[PAA-Discuss] Fwd: Levine - A Conversation with Robert Whitaker - The Astonishing Rise of Mental Illness in America

[rebelljb at aol.com]

-----Original Message-----
From: Vince Boehm <vince_19805 at yahoo.com>
To: undisclosed-recipients: ;
Sent: Wed, Apr 28, 2010 3:07 pm
Subject: Levine - A Conversation with Robert Whitaker - The Astonishing 
Rise of Mental Illness in America



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Robert Whitaker's new book, Anatomy of an Epidemic: Magic Bullets, 
Psychiatric Drugs, and the Astonishing Rise of Mental Illness in 
America (Crown Publishers, April 2010) is literally flying off the 
shelves.  A few hours ago, I reported the Amazon.com Sales Rank was 
#347 in Books.  (Amazon deals in "millions of separate titles".  
500,000 in its Kindle electronic version alone).  AT THIS MOMENT (as I 
type this) it is now # 273 in overall book sales.

This book is now #1 in sales in the Psychiatry (The DSM is SECOND! - 
Vince) and  Pharmacology, and #2 in the Science History sections on 
Amazon.


Here is a pre-release interview between Whitaker and list member, Bruce 
Levine.


Bruce E. Levine is a clinical psychologist and a friend.  I met Bruce 
in 2003 at MindFreedom's now-famous Fast For Freedom, the 21 day hunger 
strike (no solid food) that I participated in. Whitaker kicks off his 
section of this book on Solutions with a quote  from me and an account 
of the strike.

Bruce's latest book is Surviving America’s Depression Epidemic: How to 
Find Morale, Energy, and Community in a World Gone Crazy (Chelsea Green 
Publishing, 2007). His Web site is www.brucelevine.net


Vince







http://www.counterpunch.org/levine04282010.html


April 28, 2010
A Conversation with Robert Whitaker
The Astonishing Rise of Mental Illness in America

By BRUCE E. LEVINE

In 1987, prior to Prozac hitting the market and the current ubiquitous 
use of antidepressants and other psychiatric drugs, the U.S. mental 
illness disability rate was 1 in every 184 Americans, but by 2007 the 
mental illness disability rate had more than doubled to 1 in every 76 
Americans. Robert Whitaker was curious as to what was causing this 
dramatic increase in mental illness disability. The answers are in his 
new book, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and 
the Astonishing Rise of Mental Illness in America (Crown Publishers, 
April 2010).

Whitaker’s findings will create a problem for both Big Pharma and 
establishment psychiatry, but his credentials and his craftsmanship 
will make it difficult to marginalize him.

Whitaker is the author of four books including Mad in America, about 
the mistreatment of the mentally ill; and as a reporter for the Boston 
Globe, he won a George Polk Award for medical writing, a National 
Association of Science Writers Award for best magazine article, and was 
a finalist for a Pulitzer Prize. In the tradition of Michael Pollan, 
Eric Schlosser, and other investigative reporters who get taken 
seriously, Whitaker is scrupulous, fair, and describes complex 
phenomena in a way that is easy to understand.

Levine: So mental illness disability rates have doubled since 1987 and 
increased six-fold since 1955. And at the same time, psychiatric drug 
use greatly increased in the 1950s and 1960s, then skyrocketed after 
1988 when Prozac hit the market, so now antidepressant and 
antipsychotic drugs alone gross more than $25 billion annually in the 
U.S. But as you know, correlation isn’t causation. What makes you feel 
that the increase in psychiatric drug use is a big part of the reason 
for the increase in mental illness?

