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

by Robert Whitaker

Updated with bonus material, including a new foreword and afterword with new research, this New York Times bestseller is essential reading for a time when mental health is constantly in the news.In this astonishing and startling book, award-winning science and history writer Robert Whitaker investigates a medical Why has the number of disabled mentally ill in the United States tripled over the past two decades? Interwoven with Whitaker’s groundbreaking analysis of the merits of psychiatric medications are the personal stories of children and adults swept up in this epidemic. As Anatomy of an Epidemic reveals, other societies have begun to alter their use of psychiatric medications and are now reporting much improved outcomes . . . so why can’t such change happen here in the United States? Why have the results from these long-term studies—all of which point to the same startling conclusion—been kept from the public? 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.Praise for Anatomy of an Epidemic“The timing of Robert Whitaker’s Anatomy of an Epidemic, a comprehensive and highly readable history of psychiatry in the United States, couldn’t be better.”—Salon“Anatomy of an Epidemic offers some answers, charting controversial ground with mystery-novel pacing.”—TIME“Lucid, pointed and important, Anatomy of an Epidemic should be required reading for anyone considering extended use of psychiatric medicine. Whitaker is at the height of his powers.” —Greg Critser, author of Generation Rx

Genres: Psychology, Nonfiction, Science, Mental Health, Health, Medicine, Psychiatry

418 pages, Kindle Edition

First published April 13, 2010

About the author

There is more than one author in the Goodreads catalog with this name. This entry is for Robert {2^} Whitaker, medical and science writer.

Robert Whitaker, a journalist, writes primarily about medicine and science. He is the author of four books: Mad in America, The Mapmaker's Wife, On the Laps of Gods and Anatomy of an Epidemic.

His newspaper and magazine articles on the mentally ill and the pharmaceutical industry have garnered several national awards, including a George Polk Award for medical writing and a National Association of Science Writers Award for best magazine article.

A series he cowrote for the Boston Globe on the abuse of mental patients in research settings was named a finalist for the Pulitzer Prize in 1998.

Reviews

[Kennan · Rating 2 out of 5]

I would have given this book four stars if not for the fact that I felt the Mr. Whitaker was overly antagonistic in his writing, and at times even dishonest in his presentation of "facts."

His citations are frequently careless, and he cherry-picks not only the studies he presents, but also the which ones he provides access to through his website. At one point I checked a cited quote to find that he found it in a blurb on a book jacket! Unprofessional.

So much of this book, though, is true that it boggles my mind how easily Mr. Whitaker could have toned down his sarcasm and subtle asides to the point that the book could have been one for the ages. He attacks our culturally dichotomous perspective as simplistic, but in the end his is just as one-minded: psychiatry, broadly, is evil.

I see that there are a lot of high marks here for this book, and I think many of them come out of an attraction to Mr. Whitaker's skepticism than any other one thing. But skepticism shouldn't be safe from further skepticism just because it is so.

[K · Rating 4 out of 5]

I voted for two polarized reviews of this book -- one extolling its virtues, the other dismissing its arguments as simplistic. I suspect both are valid.

As a psychologist I frequently meet individuals of all ages who are taking psychotropic medication. Medication as an appropriate treatment option is unquestioned by most of the people I work with, although my colleagues often bemoan the fact that people prefer medication to therapy, thinking popping some pills will be a quick fix. I was required to learn about the range of psychotropic drugs available when I was in graduate school, memorizing their names, uses, and side effects. None of my professors or supervisors ever raised the question of whether the entire basis for prescribing psychotropic medication might be flawed.

The author of this book has an agenda, and doesn't cite counterarguments or counterevidence. That being said, this is a book that makes you sit up and take notice. Apparently Thorazine, the drug said to have kicked off the psychopharmacology revolution in the 1950s, was inadvertently discovered when a failed malaria medication was found to have sedating qualities. So in a context when frontal lobotomy was considered an appropriate and effective treatment for mental illness, and just as doctors were being newly granted prescription privileges and forging a new relationship with pharmacists, a rash of tranquilizers hit the market as a means of fighting mental illness. The whole mind-body question seemed to have been answered as people embraced the chemical imbalance theory of mental illness. While it seems to have been true that the new drugs affected brain chemistry, the question of whether mental illness was actually caused by a chemical imbalance was really not sufficiently explored. So were these drugs solving a problem, or creating one?

More drugs entered the market, and they seemed effective in the short run. Long-term outcomes were murkier, and even short-term outcome studies, upon examination, were frequently flawed and agenda-driven. Not to mention side effects and the possibility of long-term brain damage. Plus, as people relapsed whenever they went off their meds, and even when they were on them, the utility of these medications seemed questionable. Whitaker cites studies suggesting that mental illness outcomes were more positive before the introduction of medication, and notes that lots more people are collecting disability for mental illness today than ever before. So have the medications in fact helped us fight mental illness?

In the 1970s, it seems, people were actually becoming disillusioned with psychiatry, psychotropic medication, and the medical model of mental illness. Feeling threatened, the American Psychiatric Association revised the Freudian DSM-II and produced the DSM-III, which identified 265 psychiatric conditions. Although the biological underpinnings of mental illness remained unclear, the book was well-received and, according to Whitaker, launched a movement of scientific propaganda to promote the idea that mental illness was biochemical in nature and could be treated with psychotropic medication. The field was ripe for the introduction of Prozac and other newer psychotropic medications in the late 1980s, touted as miracle drugs despite appallingly shoddy research results. In the 1990s, with the popularization of childhood diagnoses like ADHD and childhood Bipolar disorder, prescribing these drugs to children took off.

