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Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America
Author	Robert Whitaker
Country	United States
Language	English
Subject	Psychiatry
Publisher	Crown Publishing Group
2010
Media type	Print
ISBN	978-0-307-45241-2
OCLC	429022293
616.89

Read online:Anatomy of an Epidemic. Free Epub book copy without downloading. But then I stumbled upon the Harvard study and the WHO findings, and that set me off on an intellectual quest that ultimately grew into this book,Anat. This item: Anatomy of an Epidemic. By Robert Whitaker MP3 CD. Only 1 left in stock - order soon. Sold by Yellow Square Books and ships from Amazon Fulfillment. FREE Shipping on orders over $25.00. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry.

Anatomy of an Epidemic 25 TABLE 2. The Disabled Mentally Ill in the United States Rate of Disabled Mentally Ill per Year 1,000 Population 1850.2 1903 1.86 1955 3.38 1987 13.75 Z003 19.69 Source: The disability rates for 1850 through 1955 are based on the number of hospitalized mentally ill, as cited by E. Fuller Torrey in The Invisible.

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America is a book by Robert Whitaker published in 2010 by Crown.^[1]^[2]^[3] Whitaker asks why the number of Americans who receive government disability for mental illness approximately doubled since 1987.^[4]

In the book, Whitaker tries to answer that question and examines the long-term outcomes for the mentally ill in the U.S.

Synopsis[edit]

Magic bullets[edit]

Number of Americans who received SSDI and SSI for mental disability in 1987 (blue) when Eli Lilly and Company introduced the antidepressive drug Prozac, compared to 2003 (red).

Whitaker begins by reviewing the discovery of antipsychotics, benzodiazepines and antidepressants. These were discovered as side effects during research for antihistamines (specifically promethazine), gram negative antibiotics (specifically mephenesin) and the anti-tuberculosis agents isoniazid and iproniazid respectively. The psychiatric mechanisms of action of these drugs were not known at the time and these were initially called major tranquilizers (now typical antipsychotics) due to their induction of 'euphoric quietude'; minor tranquilizers (now benzodiazepines) and psychic energizers (now antidepressants) due to patients 'dancing in the wards.'^[5] These compounds were developed during a period of growth for the pharmaceutical industry bolstered by the 1951 Durham-Humphrey Amendment, giving physicians monopolistic prescribing rights thus aligning the interests of physicians and pharmaceutical companies. This also followed the industry's development of 'magic bullets' that treat people with, for example, diabetes, which according to Whitaker provided an analogy to sell the idea of these drugs to the public. It was not until many years later, after the mechanisms of these drugs were determined, that the serotonergic hypothesis of depression and dopaminergic hypothesis of schizophrenia were developed to fall in line with the drug's mechanisms. According to Whitaker's analysis of the primary literature, lower levels of serotonin and higher levels of dopamine 'have proved to be true in patients WITH prior exposure to antidepressants or antipsychotics (ie as homeostatic mechanisms) but NOT in patients without prior exposure.'

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Whitaker further criticizes the magic bullet theory by attacking the historical notion that the 'invention of the antipsychotic Thorazine' emptied the asylums.^[6] His case begins by showing that during the late 1940s and 1950s ~75% of cases admitted for first episode schizophrenia recovered to the community by approximately 3 years (Thorazine was not released until 1955).^[7]^[8]^[9] He then notes that the arrival of Thorazine did not improve discharge rates in the 1950s for people newly diagnosed with schizophrenia. In fact, based on the only large scale first episode schizophrenia study of this era, 88% of those who were not treated were discharged within eighteen months compared to 74% of neuroleptic treated.^[10] This is additionally evidenced by the fact that when Thorazine was introduced in 1955 there were 267 thousand schizophrenia patients in state and county mental hospitals, and eight years later, there were 253 thousand, thus indicating that the advent of neuroleptics barely budged the number of hospitalized patients.^[11] What he argues actually cleared the asylums was the beginning of Medicare and Medicaid in 1965. These programs provided federal subsidies for nursing home care but no such subsidy for care in state mental hospitals, and so the states, seeking to save money, began sending their chronic patients to nursing homes.

Psychiatric drugs[edit]

Whitaker acknowledges that psychiatric medications do sometimes work but believes that they must be used in a 'selective, cautious manner. It should be understood that they’re not fixing any chemical imbalances. And honestly, they should be used on a short-term basis.'^[12]

Whitaker traces the effects of what looks like an iatrogenic epidemic:^[13] the drugs that patients receive can perturb their normal brain function.^[14]

A symbolic graphic of the brains dopamine function before and after antipsychotics.

Whitaker suggests that the 'wonder drug' glow around the second generation psychotropics has long since disappeared. He views the 'hyping' of the top-selling atypical antipsychotics as 'one of the more embarrassing episodes in psychiatry's history, as one government study after another failed to find that they were any better than the first-generation anti-psychotics.'^[15]

One of Whitaker's solutions is the style of care documented by professor Jaakko Seikkula at Keropudas Hospital in Tornio in Lapland where drugs are given to patients only on a limited basis, with good outcomes. According to Whitaker, the district has the lowest per capita spending on mental health of all health districts in Finland.^[16] He also advocates that those with depression engage in exercise.

Children[edit]

Whitaker sees that children are vulnerable to being prescribed a lifetime of drugs. As the author says, a psychiatrist and parents may give a child a 'cocktail' to force him or her to behave. Then when this child reaches the age of eighteen, Whitaker says the child often becomes a disabled adult.^[17]

Review of data and statistics[edit]

Whitaker spent a year and a half researching for this book,^[14] and maintains a website listing some relevant studies.^[18]

Reception and media coverage[edit]

Whitaker did interviews with Salon and The Boston Globe during the release of this book.^[12]^[19] He also did a book tour, and he spoke for an hour and a half on C-SPAN where there is an archived video.^[20] Still, in his book he says that this story was never told in mainstream newspapers.^[21] For example, Whitaker says a study of long-term outcomes for people with schizophrenia done by Martin Harrow in 2007 (which Whitaker thinks is the best work ever done on the subject in the U.S) was never in a National Institute of Mental Health press release and thus never reached reporters at U.S. newspapers.^[22]

A review by sleep researcher Dennis Rosen for The Boston Globe concludes that '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', and compares Whitaker to Thabo Mbeki and AIDS denialism.^[23] The book received positive reviews from New Scientist,^[2]The Record,^[3]Time magazine,^[1] and Salon.^[12]

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