Author Topic: Anatomy of an Epidemic by Robert Whitaker  (Read 3473 times)

Matt Koeske

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Anatomy of an Epidemic by Robert Whitaker
« on: February 21, 2013, 10:22:59 AM »
I haven't yet read Robert Whitaker's Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, but just read a book review of it and followed it with some web searching to discover a number of interesting online resources.

In this book, Whitaker explores numerous studies of psychiatric drugs that suggest these drugs are, especially in the long-term, not only not effective for the mental diseases they are supposed to treat but are often distinctly harmful (worsening the primary condition and/or creating other severe side effects).

It's clear that this is a very important book in the history of mental health, and it has generated a great deal of debate since its publication in 2010.  I have read a few reviews and rebuttals of Whitaker's arguments, and although it is unclear if the data he presents really show (should be understood as showing) that psychotropic drugs are causing more mental disease than they are treating, it seems entirely clear that a deeper, more careful reassessment of psychiatric medication in our society should be made.  Something is wrong.  Terribly wrong.  Whitaker's books seems to be an excellent tool for addressing this, even if it doesn't settle all debates.

Of course, Whitaker's analyses also touch on Big Pharma and its massive lobbying power with physicians and hospitals.  Certainly, the ugliest influence comes from that source.  Many statistics suggesting the influence of Big Pharma as well as citations of the studies Whitaker makes most use of can be found on his website or within the articles and links below.

There are also some video links that should be of interest.

Robert Whitaker's Anatomy of an Epidemic Page (contains documents citing the research Whitaker uses and also the first chapter of the book)

Special Report: Do Psych Drugs Do More Long-Term Harm Than Good? by Carey Goldberg (extensive comment section after article has many posts worth reading)

Review on Carlat Psychiatry Blog (extensive comment section after article has many posts worth reading)

Unravelling Madness by Chris Barton in the New Zealand Herald (of related interest)

Video of Whitaker's talk on C-Span

There are many other reviews and resources online worth checking out.  Just do a web search.
You can always come back, but you can’t come back all the way.

   [Bob Dylan,"Mississippi]

Matt Koeske

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Re: Anatomy of an Epidemic by Robert Whitaker
« Reply #1 on: May 09, 2013, 05:04:07 PM »
I have just finished Anatomy of an Epidemic and found it to be a strongly argued and well-evidenced piece of investigative journalism that at the very least makes it clear that Whitaker's argument is logical, credible, and worthy of both consideration and additional scientific investigation based on what Whitaker has summarized from existing studies of psychiatric drugs.

This book should be read and taken seriously by any mental health professional involved in the treatment of the mentally ill (especially the mentally ill who are medicated).

The picture Whitaker paints (without sensationalism) is beyond bleak.  It is both terrifying and disgusting.  He has managed to stay much more moderate and impartial than I would be able to . . . although I respect and appreciate his journalistic capacity to accomplish this and recognize it as by far the best approach to the presentation of these data and arguments.

I had never really ventured into the psychiatric drug literature before.  I knew from third hand sources that effectiveness of psychiatric drugs was sketchy and that side effects were often horrific.  I knew that many psychiatrists were in bed with Big Pharma in unethical ways and that drug companies ran and could control many of the results of the published drug trials.  Bud I had no idea how bad it was, no idea how poor the long term effectiveness results were for psychiatric drugs universally, no idea just how massively addictive they were, and little idea how extreme long term physiological effects could be.

I had never gotten around to investigating these things more closely because I have always been generally negative about psychiatric drug use and opposed to DSM diagnoses in many cases.  And I know how medicine and drug companies function together.  But even as a rather extreme cynic on these issues, I drastically underestimated how severe all of these issues really were.  My previous semi-informed cynicism on every single component issue was too generous to the "psychopharmacology revolution".  I still ended up swallowing some of its spin.

I did not even know (having generally believed the PR put forth by the drug companies and their employed psychiatric "experts") that there was no true scientific evidence for biological causes of mental illnesses (including schizophrenia), that the idea of "chemical imbalances in the brain" is not only a fiction, but that scientific studies had demonstrated it was a fiction decades ago. 

Since much of my knowledge of psychiatric drugs has come from psychotherapists and psychoanalysts who had numerous reasons to be critical of psychopharmacology (and generally were), I had assumed I was already getting the negative side of things.  But after reading Anatomy of an Epidemic, I have to conclude that the general negativity of many psychotherapists toward psychiatric drug prescription (or at least over-prescription) falls frighteningly short of any kind of well-informed, scientific accuracy.

