When Robert Whitaker was working as a medical reporter, he came across a series of studies he found disturbing.
One examined the risk of early deaths among patients on anti-psychotic medications. Another found that outcomes for schizophrenia patients had seen no improvement in a century, and had in fact worsened in recent years. Those studies prompted Whitaker, who's speaking in Portland this week, to embark on an investigative quest.
In his 2010 book Anatomy of an Epidemic, Whitaker confronts decades of scientific literature to reassess psychiatry's drug-based paradigm of care. Use of psychiatric drugs has skyrocketed since the 1980s—for example, the number of Americans taking antidepressants doubled from 13.3 million in 1996 to 27 million in 2005. But if such drugs are supposed to alleviate psychiatric distress, why has the number of Americans on government disability due to mental illness more than tripled from 1.25 million in 1987 to more than 4 million today? Examining long-term outcome studies, Whitaker finds that psychiatric drugs may be doing more harm than good.
Whitaker will be featured on a panel of mental health experts on Thursday, Feb. 10 at the First Unitarian Church (1011 SW 12th Ave.).
WW spoke with Whitaker over the phone about pharmaceutical myths, the Arizona shooting, and where reforms of the mental health care system in the U.S. might begin.
WW: Your book asks if psychiatric drugs are actually fueling an epidemic of mental illness, rather than helping those who suffer from such disorders. When you looked at the long-term effects of such drugs, what did you find?
Robert Whitaker: If you look at how psychiatric medications affect long-term outcomes in the aggregate, the evidence is pretty clear that they increase the severity of the disorder, lower employment rates and increase the risk of going onto government disability. That doesn't mean there aren't people that benefit short-term, and long-term as well. But evidence-based medicine says 'Listen, you can't just look at anecdotes.' A lot of our belief in psychiatric medications actually does arise from anecdotal evidence of people saying, 'Hey, these drugs have helped me so much.' But the science itself quite convincingly tells a different story. It tells of a kind of care that overall worsens long-term outcomes.
If this is the case, why is the use of psychiatric medication on the rise?
These long-term studies came forth, time and time again showing that something was amiss with this one-size-fits-all paradigm of care, emphasizing start your meds quickly and stay on your meds. And time and time again these long-term outcome studies were actually suppressed by the powers that be—academic psychiatry and other storytellers within our society. Beginning in 1980, academic psychiatry really began committing itself to telling us a certain story, that psychiatric ailments are biological ailments and these drugs are antidotes to those diseases. Unfortunately the story was false in so many ways.
One such falsehood you confront in Anatomy is the chemical imbalance theory, which posits that mental disorders are due to deficits or excesses of certain brain chemicals. Why has academic psychiatry been telling this story to the public since the 1980s?
The chemical imbalance theory was so brilliant from a marketing point of view. First of all, it fits into a historical context of medical progress. We have had this extraordinary medical progress in the past 75 years, and part of that is finding medicines that are specific antidotes to pathology—like antibiotics for bacterial infections or insulin as a replacement therapy for diabetes. We believed in magic bullets, and in essence pharmaceutical companies and academic psychiatry were telling us psychiatry now had its own magic bullets. But even after they found it not to be true, they kept telling that story to the public because it was a way to sell the medication. It was a way for psychiatry to sell the story of progress to the public, to say they're unlocking the biological mysteries of mental illness. It's just a straight-up marketing story.
If it's a marketing story, where do the big pharmaceutical companies fit into this?
I don't blame the pharmaceutical companies. They're selling a chemical product, and as is so often the case, they want to make that product look as favorable as possible. But here's the problem—pharmaceutical companies, back in the mid '80s, began hiring or paying psychiatrists at academic medical centers to be their speakers, to be their consultants, et cetera. And you start seeing this money flow from pharmaceutical companies to academic psychiatrists, and that flow of money corrupted the storytelling process. But where do I place the blame? I think it's academic psychiatry that has betrayed trust, not pharmaceutical companies.
The Arizona shooting has thrust mental illness in the national discussion, as commentators have questioned Jared Loughner's sanity and wondered if a better mental health care system might have averted the incident. How do you respond to these claims?
Society is fooling itself if it thinks it can prevent episodes like this by having policies that force people onto anti-psychotic medications. If there's anything we do know, it's that medications don't solve everything. And trying to have medications as the cornerstone of care without psychological care or social services, it's just not going to work. There are going to be disturbed human beings in our society, and the idea that you can remove that risk by a law that forces people to take medications, I just don't think that's true. It's not a germane answer, it's not an effective answer, and it has all sorts of problems with civil liberties. It is not a way for society to deal with psychiatric distress.
What has gone wrong with the mental health care system in the United States?
In the United States, spending on mental health care doubled between 2001 and 2007. There's been something like a 50 percent increase of people in treatment from 1992 to 2002. So we're throwing more money at medication and getting more and more people into treatment. But look at all the problems—we have rising disability, problems with early death, shootings. In other words, it doesn't seem like the problems are ameliorating in our society. That tells us that this paradigm of care needs to be rethought. We've come to this moment where we need to profoundly rethink how we handle psychiatric distress in a big-picture way.
Where might reforms start?
One place we could start is with children. We are diagnosing more and more of them, and something like one in every 16 kids by the time they hit adulthood is now said to be struggling with a severe mental illness. That's extraordinary. Diagnosing so many kids and putting so many kids on medications is clearly not working. So as a first step, we should really think about not diagnosing so many kids and not pathologizing so many kids. We should really think about how we can do a better job of raising healthy kids, and that means exercise, diet, socialization, all of those things.
But it's not just kids who are being pathologized and medicated—drugs are seen as a quick fix for all people and for all sorts of psychiatric distress.
One of the things I think we've lost is how to be human, so to speak. It's pretty easy to fall into depression or to fall into a bout of grief. It's pretty easy for sick kids to misbehave or for certain kids to not want to be in school. The human mind and human behaviors are not constant. But what we once understood was that by and large, things would pass—kids would learn to regulate their behaviors, or you might fall into a depression, but with time you would climb out of that depression. We've lost the sense that there's a sort of natural resilience that can help us heal from such episodes, that time can improve behaviors. It's a lack of patience, it's a lack of long-term perspective. And frankly, I think it's a lack of faith in human resilience and human capacity for change.