Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America
by Robert Whitaker
Broadway Books, 2011
In 2010 Robert Whitaker, experienced science and history writer, won the coveted Investigative Reporters and Editors Award for “best investigative journalism” with this stunning, richly documented and researched review of the rise of psychiatric drugs and their actual efficacy in treating mental illness. In this book Whitaker, also author of Mad in America, takes a hard and critical look at psychiatric medications over the history of the profession. He lifts the curtain for general readers to peer into this uncertain world and decide for themselves: Do psychotropic drugs heal or harm?
Our nation has been hit by an epidemic of disabling mental illnesses, which began after the introduction of Thorazine, the trade name for chlorpromazine, in 1954. Thorazine was the first specific psychiatric drug: a first generation (the first of its kind) anti-psychotic used to treat schizophrenia. Chlorpromazine works on a variety of receptors in the central nervous system, producing potent anticholinergic, antidopaminergic, antihistaminic, and antiadrenergic effects. Patients taking this drug likened its effects to those of lobotomy.
To set the stage, in tandem with the introduction of this drug, the passage of the 1951 Durham-Humphrey Amendment gave physicians monopolistic prescribing rights. Until this law, there was no requirement that any drug be labeled for sale by prescription only. The Durham-Humphrey amendment requires any drug that is habit-forming or potentially harmful to be dispensed under the supervision of a health practitioner as a prescription drug and must carry the statement “Caution: Federal law prohibits dispensing without a prescription.” For the first time two mortal enemies, the medical profession and pharmaceutical companies, were on the same side.
Before this drug came along, psychiatrists or “asylum doctors” as the first such practitioners were called, had little use for the prescription pad because they had no drugs to prescribe. And except for lobotomy (which was largely condemned after World War II) there were no surgical procedures to perform. According to the profession, Thorazine “initiated a revolution in psychiatry” and gave this specialty some legitimacy. At last the “asylum doctors” had metamorphosed into psychiatrists who prescribed drugs specific for mental diseases.
In 1955, there were over three hundred fifty thousand adults housed in state and county mental hospitals in this country. Although the state and county mental hospitals were on the wane, during the next thirty years the number of disabled mentally ill rose to over one million and the number of adults and children disabled by mental illness in the U.S. continued to skyrocket.
The introduction of Thorazine was followed by tranquilizers and other “magic bullets” such as antidepressants, antipsychotics, anti-anxiety drugs, stimulants and psychotropics. After the “second generation blockbuster” Prozac arrived on the scene in 1988, the number of mentally ill continued to rise, not decline. It seemed that the mentally ill became chronically ill on the new “magic bullets.”
By 2007 the number of disabled mentally ill had grown to more than four million adults. From 1987 to 2007 psychiatric drug companies, by means of willing medical experts, marketed these drugs to children and adolescents for ADHD and other behavioral problems. There followed a thirty-five-fold increase in young people qualifying for disability checks from the government, from about sixteen thousand in 1987 to five hundred sixty thousand in 2007. In twenty years the number of disabled mentally ill children rose thirty-five-fold. Of those dependent upon SSI (social security supplemental income), children comprised fifty percent in 2007. Children in foster homes seem to be specifically targeted as needing psychiatric drugs.
Today medical doctors prescribe antidepressants to pregnant and nursing moms, even though the medications appear in the fetus in measureable amounts. The newborn may start off life today with a bloodstream full of antidepressants and nourished by a breastmilk cocktail spiked with psychiatric drugs.
At the beginning of his career, Whitaker was a “believer in the conventional wisdom” that psychiatric drugs fix what is broken. For over fifty years psychiatrists have been preaching that the biological cause of mental illness is a “chemical imbalance” in the brain and that psychiatric drugs restore this balance. But no laboratory tests or scans can show proof of this “truth.” From examining published and unpublished research and conducting interviews with experts, Whitaker found that these medications actually create imbalances which become permanent over time. That’s why it’s so difficult and dangerous to stop taking them. The side effects of drug withdrawal can be fatal.
Whitaker also reviews puzzling Harvard studies which showed that outcomes for schizophrenics have worsened in America and that sufferers are no better off than a century ago. Other literature showed that outcomes for these patients were much better in poorer countries where drugs were used in only 16 percent of cases. Because schizophrenia is such a costly disease to treat (with most funds used to cover drug costs), and because it affects more than two million Americans and costs thirty-five billion dollars annually, the question becomes: what is going wrong?