Although I knew that curative results for psychiatric drugs were often not better (and sometimes worse) than placebos and or psychotherapy, I did not know that there was extremely strong evidence for seeing psychiatric drugs as the cause of massive increases in the the number of non-functional mentally ill people.  To use Whitaker's term, the effects of the radical over-prescription of psychiatric drugs (first to adults, then to children) has contributed substantially to what must be considered an "epidemic" of mental illness (especially in America, where this practice is the most extreme).  That is, between the terrible addictiveness of psychiatric drugs and the long term (perhaps sometimes permanent) damage they typically do to the brain (especially with prolonged use), modern psychopharmacological medication becomes not only self-perpetuating, but explosively increasing.  One drug typically leads to another (to ameliorate the sides effects of the first, etc.) . . . and one diagnosis (say, ADHD) typically leads to another (say, depression and often bipolar disorder) without recognition that the first drugs have been clearly shown to create the very effects that the next drugs are then used to treat.

This cycle not only manufactures additional, non-natural (i.e., iatrogenic) mental illnesses (which the DSM continues to name and catalog as if they were not largely or entirely psychopharmacologically induced), it assures that patients are massively medicated for many years and often for their entire lives.  This puts an especially revolting twist on the profiteering of Big Pharma, which can fairly (and with substantial corroborating evidence) be said to be "creating" illness in order to sell more and more of its illness-creating drugs.  It's like something out of dystopian science fiction.

But where I see the greatest ethical failing of all (given that it is well known that big business today has no ethical imperatives that conflict with the god of profit-making) is in medical psychiatry, which has lent its affirmation and expertise to this profiteering at the expense of the health, functionality, and sometimes lives of millions of people.  For an institution supposedly upholding the Hippocratic ideal, this advocacy and sell-out is both despicable and terrifying.  The amount of blood on the hands of modern "biological psychiatry" on this issue alone is already immeasurable.  Of course, many psychiatrists are the victims of PR spin and misinformation and, largely, of abiding by the conventional "wisdom" (which unfortunately happened to be the product of self-interested lies and manipulations).

I struggle to see this as a legitimate excuse, though, as the data and various clinical reasons needed to rethink the psychopharmacological approach were always apparent.  Today, we wonder how so many Germans during the rise of Nazism either supported it or failed to resist or object adequately.  I don't think that analogy is hyperbolic.  This venture on behalf of medical psychiatry is a collective sin.  If the sin was widely exposed and admitted, it might very well mean the end of an era of psychiatry . . . and so we can expect it will be fought with every ounce of denial and self-justification and every dollar in Big Pharma's bank account.

At this point, I can't help but welcome that unlikely collapse.  As critical as I have been of analytical psychology, psychoanalysis, and psychotherapeutic theories, they are a much lesser evil.  I am not convinced that they are very effective, but I don't see them (unless abused) being destructive.  That is, they are not institutionally destructive or destructive by design in the way modern psychiatric medicine has been.

Given no viable psychotherapeutic/non-drug alternatives, I am not advocating the sudden removal of all psychiatric medication.  Whitaker mentions some more ethical and humane programs for the mentally ill at the end of his book, but these are still few and far between (and historically opposed and sometimes destroyed by Big Pharma and its psychiatric cohorts).  Any recovery in the psychiatric system would have to be slow and cautious.  It would have to begin by a renewed (and protected from powerful private interests) utilization and practice of sound science and the widespread acknowledgement that long term outcomes of psychiatric drug use contraindicate long term prescribed usage in most cases.  Even where the drugs are still used to help curb or limit symptoms in the short term (the only time they are shown to have any scientific usefulness), there needs to be a widely embraced psychiatric ethic of aiming to get patients off the drugs as quickly and completely as possible.

And I can't even begin to express my feelings about the diagnosis and medication of children (sometimes as young as 2 years) with these life-destroying, psychosis-inducing, brain-damaging drugs.  To serve our children up to what amounts to personal and corporate greed is abominable and vomitous.

Even in the (not infrequent, I fully acknowledge) cases where psychiatric drugs help limit self-destructive psychotic symptoms on a short term basis, I am left with deep equivocations.  We don't have any scientific understanding of why this might work.  It is like firing a shotgun at a tremendously complex, organic system and noting that often this alters the behavior of that system.  But since the long term results and almost guaranteed side effects are so negative, we have to do some serious soul-searching about whether this whole accepted approach of short-term symptom control is really a functional means of treating and healing mental illness.  If the addictions, outcomes (increasing symptomology over time), the potential long term destructiveness to social functionality and physical health, and the massively increased cost to the state and its taxpayers are measurably worse than the initial short term symptoms unmedicated, it has to be seen as more ethical to withhold psychiatric drug prescriptions as long as possible.  At the very least, months of alternative, non-drug treatments should be attempted before any psychiatric medication is even contemplated.