Although this was a readable, intelligent, and persuasive book, I'm not ready to swallow Whitaker's arguments whole. He continues to insist that we don't have sufficient evidence to support the chemical imbalance theory of mental illness. Is that still true today, with the technological advances we have? If studies conducted today are failing to support the chemical imbalance theory, wouldn't this information get out? Are the pharmaceutical companies and psychiatrists so powerful that they can suppress news like that? And is Whitaker the first person to realize that research done by pharmaceutical companies carries an inherent conflict of interest? Has no one else ever thought of this, or taken steps to publish unbiased research on psychotropic medication?

Whitaker also claims that people who aren't prescribed psychotropic medication, or don't use this medication, have better outcomes than people who take psychotropic drugs. But might there be a selection bias there? What if the people who aren't receiving the prescriptions, or are choosing not to take them, are the people who are higher-functioning to begin with and whose problems are less pressing? Similarly, there's the age-old question of whether there's actually more mental illness today, or whether it simply went undiagnosed in earlier decades?

But here's what I think is true. I can see why popping a pill sounds more appealing, efficient, and cost-effective to everyone -- doctors, patients, parents -- than years of therapy. I can see why this might make doctors trigger-happy and prone to overdiagnosing and overprescribing, and well-meaning patients and parents eager to do what seems best. Medicine does seem more scientific and carry more authority than therapy, where so many human variables affect outcome. The psychiatrists I work with have said to me on more than one occasion that they think my job is much harder than theirs; certainly I wrestle with a lot of ambiguity and resistance in my work that doesn't seem to plague them as much. And I have memories of pharmaceutical companies showering my various workplaces with gifts and elaborate luncheons -- there's no doubt that marketing is a big priority for them, and that they would go to great lengths to promote their products.

So is this book agenda-driven? Yes. Simplistic? Somewhat. Whitaker acknowledges that psychotropic drugs were found to be more effective than placebos or no treatment for individuals with severe mental illness, and that it may be appropriate to prescribe these drugs judiciously for that population. So what he's saying is not black-and-white. When I was an intern, I was told that psychotropic medication was meant to be short-term, and was intended to make the client more accessible to therapy; with successful therapy, the client would learn missing skills and be weaned off of their medication. I think even Whitaker might agree with that particular use of medication in theory; unfortunately, I haven't seen it happen that way a lot in practice.

Whitaker cites a lot of compelling evidence. What I would like to see now is a good counterargument, also supported with solid evidence. Of course, if psychiatrists and pharmacists are in cahoots as Whitaker seems to suggest, that might be hard to find. But I'll be looking for it, and would welcome any recommendations.

[Stephanie *Eff your feelings* · Rating 4 out of 5]

Anatomy of an Epidemic is about the history of psychiatric drugs and the rise of mental illness in America right alongside these drugs development and evolution. 1'100 adults and CHILDREN are added to the government's disabled list for mental illness, daily. This didn't happen prior to 25 years ago, before big pharmaceutical companies saw $$ with the release of Prozac. Before Prozac , Eli-Lilly's biggest money maker was an antibiotic.

I realize many people have benefited from these drugs. They have pulled people out of very deep, menacing pits of hell. The issue is that people are put on these drugs to quickly, sometimes, which spurs an onslaught of more and more powerful drugs.

In Europe they prescribe, exercise first…… Huh……. Talk to the patient first, figure out what’s going on, and then lastly, prescribe drugs, if they are needed.
Manic depression used to be rare. They renamed it Bi-polar, and is much more common now. Why? Follow the money. Drug companies are in business for profit, so the more customers the better off they are. They downgraded the criteria that needed to be met for manic depression and renamed it bi-polar disorder, which gained them some new customers. Now, this new disease needs a magic bullet pill to fix the problem, presto! Money for the drug companies…..everybody is happy, until they have to take new drugs to fend off the side effects…..and those drugs have side effects…..and so on.

Kids as young as TWO are now being are prescribed psychotropic drugs. Two seems a bit too young to me to have brain altering chemicals in brains that aren’t nearly finished forming yet.

What some doctors are doing, and what I think should be done, is a much more cautious approach in the use for these drugs. First episode, do some talk therapy and prescribe exercise (proven to work by the way). If that doesn't do the trick, then drugs, low doses. Once balanced, get weaned off the drugs. No one is meant to be on these pills indefinitely. Eventually you become tolerant to what you are taking and then need something stronger, or additional. You can end up worse off than where you started.

And that, as the kids say, would suck.

[Lorri Coburn · Rating 4 out of 5]

Anatomy of an Epidemic gives facts and figures on the astonishing rise in social security disability cases due to mental illness. Whitaker makes a comparison between the advent of Prozac in 1987 and the subsequent 37-fold increase in disability cases. What I found interesting is that his observations, backed by data, paralleled my anecdotal observations in my psychotherapy practice. In fact, prior to reading this book I had planned on writing a book about the limits of psychotherapy, and had actually published an article on it. When I first started practicing, clients would be on one, maybe two medications, if any. By the time I finished, 25 years later, clients were routinely sent for medication, prescribed at least two meds, constantly switched when the initial honeymoon period of those meds wore off, and often ended up on 4-6 meds. One of my clients died from overmedication and I had attempted to get her off the meds to no avail. Further, the attitude that a patient needed to stay on meds for life became increasingly entrenched and promoted. Drug companies bought lunch for the clinical staff and gave inservices on new ways to use existing drugs. When the patent for Prozac was over, it was renamed Serafim and aggressively promoted as a treatment for PMMD, pre-menstrual dysphoric disorder, the old-fashioned PMS. What the drug companies did not tell you, but Whitaker shows and I saw, was that once on drugs it was really hard to get off. The brain got used to relying on the artificial manipulation of neurotransmitters and seemed to lose the ability to do its own work.

