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Anatomy of an Epidemic

Dear Readers,

This book presents the mounting evidence demonstrating that psychotropic drugs may be prime culprits in the epidemic of mental health disorders in developed countries. By disrupting normal brain function, they might, rather than curing mental health conditions like anxiety and depression, be turning them into intractable chronic problems. It’s well worth reading for anyone considering long-term use of these drugs.

Dawson Church.

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America

Robert Whitaker

Crown, 2011

404 pages. Softcover.

$15. ISBN 978-0307452429

This book makes a startling claim, which on the face of it seems absurd: that psychotropic drugs have fueled an increase in mental disease over the course of the past fifty years. Yet piece by piece, study by study, a troubling picture emerges. In the case of schizophrenia, US government figures show that, in 1955, 1 American in 468 was disabled by the disease. In 1987, it was 1 in 184. In 2007, it was 1 in 76. Combing through government records, he finds the same pattern for other mental diseases. At a time when disability from many other diseases is declining due to increased prevention and better medical care, mental health cases are rising, and the epidemic began when drugs were introduced into treatment. 

The author is an award-winning science writer who was a former advocate of psychotropic drugs. He believed that they were “like insulin for diabetics.” However, he was troubled by two disturbing pieces of evidence that just didn’t fit his worldview. One was that mentally ill patients in third-world countries, who were not treated with drugs, usually had much better outcomes than sufferers in Western societies. The second was that if drugs were a great advance in medicine, mental illness should be declining. Yet it was increasing, and that increase occurred in conjunction with the rise in prescriptions. He began to dig deeper, and discovered studies showing that unmedicated patients usually had better outcomes than medicated ones. He found evidence showing that bipolar disorder, for instance, is often triggered by antidepressants.

If mental illness is indeed often caused by drug treatments, what is the mechanism by which this occurs? The book cites sources which show that when, for example, serotonin receptors are blocked by an SSRI, the body tries to reopen the normal neurotransmitter signaling pathways. This attempt at restoring homeostasis is blocked by the drug, which changes the way the brain functions. The receptors may remain blocked even after the drug is discontinued, since the drug has resulted in abnormal brain function. Another piece of neural evidence is fMRI studies showing that the frontal lobes of patients on medication often shrink. As neural pathways decay, cognitive functioning declines. Many mental illnesses that were historically regarded a short-term are now chronic. 

He devotes considerable attention to the role large pharmaceutical companies have played in the drama. The clinical trials upon which they rely for FDA approval often last just a few weeks, after which the drug may be found efficacious by investigators. Yet patients may not agree. A trial of a drug for ADHD might be judged successful by observers if children’s behavior becomes calmer, but the child might feel worse. He also shows how, in some trials, investigators attributed adverse events like suicides not to the drug, but to the mental illness itself. After these brief trials, the drug is then prescribed to large numbers of patients, for far longer periods of time than those analyzed by clinical trials. Side effects might not show up for years, and be irreversible.

In his final analysis, the author underscores that some medications are useful and have a legitimate role in the treatment of some patients as part of a comprehensive regimen. He advocates the cautious and selective use of medication, and points to several successful treatment programs that do precisely this. However, for those to whom the idea of drugs as agents of mental illness is unfamiliar, this book comes as a shock. It makes the non-invasive behavioral treatments found in energy psychology seem even more compelling than they already are.