Anatomy of an Epidemic

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Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America
Anatomy of an Epidemic-cover.jpg
Author Robert Whitaker
LanguageEnglish
Subject Psychiatry
Publisher Crown Publishing Group
Publication date
2010
Publication placeUnited States
Media typePrint
ISBN 978-0-307-45241-2
OCLC 429022293
616.89

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America is a book by Robert Whitaker published in 2010 by Crown. [1] [2] [3] Whitaker asks why the number of Americans who receive government disability for mental illness approximately doubled since 1987. [4]

Contents

In the book, Whitaker tries to answer that question and examines the long-term outcomes for the mentally ill in the U.S.

Synopsis

Magic bullets

Number of Americans who received SSDI and SSI for mental disability in 1987 (blue) when Eli Lilly and Company introduced the antidepressive drug Prozac, compared to 2003 (red) SSDI-SSI-1987-2003.png
Number of Americans who received SSDI and SSI for mental disability in 1987 (blue) when Eli Lilly and Company introduced the antidepressive drug Prozac, compared to 2003 (red)

Whitaker begins by reviewing the discovery of antipsychotics, benzodiazepines and antidepressants. These were discovered as side effects during research for antihistamines (specifically promethazine), gram negative antibiotics (specifically mephenesin) and the anti-tuberculosis agents isoniazid and iproniazid respectively. The psychiatric mechanisms of action of these drugs were not known at the time and these were initially called major tranquilizers (now typical antipsychotics) due to their induction of "euphoric quietude"; minor tranquilizers (now benzodiazepines) and psychic energizers (now antidepressants) due to patients "dancing in the wards." [5] These compounds were developed during a period of growth for the pharmaceutical industry bolstered by the 1951 Durham-Humphrey Amendment, giving physicians monopolistic prescribing rights thus aligning the interests of physicians and pharmaceutical companies. This also followed the industry's development of "magic bullets" that treat people with, for example, diabetes, which according to Whitaker provided an analogy to sell the idea of these drugs to the public. It was not until many years later, after the mechanisms of these drugs were determined, that the serotonergic hypothesis of depression and dopaminergic hypothesis of schizophrenia were developed to fall in line with the drug's mechanisms. According to Whitaker's analysis of the primary literature, lower levels of serotonin and higher levels of dopamine "have proved to be true in patients WITH prior exposure to antidepressants or antipsychotics (ie as homeostatic mechanisms) but NOT in patients without prior exposure."

Whitaker further criticizes the magic bullet theory by attacking the historical notion that the "invention of the antipsychotic Thorazine" emptied the asylums. [6] His case begins by showing that during the late 1940s and 1950s ~75% of cases admitted for first episode schizophrenia recovered to the community by approximately 3 years (Thorazine was not released until 1955). [7] [8] [9] He then notes that the arrival of Thorazine did not improve discharge rates in the 1950s for people newly diagnosed with schizophrenia. In fact, based on the only large scale first episode schizophrenia study of this era, 88% of those who were not treated were discharged within eighteen months compared to 74% of neuroleptic treated. [10] This is additionally evidenced by the fact that when Thorazine was introduced in 1955 there were 267 thousand schizophrenia patients in state and county mental hospitals, and eight years later, there were 253 thousand, thus indicating that the advent of neuroleptics barely budged the number of hospitalized patients. [11] What he argues actually cleared the asylums was the beginning of Medicare and Medicaid in 1965. These programs provided federal subsidies for nursing home care but no such subsidy for care in state mental hospitals, and so the states, seeking to save money, began sending their chronic patients to nursing homes.

