Anatomy of an Epidemic


Book by Robert Whitaker; New York, Crown Publishers, 2010, 416 pp.

Robert Whitaker, a former Boston Globe reporter, was curious about why there has been such a large increase of disabling mental illness in the United States. His book, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America (Crown Publishers, 2010), begins with these data points: in 1987, 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.

During this same time period, there has also been a huge increase in psychiatric drug use. Prior to 1988 when Prozac hit the market, the annual U.S. gross for antidepressant and antipsychotic drugs was less than $1 billion, but today those two classes of psychiatric drugs alone gross more than $25 billion a year in the United States. The question for Whitaker was: is it just a coincidence that disabling mental illness and psychiatric drug use have been rapidly increasing at the same time?

Whitaker does not discount cultural factors that may have something to do with this dramatic increase in mental illness disability. However, he discovered that the most scientifically identifiable factor for the increase of severe psychiatric problems is the increase in psychiatric drug use. He identified a frightening trend: long-term psychiatric drug use has caused children and adults with minor emotional problems to have severe and chronic disorders that result in mental illness disabilities.

How Psychiatric Drugs Create Chronic Illness

Whitaker examined the scientific literature over the last 50 years with respect to 2 related questions. First, do psychiatric medications alter the long-term course of mental disorders for better or for worse? Specifically, do they increase the likelihood that a person will be able to function well over the long-term or do they increase the likelihood that a person will end up on disability? Second, how often do patients with a mild disorder have a bad reaction to an initial psychiatric drug that can lead to long-term disability? For example, how frequently does a person with a mild bout of depression become manic in reaction to an antidepressant and is then diagnosed with bipolar disorder?

He discovered that while psychiatric medications can, for some people, be effective over the short term, these drugs, in long-term use, increase the likelihood that a person will become chronically ill, increasing the possibility that a mild psychological problem will worsen into a debilitating illness. This is especially clear and tragic in the case of children.

Not too long ago, "juvenile bipolar disorder" was very rarely diagnosed, yet today it is increasingly common. Whitaker points out, "When you research the rise of juvenile bipolar illness in this country, you see that it appears in lockstep with the prescribing of stimulants for ADHD and antidepressants for depression…. Once psychiatrists started putting ‘hyperactive’ children on Ritalin, they started to see prepubertal children with manic symptoms." Increasing numbers of children have also been prescribed antidepressants, such as Prozac, and a significant percentage of these young people have become manic in reaction to their antidepressants.

These frightening manic reactions result in heavy-duty antipsychotic drugs as well as "drug cocktails" made up of multiple psychiatric drugs. Whitaker discovered that a high percentage of these medicated kids end up as "rapid cyclers," which means they have severe bipolar symptoms that put them on a path to be chronically ill throughout their lives. Also, antipsychotics such as Zyprexa cause a host of physical problems, including diabetes. Whitaker concludes, "When you add up all this information, you end up documenting a story of how the lives of hundreds of thousands of children in the United States have been destroyed in this way."

The Failure of the Corporate Media

So why don’t Americans know about the severe chronic problems created by long-term psychiatric drug use? One answer is that drug companies and their partners in establishment psychiatry are not disclosing this. The other answer is that mainstream American journalism and government agencies have failed the American people.

Whitaker, a former medical reporter, explains how medical news is typically generated. Major institutions, such as drug companies and government agencies, issue press releases which reporters rely on. If no press releases are issued, most reporters are not aware of any news and nothing is reported. Whitaker, in contrast, did not rely on press releases, but instead investigated the scientific literature and interviewed researchers.

He lists 16 major research studies that reveal a troubling picture for long-term medicated patients and a better picture for non-medicated patients. But when examining the New York Times archives and the LexisNexis database (which covers most U.S. newspapers), Whitaker could not find a single instance where the results of these 16 major studies were accurately reported.

One of these studies, unheard of by most Americans, including most mental health professionals, is a long-term study of schizophrenic patients who were treated with and without psychiatric drugs. The study was funded by the National Institute of Mental Health (NIMH) and was published in 2007 in the Journal of Nervous and Mental Disorders. Research psychologist Martin Harrow at the University of Illinois College of Medicine discovered that after 4.5 years, 39 percent of the non-medicated group were "in recovery" and 60 percent had jobs. In contrast, during that same time period, the condition of the medicated patients worsened, with only 6 percent in recovery and few holding jobs. At the 15-year follow-up, among the non-drug group, only 28 percent suffered from any psychotic symptoms; in contrast, among the medicated group, 64 percent were actively psychotic.

The year that Harrow’s study was published, Whitaker reports, "The NIMH issued 89 press releases, many on inconsequential matters. But it did not issue one on Harrow’s findings, even though his was arguably the best study of the long-term outcomes of schizophrenia patients that had ever been done in the United States." NIMH, like many U.S. government agencies, is beholden to industry, in this case Big Pharma, through revolving doors of employment.

Activists Win Battle to Get Whitaker Heard

Mainstream reviews of Anatomy of an Epidemic have been, with a few exceptions, conspicuously absent and Whitaker has been granted few mainstream media interviews. Moreover, at least one U.S. government agency has attempted to silence him, but people are fighting back and, in at least one case, winning.

The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), since 1985, has provided a grant to fund the Alternatives Conference, which brings together several hundred mental health consumers from throughout the United States. Alternatives Conference organizers in 2010 confirmed an invitation with Robert Whitaker as the keynote speaker. However, on July 15, 2010, organizers reported that Whitaker’s confirmation was retracted, saying they had received objections from U.S. government higher-ups.

The good news is that a grass-roots protest resulted in SAMHSA reversing its retraction and Whitaker was reinstated as the keynote speaker at the Alternatives 2010 Conference scheduled for September 29 through October 3 in Anaheim, California. The effective activism was spearheaded by MindFreedom, an organization composed of "psychiatric survivors" committed to reforming mental health treatment by providing Americans with truly informed choice and a variety of treatment options. Neither MindFreedom nor Whitaker are anti-drug. Both simply want Americans to be aware of the extensive body of research telling us that long-term psychiatric drug use has been, for many of its recipients, a bad idea. In the solutions section of Anatomy of an Epidemic, Whitaker describes how doctors in northern Finland use antipsychotic drugs sparingly and in an extremely selective, cautious manner when treating first-episode psychotic patients. Also, a variety of alternative therapies are provided and treatment decisions are made jointly with patients and their families. The results? "The long-term outcomes are," Whitaker notes, "by far, the best in the Western World."

The battle is clear. Will Anatomy of an Epidemic, like Rachel Carson’s Silent Spring, alert the nation to a tragedy created by an industry’s arrogant use of chemicals? Or will those who are profiting from the status quo be able to silence Whitaker and bury his book?

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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). His website is www.brucelevine.net.