Investigative reporter Robert Whitaker's Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America (Crown Publishers, April 2010) is the most important book on psychiatric treatment in a generation. I have been in practice for over 25 years and have read hundreds of books about psychiatry, and I can say without question that Anatomy of an Epidemic is the most illuminating book on psychiatric treatment that I have ever read.
Whitaker is the author of four books (including Mad in America, about the mistreatment of the mentally ill), and as a reporter for the Boston Globe, he won a George Polk Award for medical writing, a National Association of Science Writers Award for best magazine article, and was a finalist for a Pulitzer Prize. In the tradition of Michael Pollan, Eric Schlosser, and other investigative reporters who get taken seriously, Whitaker is scrupulous, fair, and describes complex phenomena in a way that is easy to understand.
The starting point of Anatomy of an Epidemic is as follows: In 1987, prior to Prozac hitting the market and the current ubiquitous use of antidepressants and other psychiatric drugs, the U.S. mental illness disability rate was 1 in every 184 Americans, but by 2007 the mental illness disability rate had more than doubled to 1 in every 76 Americans. Whitaker was curious as to what was causing this dramatic increase in mental illness disability.
Since 1955, mental illness disability rates in the U.S. have increased six-fold. At the same time, psychiatric drug use greatly increased in the 1950s and 1960s, then skyrocketed after 1988 when Prozac hit the market, so now antidepressant and antipsychotic drugs alone gross more than $25 billion annually in the U.S. But Whitaker knew that "correlation isn't causation," and that this parallel rise of mental illness disability and psychiatric drug use doesn't necessarily prove anything. In order to get to the bottom of the issue, Whitaker realized he needed to look at two areas:
(1) Do psychiatric drugs, over the long-term, increase the likelihood that a person will be able to function well or do they increase the likelihood that a person will become disabled?
(2) Is it possible that a person with a mild emotional problem may have a bad reaction to an initial drug, and that puts the person on to a path that can lead to long-term mental illness disability? For instance, can a person with a mild bout of depression be given antidepressants that cause a manic reaction, which results in a bipolar diagnosis and chronic disability?
Whitaker took an exhaustive look at what the scientific literature -- one that now extends over 50 years -- had to say about those questions. In an interview with him, I asked him if he could summarize his findings:
The literature is remarkably consistent in the story it tells. Although psychiatric medications may be effective over the short term, they increase the likelihood that a person will become chronically ill over the long term. I was startled to see this picture emerge over and over again as I traced the long-term outcomes literature for schizophrenia, anxiety, depression, and bipolar illness. In addition, the scientific literature shows that many patients treated for a milder problem will worsen in response to a drug-- say have a manic episode after taking an antidepressant -- and that can lead to a new and more severe diagnosis like bipolar disorder. That is a well-documented iatrogenic [physician caused illness] pathway that is helping to fuel the increase in the disability numbers. Now there may be various cultural factors contributing to the increase in the number of disabled mentally ill in our society. But the outcomes literature -- and this really is a tragic story -- clearly shows that our drug-based paradigm of care is a primary cause.
Bipolar disorder in children was once rarely ever seen by psychiatrists, but today well over a million children and teenagers have ended up bipolar after being treated with a stimulant such as Ritalin or an antidepressant. Reading Anatomy of an Epidemic and seeing the magnitude of the mental and physical health problems caused by the pharmaceutical industry, I couldn't help but draw comparisons to Rachel Carson's Silent Spring.
All is not bleak in the area of mental health treatment, especially if one goes outside the United States. In our conversation, Whitaker, offered one of many examples from his book:
In the solution section of Anatomy of an Epidemic, I write of how doctors and psychologists in northern Finland use antipsychotics in a selective, cautious manner when treating first-episode psychotic patients, and their long-term outcomes are, by far, the best in the Western World. So if you believe in evidence-based medicine, then American psychiatry should look to the Finnish program as a model for reform.
Bruce E. Levine is a clinical psychologist and author of Surviving America's Depression Epidemic: How to Find Morale, Energy, and Community in a World Gone Crazy (Chelsea Green Publishing).