Whitaker: The rise in the disability rate due to mental illness is 
simply the starting point for the book. The disability numbers don’t 
prove anything, but, given that this astonishing increase has occurred 
in lockstep with our society’s increased use of psychiatric 
medications, the numbers do raise an obvious question. Could our 
drug-based paradigm of care, for some unforeseen reason, be fueling the 
increase in disability rates? And in order to investigate that 
question, you need to look at two things. First, do psychiatric 
medications alter the long-term course of mental disorders for the 
better, or for the worse? Do they increase the likelihood that a person 
will be able to function well over the long-term, or do they increase 
the likelihood that a person will end up on disability? Second, is it 
possible that a person with a mild disorder may have a bad reaction to 
an initial drug, and that puts the person onto a path that can lead to 
long-term disability. For instance, a person with a mild bout of 
depression may have a manic reaction to an antidepressant, and then is 
diagnosed with bipolar disorder and put on a cocktail of medications. 
Does that happen with any frequency? Could that be an iatrogenic 
[physician-caused illness] pathway that is helping to fuel the increase 
in the disability rates? 

So that’s the starting point for the book. What I then did was look at 
what the scientific literature -- a literature that now extends over 50 
years -- has to say about those questions. And the literature is 
remarkably consistent in the story it tells. Although psychiatric 
medications may be effective over the short term, they increase the 
likelihood that a person will become chronically ill over the long 
term. I was startled to see this picture emerge over and over again as 
I traced the long-term outcomes literature for schizophrenia, anxiety, 
depression, and bipolar illness. In addition, the scientific literature 
shows that many patients treated for a milder problem will worsen in 
response to a drug-- say have a manic episode after taking an 
antidepressant -- and that can lead to a new and more severe diagnosis 
like bipolar disorder. That is a well-documented iatrogenic pathway 
that is helping to fuel the increase in the disability numbers.

Now there may be various cultural factors contributing to the increase 
in the number of disabled mentally ill in our society. But the outcomes 
literature -- and this really is a tragic story -- clearly shows that 
our drug-based paradigm of care is a primary cause.

Levine: I have a clinical practice and I have seen several examples of 
what you are talking about, and I had previously read several of the 
scientific studies that you detail in Anatomy of an Epidemic, so I am 
not exactly a naïve reader. However, in reading your book and seeing 
the enormity of the problem and just how much overwhelming evidence 
there is for a horrible crisis, I started getting a little sick to my 
stomach. I wonder, as you got into the research, did you start drawing 
comparisons to Rachel Carson and Silent Spring? Specifically, this is 
such a huge unnecessary tragedy, affecting several million people 
including children, yet there is virtually no discussion of it in the 
mass media.

Whitaker: A journalist friend of mine, who was a long-time reporter at 
the Washington Post and Newsday, said that he too was reminded of 
Silent Spring when he read Anatomy of an Epidemic. And, in fact, I was 
stunned by much of what I found when I was researching the book, and I 
did at times become overwhelmed by the magnitude of the tragedy. Let me 
give a specific example. When you research the rise of juvenile bipolar 
illness in this country, you see that it appears in lockstep with the 
prescribing of stimulants for ADHD and antidepressants for depression. 
Prior to the use of those medications, you find that researchers 
reported that manic-depressive illness, which is what bipolar illness 
was called at the time, virtually never occurred in prepubertal 
children. But once psychiatrists started putting “hyperactive” children 
on Ritalin, they started to see prepubertal children with manic 
symptoms. Same thing happened when psychiatrists started prescribing 
antidepressants to children and teenagers. A significant percentage had 
manic or hypomanic reactions to the antidepressants. Thus, we see these 
two iatrogenic pathways to a juvenile bipolar diagnosis documented in 
the medical literature. And then what happens to the children and 
teenagers who end up with this diagnosis? They are now put on 
heavier-duty drugs and often on a drug cocktail, and you find that they 
do poorly on that treatment. You find that a high percentage end up 
“rapid cyclers,” which means they have severe “bipolar” symptoms, and 
that they can now be expected to be chronically ill throughout their 
lives. We also know that the atypical antipsychotics [such as Risperdal 
and Zyprexa] prescribed to bipolar children cause a host of physical 
problems, and there is pretty good evidence that they cause cognitive 
decline over the long term. When you add up all this information, you 
end up documenting a story of how the lives of hundreds of thousands of 
children in the United States have been destroyed in this way. In fact, 
I think that the number of children and teenagers that have ended up 
“bipolar” after being treated with a stimulant or an antidepressant is 
now well over one million. This is a story of harm done on an 
unimaginable scale.