Psychiatric drugs

Whitaker acknowledges that psychiatric medications do sometimes work but believes that they must be used in a "selective, cautious manner. It should be understood that they’re not fixing any chemical imbalances. And honestly, they should be used on a short-term basis." [12]

Whitaker traces the effects of what looks like an iatrogenic epidemic: [13] the drugs that patients receive can perturb their normal brain function. [14]

A symbolic graphic of the brain's dopamine function before and after antipsychotics Dopamine function before and after antipsychotics.jpg
A symbolic graphic of the brain's dopamine function before and after antipsychotics

Whitaker suggests that the "wonder drug" glow around the second generation psychotropics has long since disappeared. He views the "hyping" of the top-selling atypical antipsychotics as "one of the more embarrassing episodes in psychiatry's history, as one government study after another failed to find that they were any better than the first-generation anti-psychotics." [15]

Whitaker speaks warmly of Open Dialogue, an organisation of care documented by professor psychologist Jaakko Seikkula at Keropudas Hospital in Tornio in Lapland where drugs are given to patients only on a limited basis. According to Whitaker, the district has [ when? ]the lowest per capita spending on mental health of all health districts in Finland. [16]

Children

Whitaker sees that children are vulnerable to being prescribed a lifetime of drugs. As the author says, a psychiatrist and parents may give a child a "cocktail" to force him or her to behave. Then when this child reaches the age of eighteen, Whitaker says the child often becomes a disabled adult. [17]

Review of data and statistics

Whitaker spent a year and a half researching for this book, [14] and maintains a website listing some relevant studies. [18]

Reception and media coverage

Whitaker did interviews with Salon and The Boston Globe during the release of this book. [12] [19] He also did a book tour, and he spoke for an hour and a half on C-SPAN where there is an archived video. [20]

A review by sleep researcher Dennis Rosen for The Boston Globe concludes that "although extensively researched and drawing upon hundreds of sources, the gaps in his theory remain too large for him to succeed in making a convincing argument", and compares Whitaker to Thabo Mbeki and AIDS denialism. [21] The book received positive reviews from New Scientist , [2] The Record , [3] Time magazine, [1] and Salon. [12]

Over a year after the book was published, Marcia Angell, former editor of The New England Journal of Medicine , published a two-part review of Whitaker's and other books in The New York Review of Books [22]

Whitaker presented his views at a psychiatric Grand Rounds at Massachusetts General Hospital on January 13, 2011, where his data and approach were critiqued by psychiatrist Andrew Nierenberg. [23] Additional criticism has come from psychiatrist and author Daniel Carlat. Whitaker has responded to critics on his website. [24]

Awards

In April 2011, Investigative Reporters and Editors (IRE) announced that the book had won its award as the best investigative journalism book of 2010 stating, "this book provides an in-depth exploration of medical studies and science and intersperses compelling anecdotal examples. In the end, Whitaker rejects the conventional wisdom of treatment of mental illness with drugs." [25]

See also

Related Research Articles

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Antipsychotics, previously known as neuroleptics and major tranquilizers, are a class of psychotropic medication primarily used to manage psychosis, principally in schizophrenia but also in a range of other psychotic disorders. They are also the mainstay, together with mood stabilizers, in the treatment of bipolar disorder. Moreover, they are also used as adjuncts in the treatment of treatment-resistant major depressive disorder.

A psychiatric or psychotropic medication is a psychoactive drug taken to exert an effect on the chemical makeup of the brain and nervous system. Thus, these medications are used to treat mental illnesses. These medications are typically made of synthetic chemical compounds and are usually prescribed in psychiatric settings, potentially involuntarily during commitment. Since the mid-20th century, such medications have been leading treatments for a broad range of mental disorders and have decreased the need for long-term hospitalization, thereby lowering the cost of mental health care. The recidivism or rehospitalization of the mentally ill is at a high rate in many countries, and the reasons for the relapses are under research.

The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 38,000 members who are involved in psychiatric practice, research, and academia representing a diverse population of patients in more than 100 countries. The association publishes various journals and pamphlets, as well as the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM codifies psychiatric conditions and is used mostly in the United States as a guide for diagnosing mental disorders.

<span class="mw-page-title-main">Typical antipsychotic</span> Class of drugs

Typical antipsychotics are a class of antipsychotic drugs first developed in the 1950s and used to treat psychosis. Typical antipsychotics may also be used for the treatment of acute mania, agitation, and other conditions. The first typical antipsychotics to come into medical use were the phenothiazines, namely chlorpromazine which was discovered serendipitously. Another prominent grouping of antipsychotics are the butyrophenones, an example of which is haloperidol. The newer, second-generation antipsychotics, also known as atypical antipsychotics, have largely supplanted the use of typical antipsychotics as first-line agents due to the higher risk of movement disorders with typical antipsychotics.

