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Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, by Robert Whitaker
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Now with bonus material, including a new foreword and afterword with updated research
In this astonishing and startling book, award-winning science and history writer Robert Whitaker investigates a medical mystery: Why has the number of disabled mentally ill in the United States tripled over the past two decades? Every day, 1,100 adults and children are added to the government disability rolls because they have become newly disabled by mental illness, with this epidemic spreading most rapidly among our nation’s children. What is going on?
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Anatomy of an Epidemic challenges readers to think through that question themselves. First, Whitaker investigates what is known today about the biological causes of mental disorders. Do psychiatric medications fix “chemical imbalances” in the brain, or do they, in fact, create them? Researchers spent decades studying that question, and by the late 1980s, they had their answer. Readers will be startled—and dismayed—to discover what was reported in the scientific journals.
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Then comes the scientific query at the heart of this book: During the past fifty years, when investigators looked at how psychiatric drugs affected long-term outcomes, what did they find? Did they discover that the drugs help people stay well? Function better? Enjoy good physical health? Or did they find that these medications, for some paradoxical reason, increase the likelihood that people will become chronically ill, less able to function well, more prone to physical illness?
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This is the first book to look at the merits of psychiatric medications through the prism of long-term results. Are long-term recovery rates higher for medicated or unmedicated schizophrenia patients? Does taking an antidepressant decrease or increase the risk that a depressed person will become disabled by the disorder? Do bipolar patients fare better today than they did forty years ago, or much worse? When the National Institute of Mental Health (NIMH) studied the long-term outcomes of children with ADHD, did they determine that stimulants provide any benefit?
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By the end of this review of the outcomes literature, readers are certain to have a haunting question of their own: Why have the results from these long-term studies—all of which point to the same startling conclusion—been kept from the public?
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In this compelling history, Whitaker also tells the personal stories of children and adults swept up in this epidemic. Finally, he reports on innovative programs of psychiatric care in Europe and the United States that are producing good long-term outcomes. Our nation has been hit by an epidemic of disabling mental illness, and yet, as Anatomy of an Epidemic reveals, the medical blueprints for curbing that epidemic have already been drawn up.
- Sales Rank: #18387 in Books
- Brand: Whitaker, Robert
- Published on: 2011-08-02
- Released on: 2011-08-02
- Original language: English
- Number of items: 1
- Dimensions: 7.90" h x .90" w x 5.10" l, .73 pounds
- Binding: Paperback
- 432 pages
From Booklist
*Starred Review* When Whitaker (Mad in America, 2002) learned that between 1987 and 2007 the number of Americans disabled due to mental illness more than doubled despite a whopping $40 billion annual psychotropic drug tab, it gave him pause. Given their widespread use—greater than even that of cholesterol-lowering drugs—he had believed that psychopharmaceuticals were magic bullets, knocking mental illness out of the game, returning formerly disabled people to the ranks of productive citizens. But the deeper he probed into clinical studies in prestigious scientific journals, some dating back more than 50 years, the more he noticed a shocking anomaly. Psychiatric drugs have repeatedly been shown to worsen mental illness, to say nothing of the risks of liver damage, weight gain, elevated cholesterol and blood sugar, and reduced cognitive function they entail. The reality, he says, is that, because no one knows what causes mental illness, there’s no cure or palliation to be found in these pills. What with the conclusions Whitaker draws from his assembled literature and the accusations he levels at those who consciously deceive consumers eager for magical cures, his book will either blow the lid off a multibillion-dollar industry or cause him to be labeled a crackpot and, perhaps, medicated into obscurity. At the very least, it should prod those who take the drugs to question those who prescribe them. --Donna Chavez
Review
NEW YORK TIMES BESTSELLER
“The timing of Robert Whitaker’s “Anatomy of an Epidemic,” a comprehensive and highly readable history of psychiatry in the United States, couldn’t be better.”