So why hasn’t the media reported on this? The answer is that the media, 
when it covers medicine, basically repeats the narrative fashioned by 
the academic doctors who are leaders in the particular discipline, and 
in this case, academic psychiatrists have told a story of new illnesses 
-- like juvenile bipolar illness -- being “discovered,” and of drugs 
for those treatments that are safe, effective and necessary. They tell 
this story to the public even as their own studies find that their 
juvenile bipolar patients -- who when they first came to a psychiatrist 
might simply have been “hyperactive” or struggling with a momentary 
bout of depression -- are ending up with severe bipolar symptoms and 
can now expect to be chronically ill for life. The problem is that our 
society trusts academic doctors to tell an honest story, and in this 
corner of medicine, it's quite easy to document -- and I did document 
this in Anatomy of an Epidemic -- that academic psychiatry has belied 
that trust.

Levine: Let’s get to the issue of psychiatric medications fixing 
“chemical imbalances.” This idea was absolutely crucial in making 
Prozac and other antidepressants attractive to depressed patients. 
However, these days even much of the psychiatry establishment has 
backed off the idea that depressed people have too little serotonin 
between their synapses and that antidepressants fix this chemical 
imbalance. Maybe it’s just me, but I can’t help but see the comparison 
between Big Pharma and the Bush Administration, which told Americans 
that the U.S. needed to invade Iraq because Saddam Hussein had weapons 
of mass destruction and he was connected to Al Qaeda. Of course, the 
Saddam Hussein-Al Qaeda connection was simply a lie, and the WMD 
rationale proved to be false. Do you believe that Big Pharma and 
establishment psychiatry were lying about this chemical imbalance 
theory at the time Prozac hit the market in 1988, or do you believe 
that they had hoped this theory was true because it sold drugs -- and 
it just turned out to be wrong?

Whitaker: The low-serotonin theory of depression was first investigated 
in the 1970s and early 1980s, and those studies did not find that 
people diagnosed with depression had “low serotonin.” As the NIMH 
[National Institute of Mental Health] noted in 1984 at the conclusion 
of such investigations: “Elevations or decrements in the functioning of 
serotonergic systems per se are not likely to be associated with 
depression.” So why was the public told differently? 

The answer is a bit complicated. In the late 1970s, the market for 
psychiatric drugs declined and psychiatry suddenly saw itself as a 
profession under “siege,” having now to compete with a burgeoning 
number of psychologists and other non-physician therapists for 
patients. In response, the profession -- at its highest levels -- 
decided to sell the public on a biomedical model of mental disorders, 
as that model would naturally emphasize the importance of taking 
“medications” for a disease and it was only psychiatrists who could 
prescribe those drugs. This story-telling began with the publication of 
DSM-III in 1980, which the American Psychiatric Association (APA) 
heralded as a grand “scientific achievement,” and then soon the APA was 
announcing that great discoveries were being made about the biology of 
mental disorders. And once psychiatry began to tell a story that wasn’t 
science based, but rather was best described as a marketing campaign, I 
think it began to believe its own marketing slogans. I don’t know this 
for a fact, but I am willing to bet that Bush, Rumsfeld, Cheney and 
others began to believe their own public pronouncements about weapons 
of mass destruction and a Saddam Hussein-Al Qaeda connection, and I 
think something similar to that happened in American psychiatry when 
Prozac came to market. The field stopped looking at the science that 
showed that the low-serotonin theory of depression had basically 
already flamed out, and instead began to believe its own propaganda.