Whitaker gives fascinating details of an American Psychiatric Association conference that he attended, in which the presentations questioned the efficacy of medications. More and more reports are coming out about the adverse effects of anti-depressants and other psychotropic medications. He raises an important question: Why, when we have so many new and supposedly wonderful drugs, are there more people permanently disabled by mental illness than ever?

This is not to say there is not a place for medication, but that it is being over-prescribed and given to people who should be using behavioral, emotional, and spiritual interventions. I personally know a number of "normal" people who are on anti-depressants and/or anti-anxiety agents who don't really need to be, in my clinical opinion.

Anatomy of an epidemic is an important book that anyone considering taking psychotropic medication, or is already on those medications, should read.

[Jeffrey May · Rating 5 out of 5]

Medication Madness. A must read. Usually, I don’t open with my bottom line, but in this case, it should be stated up front – you absolutely must read this book. Since “one in every eight” of us “takes a psychiatric drug on a regular basis” you or someone you know will be profoundly influenced by Robert Whitaker’s Anatomy Of An Epidemic. Using thorough research, flawless logic, and an almost overwhelming number of studies, he reveals that psychiatric drugs are prescribed under false assumptions. Furthermore, these drugs are often detrimental, especially over the long haul. He traces the history, the motives, and the manipulation of media that has led us to accept that they are good for everything from mild depression to schizophrenia.

Conventional wisdom assumes that mental illness results from a chemical imbalance in the brain. However, Whitaker contends, compellingly so, that no evidence supports this claim. None. In case after case, he debunks this widely accepted notion and weaves this into his persuasive narrative. What he finds is that these drugs interrupt synaptic neurotransmissions; the brain then compensates in various ways to revive itself, to return to its pre-drugged transmissions. This accounts for such things as the delay period before the medication “works,” and various side effects such as mania, insomnia, suicidal ideation, and actual suicide. He shows us, with plenty of supporting data, that the treatment itself is a side effect, not a simple adjustment back to a “normal” or “balanced” brain.

Whitaker started his investigation wholly accepting of the seemingly rational view that these “magic bullet” pills worked (and I began reading with the same assumptions). He started on his investigative journey when reporting on what he considered medical abuse (psychiatrists withholding medicine from patients for research purposes). By asking “impertinent” questions, he began trying to explain how and why we so readily accept doctors prescribing a psychotropic drug just as they would an antibiotic.

I read Anatomy Of An Epidemic from start to finish and couldn’t put it down. However, even with Whitaker’s astounding ability to make this a compelling read, some readers may be daunted by the data, and the number of psychiatric terms. He acknowledges this and promises “not just a book of statistics.” He delivers, weaving in plenty of tragic and uplifting stories. For me, the terms didn’t interfere much, probably because I worked extensively with troubled teenagers and dispensed medicine throughout the day. (I was following doctors’ orders but whose orders were they following?) The medication seemed to help, at least in the short term. But Whitaker shows that efficacy of these drugs are based entirely on six-week trial periods, and statistics for long-term benefit show the opposite of what you might expect.

Whitaker presents a one-sided case. Given the depth and intractability of prevailing views, he has to. It takes just such a persuasive assault to effect even minor change. To his credit, he does not rule out the use of these medications entirely. He merely proposes that their use should be based on scientific fact. Seems reasonable enough. We can learn by studying the past, and Whitaker does an excellent job investigating the recent history of psychiatry and its relationship to pharmaceutical companies, government, and advocacy groups.

Most of us, professionals in medicine, education, parents, the public in general, have been duped. We have wholly swallowed this nicely packaged psychiatric pill. We unquestionably accept that these pills fix brain imbalance. When physicians suggest psychotropic drugs, we need to ask why. We need to ask for reasonable explanations. Robert Whitaker’s book Anatomy of an Epidemic provides a rock-solid foundation for asking these “impertinent” questions.

Jeffrey Penn May, author of Where the River Splits, No Teacher Left Standing, and others. Website - http://www.askwritefish.com

[michelle · Rating 2 out of 5]

This book pissed me off, but not in the way I think the author would have liked.

Personally I believe Whitaker is correct in that we are overmedicated and this is primarily because of the push by pharmaceutical companies and malleable doctors. I am also of the belief that children should only be medicated in the most extreme of circumstances, not at the slightest change in behaviour or mood.

However, he lost me due to the general tone he used when speaking about those of us who choose medication to treat our illness (and about mentally ill people in general); his apparent belief that getting off the medication is something that everyone can do or is in the privileged position to do; and his bloody awful writing.

I stuck with it because in some ways it reminded me of (the much better written) Prozac Backlash. While it has been many years since I first read that, I do remember it as being less ... evangelical. Whitaker has the aura of someone who thinks that everyone can be saved if only they believed the 'right' way. (He didn't really help his argument by talking about Scientology as though they aren't harmful to others.)

So, while I may agree with some of the basics of his argument, I do not recommend this book to educate yourself about the negatives of pharmaceuticals.

[Phoebe · Rating 2 out of 5]

I'm surprised to see so many people swallow these ideas whole. Take this book with a grain of salt.