That would likely mean that (sometimes institutionalizing) non-invasive social and psychotherapies should be first line (but not ONLY first line) treatments.  Whitaker tells of a clinic in Lapland that has had great success with this kind of approach (beginning on p.336).  Ultimately, treatment should be directed at helping mentally ill people return to functional roles in society whenever possible and not to turning them into lifelong drug consumers.  As for the latter, I can only think of the film The Matrix where artificially intelligent programs that have taken over the earth have the remaining humans plugged into "the Matrix" and sedated with virtual reality narratives while they are used by the computers as batteries to generate the essential electricity they (the computers) need to survive.

I always thought that was science fiction allegory . . . until now.


Finally, I would like to address what the (unlikely but desirable) spread of Whitaker's arguments to general acceptance in both the lay population and the psychiatry profession might potentially mean to psychotherapy.  It may be ten or twenty or fifty or more years in coming, but unless our society does turn into a sci-fi dystopia, the "biological psychiatry" industry will have to crash and be dismantled.  Scientific progress can be slowed and redirected, but thus far it has not been utterly thwarted.  And the (sound) science supports Whitaker's arguments.  The most positive twist I can muster on all of this is to say that there is an opportunity for psychotherapeutic treatments of mental illness to step forward and demonstrate that they can be ethical and do no harm.  Hopefully, they can also be at least somewhat effective.  The bar has been set incredibly low by psychopharmacology.  Even though psychotherapists have gotten (often deservedly) a lot of bad press over the last 100 years or so, I think they should take "reformative consolation" in the recognition that the "medical model" of psychiatry has done much worse and acted in even more unethical, even criminal ways.

The "medical model" of psychiatry (according to Whitaker) managed to oust psychoanalysis from it prior role as the chief definer and treater of mental illness.  Psychoanalysis has a long shadow to reckon with, but it now stands to benefit if it can learn both from its own and from psychopharmacology's mistakes.  In fact, some kind of Jungianism (that was less subject to many of the errors and arrogances that led to psychoanalysis's ouster) may even be positioned to rediscover a lost usefulness.

It would, of course, require immense, systemic change and deep re-visioning of the identity and approach of Jungian psychotherapy.  For instance, when I learned from Whitaker how atrocious the track record of the "medical model" of psychiatry has been (especially since the 70s), I though of all the Jungian hostility to "science" and "materialistic medicine".  I thought, "This is the kind of 'bad science' Jungianism always has its hackles up about."  In this case, Jungian criticism would be quite justified.  But I simultaneously thought that Jungianism has no real capacity or established philosophical/intellectual mechanism with which to differentiate the "bad science" of the biological psychiatry/Big Pharma hybrid from the kind of "good science", science that is sound in its arguments, evidence, and data analysis and used in an ethical pursuit of truth like the science Whitaker is pulling together to found his arguments.

Jungian anti-science is generalizing, and therefore self-defeating.  It is not, in fact "science" that is responsible for the ethically horrific failures of medical psychiatry.  It was the lack of sound scientific practices that enabled that unethical enterprise.  It was the combination of drug company profiteering and the personal greed and pride of the psychiatrists (and other government and lay advocates) it managed to buy and/or bamboozle.  And that has nothing to do with science . . . even if these experts were credentialed "scientists" interpreting or performing what seemed to be scientific studies.

Science is not inherently unethical, nor is it inherently ethical.  Sound medical science becomes ethical because of its Hippocratic imperative.  In the case of medical psychiatry, that imperative was defied (and defiled), and sound science was defied along with it.  But only sound science can remedy this kind of defilement.  No amount of anti-science ranting will make a lick of difference.

Whitaker notes that one of the key opponents of medical psychiatry was Scientology . . . but because of Scientology's loopiness, medical psychiatry was able to dismiss any sound criticism of its ideas and practices.  Having an enemy like scientology only benefited medical psychiatry, because it could cast all of its opponents as "nutty as Scientologists".  Jungianism needs to pull itself out of a similar intellectual ghetto.  Both across the board dismissals of science and scientistic and pseudo-scientific misuses of science just do further damage to Jungianism and its tarred reputation.

