder) do not show any benefit from ADHD drugs.  Drugs are dangerous, and their use should be a last resort, not a first resort, Whltaker said.

Robert Whitaker

Whitaker traced the origins of the drug epidemic to the American Psychiatric Association’s struggle  in the 1950s and 1960s to define psychiatry as a profession.  Psychiatry was under attack on the one hand by critics who claimed that Freudian psychotherapy was too expensive and had no scientific basis, and by various New Age therapies that offered alternatives to psychiatry.  What gave psychiatrists an edge was that they, unlike psychologists and other therapists could, could prescribe drugs.

About the same time there was a move to close mental institutions, both because they were costly and because often patients were badly treated.  It was thought that mental patients could live in society, provided their aberrant behavior was controlled by drugs.

In the 19th century, when drugs and medicines of all kinds were freely available, the American Medical Association gave itself the watchdog task of evaluating these drugs on a scientific basis.  When the Food and Drug Cosmetics Act of 1938 gave physicians an exclusive right to prescribe certain drugs, the medical profession became a purveyor rather than an evaluator of drugs.   The same thing happened to the psychiatric profession.

The pharmaceutical industry saw its opportunity, and formed an alliance with the APA.  Drug companies sponsored symposia at APA conventions, and paid top scientists (known as to the companies as KOLs, or key opinion leaders) to serve as consultants, on advisory boards and as speakers.  The value of psychiatric drugs became an orthodoxy that was dangerous to challenge.

Loren Mosher, head of schizophrenia studies at the National Institute of Mental Health, ran a 12-year project in which patients – 82 in all – were helped to work through their problems without benefit of drugs.  He compared his patients with a matched group of patients taking drugs, and found his patients did better.  But the APA did not accept the validity of his results, Mosher lost his position, and there never was a follow-up study to verify or refute his findings.

Whitaker gives many case studies, many of which are like classic cautionary tales of the danger of getting hooked on drugs.   A number of his stories are about high school and college students who felt severely depressed or had other psychological problems, and were given an antidepressant, which was followed by a bipolar episode, after which they were given an anti-anxiety medication.  Soon they had begun careers as a drug addict and mental patient, from which a heroic few were able to wean themselves.

I am struck by the fact that while the National Institute of Mental Health is promoting addictive drugs,  the U.S. Drug Enforcement Administration is waging a war on drugs, which involves destruction and confiscation of private property and the negation of state laws and historical Constitutional rights.  We have on the one hand an ineffective war against addictive street drugs, and an all-too-successful campaign to promote addictive prescribed drugs.

In earlier centuries, the medical profession believed in bleeding patients.  Early in the 20th century, the psychiatric profession believed in lobotomies, electric shock treatment and insulin injections to induce coma.  I am persuaded by Whitaker’s book that people in the future will regard our current use of psychiatric drugs in the same way we now regard lobotomy and electroshock.

Click on Anatomy of an Epidemic for Robert Whitaker’s home page and links to the scientific studies he cites in his book.

Click on Antipsychotic drugs and chronic illness for Robert Whitaker’s list of studies for his earlier book, Mad in America.

Click on Mad in America for Robert Whitaker’s web log for Psychology Today.

Click on Robert Whitaker’s Anatomy of an Epidemic: the Carlat Take and The Carlat Take Part 2 for an thoughtful critique of Whitaker’s book by a psychiatrist named Daniel Carlat.  Both his mini-essays and their comment threads are well worth reading.

Click on Do Psych Drugs Do More Harm Than Good? for an account of a confrontation between Whitaker and Andrew Nierenberg, a psychiatrist who directs Massachusetts General Hospital’s bipolar research program.

Click on The Epidemic of Mental Illness: Why? and The Illusions of Psychiatry  for a two-part series by Marcia Angell in the New York Review of Books.

I’ll present some charts from Whitaker’s book and video interviews of Whitaker in my next two posts on this subject.

Tags: Anatomy of an Epidemic, Psychiatric drugs, Robert Whitaker