[Amy · Rating 5 out of 5]

I found this fascinating read because it was recommended by Scientific American. Once I began I couldn't stop reading it or telling my husband everything about it. So many things I thought I knew about mental illness turn out to be wrong. Any study that has attempted to find a chemical imbalance in a population with schizophrenia or depression has failed to find one. Psychiatric drugs work by causing the brain to function abnormally, not by returning an abnormal brain to a normal state. Over time they can also exacerbate the symptoms they are supposed to fix. While medications may help, the author recommends that they never be the first or only treatment for mental illness, especially for children. His evidence is overwhelming and frightening.

[Colleen · Rating 5 out of 5]

I enjoyed this book because I was one of the adolescents put on Prozac in the 90s for my "social anxiety." I was 15 and so would begin 18 years of various drugs and dosages and cocktails to fix my "chemical imbalance." I was told that I suffered from a hereditary or genetic imbalance that I would have to manage my entire life with drugs. When they stopped working, the drug would be upped to an off label dose or a new drug given or added on top. I've been on them all, and none worked for very long or "cured me." I began suffering major depressive episodes in college that each time, would last longer than the last. If I missed a dose, my mood would plummet. I was no longer in control. Looking back, I wish that a doctor would have just seen that I was shy and being bullied- that there may have been other avenues to pursue instead of drugs. They may have been able to help me reduce public speaking anxiety instead of drugging me. Because yes, these drugs worked amazingly well in the short term. My entire personality changed, but this was never maintained long. For the first time in my life, I am going off these drugs and finding out who I really am in my 30s. I am afraid that these drugs may have caused permanent damage. These drugs may be instrumental in aiding some people, and may have many benefits for short term outcomes. But for me, no one talked of the end game. No one took responsibility for helping me maintain long term success or began a discussion on what the goals of my drug therapy were. I'm left on my own to figure this out, which to me, is the big failure of modern psychiatry. They made me into a consumer of a never ending supply of drugs, and not a single person challenged this paradigm or asked me what I really wanted. I was for years, told of all the horrible things that could happen if I stopped my medications. I wish they would have told me what horrible things could happen if I stayed on them. This book really highlighted all the fears I have been holding, and my growing suspicion that I was not one of those who needed long term maintenance of these drugs. It was frightening to read the actual studies and see that there really is absolutely no foundation for the basis of a lot of the claims made over the years, and even worse, the way they have hidden the outcomes and marginalized anyone who dared to ask the questions that so need to be asked. Modern medicine can work amazing wonders and treat so many diseases, and yet, there is the darker side of the influence of money that is so perfectly illustrated here, when profits come before good medicine and doctors become paid arms of the pharmaceutical industry.

[Kater Cheek · Rating 3 out of 5]

This book is written with an agenda, and I usually don't like one-sided arguments, but in this case, the argument is one that I was already disposed to believe: namely, that taking mind-altering drugs does not make a person mentally healthy. Anyone who knows me knows that I have a strong personal aversion to drugs of any sort (not you caffeine! You're different! BFF!) but I made an occasional exception in my anti-drug worldview for the case of anti-depressants, anti-psychotics and the like when clinically prescribed. After reading this book, I now look at the proscribing of ritalin and anti-depressants to children with the same horror that I previously reserved for those who gave mercury and leeches to people suffering from seasickness.

The book starts out with the history of psychology, and how it dovetailed into the "magic bullet" idea of medicine with the invention of the sulfa drugs. It talks about the invention of psychiactric drugs and how they not only provided new therapies, but catapulted psychiatry from the peripheries firmly into the sphere of science and medicine.

What follows is a rather harrowing account of sloughs of mind-altering drugs being promoted as the only solution to a growing medical epidemic of mental illness, when in fact, the author concludes, the medicines themselves turn what should be a one-time temporary condition into a life long debilitating disability. The epidemic is iatrogenic.

I have mixed feelings about promoting this book. Several members of my family have been on psychiatric drugs (ADHD diagnoses used to be all the rage in the eighties) and I would hate for them to feel regretful about a decision that wasn't theirs to make (go on drugs or not.) I also have some friends who have been on Xanax, Wellbutrin, Prozac, and the like, and feel that these drugs have helped them.

On the other hand, I think this is a must-read for anyone who is ever considering on going on psychiatric drugs for any reason. Schizophrenia and Bipolar disorder can be very serious, but the evidence presented here is of a giant drug company that has steamrolled the ADA into promoting their drugs as the cure for a serious illness, when in fact they have consistently failed to prove that their drugs are safe and/or effective. They have used their considerable financial might to shunt aside other, non-drug therapies which have proven more effective.

It has been suggested that this book is promoted by the Scientologists. I don't think there's a connection. (In fact, the author says that the fact that the Scientologists are so outspoken against psychiactric drugs was an amazing boon for Eli Lilly.) I know the Scientology people don't like psychologists (because they compete for customers), and those people can be a little kooky, but even a blind squirrel gets a nut once in a while.

The prose is good enough, though I will admit that even a well-read layperson is going to have issues with some of the neurological descriptions. It runs on a little long, because it's meant to be more of a comprehensive and well-backed argument than an entertaining non-fiction.

[Mehrsa · Rating 5 out of 5]

This book is fascinating and a must-read. I bet it will (or has) ruffled some feathers, but the animating question of the book is: hey, what if the SSRI revolution was all bunk and we would have been better off without it? He's not saying there is no such thing as depression or mental illness, but he is saying that the studies about whether SSRI's help are not conclusive. If anything, the findings have been manipulated and the facts show that maybe they have way too many side effects to make up for their benefits. The numbers are staggering--how many more SSRIs are prescribed year after year. Shouldn't a drug fix the problem it's trying to manage rather than perpetuate it? I don't know. I know SSRI's have helped many people I know and love, but I also know many people who were prescribed SSRI's when they were not clinically depressed.

