Robert Whitaker is in town this week to talk about his latest book, Anatomy of an Epidemic (Tuesday, May 10). Whitaker, formerly a Boston Globe reporter and the winner of a George Polk Award for medical writing, traces the sharp increase in disabling mental illness in America over the past two decades.
The book, subtitled Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, analyzes statistics showing that the number of individuals on disability for psychiatric disorders has more than doubled during that time. This has happened despite the fact that new generations of antipsychotic drugs, regularly prescribed for rising numbers of children and adults, are touted as spectacularly better than those prescribed years ago.
In the past, argues Whitaker, many people who experienced a psychotic breakdown could gradually recover and return to work with the help of counseling and a supportive community. Now prescription drugs, especially when used long-term, render too many individuals with mental illnesses permanently incapable of fulfilling the demands of a job or even a social life.
Also problematic are recent trends in which patients taking one of these drugs end up having to take cocktails of four or more powerful prescriptions combined, in attempts to renew the original drug's fading effectiveness or to counteract multiplying side effects.
"We can’t keep going down this path," Whitaker told me over the phone. About medications for depression, for instance, he said, "Normally depression is considered pretty mild, and you can expect to get better." But antidepressants increase the risk of being tipped into a manic or psychotic episode. "Then there’s the chance you’ll be diagnosed with a bipolar disorder, which is much more disabling." Antidepressants, he said, are "one of the big pathways to bipolar."
And compared to 70-80 years ago, Whitaker said, "the course of bipolar is now more rapid-cycling, more mixed-moods, more depression between moods, more unemployment, and you also have more experts in the field saying that there used to be better outcomes, that people are now less functional.... Even with schizophrenia you see a decline in employment now." Medications for ADHD can impair health in the long run, too.
"Promoters [of psychiatric medications] admit the evidence doesn’t show they improve long-term functioning," said Whitaker. However, "that doesn’t mean there’s no place for meds." His book explicitly argues that they are sometimes called for. The challenge he raises in Anatomy of an Epidemic, which won the IRE 2010 book award from Investigative Reporters and Editors, is not to psychiatric drugs per se but to their automatic, long-term, exclusive use in mental health care.
Many physicians who prescribe antipsychotics have been influenced by heavy marketing campaigns, and sometimes by lavish payments for consulting work on behalf of a pharmaceuticals industry that makes billions of dollars in profits every year from the sale of drugs for schizophrenia, bipolar disorder, ADHD, and depression. An egregious instance was described in a New York Times article that appeared in 2009.
So there's ongong controversy around this book. Some mental-health care providers fear that even raising a question about the value of these medications could harm clients who really need them, when persuading people with delusions to adhere to a doctor's orders is a challenge to begin with. Further, said Whitaker, "I understand why this can be a threatening discussion if you’re someone involved in the delivery of care, a psychiatrist, social worker, psychologist." People go into the field "because they want to help, and don’t want to think they’re doing harm. It's an upsetting conversation."
But "clearly some attacks [on the book] arise out of financial reasons," Whitaker said. Indeed, a Massachusetts psychiatrist who publicly assailed the science behind Anatomy of an Epidemic was a consultant for 22 companies in the pharmaceuticals industry, had received grants from 12, and was on the speakers' bureaus of seven.
Whitaker presents what he sees as a better paradigm of mental health care: a combination of short-term meds, therapy, and other in-person support, which can help a surprisingly high percentage of people get through a psychotic break and avoid a lifelong, potentially disabling dependence on antipsychotic medications.
If you go: Robert Whitaker, Anatomy of an Epidemic (Crown, 2010), reads Tuesday, May 10, at 5 p.m., Elliott Bay Book Company, 1521 Tenth Ave. and at 7 p.m., Ravenna Third Place Books, 6504 20th Ave. NE.