It is common wisdom that mental illness can be alleviated with psychotropic medications. The pharmaceutical industry promotes meds to relieve a spectrum of afflictions: psychosis, depression, anxiety, hyperactivity, etc. As diabetics take insulin, the mentally ill must take psych meds to stay well.
But what if this prevailing belief is severely flawed, even dangerous?
In his stunning book, "Anatomy of an Epidemic," Robert Whitaker makes a cogent case for a profound re-evaluation of the way mental health services are provided. Recent studies reveal disturbing shortcomings of psychotropic meds. Research demonstrates that these drugs can be damaging to physical and psychological health, especially when taken over a long period.
"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 illness and that this knowledge had led to the development of a new generation of psychiatric drugs that helped 'balance' brain chemistry." Whitaker learned this is not the case. Since these medications are prescribed widely for troubled adults, teens, adolescents, and even children, the issue is an urgent one.
Throughout his narrative are vignettes of those literally strung out on an array of medications. Consider Greg, a brilliant kid who in junior high used "scrounged parts" to build a Van de Graaff generator -- an electrostatic contraption that can simulate lightning or make a person's hair stand on end. While still a teen, he ran headlong into serious problems. "I was delusional, very paranoid, and full of anxiety. ... I was convinced that my parents were trying to kill me."
Hospitalized twice, he was prescribed a heavy-duty medicinal cocktail. Greg gained an enormous amount of weight. He was told to forget his academic aspirations. "They told me that I would be on medications for the rest of my life, and that I would probably be a ward of the state, and that maybe, by the time I was twenty-five or thirty, I could think about getting a part-time job. And I believed it, and so I began trying to figure out how to live with the crushing hopelessness that they are telling you is going to be your life."
Greg was "in a haze most of the time." He pursued higher education, but did poorly. "I rarely left my room, and I was kind of out of touch with reality." A medical checkup revealed his liver was almost shot. He had to immediately stop the psych meds, Depakote and Geodon, two well-known names in psychiatry's pharmacopeia. He suffered severe symptoms indistinguishable from any addict's report of narcotics withdrawal -- "sweats, joint and muscle pain, nausea, dizziness."
Eventually Greg emerged from the fog. "It felt like I had been turned off all those years and had just been rolling through life and was being pushed around in a wheelchair and finally I had woken up and had gotten back to myself again. I felt like the drugs had taken away everything that was me, and then when I went off the drugs, my brain woke up and started working again." His is one of numerous testimonials to this effect. Greg now deals with his anxiety without meds and goes forward with his academic career. In 2009, he was "designing and constructing a robot capable of conducting brain surgery inside an MRI."
Others whose stories are chronicled by Whitaker have suffered permanent physical and mental impairment. He notes that atypical antipsychotic drugs "regularly cause metabolic dysfunction" and that mentally ill persons are likely to die 25 years earlier than their peers.
Pharmaceutical corporations are lucrative enterprises and many psychiatric professionals have shared the bounty. Compensation for advocating the use of psych meds can be substantial. With regard to the American Psychiatric Association's cozy relationship with Big Pharma, psychiatrist E. Fuller Torrey stated, "The present system is approaching a high-class form of prostitution." For many unsuspecting victims this corporate drug pushing has been disastrous. Writes Whitaker: "If psychiatry had been honest with us, the epidemic could have been curbed long ago. The long-term outcomes would have been publicized and discussed, and that would have set off societal alarms. Instead, psychiatry told stories that protected the image of its drugs, and that storytelling has led to harm done on a grand and terrible scale."
Whitaker makes an eloquent case for reassessing the utility of psychiatric medications. "Today, there are an estimated 2 million adults disabled by schizophrenia in the United States, and this disability number could be halved if we adopted a paradigm of care that employed antipsychotic medication in a selective, cautious manner." It is a call for a truly humane and compassionate system of care to help heal the wounds and restore the vitality of those whose lives have been disrupted and broken by ailments that so torment a human mind.
Were you shocked as you unveiled the current state of psychiatry in the U.S.?
In 1998 I stumbled upon information about the abuse of psychiatric patients in research settings. I had been a believer that science was making progress uncovering the biological causes of mental disorders, that drugs were so much better and could fix chemical imbalances in the brain. I then came upon studies by the World Health Organization reporting that schizophrenic patients in poor countries -- India, Columbia and Nigeria -- fared better than patients in the U.S. and six other richer countries. The studies concluded that by living in a developed country one suffering from this ailment would never fully recover.
Could you give a synopsis of the history of mental health treatment in America?
In different periods there are different thoughts about what mental illness is. In colonial days the perception was that those who were "mad" had lost their reason and were no longer fully human. That led to horrible treatment. Mad persons were thought to be impervious to heat or cold and kept naked in cells. The caretaker would have a whip to keep them in line the way you would animals. Later, the Quakers introduced "moral therapy," which was applied roughly from 1815 to 1860. The Quakers said that the insane were our brethren and should receive proper shelter, be treated with kindness and that they could regain their mental health. It was effective.
However, moral therapy became a victim of its own success. The first moral therapy asylums were private -- often rustic and small scaled, available to those who could afford it. The provision of publicly funded asylums for the poor became a great public works effort. But communities started dumping all sorts of unwanted people into them with problems like syphilis or end-stage dementia. Funding was inadequate. People stopped getting well. Recovery rates dropped. Facilities became crowded warehouses.
What about the arrival of lobotomy?
A therapeutic technique that quieted troubled people was considered a good outcome. The ultimate procedure was the frontal lobotomy, which destroyed the frontal lobes of the brain. The physician who invented the technique, Antonio Egas Moniz, was awarded the Noble Prize in medicine in 1949. It was a devaluation of those human beings subjected to this procedure.
We now have a cornucopia of medications embraced by psychiatry and pushed by the pharmaceutical industry, even though studies demonstrate the dark side of these drugs.
Thorazine arrived in 1955 -- the first "antipsychotic." The term evokes the word "antibiotic." Supposedly it's a great leap forward in the treatment of mental illness. It kicks off a psychopharmacological revolution of first-generation psychiatric drugs: antipsychotics, antidepressants, anti-anxiety agents. Then Prozac arrives in 1987, and so on.
But drugs were not the reason mental institutions emptied. It was the enactment of Medicare and Medicaid. The federal government told the states that if you discharge people from the institutions to other facilities we will cover half the care. It was a financial thing. Evidence indicates that psychotropic drugs in the short term can knock down a psychopathological symptom. But in the long term are employment options, overall health and social functioning improved? Time and, again, long-term studies show that a paradigm of care emphasizing medications worsens long-term outcomes. We must rethink our system of care. What's unforgiveable is that this information has not been incorporated into the use of these drugs. They should be used selectively and more cautiously over the long term.
You don't argue for the elimination of psychopharmacology.
No. Drugs have a place, but we need honest science.
You note that in 2008, $24.2 billion was made in the sale of antidepressants and antipsychotics in the U.S. alone.
Makers of these drugs want to expand markets. You want people on these drugs long term to maximize profits. Psychiatrists and academic centers are made advocates for these drugs by paying them to be consultants and advisers. Commercial interest wants expanded diagnostic boundaries inviting more people to use these drugs. What is kept hidden is outcome data that show unmedicated patients on the whole do better. That's the betrayal. Today, we know compassionate treatment incorporating exercise and diet -- along with the carefully monitored use of medications when administered -- is the best therapeutic approach to dealing with these problems.