February 28, 2012
"Anatomy of an Epidemic," by the award-winning journalist Robert Whitaker, is one of the most disturbing books I have read in a long time. Published in 2010, it argues that modern psychiatry may be harming many of those it purports to help. Indeed, according to Whitaker, American psychiatrists, together with the pharmaceutical industry, are perpetrating what may be the biggest case of iatrogenesis — harmful medical treatment — in history.
As recently as the 1950s, Whitaker contends, the four major mental disorders — depression, anxiety disorder, bipolar disorder and schizophrenia — often manifested as episodic and "self limiting"; that is, most people simply got better over time. Severe, chronic mental illness was viewed as relatively rare. But over the past few decades the proportion of Americans diagnosed with mental illness has skyrocketed. Since 1987, the percentage of the population receiving federal disability payments for mental illness has more than doubled; among children under the age of 18, the percentage has grown by a factor of 35.
This epidemic has coincided with a surge in prescriptions for psychiatric drugs. Between 1985 and 2008, sales of antidepressants and antipsychotics multiplied almost fiftyfold, to $24.2-billion. Prescriptions for bipolar disorder and anxiety have also swelled. One in eight Americans, including children and even toddlers, is now taking a psychotropic medication.
Whitaker acknowledges that antidepressants and other psychiatric medications often provide short-term relief, which explains why so many physicians and patients believe so fervently in the drugs' benefits. But over time, Whitaker argues, drugs make many patients sicker than they would have been if they had never been medicated.
Whitaker compiles anecdotal and clinical evidence that when patients stop taking SSRI's, they often experience depression more severe than what drove them to seek treatment. A multination report by the World Health Organization in 1998 associated long-term antidepressant usage with a higher rather than a lower risk of long-term depression. SSRI's cause a wide range of side effects, including insomnia, sexual dysfunction, apathy, suicidal impulses, and mania — which may then lead patients to be diagnosed with and treated for bipolar disorder.
Indeed, Whitaker suspects that antidepressants — as well as Ritalin and other stimulants prescribed for attention-deficit disorder — have catalyzed the recent spike in bipolar disorder. Though bipolar disorder was relatively rare just a half-century ago, reported rates of it have increased more than a hundredfold, to one in 40 adults. Side effects attributed to lithium and other common medications for bipolar disorder include deficits in memory, learning ability, and fine-motor skills. Similarly, benzodiazepines such as Valium and Xanax, which are prescribed for anxiety, are addictive; withdrawal from these sedatives can cause effects ranging from insomnia to seizures, as well as panic attacks.
Whitaker's analysis of treatments for schizophrenia is especially alarming. Antipsychotics, from Thorazine to successors like Zyprexa, cause weight gain, physical tremors (called tardive dyskinesia) and, according to some studies, cognitive decline and brain shrinkage. Over the past half-century, the rate of schizophrenia-related disability has grown by a factor of four.
A decades-long study by the World Health Organization found that schizophrenic patients fared better in poor nations, such as Nigeria and India, where antipsychotics are sparingly prescribed, than in wealthier regions such as the United States and Europe. A long-term study by Martin Harrow, a psychologist at the University of Illinois College of Medicine, found an inverse correlation between medication for schizophrenia and positive, long-term outcomes.
Objections have been raised to Whitaker's case against psychiatry. First of all, over time heavily medicated patients may not fare as well as less-medicated patients simply because the former are sicker. Also, the recent surge in mental disability may stem at least in part from a decrease in the stigma associated with mental illness, spurring more people to seek and obtain treatment and government assistance.
And yet Whitaker's claims, at the very least, warrant further investigation. That is why I am bringing him here to Stevens to give a talk on Wednesday, February 29, from 3 to 4:30 p.m. in the Babbio Center's ground-floor auditorium. If you or someone you know is taking a psychiatric medication, you should come and hear what Whitaker has to say.
John Horgan directs the Stevens Center for Science Writings, which is part of the College of Arts & Letters. This column is adapted from one originally published in The Chronicle of Higher Education.