Book Review: Mental Health & Drugs – July 2010
Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in AmericaBy Robert Whitaker
Hardcover: 416 pages
Review by Mary Ackerley, MD, MDH
Tucson Green Times – July 2010
Robert Whitaker’s brilliant book Anatomy of an Epidemic asks a simple question: Why, if psychiatric drug treatments are so efficacious, has the number of people on disability for mental illness more than tripled in the last 25 years?
Most doctors and researchers answered this question by stating that the numbers have increased simply because we are diagnosing more people with mental illness. In response to this stereotyped dismissal of his data, Whitaker began to do more research on the efficacy of known psychiatric treatments. And then, while poring through the psychiatric scientific literature on treatment effectiveness for the last 50 years, he found an even darker question beginning to emerge. “Is it possible that psychiatric drugs are actually making people much worse?”
Could it be that – far from “fixing broken brains” – the drugs being offered actually are worsening, and even causing, the very illnesses they claim to heal?
The year 1987 can be considered ground zero for the new era of psychopharmacology. Prozac had just been introduced and was being widely advertised to the psychiatric profession, as well as to the general public, as a new and safer antidepressant.
As a young psychiatric resident, I was proudly confident that the treatment of psychiatric illness was being revolutionized and that we could all look forward to a world where severe depression, anxiety and mania no longer crippled and ruined human lives. Wrong.
It should be apparent to many that, despite the incredible profiteering of the pharmaceutical industry off of psychiatric illness, that depression and anxiety are still rampant in this country. At the start of the psychopharmacological “revolution” when it became popular to blame all illness on “imbalanced brain chemistry” the percentage of bipolar patients who could return to work was 85 percent. Today it is less than 30 percent.
Certainly the introduction of the SSRI’s (selective serotonin reuptake inhibitors) revolutionized the profitability of the pharmaceutical industry. In 1987 about half a billion dollars were spent on psychiatric medications. By 2010 the figure is closer to $40 billion!
Actually, in children the disability figures are far more frightening. In 1987 there were less than 20,000 severely mentally disabled children. Today there are almost 600,000. That is a 30-fold increase. Part of that is due to the diagnosis of autism, while more is due to the even newer diagnosis of bipolar disorder in children, which has increased 40-fold in the last 10 years!
Most frightening are the numbers of children under the age of six receiving SSRI, which have tripled over the last 10 years to more than 65,000. Under six? How can this possibly be? Were psychiatrists 20 years ago oblivious to the plight of these severely disabled children? I can assure you, from my experience that is not true.
Rather, it seems that drug companies have discovered another very profitable market in young children and are busy pushing their drugs, in particular the atypical antipsychotics, onto children with the newly diagnosed pediatric bipolar disorder. How can anyone possibly predict the long-term impact of a major tranquilizer, used to subdue agitated and psychotic adults, on a five-year-old brain? Those studies have not been done.
From these sobering statistics, the author then goes on to answer the following questions about long-term results with psychiatric medicines:
- Does antidepressant usage make it more likely that you will become disabled?
- Are bipolar patients better off than they were 40 years ago?
- When the National Institute of Health studied the long-term outcome of children treated for ADHD did they find that stimulants provided any benefit?
- And, most startlingly of all to anyone who has been indoctrinated in the current medical thinking that psychiatric patients are always better off on medications, he asks an unthinkable question – are recovery rates for schizophrenics better with or without medication?
In addition, Whitaker chronicles the stories of many of the people who have been diagnosed for depression and bipolar disorder and treated with many different types of psychiatric medication. In fact, in some parts of the book where he examines scientific evidence it may seem a bit heavy, he more than makes up for it by interweaving the stories of many psychiatric patients whom he has personally interviewed.
In one of the most interesting parts of the book for me, it seems that if you are schizophrenic and living in India or Nigeria, your chances of a good outcome are far higher than if you live in the U.S. where everyone is medicated. The fact seems astonishing, and the World Health Organization repeated the study, but found the same thing: Living in an undeveloped country where meds are scarce, but patients are cared for by the community, assures a much better prognosis for schizophrenia.
However, Whitaker also quotes several studies done in the U.S. from the late 70s that showed similar results: Young adults suffering a first episode of schizophrenia who were not medicated showed significantly better outcomes in terms of subsequent relapse. Later in the book he details the current treatment of schizophrenia in an experimental clinic where drugs are rarely prescribed. Again, the findings are similar – patients there have much better long term outcomes than other schizophrenics who are routinely medicated.
I admit to having been somewhat naïve as a young doctor. I thought the fact that drug companies paid psychiatric professors to do their research was not a big deal. Again, wrong!
The last chapters of Anatomy of an Epidemic tallies up the enormous profits the drug companies and certain psychiatrists have made off the reinvention of psychiatry as biological psychopharmacology. He details how the growth of the Diagnostic and Statistical Manual from DSM 2 to DSM 4 has fueled the growth of diagnosing more and more Americans as having a psychiatric illness which requires pharmacological treatment, and suggests this was a necessary preparation for “building the market” for the drug company’s wares.
Now, most scientists would absolutely bristle at the suggestion that their passion to finally make psychiatry a real science was actually a ploy to help the drug companies remarkably expand their profits. Yet there is no doubt the expansion of the definitions of psychiatric illness, which now has one in every eight Americans taking a psychotropic medication, has been exceedingly profitable.
Drug company sales of psychotropic medication went from about half a billion in 1987 to more than $40 billion in 2008. Atypical antipsychotics, once reserved for the most severely ill patients, are now the top revenue producer for drug companies, helped by the psychiatric professions’ willingness to prescribe these meds even to two-year-olds. Dr. Joseph Biederman, the psychiatrist most associated with leading the way to using antipsychotics for children by popularizing pediatric bipolar illness, personally received $1.6 million from 2000 to 2007, as well as procuring another $2 million for a pediatric pathology department at Massachusetts General Hospital. He is a designated KOL by the drug companies, which means a Key Opinion Leader. That means what he writes and says is usually followed by other psychiatrists.
In a recent deposition, he was asked his rank at Harvard Medical School. “Full professor,” he replied. “What’s above that?” asked the attorney. “God,” replied Dr. Biederman. Truly that is a response worthy of a KOL.
This is not the book of a disgruntled patient who is angry at the system. It is the carefully researched and documented expose of a multi-billion dollar industry that affects the lives of at least a quarter of the population. It is also an engrossing read, and an accurate depiction of the lives of people who are afflicted with these illnesses. I would recommend it to anyone who has ever used, or had a family member use, psychiatric services or been given psychiatric medication.
Author: Mary Ackerley MD, MDH, is a classically trained psychiatrist and homeopathic physician in private practice in Tucson.