Before the advent of psychiatric drugs in the late 1940s and 1950s, about seventy-five percent of cases first admitted to hospitals for schizophrenia recovered and returned home to their families in three years, with little or no readmission. What closed the asylums and state hospitals was Medicare and Medicaid programs begun in 1965, which provided federal subsidies for nursing home care but no such subsidy for care in state mental hospitals. States seeking to save money began shipping their chronically ill patients to nursing homes. Those patients in nursing homes were maintained on psychiatric drugs and remained chronic cases.
According to Whitaker’s findings, it appears that when people are diagnosed with mental illness in America it is nearly certain that they will become chronically ill and take psychiatric medications for life. Because of their medication’s effects, they will lose twelve to twenty years of life expectancy compared to people not taking the drugs. In addition, those who take psychiatric drugs can develop cognitive deficits as well as tardive dyskinesia (TD). This condi tion occurs when pathways in the brain become dysfunctional because of psychiatric drugs. TD is an incurable disorder, which involves grimacing, involuntary tongue movements, lip smacking, lip puckering, eye blinking, inability to keep the tongue in the mouth and other related behaviors. Rapid involuntary movements of the arms, legs and fingers can also occur, which do not cease upon withdrawal of the drugs. Not only are people not cured, but while on drugs they exhibit freakish behaviors, lose motor control, experience much diminished quality of life and die earlier.
Whitaker found that children today are at high risk of becoming mentally ill because of the practice of prescribing them psychiatric cocktails of stimulants and antidepressants for ADHD (attention deficit hyperactive disorder) and other conditions. When the child reaches the age of eighteen, Whitaker says, he often becomes a disabled adult.
In the case of bipolar disease, which was rare in the 1950s, the outcomes have seriously worsened in the past twenty years. Numbers began to increase with the hippie era of marijuana use and picked up steam with the introduction of antidepressants in the late 1980s. Today one out of forty is affected with the condition. Research points to the conclusion that it is most certainly drug use, whether illicit or prescription, that has contributed most to the diagnosis of bipolar illness, a condition where the person experiences extreme highs (mania) and lows (depression). Whitaker found that most first episodes of bipolar disease were preceded by substance abuse of marijuana, cocaine or amphetamines, or from legal prescription use of antidepressants. Studies have shown that smoking marijuana is associated with a five-fold increased risk of a bipolar diagnosis and accounted for one-third of all new cases. The psychiatric profession has admitted that all antidepressant treatments, including electroshock, can cause manic or hypomanic (depressive) episodes and that patients can continue to have episodes even when the treatment is stopped. The more quickly these states of manic-to-hypomanic change (rapid-cycling) occur, the more dangerous the disease becomes. These rapid cyclers can lose cognitive abilities and “come to a bad end.”
Whitaker did find bright stars in the darkness of mental illness treatment in programs run in Finland, Europe, and the U.S., where drugs are given only on a limited basis and lifestyle changes like exercise are seriously incorporated into patients’ treatment. In fact, studies have shown that exercise produces a “substantial improvement” within six weeks and that seventy percent of all depressed patients respond to an exercise program. Patients living with good family support did much better in these programs.
Anatomy of an Epidemic was enthusiastically received by many audiences, but not by the psychiatric community, which has opposed its contents. Yet this book contains more interesting, surprising and even shocking information in addition to that which I have described here. By the end of this book, readers are certain to have many disturbing questions of their own about the history and continued use of psychiatric drugs in this country. Despite their poor outcomes, these drugs continue to be the treatment of choice for the major mental illnesses in America.
We give Anatomy of an Epidemic a resounding “Thumbs Up” for its contribution to our understanding of mental illness and current treatments, and for describing alternative methods of treating the mentally ill. If you suffer from a mental illness, have a mentally ill family member, are a parent, grandparent, or intend to have children, I highly recommend this book for your required reading list.
The first chapter of Anatomy of an Epidemic, “A Modern Plague,” may be found at this link: http://robertwhitaker.org/robertwhitaker.org/Anatomy%20of%20an%20Epidemic_files/anatomych1.pdf.
This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly journal of the Weston A. Price Foundation, Winter 2014