Bob Livingstone is a Licensed Clinical Social Worker (LCS 11087) in private practice for 22 years in San Francisco, California. He holds a Masters Degree ...Read More
A new book, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker (Crown Publishers, April 2010) should be creating an upheaval in the world of mental health clients, providers and the pharmaceutical industry.
Robert Whitaker has impeccable credentials and it will be difficult to label him as an extremist or one that has an ax to grind. He is a reporter for the Boston Globe, he won a George Polk Award for medical writing, a National Association of Science Writers Award for best magazine article, and was a finalist for a Pulitzer Prize.
In his book, he wonders why the number of disabled mentally ill in the United States has tripled over the past two decades. He poses the question as to why every day 1,100 adults and children are added to the government disability rolls because they have become disabled by mental illness. He states that this epidemic is increasing the most quickly among our country’s children.
During a recent Alternet.com interview, Whitaker states, “What I then did was look at what the scientific literature — a literature that now extends over 50 years — has to say about those questions. And the literature is remarkably consistent in the story it tells. Although psychiatric medications may be effective over the short term, they increase the likelihood that a person will become chronically ill over the long term. I was startled to see this picture emerge over and over again as I traced the long-term outcomes literature for schizophrenia, anxiety, depression, and bipolar illness. In addition, the scientific literature shows that many patients treated for a milder problem will worsen in response to a drug– say have a manic episode after taking an antidepressant — and that can lead to a new and more severe diagnosis like bipolar disorder. That is a well-documented iatrogenic pathway [physician-caused illness] that is helping to fuel the increase in the disability numbers. Now there may be various cultural factors contributing to the increase in the number of disabled mentally ill in our society. But the outcomes literature — and this really is a tragic story — clearly shows that our drug-based paradigm of care is a primary cause.”
He continues, “When you research the rise of juvenile bipolar illness in this country, you see that it appears in lockstep with the prescribing of stimulants for ADHD and antidepressants for depression. Prior to the use of those medications, you find that researchers reported that manic-depressive illness, which is what bipolar illness was called at the time, virtually never occurred in prepubertal children. But once psychiatrists started putting “hyperactive” children on Ritalin, they started to see prepubertal children with manic symptoms. Same thing happened when psychiatrists started prescribing antidepressants to children and teenagers. A significant percentage had manic or hypomanic reactions to the antidepressants. Thus, we see these two iatrogenic pathways to a juvenile bipolar diagnosis documented in the medical literature. And then what happens to the children and teenagers who end up with this diagnosis? They are now put on heavier-duty drugs and often on a drug cocktail, and you find that they do poorly on that treatment. You find that a high percentage end up “rapid cyclers,” which means they have severe “bipolar” symptoms, and that they can now be expected to be chronically ill throughout their lives.”
As a psychotherapist (I am a clinical social worker and don’t prescribe medication. I do work with several psychiatrists who I work collaboratively with), reading this material is overwhelming and frightening. I am reading it in a state of shock. I wonder if the interpretation of the research is accurate. Perhaps the increase in the use of psychiatric medication didn’t create an increase in mental health disorders. Maybe the awareness and subsequent reporting systems of mental illness in the United States are so thorough; that may explain the spike in numbers of the mentally disabled.
Could it be that over the years, entitlement programs have increased the coverage for those suffering from mental illness as Neuropsychologist and blogger The MacGuffin points out? I also speculate if the unrelenting stress of living in America is a factor in the increasing numbers of the mentally disordered.
My mind is not made up yet and I’m not ready to advocate for the total non-use of psychiatric medications. I will have to study Anatomy of an Epidemic and those writers who oppose Whitaker’s views. I also want to have intense conversations with my colleagues and clients about this book and the issues it raises. I have witnessed medication being a positive, integral part of a client’s treatment plan. I have seen adults dramatically improve their lives with anti-depressants. I have worked with children whose acting out behavior led them to a path of school suspensions and detention. Once these children were in therapy and on medication; their behavior and attitudes improved greatly.
I have also worked with adults and children where medication was not helpful and sometimes made their conditions worse.
How do you feel about this? Have you or your child ever been on psychiatric medication? Please share your experience.
