Tying the rise in mental illness to drugs used in its treatment
By Dennis Rosen
April 14, 2010
ANATOMY OF AN EPIDEMIC: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America By Robert Whitaker
Crown, 416 pp., $26
In “Anatomy of an Epidemic’’ Whitaker presents his theory that the dramatic increase in mental illness in the United States since World War II is the direct result of the medicines psychiatrists have been prescribing to treat it, and that this itself stems from an unholy alliance between the pharmaceutical industry and corrupt physicians. However, although extensively researched and drawing upon hundreds of sources, the gaps in his theory remain too large for him to succeed in making a convincing argument.
Whitaker cites studies showing better outcomes for patients with depression or schizophrenia who have come off their medications than for those who have stayed on them, but doesn’t consider the possibility that this may be because those with milder disease recovered and no longer needed medications, while those who were sicker to begin with simply could not do without them.
He also includes the stories of individual patients, all of whom fared poorly on psychiatric medications and did better after coming off them. One was of a young woman from Seattle prescribed an antidepressant at age 11 to treat her bed-wetting, who then became agitated and spiraled into full-blown psychosis. When Whitaker met her at age 21 she was living in a group home for the severely mentally ill, mute, and withdrawn. Her story is heartbreaking, and the implication is that her deterioration was triggered by the medications she was given.
But how can one be certain of this? Perhaps she was destined for mental illness through a combination of her genes and the environment in the same way that some children develop cancer, irrespective of any medications they may be taking. Perhaps without the medications given to treat her psychosis her course would have been even worse. Many children are treated with tricyclics for bed-wetting and the vast majority do fine. A single case does not prove the rule, and here lies the basic problem of this book. As Whitaker himself points out, there simply are not enough data from well-designed, trustworthy studies. And without this information, it is impossible to conclude anything meaningful about cause and effect.
Though there remain unanswered questions about the efficacy of some psychiatric medications in some patients and their long-term consequences, there is no denying that they have brought about a huge improvement in quality of life for millions. While it is reasonable for Whitaker to raise his concerns, it is critical to remember that hypothesis is no substitute for data.
Ignoring this can lead to disastrous consequences, such as occurred in South Africa at the turn of this century. Thabo Mbeki, then president of that country, refused to accept that AIDS was caused by the HIV virus, believing instead that it was a side effect of malnutrition and the medications used to treat AIDS itself. In the absence of an effective treatment and prevention program, it is estimated that 365,000 South Africans died prematurely of AIDS between the years 2000-05 (currently, 18.1 percent of South African adults have HIV/AIDS).
Those who would seize the opportunity to cast psychiatry as a discipline into the rubbish heap without consideration for the benefits it has brought to so many would do well to remember how Mbeki’s inability to distinguish between theory and fact exacted such an enormous toll in human life and suffering.
Dr. Dennis Rosen is a pediatric lung and sleep specialist at Children’s Hospital Boston and an instructor in pediatrics at Harvard Medical School.
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