Anatomy of an Epidemic

Anatomy of an Epidemic

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Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America

by Robert Whitaker

1. Mental illness—United States. 2. Psychotropic drugs—Prescribing—United States. 3. Psychiatry—United States. 4. Mental Disorders—epidemiology—United States.

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Book Details
 353 p
 File Size 
 2,404 KB
 File Type
 PDF format
 2010 by Robert Whitaker 

“Few dare to announce unwelcome truth.”

This book tells a history of science that leads readers to a socially awkward
place. Our society believes that psychiatric medications have led to a
“revolutionary” advance in the treatment of mental disorders, and yet these
pages tell of a drug-induced epidemic of disabling mental illness. Society
sees the beautiful woman, and this book directs the reader’s gaze to the old
woman. It’s never easy to hold a belief that is out of sync with what the rest
of society believes, and in this instance, it’s particularly difficult because
the story of progress is told by figures of scientific authority—the APA, the
NIMH, and psychiatrists at prestigious universities such as Harvard
Medical School. Disagree with the common wisdom on this topic, and it
seems that you must be a card-carrying member of the flat-Earth society.
But for those readers still wondering about the history told here, I offer
one last story. You can read it and decide for yourself whether you are now,
metaphorically speaking, in the flat-Earth camp.

After I interviewed Jaakko Seikkula at the University of Jyväskylä, he
asked me to give a short talk on the history of antipsychotics to a few of his
colleagues. Now, Seikkula and others at Keropudas Hospital in Tornio did
not decide to use antipsychotics in a selective manner because they thought
that the drugs worsened psychotic symptoms over the long term. Instead,
they observed that many people did better when off them. Thus, when I
spoke to Seikkula’s colleagues at the University of Jyväskylä, this notion
that antipsychotics can make people chronically ill was something they
hadn’t thought much about before, and at the end of my talk, one of the
members of our circle asked if this could be true of antidepressants, too. He
and others had been researching the long-term outcomes of depressed
patients in Finland, and charting too whether they had used the drugs, and
they had been startled by their results.
So, dear readers, ask yourself this: What do you think they found? And
are you surprised?

To read many of the source documents listed here, go to

The Epidemic
The history of psychiatry and its treatments can be a contentious issue in
our society, so much so that when you write about it, as I did in an earlier
book, Mad in America, people regularly ask about how you became
interested in the subject. The assumption is that you must have a personal
reason for being curious about this topic, as otherwise you would want to
stay away from what can be such a political minefield. In addition, the
person asking the question is often trying to determine if you have any
personal bias that colors your writing.
In my case, I had no personal attachment to the subject at all. I came to it
in a very back-door manner.
In 1994, after having worked a number of years as a newspaper reporter,
I left daily journalism to cofound a publishing company, CenterWatch, that
reported on the business aspects of the clinical testing of new drugs. Our
readers came from pharmaceutical companies, medical schools, private
medical practices, and Wall Street, and for the most part, we wrote about
this enterprise in an industry-friendly way. We viewed clinical trials as part
of a process that brought improved medical treatments to market, and we
reported on the financial aspects of that growing industry. Then, in early
1998, I stumbled upon a story that told of the abuse of psychiatric patients
in research settings. Even while I co-owned CenterWatch, I occasionally
wrote freelance articles for magazines and newspapers, and that fall I
cowrote a series on this problem for the Boston Globe.
There were several types of “abuses” that Dolores Kong and I focused
on. We looked at studies funded by the National Institute of Mental Health
(NIMH) that involved giving schizophrenia patients a drug designed to
exacerbate their symptoms (the studies were probing the biology of
psychosis). We investigated the deaths that had occurred during the testing
of the new atypical antipsychotics. Finally, we reported on studies that
involved withdrawing schizophrenia patients from their antipsychotic
medications, which we figured was an unethical thing to do. In fact, we
thought it was outrageous.
Our reasoning was easy to understand. These drugs were said to be like
“insulin for diabetes.” I had known that to be “true” for some time, ever
since I had covered the medical beat at the Albany Times Union. Clearly,
then, it was abusive for psychiatric researchers to have run dozens of
withdrawal studies in which they carefully tallied up the percentage of
schizophrenia patients who became sick again and had to be rehospitalized.
Would anyone ever conduct a study that involved withdrawing insulin from
diabetics to see how fast they became sick again?
That’s how we framed the withdrawal studies in our series, and that
would have been the end of my writing on psychiatry except for the fact
that I was left with an unresolved question, one that nagged at me. While
reporting that series, I had come upon two research findings that just didn’t
make sense. The first was by Harvard Medical School investigators, who in
1994 announced that outcomes for schizophrenia patients in the United
States had worsened during the past two decades and were now no better
than they had been a century earlier. The second was by the World Health
Organization, which had twice found that schizophrenia outcomes were
much better in poor countries, like India and Nigeria, than in the United
States and other rich countries. I interviewed various experts about the
WHO findings, and they suggested that the poor outcomes in the United
States were due to social policies and cultural values. In the poor countries,
families were more supportive of those with schizophrenia, they said.
Although this seemed plausible, it wasn’t an altogether satisfactory
explanation, and after the series ran in the Boston Globe, I went back and
read all of the scientific articles related to the WHO study on schizophrenia
outcomes. It was then that I learned of this startling fact: In the poor
countries, only 16 percent of patients were regularly maintained on
antipsychotic medications.
That is the story of my entry into the psychiatry “minefield.” I had just
cowritten a series that had focused, in one of its parts, on how unethical it
was to withdraw schizophrenia patients from their medications, and yet
here was a study by the World Health Organization that seemingly had
found an association between good outcomes and not staying continuously
on the drugs. I wrote Mad in America, which turned into a history of our
country’s treatment of the severely mentally ill, to try to understand how
that could be.
I confess all this for a simple reason. Since psychiatry is such a
controversial topic, I think it is important that readers understand that I
began this long intellectual journey as a believer in the conventional
wisdom. 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. These medications were like “insulin for diabetes.” I
believed that to be true because that is what I had been told by psychiatrists
while writing for newspapers. But then I stumbled upon the Harvard study
and the WHO findings, and that set me off on an intellectual quest that
ultimately grew into this book, Anatomy of an Epidemic.

Table of Contents

Part One: The Epidemic
1. A Modern Plague
2. Anecdotal Thoughts
Part Two: The Science of Psychiatric Drugs
3. The Roots of an Epidemic
4. Psychiatry’s Magic Bullets
5. The Hunt for Chemical Imbalances
Part Three: Outcomes
6. A Paradox Revealed
7. The Benzo Trap
8. An Episodic Illness Turns Chronic
9. The Bipolar Boom
10. An Epidemic Explained
11. The Epidemic Spreads to Children
12. Suffer the Children
Part Four: Explication of a Delusion
13. The Rise of an Ideology
14. The Story That Was … and Wasn’t Told
15. Tallying Up the Profits
Part Five: Solutions
16. Blueprints for Reform

Anatomy of an Epidemic- Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America
Published in the United States by Crown Publishers, an imprint of the Crown Publishing Group, a division
of Random House, Inc., New York.
CROWN and the Crown colophon are registered trademarks of Random House, Inc.

Illustrations by Hadel Studio, Westbury NY