[Lisa · Rating 1 out of 5]

This is a fallacious and alarmist piece of garbage. Read the actual research, rather than sentences taken out of context from multiple studies and pieced together to support his agenda.

[Ryan · Rating 2 out of 5]

If you're a scientologist, this is a really good, self-affirming book read. If you are a stats nerd, it's just manipulating research and data to serve a bias.

[Melody · Rating 4 out of 5]

An entirely damning look at the psychiatric profession, Big Pharma, NIMH and the epidemic of mental illness the combination has caused. Whitaker looks at rates of diagnosis of such currently common maladies as bipolar disorder, schizophrenia, anxiety and ADHD. He cites statistic after statistic showing how much better off most of the mentally ill are without medication, and in a terrifying chapter, focuses on what anti-depressants, anti-psychotics and ADHD drugs appear to be doing to the long-term mental health of our kids.

The way the brain reacts to the medicines discussed here is fascinating. Though fascinating seems a callous word to use in this case, inasmuch as the drugs seem to be doing damage that may never be able to be undone.

I expect Big Pharma to lie and manipulate and be generally evil. Frankly, I don't expect much more of psychiatry as a whole. But reading this and examining the data made me so sad and so angry and (dare I say it) so depressed.

I'll leave you with a quote from The Lancet dated 2004:

"The story of research into selective serotonin reuptake inhibitor use in childhood depression is one of confusion, manipulation, and institutional failure."

[Scott Meadows · Rating 4 out of 5]

Valuable information, a slog to push through, and incredibly awkward to think about in social situations. Yet another book that makes me dislike every news source, not trust a marketing company, or place any faith in someone who makes money through the western exploitation of the uneducated.

Must read quickly or you will loose interest. Give yourself permission to skim. Final chapter contained some interesting thoughts and approaches to soul care or children’s homes that actually work - without a cliche Christianese (cough baptist) foundation.

[Emily · Rating 5 out of 5]

This book changed my views of the modern world, revolutionized my thought process, and probably saved my life. Everyone should read this.

[Rise · Rating 5 out of 5]

I'm so angry about this I could spit nails. This is a must-read for anyone considering going on antidepressants. The author reveals that the drugs most commonly used in treating mental illness have been unsuccessful in improving the health and well-being of the people they were intended to help; more to the point, they have made people worse by permanently altering their brain functions, consigning many to a lifetime of medication cocktails. The psychological establishment and big pharma have successfully sold the narrative that these drugs "correct chemical imbalances in the brain" and are as necessary to the mentally ill "as insulin is to diabetics," but Whitaker analyzes (and meta-analyzes) the data, showing that none of these claims hold up under any scrutiny whatsoever. The study that troubled him most and led him to research and write this book concluded that people in developing countries like Nigeria and India had a better remission rate from schizophrenia than did people in the US. What's the difference? People in Nigeria and India are seldom medicated and are integrated into their communities. Here in the US, we medicate schizophrenics, call them dangers to themselves and others, hospitalize them, and segregate them from everyone else. Whitaker then describes a psychotherapeutic organization in Finland that listens to schizophrenics, assuming that they have valid complaints about their worlds, instead of medicating them, and enjoys great success at rehabilitating people. Whitaker also describes how people who have tried to tell the true story--that psychoactive medicines have harmed more than they have helped--have been silenced and pushed out of their professions by the medical establishment. I feel everyone should read this book, but I will warn you that if you are on antidepressants or antipsychotic medications and have been on them for any length of times, you may find this information too depressing.

[Kate · Rating 5 out of 5]

Oh my God! This book opened my eyes to the dangers of psychoactive medications, like antidepressants, and the cavalier attitude of psychiatry and the pharmaceutical industry to the damage they can potentially cause. Of course, most psychiatrists who have critiqued and commented on this book totally miss the point, and their objections to it are straw man objections. This book is good--I couldn't put it down, and it is so scary! A clear explanation as to why capitalism and medical care DO NOT MIX! If you are on any sort of anti-depressant--if your kid has been declared "bipolar"--if you have any psychiatric malady, read this!

[Dave Biggus · Rating 5 out of 5]

All I can say is: I had NO IDEA!. I'm familiar with the supposed science behind the chemical imbalance theory of psychiatric conditions. I think everyone's heard something along these lines: too much or too little dopamine, or serotonin, or other neurotransmitters can cause psychological problems. The medical basis for "you must be out of whack!" Only trouble is, it isn't known to be true! People aren't tested for, say, dopamine levels, and on the basis of that test given Ritalin. They are given Ritalin because of advice, from parents, teachers, licensed professionals. Then what happens?

Ritalin (methylphenidate) is basically cocaine, only slower acting. Instead of being out of your system in an hour, it is out in eight. Otherwise, there'd be bigger problems. As it is, the patient's brain tries to compensate for the flood of dopamine in the brain by releasing less of its own. And the re-uptake receptors start to shrink, in order to stem the increased flow. OK, but the results from all this dopamine are worthwhile?: increased focus, better behavior, less impulsivity. Maybe, and only in the short run. Studies show that after a few years, the person actually displays less focus and more impulsivity than before the meds. So, no big deal, stop taking them. Only problem with that is that it is very likely the brain cannot go back to it's former unaffected self. Which means less of the good side of dopamine (creativity, laughter, the highs of life) because there are (permanently) less receptors, and less natural dopamine released. We are left with a flat, sad person subject to many more mind games than if they were left alone in the first place.

