ANATOMY OF AN EPIDEMIC:
Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America
“I suppose, if your only tool is a hammer, it's tempting to treat everything as if it were a nail.” – Abraham Maslow
Whitaker introduces the book, explains how he ended up in this complicated position (13 minute mark to the 23:25 mark**) and rushes to scratch the surface of the science before running out of time. (WGBH Boston, 2010.)
[ Note: The book's a thorough, nuanced, big picture and in-depth examination of the long-term biology, bio-chemistry, epidemiology and politics at play... and it's a million miles from the straw-man its critics have tried to make of it.
In fact, Whitaker actually does a significantly better job of explaining (and thereby, inadvertently supporting) the precise effects, biochemistry and utility of psych-drugs than anyone I've seen, heard or read in 18+ years of interest. [ *-* See the note(s) at the bottom of the page.]
Here's how he sums up the driving question of the book: “We know that many people are helped by psychiatric medications. We know that many people stabilize well on them and will personally attest to how the drugs have helped them lead normal lives. Yet, during the past 20 years, a period during which our society has embraced the use of psychiatric medications, the number of people on [US] government disability due to mental illness has tripled, from 1.25 million to 4 million. And so I ask this question, specifically noting that it is heretical in kind: Could our drug-based paradigm of care, in some unforeseen way, be fueling this modern-day plague?”
[ emphasis added ]
Ultimately he makes one hell of a compelling case for more comprehensive approaches to treatment, diagnosis and healing --- without throwing effective drug use under the bus. ]
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“This is the most alarming book I’ve read in years. The approach is neither polemical nor ideologically slanted. Relying on medical evidence and historical documentation, Whitaker builds his case like a prosecuting attorney.” — Carl Elliott, M.D., Ph.D., Professor, Center for Bioethics, University of Minnesota
“There is nothing unorthodox here—this case is solid and evidence-backed. If psychiatry wants to retain its credibility with the public, it will now have to engage with the scientific argument at the core of this cogently and elegantly written book.” — David Healy, M.D., Professor of Psychiatry, Cardiff University
“A devastating critique. . . . One day, we will look back at the way we think about and treat mental illness and wonder if we were all mad. Anatomy of an Epidemic should be required reading for both patients and physicians.” — Shannon Brownlee, Senior Research Fellow, New America Foundation; Author of Overtreated
**If you're interested in the material the first 24 minutes (of the above video) are a good place to start, but much of the rest of the science discussed (i.e. antipsychotics as a case study for the larger problem***) is improved in the Vermont video, posted a little ways down.
(In Vermont he's less rushed, and more practiced and up to date.)
{ Links: A.B.E. (hardcover/1st edition), Chapters (softcover), Amazon ...
Btw: "Brilliance Audiobooks" did a less-than brilliant job of selecting the right reader for the material... Wouldn't recommend it.}
***re. withdrawal–relapse; using anti-psychotics, and dopamine, for example:
It's now fairly widely known that antipsychotic (neuroleptic) withdrawal can and does trigger psychotic behaviour in and of itself — even in people with absolutely no previous history of mental illness.
This happens because (1st) the drugs put the emergency brake on dopamine neurotransmitter biochemistry; (2nd) the brain responds by hitting the gas, through gene regulation and neuroplasticity — to try to maintain as much normal function as possible; then, upon withdrawal, the drugs are metabolized away much faster than the brain's (slow) neuroplastic responce — so the dopamine systems are left in an unnerving, peddle-to-the-metal twilight-zone.*✝*
And because it usually takes weeks and weeks (or months) for even the healthiest and nimblest of brains to BEGIN to re-calibrate, both withdrawal and abrupt change regularly produce TERRIBLE results — in almost all classes and brands of psych-drugs. (E.g. SSRI's, stimulants, etc*✝* )
[Scroll down, see the Vermont talk and / or *✝*the footnote 3/4ths down.]
[ Answering the Critics | Behavioural Therapy for Depression, Stephen Ilardi | 15 minute shotgun profile of the science, and paradigm shift, re depression and anti-depressants (Whitaker in Maryland, 2011) | Bird's eye-view of a complex book, Sunday Edition w. M. Enright | John Oliver: 'Marketing to Doctors' ]
Psychotropic drugs and kids, on WGBH Boston (2010)
Note: The 2013 ADHD talk (down the page) covers a lot of the same material but focuses on just ADHD, is slightly more up-to-date and, (as with the Vermont talk, below) Whitaker's slightly more practised, relaxed and careful presenting.
Incidentally — because he touches on the subject of SSRIs here — the story of how Eli-Lilly brought Prozac to market (the first "second generation" SSRI "wonder drug") and how shoddy some of its original scientific underpinnings were is — if you're interested in the story — must read material.** (Anatomy of an Epidemic, Chapter 14, pgs 284-295.)
**Ps: Here's the guy who first broke the story, Dr Peter Breggin, testifying to the US House Committee on Veterans' Affairs on SSRI induced** suicide, mania, violence and bi-polar (26 minutes).
Breggin's one of the most high-profile, unorthodox academic Psychiatrists around; part counter-cultural idealist, part behavioural psychotherapist.
He's been at odds with a lot of contemporary — drugs, drugs and more drugs — psychiatry for most of his career...
(And his critics — Eli Lilly et al. — tried hard to systematically paint him as a scientologist quack.)
**See Breggin's collection of articles, D. Healy, J. Moncrieff, (said brilliant book) etc., to see how — and why — this increased suicide, violence, mania and bi-polar risk story is, tragically, anything but scientology.
