Saturday 29 June 2013

Book Review: Anatomy of an Epidemic

[Edit 12/06/15: After reading some critical commentary on this book that reveals its strong bias, I'm less convinced by the anti-medicine arguments. Reader beware.]

Psychiatry has apparently undergone a "psychopharmacological revolution", discovering drugs such as the atypical antipsychotics, Prozac, lithium, and the  benzodiazepines, to name a few, which appear to be promising candidates as "magic bullets" to cure a range of mental illnesses: schizophrenia, depression, bipolar disorder, anxiety, ADHD, etc... Finally, we've discovered the biological bases of mental illnesses, and have effective drugs for treating them.

If that is the case, we would expect that the incidence of mental illness and their disabling impact would be reduced today, compared to the late 1980s.

Instead, the reverse has occurred, with 1,100 adults and children being added to government disability rolls in the US every day, leading Whitaker to ask, "Why has the number of disabled mentally ill in the United States tripled over the past two decades?" In other words, what can explain this epidemic of mental illness?

What beliefs do you hold about drugs and mental illnesses?

  • That all mental illnesses are caused by a chemical imbalance in the brain, and that psychiatric medications restore this balance?
  • That psychiatric medications for psychotic, anxious, depressed or hyperactive patients are "like insulin for a diabetic"?
  • That psychiatric medications have been scientifically shown to be efficacious and safe? 

These are all common claims made by psychiatrists and pharmaceutical companies alike, messages which have been purposefully disseminated to the public, and which are now, to a large extent, considered "common knowledge".

Indeed, prior to reading this book, I held these beliefs, at least to some extent, given the very limited (one lecture) knowledge of psychopharmacology I learned in Biological Psychology last semester. However, Whitaker's book, by telling "the story that wasn't told", shows how ill-conceived these beliefs may be, leaving the reader feeling disturbed about the scientists, the industry, and the ethical implications of our current standard of care, in which psychiatric medications, undeservedly, play a starring role.

Whitaker's Argument

Whitaker's central claim is that psychiatric drugs have in fact contributed to the epidemic of mental illnesses (over and above, and making a greater contribution than other factors like social changes), worsening long-term outcomes. That is, a large proportion of mental illnesses may be maintained and even caused by iatrogenic processes; caused by the medications themselves. This is a rather counterintuitive and even shocking thesis, but through a thorough review of the literature and interviews with psychiatrists and patients, Whitaker presents a well-supported and compelling argument, showing us that:

  • We still don't really know the biological bases of mental illnesses, so "magic bullets" can't really exist.
  • Psychiatric drugs have transformed mental illnesses which used to have good long-term outcomes and recovery rates in the pre-psychopharmacology era to chronic illnesses that "require" constant medication with limited prospects for recovery.
  • Psychiatric drugs may cause, rather than fix chemical imbalances in the brain by messing with the normal neurotransmitter pathways and mechanisms, leading to a range of long-lasting compensatory mechanisms in the brain.
  • Side effects of these medications have deleterious effects on the physical health and cognitive function of patients.
  • Children are being groomed to become lifelong patients by being diagnosed and medicated early on, and these medications may be used for the purposes of behavioural control, rather than the wellbeing of the child.
  • There are effective alternatives to drug therapy, such as psychosocial care for schizophrenia, and exercise as an antidepressant
  • Psychiatry and pharmaceutical companies are working in cahoots, and go to extensive lengths to deceive us, by hiding negative results and reporting false information in scientific journals. Why? The legitimacy of the field of psychiatry and a whole lot of $$$$$$ are at stake!
  • And those who disagree are quickly shut up.

These are all disturbing points that are well worth at least considering.

Bottom Line

Today, mental illnesses are often compared to physical illnesses, which has contributed to the destigmatisation of mental illnesses. Yet, this process has also contributed to the normalisation of the use of psychiatric drugs.

However, while there probably remains a valid role for psychiatric drugs, perhaps they should be used in a selective, limited, and cautious manner, not right at the outset, and not as a long-term solution.

Moreover, with the health, wellbeing and lives of millions of patients at stake, doctors, scientists and pharmaceutical companies need to be honest about what these drugs can and can't do. There needs to be an honest scientific discussion about these matters.

For these reasons, this book is a must-read for physicians, mental health professionals and students alike, as well as those who are currently on psychiatric medications or considering taking them, to be fully informed of both sides of the argument.

Finally, perhaps this book reveals how irrational it may be, though typical of a "quick fix" society, to hope for "magic pills" to cure the ailments of something as complex as the mind.

I welcome your views...

Please, discuss!


  1. Interesting post. I think I share Whitaker's scepticism.

  2. "However, while there probably remains a valid role for psychiatric drugs, perhaps they should be used in a selective, limited, and cautious manner, not right at the outset, and not as a long-term solution."

    Agreed. It's always a matter of weighing the cost to benefits, but patients are often unaware of said costs. This isn't just a problem with psychopharm, but big pharm in general. All too often we see medications being prescribed to alleviate symptoms, without a true attempt at finding the root cause. Recent movements bringing integrative med into the mainstream medicine are promising, but there is a lot of progress to be made!

    Great review!

    1. Cheers, Roddy. Hopefully it's not too idealistic to hope that the situation will change in the future, given that the health and lives of so many are at stake. I would love to see a more holistic and root-focused approach to medicine as the norm, not the exception.