So sad! What's worse, the heightened focus, followed by mini-crashes that every Ritalin user experiences to one degree or another is the same pattern as for bi-polorism. In fact, it sets the stage for it. In ten years, there was a forty fold increase in bipolarism!! (http://www.naturalnews.com/022676.html).

Whitaker did not start out to bash the pharmaceutical companies. He actually published a magazine to promote the best side of the industry. But the more he looked into what was happening, the more HE couldn't believe his eyes and ears. His work is thoroughly documented, and in his website he encourages further research (http://robertwhitaker.org/robertwhita...). Just the history of mental illness (which Whitaker explores in his book Mad in America) is worth this read.

The same effect happens with Ambien, Zoloft, schizophrenic medications, etc. The brain adjust to a flood of drugs by changing itself, permanently over time. The drugs are taken to correct an imbalance that is not tested for, and not known to cause the given malady. Other methods are shown to be superior than any long-term drug use. It is possible they can be an effective part of a short-term strategy, but it's also possible in the short-term someone could consider suicide, or have manic episodes, etc..

Is it worth it??

I am a firm believer in not taking any psychiatric medications. There are many other approaches to depression, anxiety, ADD, etc. Of course one of the best is adjusting your exercise and diet until you get more "in line" (whatever that may be for you or a loved one). If you know anyone who is on meds, or someone in their family, they should AT LEAST read this first.

[Justin · Rating 4 out of 5]

An excellent (albeit polemical at times) account of the modern history of mental illness in the United States, one whose prevalence has been largely driven (unsurprisingly) by artificial demand created by large pharmaceutical concerns, as well as by plain old backward-thinking.

While Anatomy is not a conclusive bit of scientific research, it nevertheless manages to fashion a convincing argument that suggests that our current "chemical imbalance in the brain" paradigm for mental illness is at best unsubstantiated, and at worst demonstrably wrong. What is substantiated, and what Whitaker spends a great deal of time on, are the long term effects of patients who remain on anti-depressant medications: the brain changes over the course of lengthy treatments, causing a feedback loop of side-effects which then in turn often cause new diagnoses (or worse, are seen to confirm the original diagnosis).

The reality is that many of the medications prescribed to umpteen millions of Americans are merely symptom deflectors; since certain anti-depressants were seen to increase serotonin levels, researchers began to posit that depression was caused by a deficiency of serotonin. This is, of course, backwards science, and yet, our modern selective serotonin re-uptake inhibitors (SSRIs) have all been designed, prescribed, sold, and consumed based on this premise. As another writer eloquently put it, it would be like arguing that fevers were caused by too little aspirin, or that the cause of all pain was a lack of opiates.

The disturbing fact is that modern psychiatry is largely constructed on an edifice of pseudo-science and vague generalities, as even a cursory glance at the latest edition the Diagnostic and Statistical Manual of Mental Disorders will show: the component symptoms of many mental illnesses are so omnipresent, that the creative psychiatrist can (and in many cases, does) create diagnoses out of whole cloth. This, combined with a multi-billion dollar pharmaceutical industry that skews research trials, co-opts the FDA, advertises relentlessly, and incentivizes the writing of prescriptions, makes this epidemic all the more outrageous for being largely self-inflicted.

[Laura · Rating 5 out of 5]

This book really shook this psychology major's worldview. I was taught in college that most psychological problems are because of a chemical imbalance in the brain and that psychiatric drugs are a useful and valuable tool in fixing these problems. This book quite convincingly lays out the evidence that this is not true. No researcher has ever been able to prove the "chemical imbalance" theory. Rather, psychiatric drugs create chemical imbalances in the brain (not fix them).

The author presents research on the three big areas in psychology - schizophrenia, depression, and bipolar disorder. He also discusses the use of anti-psychotics with kids with ADHD. In all cases, the research literature is pretty clear the drugs really don't work, and in most cases, do more harm than good . By the end of this book, I was frankly scared for all my friends and others I know who take psychiatric drugs - most for either depression or (if kids) for ADHD. The outcomes in the psychological literature are really sobering. I was also really outraged at the way the pharmaceutical companies have obscured/distorted research trials to make them come out even mildly positive in support of new drugs.

In short, I think every psychology major needs to read this book, along with anyone who is taking or considering taking psychiatric drugs (or giving them to their children).

Whitaker does not say that drugs don't have any place in a treatment regimen but rather, they need to be used as a last resort and used for as short amount of time as possible.

[Karina · Rating 5 out of 5]

OTHER RELATED INTERESTING TIDBITS

I think anyone interested in this book would also like the following article and the following film links:

How medical research is done and what it means (and DOESN'T mean):
http://www.theatlantic.com/magazine/a...

The idea that mental illness is caused by a chemical imbalance is not universally accepted. If you said that idea in Europe, they would look at you like you had 3 heads. In Finland, they are very successful treating schizophrenia, and most often without anti-psychotic medication:
http://www.youtube.com/watch?v=aBjIvn...


Robert Whitaker began his journey looking at psychiatric medications without an agenda - you could even say he was pro-medication. He is not anti-medication now, but he certainly sees how we are wrongly using and overusing these drugs in a way that is dangerous for patients as well as for society. Somebody here said in one review that he is "not a scientist," I guess meaning that he does not himself do research; but the man has the science of this down and he knows more biochemistry than I do (I am a "scientist" of the kind the reader was talking about). Through much learning, he came to the conclusions presented in the book. I wish everyone had his level of integrity.

