An award-winning book says long-term use of psychiatric drugs does more harm than good for most people, especially children and teenagers, though they helps many people in the short-term.
Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. by Robert Whitaker, an investigative journalist who specializes in medical issues, challenges what almost everyone has “known” about the science and treatment of mental illness for nearly 60 years.
“Everyone” includes doctors, other mental health professionals and researchers, the National Institute on Mental Health (NIMH), the National Alliance on Mental Illness (NAMI), and most people being treated for mental illness. They know that mental illness is caused by a chemical imbalance in the brain. It cannot be cured, but can be successfully managed by taking psychiatric medication for life, just as diabetes is a malfunction of the pancreas that can be managed by medication.
For a book about brain science, it is wonderfully clear. What little technical language it contains is explained carefully and clearly.
Like all responsible people who challenge the value of psychiatric medication, Whitaker acknowledges that they do a lot of good for a lot of people in the short term, and many people do well on them in the long term. Getting off them too quickly without supervision is dangerous, he says
Long-Term Use of Psychiatric Drugs Questioned
The questions he raises in Anatomy concern long-term use of anti-psychotics and anti-depressants. We’ve only had enough long-term users to draw statistically valid conclusions about them for a short time. We can now study the effects of these drugs after five to 30 years of constant use.
Medical psychiatry has had critics since Thorazine, the first psychoactive drug, was introduced in asylums in 1955. These challengers were ignored, marginalized, and denounced by mental health professionals, many of whom had cozy relationships with big drug companies.
Whitaker is not being marginalized because his book is so well documented in the scientific literature, going back to the introduction of Thorazine.
He is giving the critics new energy, and a scientific basis for their beliefs they never really had before – though they always claimed there was no scientific proof of a chemical imbalance in the brain, or a gene that caused mental illness.
Soon after the book was published, Whitaker was invited to address a federally-funded mental health conference called Alternatives. The conference organizers, the National Empowerment Center (NEC), uninvited him under pressure from the Substance Abuse and Mental Health Services Administration (SAMHSA).
SAMHSA reconsidered after an enormous public protest, but they still required NEC to give a conventional psychiatrist equal time to rebut him, an embarrassed Dan Fisher, director of NEC, explained to people attending the conference. Since then, more and more doctors and researchers are inviting Whitaker to address their conferences.
Does a Chemical Imbalance in the Brain Cause Mental Illness?
The main thrust of the book is there is no evidence of a chemical imbalance; studies used to prove it don’t really prove it; and studies disproving it have been ignored and, in some cases, suppressed by the medical-industrial complex.
He says the medicines themselves create the chemical imbalance by changing the way neurons in the brain interact with one another, both in the dopamine system and serotonin system, which are associated with psychosis and depression respectively.
There is no space here to outline his scientific reasoning, and I do not have the scientific training necessary to evaluate the dozens of studies he cites to support his arguments. They are all clearly spelled out in the book, and referenced in detail, with a minimum of technical language.
Here is a summary of what Whitaker says are his major findings:
- Disabilities due to mental illness have soared since the medical “revolution” began;
- Disorders are much more chronic today than in the pre-drug era;
- It is a myth that all people with schizophrenia need anti-psychotic meds for life;
- Anti-depressants are fueling the so-called “bipolar boom”; and
- Use of psychiatric drugs in young people does not help them.
One in 468 Americans collected government disability for mental illness when Thorazine was introduced in asylums in 1955. Today, one in 76 adults are disabled by mental illness.
Since 1987, when Prozac was introduced as the first “2nd generation” psychiatric drug, the number on adults on Social Security Disability has increased from 1.25 million to 4 million today. There were 16,200 children and adolescents receiving government disability in 1957; more than 600,000 today.
“Yet, most people believe that the introduction of Thorazine started a psycho-pharmacological revolution in psychiatry that led to much better long-term outcomes for people with mental health disorders,” he says.
Disorders Are Much More Chronic Today than in the Pre-drug Era
Based on a study by Carlos Zarate of NIMH, Whitaker claims that, before medication, 15 to 20 percent of bipolar patients became chronically ill. Half remained symptom-free in long-term studies after a first hospitalization for mania or depression. Seventy-five to 90 percent worked, and showed no signs of cognitive decline.
Today, Whitaker says, bipolar patients suffer many more acute episodes, and are much more likely to become “rapid-cyclers.” They often suffer low-grade depressive symptoms between acute episodes, and only about 33 to 40 percent are employed. They show much greater incidence of cognitive impairment.
It is a Myth that All People with Schizophrenia Need Anti-Psychotic Meds for Life
In the decade before Thorazine, 65 percent of first-episode schizophrenia patients in state hospitals were discharged within 18 months, Whitaker says. At the end of five years, 70 to 75 percent were living independently in the community, and half the men were employed.
Most recently, a study by Martin Harrow and NIMH, presented at the 2008 meeting of the American Psychiatric Assn., found that 40 percent of schizophrenia patients off medication were recovered, versus 5 percent of people on medication.
The best outcomes in the western world, Whitaker says, come from “Open Dialogue,” a therapeutic community in Finland that uses medicines very selectively. Eighty percent of first-episode psychotic patients are working or in school; only 33 percent have been exposed to medication; and 20 percent are regularly maintained on it.
Anti-Depressants are Fueling the Bipolar Boom
Fifty years ago, bipolar disorder affected about one in 3,000 adults, Whitaker says. Today, one in every 40 Americans has it, he claims.
“While this increase is driven in part by an expansion of diagnostic boundaries,” he says, “it is also being fueled by widespread use of illicit drugs, and… [prescribed] anti-depressants and stimulants,” he says.
Roughly one-third of first episode bipolar patients had their first manic episode after abusing illicit drugs, he says. Patients with unipolar depression, treated with anti-depressants, triple their chance of developing bipolar disorder, Whitaker says.
One survey says 20 t0 40 percent of people who use anti-depressants long-term become bipolar. Another survey, by the Depression and Bipolar Support Assn.(DBSA), says 60 percent, Whitaker says.
Use of Psychiatric Drugs in Young People Does Not Help Them
Ten to 25 percent of young people treated with stimulants for Attention Deficit/Hyperactivity Disorder (ADHD) develop bipolar disorder, Whitaker says, which often becomes chronic.
A long-term study of ADHD by NIMH, called the “Multi-Site, Multi-Modal Treatment Study,” concluded that three years of medication “was a significant marker not of beneficial outcome, but deterioration.”
Twelve of 15 studies of SSRI’s, a family of anti-depressants that includes Prozac and Paxil, showed no short-term benefit for young people over placebo, he says. But they can cause a host of physical and mental health problems; 25 percent of youth treated with anti-depressants convert to bipolar disorder, Whitaker says.
Before the 1980s, when medicating children became widespread, bipolar disorder was virtually unknown before puberty, he says. Today, one percent of all American children have it, and more than 65 percent of them developed bipolar after being treated with a stimulant or anti-depressant, Whitaker says.
Anatomy of an Epidemic is an indictment of medical psychiatry, not a guilty finding. Like a prosecutor before a grand jury, he only presents evidence of guilt, with no evidence on the other side. When asked about that, he said, “If I had found any evidence on the other side, I would have included it.”
It is a disturbingly persuasive indictment. It won the 2010 award for best book-length piece of investigative journalism, from the Investigative Reporters and Editors Association.
- Whitaker, Robert, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. 2010, Crown (Random House). ISBN 978-0-307-45241-2.
- More on “Open Dialogue” therapeutic community,http://bipolarblast.wordpress.com/2011/03/21/finnishopendialogue/
Copyright Ken Braiterman. Contact the author to obtain permission for republication.