—Salon.com
“Anatomy of an Epidemic offers some answers, charting controversial ground with mystery-novel pacing.” —TIME.com
“Lucid, pointed and important, Anatomy of an Epidemic should be required reading for anyone considering extended use of psychiatric medicine. Whitaker is at the height of his powers.” —Greg Critser, author of Generation Rx
“Why are so many more people disabled by mental illness than ever before?� Why are those so diagnosed dying 10-25 years earlier than others?� In Anatomy of an Epidemic investigative reporter Robert Whitaker cuts through flawed science, greed and outright lies to reveal that the drugs hailed as the cure for mental disorders instead worsen them over the long term.� But Whitaker’s investigation also offers hope for the future: solid science backs nature’s way of healing our mental ills through time and human relationships.� Whitaker tenderly interviews children and adults who bear witness to the ravages of mental illness, and testify to their newly found “aliveness” when freed from the prison of mind-numbing drugs.” —Daniel Dorman, M.D., Clinical Assistant Professor of Psychiatry, UCLA School of Medicine and author of Dante’s Cure: A Journey Out of Madness
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“This is the most alarming book I’ve read in years.� The approach is neither polemical nor ideologically slanted. Relying on medical evidence and historical documentation, Whitaker builds his case like a prosecuting attorney.” —Carl Elliott, M.D., Ph.D., Professor, Center for Bioethics, University of Minnesota and author of Better than Well: American Medicine Meets the American Dream
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“Anatomy of an Epidemic investigates a profoundly troubling question: do psychiatric medications increase the likelihood that people taking them, far from being helped, are more likely to become chronically ill? In making a compelling case that our current psychotropic drugs are causing as much—if not more—harm than good, Robert Whitaker reviews the scientific literature thoroughly, demonstrating how much of the evidence is on his side. There is nothing unorthodox here—this case is solid and evidence-backed. If psychiatry wants to retain its credibility with the public, it will now have to engage with the scientific argument at the core of this cogently and elegantly written book.” —David Healy, M.D., Professor of Psychiatry, Cardiff University and author of The Antidepressant Era and Let Them Eat Prozac
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“Anatomy of an Epidemic is a splendidly informed, wonderfully readable corrective to the conventional wisdom about the biological bases—and biological cures—for mental illness. This is itself a wise and necessary book—essential reading for all those who have experienced, or care for those who have experienced, mental illness—which means all of us! Robert Whitaker is a reliable, sensible, and persuasive, guide to the paradoxes and complexities of what we know about mental illness, and what we might be able to do to lessen the suffering it brings.” —Jay Neugeboren, author of Imagining Robert and Transforming Madness
“Every so often a book comes along that exposes a vast deceit. Robert Whitaker has written that sort of book. Drawing on a prodigious quantity of psychiatric literature as well as heart-rending stories of individual patients, he exposes a deeply disturbing fraud perpetrated by the drug industry and much of modern psychiatry—at horrendous human and financial cost to patients, their families, and society as a whole. Scrupulously reported and written in compelling but unemotional style, this book shreds the myth woven around today’s psychiatric drugs.” —Nils Bruzelius, former science editor for the Boston Globe and the Washington Post
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“A devastating critique. . . . One day, we will look back at the way we think about and treat mental illness and wonder if we were all mad. Anatomy of an Epidemic should be required reading for both patients and physicians.” —Shannon Brownlee, senior research fellow, New America Foundation and author of Overtreated
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About the Author
ROBERT WHITAKER is the author of Mad in America, The Mapmaker’s Wife, and On the Laps of Gods, all of which won recognition as “notable books” of the year. His newspaper and magazine articles on the mentally ill and the pharmaceutical industry have garnered several national awards, including a George Polk Award for medical writing and a National Association of Science Writers Award for best magazine article. A series he cowrote for the Boston Globe on the abuse of mental patients in research settings was named a finalist for the Pulitzer Prize in 1998.
Most helpful customer reviews
402 of 441 people found the following review helpful.
Evidence-Based Medicine or an Epidemic of Iatrogenic Disorders?
By Louise Gordon
Robert Whitaker's Anatomy of an Epidemic reveals the damage that can and very often does result from long-term use of psychotropic drugs, and, along with it, the alarming rise in chronic mental illness in this country since such drugs as Thorazine were introduced in the 1950s. Because this drug could cause tardive dyskinesia and other permanent nervous system damage, the pharmaceutical industry got to work on new generations of drugs that are being used now.
The rise in drug use corresponds with psychiatry staking a renewed claim to therapeutic expertise and market share, which had begun to erode due to competition from counselors, social workers and others (see the Selling of DSM by Kirk and Kutchins -- [...]-- and Making Us Crazy by the same authors). The prescription pad, and the power of academic psychiatry in collaboration with Big Pharma, allowed psychiatry to open up a very large market, one that today seems to encompass the entire population.
Whitaker documents the alarming rise of disability and increasing number of people on SSI and SSDI due to mental illness over the last 50 years, including the increase since the 1980s, when serotonin reuptake inhibitors such as Prozac were introduced, and again, with the introduction of what are called atypical antipsychotics (e.g., Risperdal, Zyprexa), and reliance on drugs in the benzodiazepine family (Valium). But perhaps the most tragic of all cases with drugs used to treat what were once considered within the range of "normal" behavior (e.g., shyness) is the prescribing of amphetamine-like agents such as Ritalin or Adderall for so-called attention deficit disorder (ADHD) in children, and, even worse, powerful psychotropic drug cocktails to treat a newly introduced category of illness, childhood-onset bipolar disorder. In all of these cases, Whitaker documents how long-term use of such drugs can lead to severe debilitating effects and what may be irreversible brain damage. He also reveals that there is no scientific evidence, none whatsoever, for the psychiatric storyline that psychotropic drugs compensate for chemical imbalances in the brain.