[Wendy · Rating 2 out of 5]

Renewed this book from the library twice and read a few other books in the meantime and still couldn't get though it. Wanted to hear his argument but the heavy handedness of the first part made it difficult to get through. Maybe someday I'll get back to it and finish it. Until then, I'll continue to work with people on their emotions and relationships but also using meds when needed. Just because the psych meds we have now don't 'cure' doesn't mean they're not useful to relieve suffering and give someone a toe-hold on reality in order to do the psychological work to create long-term change.

[David M · Rating 5 out of 5]

Given that many American cities are now swarming with insane people, antipsychiatry’s reputation has suffered recently. Nonetheless the arguments in this book are shocking and compelling. I challenge anyone to read it and still argue that psychiatry is in any way a legitimate branch of science or medicine.

[Samuel · Rating 4 out of 5]

3.5 stars, rounded up. This book is an insightful look into the inner workings of psychiatric medicine and the serious flaws in the “science” behind such practices. I found myself getting frustrated that such mangled medicine could be so prevalent, especially when Whitaker gets into what actually happens when a person starts taking psychiatric medications and the dangerous consequences that result from it. This book gets very technical and digs deep into the history of psychiatry, so make sure you know what you’re getting into if you pick it up.

[Juliana Coppini · Rating 4 out of 5]

Simplesmente incrível. Um dos melhores livros que já li. Não dou cinco estrelas porque acredito que é um livro bem enviesado e que não traz referências tão atualizadas... Apesar disso, me fez repensar todo o modelo de cuidado que adotamos no âmbito da Saúde Mental, na maneira como muitos psicólogos se isentam e se colocam a parte da discussão, deixando-a a cargo apenas da Medicina. Por isso, acredito que todo psiquiatra e psicólogo deveria ler esse livro. Não como uma Bíblia - já temos o DSM rs - mas como uma porta de entrada a um debate essencial, para repensarmos os caminhos e tomarmos decisões mais honestas com nossos pacientes e, inclusive, como sociedade. Partimos de pressupostos absolutos e modelos biomédicos, tomamo-os como verdade inquestionável, validamos apenas um caminho como possível e criticamos todos que não o seguem - ou até mesmo o criticam - como antiéticos, anticientíficos ou irresponsáveis. Esse livro foi muito importante pra mim, porque me deu um pontapé inicial para buscar outras referências, pensar alternativas e me apresentar um debate que todos da área da Saúde Mental deveriam estar.

[Jeff Russo · Rating 5 out of 5]

I declare this a must-read.

Before reading this book, I had assumed that the "explosion" of mental illness over the last few decades was 100% pure diagnosis bloat and pursuit of government disability cheese. The truth appears to be much worse than that.

I won't repeat the book's summary but Whitaker's review of patient outcomes for the various "mental illnesses" with and without medication is damning. It's worse than damning.

I'm astonished at the incredibly flimsy pretexts for which children are given antidepressants and other psychoactive drugs (e.g. being a bit upset about going away to summer camp) and the certitude with which completely unproven theories are parroted by psychiatrists as they hand you your pills ("you have a chemical imbalance. These pills fix it. You'll need to take them for the rest of your life. It's kinda like taking insulin for diabetes.")

I'm not inclined to get emotional reading about the troubles of people I don't know, but some of the anecdotes in this book brought me very close.

Thank goodness I didn't end up on any of these poisons as a child. It's probably a combination of being born a few years too early, and having a bit of a superstitious mother who would be more inclined to execute a novena than take her child to a psychiatrist. In fact, after reading this I asked my mother if I had engaged in any behavior that may have gotten pills shoved down my throat were I a child today. She said, when I was of pre-kindergarten age, if I didn't get my way I'd bang my head into a wall repeatedly. She told this to our pediatrician, and he said "let him do it. When it hurts enough he'll stop." That was good, classic doctoring - sounds like such behavior would get a child on a three-drug cocktail today.

I suspect I also dodged a bullet (and by bullet, I mean getting put on these poisons) in my first semester of grad school; I was experiencing culture shock about being away from NJ for the first time, and I was struggling with my classes, and I kinda turned into a bitterman for a while. I'm glad that is was not my inclination then (nor is it now) to seek out a "mental health professional".

I can't pinpoint when and why I developed my skepticism of the mental-health industries. But it was a long time ago, and the more I research it the more my instincts have been validated.

Sorry, I seem to be talking more about me than the book. I'm more fired up than usual. The book is very good. Lots of excellent historical stuff around the whole evolution of "mental health" in the 20th century.

Is this a balanced book, giving a detailed presentation of an opposing argument? No. (Assuming that a credible opposing argument exists.) In that sense, it may only deserve to be a four-star book. But I think the ideas contained in this book deserve promotion.

[Zosia · Rating 1 out of 5]

ale gówno

[Michelle · Rating 5 out of 5]

It is no exaggeration to say Anatomy of an Epidemic is one of the most important books of our times. Imagine a dystopian future where 1 in 6 adults in the United states and 1 in 12 children regularly consume a psychoactive substance which has been associated with shortened lifespans and worsened long term outcomes. When they attempt to discontinue taking this substance, they experience problems worse than and sometimes completely different from any issues they’ve ever previously experienced, including suicidality and personality changes. This dystopian future is actually the current state of affairs in the United States. Millions of people around the world are taking psychiatric “medications” which worsen the problems they purport to treat and cause chemical dependence and harm with long term use. Every year the number of people taking SSRIs, antipsychotics, stimulants, or similar drugs increases because severe withdrawal symptoms prevent people from coming off the drugs even when they desire to. Driving this epidemic is corporate greed from the pharmaceutical industry (from the same people who brought you the opioid epidemic…) and psychiatry, a pseudo-medical field that prioritizes short term outcomes and is all-to-willing to pathologize normal human emotions.