I have said this before (and argued it repeatedly in IAJS forums to no response from others), but one of the chiefest failures of Jungian thought has been its inability to imagine a functional science (to which it might be able to contribute).  It is not merely an intellectual failure.  Jungianism is ultimately condemned by a failure to imagine, a creative or even "poetic" failure.  It has failed to think outside of its preconceived prejudices and simplistic, self-serving reductions.  Because it might ask of science that it, say, recognize astrology or some other entirely unscientific absurdity, and science understandably refuses, Jungianism rejects all of science.

But because it makes such ridiculous claims and insists defiantly upon them, it misses the kind of scientific work that Whitaker is advocating (and doing, by bringing so much data together in such a coherent and convincing way).  But Whitaker's science is the kind of science Jungianism could actually use and benefit from. 

I don't have some kind of theoretical program for the revised treatment of mental illness.  I am strongly in favor of humane and humanizing treatment and skeptical about pathologization (and the whole DSM approach).  I believe psychotherapies (not one particular kind) can be effective, but I see this as dependent on numerous factors that can't be controlled.  For instance, I suspect most mental illness has strong situational causes and perpetuators.  Often, the situations that are causing or aggravating psychological symptoms can't be altered or altered enough.  To varying degrees, we all have to live with certain stressors . . . and not infrequently the particular stressors we can't really avoid are specifically aggravating to an earlier wound to identity.  Sometimes we need to remove ourselves from stressful situations and other times we need to figure out how to work through and cope with them.

Perhaps as or almost as signifanct a deterrent to psychotherapies is the common unwillingness or inability of people to make the changes they need in order to heal (or at least relieve their symptoms somewhat).  Even among most of the people I have known that are not mentally ill (or even openly "neurotic"), I see very little evidence that people are often capable of significant, life-altering changes in attitude and belief.  Almost everyone experiences shifts of belief and attitude throughout their lives, but these are not necessarily ones that improve mental health.  More often, we move from one identity affiliation to another because it facilitates us, because it keeps us from changing as drastically as we would have to if we did not shift affiliations.  The relief identity re-affiliations give us has little or nothing to do with the functionality of the new identity shifted to.  It is largely the support and protection the new affiliation affords the individual that eases anxiety, depression, and other symptoms of diseased identity.

Although I am somewhat cynical of this approach, I also recognize that functional affiliations with groups or tribes that allow our personal identities to be accepted and seen as good-enough is the primary and most effective means of "curing" diseases of identity.  Over time, the new identity affiliation prove its limitations, and the individual's symptoms will return.  In other words, re-affiliation is not necessarily a permanent cure in and of itself.  Its longevity may be a factor of the general psychic health of the tribe and the identity totems affiliated with.

My sense, in other words, is that individual psychic health and tribal psychic health have to be co-moderated.  Both are essential factors in the treatment of identity (or the treatment of "soul", as more romantic Jungians might have it).  Much of the persistence of mental illness in the modern world I would account for by the general "sickness" of modernity.  We can adapt to the world, but a sick world can only be adapted to with a sick identity.  Social groups and their identity totems need to be treated as much as individual identity wounds and dysfunctions.

That is my main gripe with Jungianism.  Even when effective in an individual analysis, Jungianism only manages to indoctrinate the individual into a sick tribe.  So whenever the indoctrinated individual has to interact with the world through the new identity constructions of the Jungian tribe, s/he still exhibits relational dysfunctions.  All is right and holy when we are alone in our Bollingen Towers, but the otherness of the modern world is not so tolerant or protective.

Currently, I have more faith in the healing and reform of tribes than I do in the healing of individuals.  Even "healed" individuals have insignificant healthiness in the embrace of sick tribes.

Where I see Jungianism as potentially capable of becoming psychotherapeutically useful, a drastically revised understanding of the construction and maintenance of identity in the relationship between tribe and self would need to be developed.  That goes for any psychotherapy that would be functional in the modern world.  It would have to understand how tribe constructs identity and how individual identity can only be effectively treated within the context of tribe.  Psychotherapies are often unconscious of this, but go about a stunted version of tribal indoctrination therapy nonetheless.

A psychotherapy of the future would have to have a functional way of healing tribes that heal individuals.  Individual identity simply doesn't exist in a context of the modern global world.  One can't be made to "adapt" to that world . . . and that world cannot be reduced in a Freudian or other way to some kind of tribal or "primal" consistency.  Identity can only become as healthy as the tribes it belongs to.

I therefore think there may be a lot of use in social therapies (a couple instances of of which Whitaker mentions).  At the same time, I worry about the potential for conformation and coercion in "group therapies".  In any social therapy, the goal should be to recognize, protect, and celebrate individual identity and rights.  But there will often be a fine line between encouragement of individuality and protection of the group against hostile individuality.  There is also an innate tendency in groups to unconsciously conform and outcast dissidents.  So the structuring and leadership of any such group would have to be extremely adept and openminded.