Impeccably researched and documented, Whitaker's book is based on long-term outcome studies that have received almost no publicity from psychiatry and other guardians of the psychiatric establishment, including, of course, the pharmaceutical companies that keep churning out new generations of magic bullets. It's a multibillion dollar industry with a lot to lose were the full truth about the drug risks disclosed and understood.
While far from an anti-psychiatry or anti-drug polemic, Whitaker's interviews with patients who are on psychiatric medications are nonetheless heartrending. Also revealing is his disclosure of the brutal treatment meted out to maverick doctors like Peter Breggin, David Healy and Loren Mosher, who all questioned the efficacy of pharmaceutical treatment of mental disorders, from schizophrenia to bipolar disorder and other maladies. Harvard Medical School-trained Breggin was in effect blacklisted. Mosher lost his position with the NIMH over his successful drug-free treatment of patients through the Soteria project he founded. And Healy promptly lost a job offer after publicizing his criticism of SSRIs and their possible relation to suicide.
In a TLS April 2009 review of Healy's book Mania, the reviewer says Healy "goes on to describe how Big Pharma has captured almost total control over the research process, to say nothing of buying up academic experts and turning them into marketing shills." Whitaker essentially reports the same thing; especially telling is the chapter titled Tallying Up the Profits, including a subsection titled the Money Tree.
On top of this, there is the DSM, or Diagnostic and Statistical Manual (the fifth edition soon to be released; see Ofer Zur's critique at the Zur Institute site), with its ever-expanding list of disorders. No longer are only those thought to be suffering from schizophrenia or bipolar disorder entreated to take their medication, without which, they are told, they would be like a "diabetic without insulin." Now everyone suffering from problems such as grief or the blues or any number of things -- in the case of children, ADHD, "oppositional defiant disorder" or childhood-onset bipolar disorder -- are also told they should take drugs, as if they needed the psychological equivalent of insulin. The tragedy in the case of children is that often, after taking stimulant drugs, they begin to experience psychotic symptoms. Then, more drugs are used to treat the additional symptoms, a fact that accounts for more and more young people ending up on disability rolls.
I hope everyone who sees a primary care doctor or counselor or any kind of therapist will read this book and think twice or a dozen times before attempting to solve any type of emotional problem or bedeviling symptoms with Big Pharma remedies. While Whitaker does explain how such medicines can be useful in taking down severe symptoms on a short-term basis, this book sounds the alarm to proceed with caution. Once "treatment" is begun, brain chemistry is altered, and an insidious dependence on the drugs can develop. Withdrawal from the drugs also sounds as if it might be more challenging than withdrawal from heroin or cocaine.
On a positive note, Whitaker has started a blog that accompanies description of this book at his Mad in America book site. Here, he not only lists results of the long-term studies he documents, but also lists promising alternative treatments, including exercise, that are helping people. I admire Whitaker's courage in writing this book, which can give hope to all the people psychiatry may have condemned to chronic illness. Disclosure: After meeting Robert Whitaker for the first time and hearing him speak about his book last week, we are now friends on Facebook.
164 of 180 people found the following review helpful.
Only The Pharma-Industry?
By kamasl
As others have stated, this book is impeccably researched and the author presents his argument in a very thoughtful, careful way, with a lot of compassion for the individuals whose stories he tells to illustrate his point.
However, as I reach the end of the book, I find myself wondering whether it is fair to implicate only Big Pharma and the proponents of biological psychiatry in this scandal. I find myself wondering about the roles of shareholder value in the decision making process in the pharmaceutical industry, and of teachers and parents who would rather think that their children's behavior is due to "chemical imbalance" than to psychosocial issues like peer pressure, unavailable parents, overwhelmed teachers, and the like.
While the lopsided presentation of psychotropic drugs by the media certainly is part of the picture (and the problem), the truth is, I think, that we as a society would much prefer the idea of mental illness as a biological problem. It relieves us from personal responsibility, for our financial investments, our children, our students. To me, the most striking part of the book is the description of the callous use of psychotropic drugs to control children and pathologize perfectly normal childhood behaviors, based on the short-term efficacy of the drugs and with no regard for the long-term consequences. I'm a little disappointed that Whitaker doesn't even comment on the wider ethical implications of the problem he is addressing!
996 of 1123 people found the following review helpful.
Whitaker presents a lopsided view of mental illness and the drugs used to treat it
By W.H.
Whitaker and many of Amazon's reviewers have a lot to say about psychiatric drugs, most of them virulently negative. As someone who actually is mentally ill and takes some of these drugs, I see things very differently and I want to share my story and my point of view.