But wait, you say. Depression/bipolar/schizophrenia/ADHD are real diseases (the DSM even says so, and the DSM could never be wrong or motivated by anything other than the purest of intentions). Couldn’t it be the case that people with mental illnesses who take medication will have worse long term outcomes than people without mental illnesses because of the illness, not the medication? Besides, in order to get FDA approval to sell the drugs, randomized, double blinded studies have been done showing these medications are effective in the short term (though many are barely better than placebos (285), and also, the FDA don’t have to publish trials that don’t show their antidepressants work— in an SSRI-related lawsuit it was revealed that 12 of 15 pediatric antidepressant trials that were conducted had failed (230)). It may be the case that the numbers of disabled mentally ill in the United States are rising (the number of disabled mentally ill children rose by a factor of 35 from 1987 to 2007 (8) even while the numbers of children disabled due to other illnesses like cancer decreased during this time period) but what if that’s because of reduced stigma around mental illness and better detection of it in recent times? Without a randomized, double blind study, how can we know whether negative long term outcomes for mentally ill patients are due to their underlying illness, or, as Whitaker claims, due to their treatments?

It’s true and unfortunate that many of the studies that Whitaker presents showing worsened long term outcomes for the mentally ill taking medication only associate medication use with worse long term outcomes rather than showing the medication causes the worse long term outcomes. However in the few long term randomized, double blind studies that do exist, we do see worsened outcomes for medicated vs unmedicated patients (99-101). In one case, 80 schizophrenic patients were randomized to either placebo or antipsychotic, and treated for six weeks in a mental hospital. After the six weeks the patients were released, and during the following three years, some of the placebo-treated patients went on medication and some of the medication-treated patients came off. But at the end of three years, the percentage of patients who had been initially randomized to a placebo who relapsed was only 27% while the percentage of patients who had been initially randomized to an antipsychotic who relapsed was 61% (if I’ve done my math right, that’s a one-tailed p value of 0.0007 for a null hypothesis that there are no differences in relapse rate between the medication-treated and the placebo-treated). Another study which shows worse long term outcomes for schizophrenic patients taking antipsychotics in a randomized double blind study is discussed on page 370. There are also many random, double blind animal studies which show negative long term effects and pathological changes to the brain after exposure to psychiatric medications (76 - rats exposed to antipsychotic medications have persistently upregulated D2 receptors). “In 1984, Swedish physician Lars Martensson… summed up the devastating bottom line, ‘The use of neuroleptics is a trap,’ he said, ‘It is like having a psychosis-inducing agent built into the brain’.” (107)

The evidence against psychiatric drugs is damning at this point. The only questions left are: how many more people will have to needlessly suffer before people are fully and completely informed about psychiatric medication risks and long term harm? Before we stop handing out these drugs to children like candy? And before we take the pharmaceutical industry to task for the immense harm it’s caused?

Misc. quotes:
- “Antidepressant drugs in depression might be beneficial in the short term, but worsen the progression of the disease in the long term, by increasing the biochemical vulnerability to depression… Use of antidepressant drugs may propel the illness to a more malignant and treatment unresponsive course.” (160)
- The story of how longer term clinical trial data which showed worse outcomes from alprazolam was ignored so that the drug would get approved will make you physically ill, (298)
- “Exposure to antidepressants, wrote German physician H. P. Hoheisel in 1966, appeared to be ‘shortening the intervals’ between depressive episodes in his patients.” (157)
- “If you expand the boundaries of mental illness, which is clearly what has happened in this country during the past twenty-five years, and you treat the people so diagnosed with psychiatric medications, do you run the risk of turning an angst-ridden teenager into a lifelong mental patient?” (30)
- “Over the short term, those who take an antidepressant will likely see their symptoms lessen. They will see this as proof that the drugs work, as will their doctors. However, this short-term amelioration of symptoms is not markedly greater than what is seen in patients treated with a placebo, and this initial use also puts them onto a problematic long-term course. If they stop taking the medication, they are at high risk of relapsing. But if they stay on the drugs, they will also likely suffer recurrent episodes of depression, and this chronicity increases the risk they will become disabled.” (170)

[Bobby James · Rating 4 out of 5]

Some surprising things in this one. Well-researched. Painfully detailed. Another contribution to my growing antipathy to modern psychiatric practice.

His documentation of the history of mental illness and psychiatric medication is extensive and fascinating. The rise of some of our present methods and medications seem to be due to a learning curve in some ways but in many, MANY other ways it seems we haven’t learned at all.

The PR controversy between Eli Lilly and the “church” of Scientology was fascinating. And explains a lot of the sensitivity around psychiatric medicine. And explains why it’s so universally accepted at every level. Because, in that controversy, those who oppose psychiatric medication were branded as cult fanatics while the other side were marketed as rational scientists.

He gives a few more anecdotal stories than I would’ve liked but I don’t think they’re necessarily anecdotal given how much research he’s done and so they serve his argument well.

This very much reinforced my belief that the modern psychiatric methods (as well as social media which Whitaker does not address) are in fact contributing to the mental health epidemic we find ourselves in. It’s a tragedy that the country’s iatrogenic deteriorating mental health is now encroaching on children. And contrary to the advent and current use of psychiatric medication there is no such thing as a so-called “magic bullet.”