Moreover, the chemical-imbalance story did more than just spur sales of 
drugs. It provided psychiatrists with a desirable public image. They 
were now like doctors in infectious medicine and other respected 
specialties, their medications “like insulin for diabetes.” The 
chemical-imbalance story told of medical progress, of a discipline that 
was unlocking the mysteries of the brain. Indeed, when Prozac came to 
market, there were newspaper stories about how psychiatry now had a new 
reason to “feel proud,” and how its public image had improved. So in 
the late 1980s and early 1990s, the chemical imbalance story is not one 
that tells of how lying moved into the heart of the field, but rather 
how professional delusion did. 

At some later point, however, as the chemical imbalance story 
repeatedly fell apart, psychiatrists in the research community 
understood that they were telling a “fib.” I can still remember -- this 
was the summer of 1998 -- when I questioned a prominent academic 
psychiatrist about whether the chemical imbalance story was really 
“true” and he replied by stating that it was a “useful metaphor” that 
“helped patients understand why they needed to take their 
medication.” This really is the tragedy of modern psychiatry -- it 
became a medical discipline devoted to telling a public story that made 
its drugs look good, as opposed to telling a story rooted in honest 
science.

Levine: Big Pharma and their partners in establishment psychiatry would 
like the general public to believe that the only critics of psychiatry 
are Scientologists. In reality, most scientists who are critics of 
psychiatry are also critics of the pseudoscience of Scientology. It is 
my experience that serious critics of psychiatry are not anti-drug 
zealots. For example, I know that you have talked with “psychiatric 
survivors” -- ex-patients who want to reform mental health treatment. 
David Oaks, one of the leading activists in the psychiatric survivor 
movement, often repeats that some members of his MindFreedom 
organization continue to take their psychiatric drugs while many choose 
not to, and what MindFreedom and other psychiatric survivors are 
fighting for is truly informed choice and a wider range of treatment 
options. Do you think that David Oaks’s fight is the right one?

Whitaker: Big Pharma and their partners in establishment psychiatry 
have smartly used Scientology to defuse criticism of their medications. 
I honestly believe that if Scientology weren't around, then our society 
could have a much more rational discussion about our drug-based 
paradigm of care. As for the position taken by MindFreedom and other 
psychiatric survivors, I basically do think that is the right one to 
take, with two caveats. In order to make a “truly informed choice,” a 
person needs to know the long-term effects of a treatment. It’s not 
enough for people to be fully informed about the immediate “side 
effects” of a drug. People need to be presented with information about 
whether such treatment has been shown to better the long-term course of 
the disorder, or worsen it. They need to be told about long-term 
physical and cognitive problems that often arise with every day use of 
psychiatric drugs. So providing people with a “truly informed choice” 
is a tall order. 

My second caveat is this: As a society, we expect the medical community 
to develop the best possible form of care. We do not expect a medical 
community to offer a therapy that regularly leads to a bad end. And so, 
if we were to draw up a blueprint for reforming the current paradigm of 
care, it would be nice if the psychiatric community would try to 
develop therapeutic approaches that involved using psychiatric 
medications in a selective, cautious way that best promoted good 
long-term outcomes. In other words, I think psychiatry does have a 
responsibility to develop a true evidence-based model for using its 
drugs, a model that incorporates the long-term outcomes data. In the 
solution section of Anatomy of an Epidemic, I write of how doctors and 
psychologists in northern Finland use antipsychotics in a selective, 
cautious manner when treating first-episode psychotic patients, and 
their long-term outcomes are, by far, the best in the Western World. So 
if you believe in evidence-based medicine, then American psychiatry 
should look to the Finnish program as a model for reform. Doctors have 
a responsibility to lead, but I think that you see in David Oaks’ 
position a belief that establishment psychiatry in America cannot be 
trusted to provide such leadership. He’s right to believe that, of 
course, and that's what is so tragic about modern American psychiatry.

                                                                 

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