It is often helpful for people to talk about their problems and feelings with others, but I suspect it is often even more helpful therapeutically for people to simply be able to socialize with others they identify with . . . or ideally, trust.  That is, it doesn't require a doctor or analyst or guru to interpret feelings and thoughts or prescribe actions and solutions.  Mostly, we just need to be (socially) and not feel oppressed or condemned for that being.

If such groups or tribes had to be socially adaptive (as groups) and functional, they would not be able to maintain collective delusions and self-destructive habits.  That is, there has to be something valid to achieve and work for as a group . . . both in the name of survival and in the name of relationship with outside groups and others.  Identity needs to be "employed" (in a group-benefiting task and purpose) to be and feel healthy . . . and such "employment" is clearly not the goal of psychopharmacology.

These lofty ideals are extremely hard to actualize, though . . . especially when the society in question is made up largely of dysfunctional personalities (as would be the case in a therapeutic community).  I don't really know the best way to make such therapies work.  I am merely observing the way the "pieces of identity" fit together and in what contexts this fitting together can be most functional.

My only recommendation (not seeing or conceiving of the ultimate goal) would be to take every small step with care and consciousness, to do our best to do no harm . . . to do the least harm we can, and to correct those errors we discover along the way.
You can always come back, but you can’t come back all the way.

   [Bob Dylan,"Mississippi]

Matt Koeske

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Re: Anatomy of an Epidemic by Robert Whitaker
« Reply #2 on: May 10, 2013, 05:19:39 PM »
Some additional follow up.

Check out the Mad In America webpage for various articles and blog posts from many authors relating to issues in Whitaker's books.

See this list of rebuttals to criticisms (from pharma industry sponsored psychiatrists) of Whitaker's arguments and data.

More videos of talks by Robert Whitaker.


------

In my previous post I mentioned the potential value of therapeutic communities in the treatment of mental illness.  Whitaker writes about Loren Mosher's (1933-2004)Soteria project in the 70s.  Both in the book and in his answers to critics (linked above), Whitaker tells of Mosher's ouster from NIMH once the biological psychiatry movement had taken control.  Although Mosher's data showed that the Soteria therapeutic community approach was effective for treating schizophrenia, his biological psychiatry colleagues rejected Mosher's data for ideological reasons and soon Mosher's funding was taken away. 

There is a website with some more info on Mosher and Soteria here: http://www.moshersoteria.com.


I also wanted to add (to my comments above) that I suspect there is some sort of biological aspect to mental illness, probably in the form of fairly complex predispositions in most cases and NOT "genetic brain defects".  Those predispositions may or may not become "diseases".  Environmental conditions are likely to determine this.  What is important here in my opinion is that these predispositions should probably not be seen as predispositions for mental illness, per se.  They are not "latent diseases" or "diseases waiting to happen", but complex mental/emotional structures that may be entirely functional depending on the situation and on how they are environmentally developed.

As a fairly typical example, any artist knows there is a gray area between creativity and illness where they are not distinguishable.  And as many people, therapists, artists, and patients, have discovered, art/creation can heal in very profound ways.  Representation and narrativization are the cornerstones of such healing.

Jungians should be aware that as the "gods have become diseases", dealing constructively and analytically with complexes (that often exhibit disease symptoms) can eventually become a relationship and reckoning with "pre-complex" psychic forces that cannot be pathologized and are in fact essential to functional self-definition and healthy identity construction.  The "archetype" or "Self" often lies behind a complex, and successful psychotherapeutic work often finds that complexes cannot be merely excised or destroyed.  They must be transformed in order to allow the functional drives and organizational forces that have become "complexed" to take on more adaptive forms of expression.

I don't mean to euphemize mental disease or claim that every schizophrenic is an unrecognized genius or artist.  I am merely taking the (conventionally Jungian) approach to seeing mental disease as often a problematized and dysfunctional expression of underlying, very likely functional psychological structures and dynamics.  Not every mental disease can be "cured".  I merely wish to suggest (by no means originally) that the precursors and predispositions that translate certain environmental occurrences for certain individuals into "disease" should not unquestioningly be seen as diseased or as some kind of innate "degeneration".

The successful treatment of many mental diseases does not involve a "removal" of the disease or a masking of its symptoms (as psychopharmacology imagines), but the reconstruction and re-storying of the disease (itself a "story") into something non-pathological.
You can always come back, but you can’t come back all the way.

   [Bob Dylan,"Mississippi]