Robert Whitaker’s ANATOMY OF AN EPIDEMIC is a profoundly unsettling book, especially if (like me) you spend a good deal of time promoting the National Alliance on Mental Illness (NAMI) and its view that mental illnesses are “biological brain disorders” rooted in chemical imbalances in the brain. Mr. Whitaker (who previously authored MAD IN AMERICA) begs to differ, and his book makes a convincing case.
Here is Whitaker’s closing brief, after 350 pages of argumentation and evidence:
“For the past twenty-five years, the psychiatric establishment has told us a false story. It told us that schizophrenia, depression, and bipolar illness are known to be brain diseases, even though…it can’t direct us to any scientific studies that document this claim. It told us that psychiatric medications fix chemical imbalances in the brain, even though decades of research failed to find this to be so. It told us that Prozac and the other second-generation psychotropics were much better and safer than the first generation drugs, even though the clinical studies had shown no such thing. Most important of all, the psychiatric establishment failed to tell us that the drugs worsen long-term outcomes.”
Those claims are, to say the least, sobering, in particular that last: that the drugs are worsening the long-term prospects for people who take them: people like me and many of my friends.
Robert Whitaker is indignant, as he has every right to be if his claims are correct:
“If psychiatry had been honest with us, the epidemic [of disabling mental illness] could have been curbed long ago. The long-term outcomes would have been publicized and discussed, and that would have set off societal alarms. Instead, psychiatry told stories that protected the image of its drugs, and that storytelling has led to harm done on a grand and terrible scale. Four million American adults under sixty-five years old are on SSI or SSDI today because they are disabled by mental illness. One in every fifteen young adults (eighteen to twenty-six years old) is ‘functionally impaired’ by mental illness. Some 250 children and adolescents are added to the SSI rolls daily because of mental illness. The numbers are staggering, and still the epidemic-making machinery rolls on, with two-year-olds in our country now being ‘treated’ for bipolar illness.”
Whitaker is not advocating for the abolition of psychiatry or of psychiatric medication. What he wants is much more modest and much more achievable: an open discussion. As he concludes:
“We need to become informed about the long-term outcomes literature…we need to have an honest scientific discussion. We need to talk about what is truly known about the biology of mental disorders, about what the drugs actually do, and about how the drugs increase the risk that people will become chronically ill. If we could have that discussion, then change would surely follow. Our society would embrace and promote alternative forms of non-drug care. Physicians would prescribe the medications in a much more limited, cautious manner…In short, our societal delusion about a ‘psychopharmacology’ revolution could at last fade away, and good science could illuminate the path to a much better future.”
I have been taking the anti-depressant Zoloft for the past twenty years. Before that (and even more recently), I was prescribed (and took) a variety of anti-depressants, mood stabilizers, anti-psychotics, and anti-anxiety medications. At no time in my long history of psychiatric treatment has anyone ever given me the least bit of evidence that my brain was suffering from a chemical imbalance.
I’m not going to go off my meds; you shouldn’t go off your meds, either, nor should your loved one. Whitaker documents the immense problems caused by withdrawing from psychiatric medications, even when the withdrawal is done gradually and under medical supervision. That, in fact, is part of the argument against those medications: once you’re on them, they’re so damned hard to get off.
What I am going to do is continue to work for NAMI and continue to advocate for better treatment—medical, social, and cultural—for persons with mental illness. There may or may not be a world’s worth of difference between, on the one hand, locking people away on the back ward of a state facility (that was, reputedly, the “old” treatment); and, on the other hand, condemning them to a lifetime of dependency on drugs that may or may not be fixing something that may or may not have been wrong with their brain in the first place (that’s the “new” treatment). Whatever the case, people living with mental illness continue to be dismissed, disregarded, stigmatized, and—to one degree or another—shunned; and I’m going to continue to speak out against all that.
But I’m also going to recommend ANATOMY OF AN EPIDEMIC. I’m going to urge people to read it with an open mind, and I’m going to call their attention to this, which comes from page 347 of the book: psychiatric patients who have been treated with alternatives to medications (including simple daily exercise) have told the Mental Health Foundation that such treatments have allowed them “to ‘take control of their recovery’ and to stop thinking of themselves as ‘victims’ of a disease. Their confidence and self-esteem increased; they felt calmer and more energetic. Treatment was now focused on their ‘health’ rather than on their ‘illness.’”
My fifty years of living with depression has taught me this: living well is the best treatment for mental illness. Treat the person and help that person heal her life, and the illness will become manageable. When we focus on the illness to the neglect of the person, we end up with the long-term outcomes Whitaker documents: we end up with people who are (to quote the late Philip K. Dick) “always ill but never die.” There has to be more to life, even for people with mental illness, than just not dying.