[** Unfortunately it's not just correlation that violence, mania and suicide risks peak during withdrawal, and when starting a drug or changing a prescription. Rather, in a significant percentage of cases it's a direct consequence of drug-induced abnormalities — which peak at these exact times. (Immediately AFTER a med increase, change and or withdrawal.)[ 1, 2, 3...] ]
Antipsychotics, bi-polar, Hippocrates, and an informative discussion with the audience; Brattleboro, Vermont. (March, 2014.)
(Fyi: The first 10 minutes is just the usual boiler-plate intro to the big picture disability epidemic... And again, 75% of the antipsychotic science is a repeat of the 2010 talk (but here he brings the story up to date, discusses iatrogenic cognitive decline, and has more time, and practice, presenting the material.)
[update: Here's a recent (2016) student Q & A on the same material (right up to date).]
ADHD and long-term outcomes in children; on WGBH, Boston (2013.)
[Again, this talk covers a lot of the same material as the 2010 children's discussion (up the page), but focuses mostly on ADHD, is more polished, and slightly more up to date.)
Footnote(s)
*✝* re. Withdrawal (aka "discontinuation syndrome"), with respect to most psychiatric drugs: Again, because the brain's re-calibration process is so painstakingly slow (dependent on gene regulation and neuroplasticity), most of us have been bamboozled into thinking many disturbing and longer-term withdrawal effects are entirely “underlying illness”, rather than pernicious biological dependence — that's often the case. (i.e. Drug-altered receptor density, size and/or super-sensitivity.)
Accordingly, way too many otherwise healthy people are withdrawn from their medication way too abruptly; Which leaves the drug-conditioned neurotransmitter systems grasping at straws for some semblance of normal function; Which, in turn, regularly sends recovered, balanced and optimistic patients into one brand or another of prolonged, iatrogenic regression.
Which, again — and not surprisingly — too often triggers a downward spiral, a severe relapse, and/or a new extreme in mania, depression, psychosis and or anxiety.*✝*
(And again [contrary to popular belief], often this has little or nothing to do with underlying illness, and everything to do with how the drugs — and our brains — actually work.)
[ *✝*btw: most well informed withdrawal prescriptions now follow very slow, calculated and cautious protocols for tapering-off much more gradually than was traditionally the case. (E.g. As many as a dozen incremental dose reductions*, and as long as a month of clear stability, each reduction; in accordance with the limitations of the brain's neuroplastic, gene-regulated, re-calibration response.)
(And fyi: Optimum recovery, post withdrawal, is often a multi-year process.)
Addendums
[ Again: Answering the critics (4 links)]
Irving Kirsch on Antidepressants vs Placebos for the treatment of depression and anxiety, at U of Missouri. (March, 2014.)
The lengthy Q & A afterwards is excellent, btw.
"Depression is a disease of modern civilization."
Depression researcher Stephen Ilardi begins to explain some behavioural therapy interventions for combating depression and anxiety*. (At TEDxEmoryUniversity, Kansas City.)
[*And here's a more complete, 1 hr and 46 minute discussion of his material.]
*note: thankfully Ilardi's not depressing or stigmatizing.
Much Lighter, Also Brilliant:
Last Week Tonight with John Oliver: Marketing to Doctors (HBO)
*-*(ps) My mom worked as a psychiatric nurse for more than 25 years,
And it was her prescient, professional misgivings — about over-medicating the vulnerable, and worsening outcomes — that started me, very reluctantly, down the long road to this seemingly paradoxical and widely misunderstood material.*
Then, back in '99-2000 I worked as a high-end audio/video technician out of the Canadian corporate–conference leader's max schmooze Banff / Bow-Valley office. (Before Alberta's good reputation, and the afterglow of the 88 Olympics began to get tarred and feathered...) *-* And after serving as a fly-on-the-wall at one 3-day solo gig — helping a billionaire pharmaceutical client's select Canadian Psychiatric 'thought leaders' learn about prescribing psych-drugs to children (HERE) — I can assure you, 'meatball subs' from undereducated footsoldiers✝ is DEFINITELY NOT how wily pharmaceutical marketing execs make their real bones. [✝see Oliver, above]
(That became really clear after a couple evenings in the hot-tub, the cigar lounge, our private wood-fired cabins... and a few days of peer-to-peer discussion.
Peer-to-peer discussion that justified, legitimized (camouflaged), and set the stage for the true — subtle — purpose of the event: the smoothest (short and sweet) gut-shot soft-sell I'd ever seen. Followed-up, leisurely, with some private murder-mystery diner theatre, parachuted-in for a feel-good chaser.
[ Note the golden rule of marketing and sales:
"People don't remember what you say (or do), they remember how you make them feel." ]
I recorded the discussions, manned the microphone levels and, as usual, soaked-up a fair bit of disparate knowledge — sifted from hubris and b.s.
Speaking of which, the best spare-no-expense data my soft-sales master could muster (and pitch), showed what I at the time thought were OUTRAGEOUSLY LARGE placebo effects — in all categories of diagnosis. Like 80 to 85% in depression and anxiety.
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[*pps: Again — just to be clear: Whitaker's book has NOTHING to do with throwing effective drug use under the bus.]
[...Speaking of effective drug use:
Ben Goldacre: 'What doctors don't know about drugs' (Ted Talk)]
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(Thanks for your interest,
and all the best.)
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