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<span class="mw-page-title-main">Rosenhan experiment</span> Experiment to determine the validity of psychiatric diagnosis

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References

  1. 1 2 Fitzpatrick, Laura (May 3, 2010). "The Skimmer". Time. Archived from the original on 23 September 2010. Retrieved October 5, 2010.
  2. 1 2 Burch, Druin (April 7, 2010). "Does psychiatry make us mad?". New Scientist. Reed Business Information. Archived from the original on 25 October 2010. Retrieved October 5, 2010.
  3. 1 2 Good, Alex (May 21, 2010). "Book review: Anatomy of an Epidemic". The Record. Metroland Media. Archived from the original on 26 October 2010. Retrieved October 5, 2010.
  4. ↑ Whitaker, p. 7
  5. ↑ Whitaker, Robert (2010). Anatomy of an Epidemic. Crown Publishing Group. pp.  48–54. ISBN   978-0-307-45241-2.
  6. ↑ Whitaker, Robert (Spring 2005). "Anatomy of an Epidemic: Psychiatric Drugs and the Astonishing Rise of Mental Illness in America" (PDF). Ethical Human Psychology and Psychiatry. 7 (I). Springer: 1. Retrieved October 11, 2010.
  7. ↑ Warner, R. (1985). Recovery from Schizophrenia. Boston: Routledge & Kegan Paul. p. 74.
  8. ↑ N. Lehrman (1961). "Follow-up of brief and prolonged psychiatric hospitalization". Comprehensive Psychiatry. 2 (4): 227–40. doi:10.1016/s0010-440x(61)80015-1. PMID   14463804.
  9. ↑ Cole, J. (1959). Psychopharmacology. Washington DC: National Academy of Sciences. pp. 142, 386–87.
  10. ↑ L. Epstein (1962). "An approach to the effect of ataraxic drugs on hospital release rates". American Journal of Psychiatry. 119: 36–47. doi:10.1176/ajp.119.1.36. PMID   13890431.
  11. ↑ Silverman, C. (1968). The Epidemiology of Depression . Baltimore: Johns Hopkins Press. pp.  139.
  12. 1 2 3 Lipinski, Jed (April 27, 2010). ""Anatomy of an Epidemic": The hidden damage of psychiatric drugs". Salon. Salon Media. Archived from the original on 2 October 2010. Retrieved October 9, 2010.
  13. ↑ Whitaker, p. 208
  14. 1 2 Whitaker, p. 210
  15. ↑ Robert Whitaker (2010). Anatomy of an Epidemic . Crown. p.  303. ISBN   9780307452412.
  16. ↑ Whitaker, p. 343
  17. ↑ Whitaker, chapters 11 and 12
  18. ↑ Whitaker, Robert. "Mad in America" . Retrieved October 10, 2010.
  19. ↑ Weintraub, Karen (May 10, 2010). "The downside of meds". The Boston Globe. The New York Times Company. Retrieved October 9, 2010.
  20. ↑ Robert Whitaker (April 22, 2010). Anatomy of an Epidemic. C-SPAN. Retrieved October 9, 2010.
  21. ↑ Rosen, Dennis (April 14, 2010). "Tying the rise in mental illness to drugs used in its treatment". The Boston Globe. The New York Times Company. Retrieved October 9, 2010.
  22. ↑ Angell, Marcia (June 23, 2011). "The Epidemic of Mental Illness: Why?". and Angell, Marcia (July 14, 2011). "The Illusions of Psychiatry". The New York Review of Books. Retrieved September 23, 2011.
  23. ↑ Goldberg, Carey (Jan 19, 2011). "Special Report: Do Psych Drugs Do More Long-Term Harm Than Good?".
  24. ↑ "Answering the Critics". 19 June 2012. Retrieved March 30, 2013.
  25. ↑ "IRE Awards 2010". Investigative Reporters and Editors. Archived from the original on 2012-05-30. Retrieved 2011-05-11.

Bibliography

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