Previously I reviewed the book Overtreated which explains why too much medicine is making us sicker. Robert Whitaker’s book Anatomy of an Epidemic explains why too much reliance on psychoactive drugs is making us crazier.
This seems like the right time for a book on treatments for mental illness. With today’s increased public concern about mental illness that leads to violence, evidence that our current treatments may be making the problem worse should worry us all. On a personal note, I have ties to four people who committed suicide. All were under doctors’ care when they died and had been for a long time. That seems hard to accept in the world of modern medicine.
Whitaker concentrates on the illnesses of schizophrenia, bipolar disorder, and depression. He once accepted the common wisdom that imbalances in brain chemistry cause mental illness and that the latest drugs help these patients “like insulin for diabetes”. While researching the book, he found evidence that the outcome for patients with mental illnesses has been getting worse over time in the United State and most other wealthy countries despite the medicines available.
The statistics Whitaker presents are scary. He documents the increasing number of people in the U.S. on Social Security Disability because of mental illness. The numbers have soared to 1 in every 76 Americans; six times the per-capita rate in 1955. Mental illness has become the leading cause of disability in children. (Whitaker acknowledges the differences that exist between 1955 and today. He shows that, despite the differences, the trend is real.) “The GAO, in its June 2008 report, concluded that one in every sixteen young adults in the United States is now ‘seriously mentally ill’.” The “mind-boggling” increase in mental illness has occurred in tandem with the use of more and newer psychoactive drugs. Whitaker explores whether the drugs are causing the epidemic.
Whitaker presents many stories of individuals’ treatments as they descend into mental illnesses. Psychoactive drugs are very powerful and cause physical changes in the brain. Patients who wean themselves from the drugs call the experience “pure hell”. He acknowledges that stories can’t provide proof; they serve to raise the questions America must address.
Drugs provide an initial reduction in symptoms, but with substantial side effects. The physical effects are bad enough: stiff muscles, drooling, weight-gain, damage to motor control, dizziness, constipation, difficulty urinating, and perverse skin sensations. But the mental side effects are as bad as the patients’ initial symptoms: chronic confusion, depression, suicidal thoughts, bipolar episodes, and psychosis. Patients may become so passive they cannot take care of themselves; one patient describes the feeling as “wearing a wet wool coat”. Side effects are common, even universal over time.
The long-accepted model of mental illness hypothesizes it is caused by imbalances in brain chemistry. Whitaker reviews research that has demonstrated this model is false. Consider one study, where patients who initially received a placebo were less likely to be rehospitalized than patients who received a cocktail of three psychoactive drugs. In another example, a brain chemical related to serotonin had been found to be at low levels in eight depressed patients (a very small study!). This was the basis for using drugs to elevate those levels. But, after fifteen years of research, scientists failed to find a statistically significant difference in the levels between depressed and normal individuals. Indeed, “depressed patients who had not been exposed to antidepressants had perfectly normal… levels.”
This does not mean people with mental illness should not be treated or even that all drugs are bad. In the 1970s, Finland had one of the highest rates of schizophrenia in Europe, and patients regularly became chronically ill. “But today the long-term outcome… [is] the best in the Western world” thanks to “need-adapted” treatment which includes “open dialogue therapy”. “Psychosis teams” which include two or three medical personnel treat the patient, and the patient’s family is included. Treatment may include low doses of drugs on a temporary basis. I tried to summarize this treatment, but anything I write leaves out important information, so please read the book if you are interested.
Why are we so willing to accept drugs to treat mental illness? The initial symptoms are frightening to patients and their families, so anything that stops those symptoms seems “to work”. The paradox is that drugs that work in the short-term make long-term mental health worse.
The mental illness epidemic is alarming and our resistance to the research Whitaker presents is puzzling. Once a standard treatment is established, is it impervious to new evidence? Are drug company profits so important we no longer see human beings suffering? Do patients demand drugs? If the science is so clear, how could any doctor condemn a patient to a life of misery by prescribing the overuse of drugs?
The economic impact of placing millions of Americans on disability is enormous, but the human tragedy is horrifying. Whitaker says that science shows us a way out of this man-made epidemic. We should not keep doubling-down on a failed treatment approach.
A word of caution: this book is not a treatment plan, and neither is this review!
PS: You should also read some of the negative reviews on Amazon. Not everyone agrees with Whitaker’s interpretation of various studies. If the science was so clear, I’d have to believe doctors don’t care about their patients, and that seems incredible. There is no easy answer to mental illness and all of us should realize there is no magic pill.