Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America
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Now with bonus material, including a new foreword and afterword with updated research
In this astonishing and startling book, award-winning science and history writer Robert Whitaker investigates a medical mystery: Why has the number of disabled mentally ill in the United States tripled over the past two decades? Every day, 1,100 adults and children are added to the government disability rolls because they have become newly disabled by mental illness, with this epidemic spreading most rapidly among our nation’s children. What is going on?
Anatomy of an Epidemic challenges readers to think through that question themselves. First, Whitaker investigates what is known today about the biological causes of mental disorders. Do psychiatric medications fix “chemical imbalances” in the brain, or do they, in fact, create them? Researchers spent decades studying that question, and by the late 1980s, they had their answer. Readers will be startled—and dismayed—to discover what was reported in the scientific journals.
Then comes the scientific query at the heart of this book: During the past fifty years, when investigators looked at how psychiatric drugs affected long-term outcomes, what did they find? Did they discover that the drugs help people stay well? Function better? Enjoy good physical health? Or did they find that these medications, for some paradoxical reason, increase the likelihood that people will become chronically ill, less able to function well, more prone to physical illness?
This is the first book to look at the merits of psychiatric medications through the prism of long-term results. Are long-term recovery rates higher for medicated or unmedicated schizophrenia patients? Does taking an antidepressant decrease or increase the risk that a depressed person will become disabled by the disorder? Do bipolar patients fare better today than they did forty years ago, or much worse? When the National Institute of Mental Health (NIMH) studied the long-term outcomes of children with ADHD, did they determine that stimulants provide any benefit?
By the end of this review of the outcomes literature, readers are certain to have a haunting question of their own: Why have the results from these long-term studies—all of which point to the same startling conclusion—been kept from the public?
In this compelling history, Whitaker also tells the personal stories of children and adults swept up in this epidemic. Finally, he reports on innovative programs of psychiatric care in Europe and the United States that are producing good long-term outcomes. Our nation has been hit by an epidemic of disabling mental illness, and yet, as Anatomy of an Epidemic reveals, the medical blueprints for curbing that epidemic have already been drawn up.
two-year-old daughter is sleeping in the next room. With her freckles and slightly frizzy hair, and evident zest for life, Dorea seems like someone who might have been a bit of a mischievous child, and to a certain extent, that is how she remembers herself. “I was extremely smart, at the far end of that spectrum, and so I was the geeky kid. But I had friends. I was skillful at social navigation—I was also the funny kid.” If there was one thing amiss in her life as a child, it was that she was
their hypothesis. In 1982, they reported that 30 percent of 216 schizophrenia outpatients they studied showed signs of tardive psychosis.36 They also observed that it tended to afflict those patients who, at initial diagnosis, had a “good prognosis,” and thus would have had a chance to fare well over the long term if they had never been exposed to neuroleptics. These were the “placebo responders” who had fared best in the studies conducted by Rappaport and Mosher, and now Chouinard and Jones were
this was going to solve my anxiety problem. It absolutely worked for me. I felt great.” Hal’s life since then is a story of addiction. Shortly after going on the drug, he moved to San Francisco to pursue a career as a musician, and for a time it went well—he even got to hang out with Carlos Santana, the great guitarist. But his music career failed to take off, and today he thinks that the Klonopin was partly to blame, for it stifled his ambition and didn’t help his finger dexterity, either.
were only moderately ill, and yet fewer than 20 percent remitted and stayed well for a year. “Most individuals with major depressive disorders have a chronic course, often with considerable symptomatology and disability even between episodes,” the investigators concluded.53 In the short span of forty years, depression had been utterly transformed. Prior to the arrival of the drugs, it had been a fairly rare disorder, and outcomes generally were good. Patients and their families could be
with an older student who was “totally psychotic” and she began using illicit drugs—Ecstasy, acid, mushrooms, and nitrous oxide. Her sense of self began to crumble, and after a summer of talk therapy left her more confused than ever, she was hospitalized for psychotic depression. When she was released, she had prescriptions for an antipsychotic, an antidepressant, and a benzodiazepine (Xanax). “None of those drugs helped me,” she says. “They numbed me out, and trying to get off Xanax was a