I have schizoaffective disorder (a combination of schizophrenia and bipolar disorder). I developed this disease in my early 20s. I was beset by mania, depression, and psychosis. The mania and depression were bad but easier to manage than my psychosis. I heard loud, terrifying voices which threatened to kill me and worse. They sounded just as real as any voice I had ever heard in my life. They tortured me morning, noon, and night without interruption. I was completely disabled by them.
I was a bright young woman with a good education but I could barely leave my house, let alone work. I could not even have a meaningful conversation with anyone because the voices were too loud. My parents became my caretakers and my friends disappeared completely. Despite my family's support, I felt utterly alone in the world.
This went on for years as I tried different antipsychotics. They worked to a degree but the voices simply would not go away. I certainly did not get better or "heal" on my own--despite my family's love and support. No words can describe how hellish and worthless my life felt. I thought about killing myself but my parents helped me hold on to what seemed like a very slim hope that the voices would be stilled one day.
Geodon, the last antipsychotic I had settled on, began to give me symptoms of dyskinesia and my doctor made me stop taking it right away. The symptoms went away and I began to take a new drug: Seroquel.
Within weeks of starting on Seroquel, the voices dropped off and virtually disappeared. They are very few and far between now and they no longer seem real. It took me a while to adjust to the absence of the voices. I did so rather slowly and with cautious optimism--what if this freedom didn't last?
It lasted. Several years have passed and the Seroquel is still working. It can be very sedating, which is why I take it bedtime. It really wasn't such a bad side effect--my body eventually adjusted and in the meantime I just learned to love my morning coffee. All drugs have possible side effects: Seroquel's most dangerous one is that it can cause high blood sugar which can lead to diabetes.
I have a battery of blood tests done every year to be cautious. Anyone on medication (psychiatric or otherwise) should. I am in fine shape physically and mentally. I don't have cognitive problems and I am certainly not subdued or "drugged into a stupor."
I am happier and more productive than I have ever been before in my life.
The pharmaceutical industry, which Whitaker and so many reviewers here look askance at, restored my sanity and saved my life. It didn't work on the first try or even the second, but my doctor and I persevered and did not give up. I am no longer afraid to leave my house and I have a good job. I have a great relationship with my family and I can talk to anyone at anytime without being interrupted by voices. I have friends and a social life again.
This may not sound exceptional to a normal person, but it means the world to me. None of it would be possible without the drugs I take. I take them every day--happily and with more gratitude than Whitaker or his acolytes will or could ever understand.
I realize that my experience is not everyone's. Like "normal" people, the mentally ill are quite different from each other and we respond differently to different drugs and therapies. Whitaker would have you believe that psychiatric drugs are useless and even detrimental to people like me, though, and that is simply not the truth--not my truth, anyway.
I should mention that I work in NYC. The streets are full of unmedicated schizophrenics. Some of them beg for money but others are too out of it to do even that--they are completely absorbed in their fights with their voices. Some are loud and menacing, others just sit in silence looking terrified.
It breaks my heart to see them because I could have wound up like them. I would have had it not been for my parents, my doctor, and my drugs.
I'd like to bring Whitaker along with me one morning so he could see them, too. Would he really tell me that they're better off than I am? Happier? Healthier?
I give them food and money (I want to make them feel better even if it's only temporarily) but most people hurry away from them without even trying to hide their fear and disgust.
I would never, ever want to trade places with any of them. Neither would Whitaker or anyone else.
(You may have noticed that I wrote the same review for Whitaker's "Mad In America." This is because I have the exact same problem with both books. People with mental illnesses like mine who benefit greatly from medication are not represented. Mr. Whitaker, we do exist!)
***One of the fundamental differences between Whitaker and myself is what constitutes a "positve outcome" for people like me. I believe that the most (if not only) positive outcome for someone with schizophrenia or schizoaffective disorder is that the voices and any other delusions GO AWAY. I've never met anyone for whom this has happened without drugs.
I want to take my drugs and live independently. Others seem to think that living in a group home with a kind caretaker is a positive outcome. I do not see that as a positive outcome, though it could be used as a temporary stepping stone for people who are recovering and learning to be independent.
Don't get me wrong--of course it is better to be treated kindly than it is to be treated cruelly. But all the kindness in the world will not put an end to psychosis or silence the voices.
Everyone who reads this book, whether they like it or not, must give some serious thought to what truly constitutes a "positive outcome." You all know my opinion and you need to form your own by thinking critically about the information you read--don't just accept the words blindly.
edit: Whitaker mentions that atypical antipsychotics (such as Seroquel, Risperdal, and Zyprexa) can cause severe weight gain. This is certainly true, but he fails to mention that a diabetes drug called metformin (brand name: Glucophage) can be used in addition to diet and exercise to help people on these drugs lose weight and maintain a healthy weight. It has been very helpful to me personally in this regard.(You do not have to be diabetic to use metformin for this purpose--I'm not.)
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