Anatomy of an Epidemic
Magic Bullets, Psychiatric Drugs,
and the Astonishing Rise of Mental Illness in America
by Robert Whitaker
  

Crown: New York, 2010
416 pages

We have all had that feeling: when we know something is wrong but we cannot quite identify what it is. This has been a common feeling for me when I consider my own profession in the mental health field. I love my work, I get to work with people who are trying to better their lives and families. It is rewarding and I am grateful for it. But there has been a nagging feeling that my theoretical orientation and the orientation of the field are not quite in alignment. I decided to research it. I discovered a telling link between leftist politics and the mental health field, which I write about in Psychology / Psychiatry and the Left.
  

One of the most important pieces of my research was reading Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker. The author set out to discover why there has been such a huge increase of disabled mentally ill in the United States. His book is a thoughtful examination of the history of psychiatric medications and the effects it has had on individuals and on our society. The epidemic he identifies is the dramatic rise of Americans diagnosed with and medicated for mental illness.

Whitaker delineates, by the numbers, the modern day epidemic of mental illness on our country. In 1955, 1 in every 468 Americans were hospitalized due to mental illness. In 1987, 1 in every 184 Americans were disabled by mental illness (identified by receiving SSI or SSDI payment due to mentally ill status). In 2007, 1 in every 76 Americans were disabled by mental illness — more than doubling the rate of 1987 (pp. 6-7). He also lays out the numbers for children: in 1987 there were 16,200 children (under 1) receiving SSI payments due to mental illness. By 2007 there were 561,569 children receiving those payments. Whitaker summarizes,

The baffling nature of this childhood epidemic shows up with particular clarity in the SSI data from 1996 to 2007. Whereas the number of children disabled by mental illness more than doubled during this period, the number of children on the SSI rolls for all other reasons — cancers, retardation etc. — declined, from 728,110 to 559,440. The nation's doctors were apparently making progress in treating all of those other conditions, but when it came to mental disorders, just the opposite was true. (pp. 8-9)

Whitaker does not discount the effectiveness of medication for some individuals. He gives anecdotal accounts of people who were helped by it, and felt that to go off of medication would be detrimental. He also provides accounts of people who have felt they suffered from using medication.
  

Drugs for mental-health issues were first introduced in the mid 20th Century. At this time, the Psychological fields were floundering a bit, trying to determine which direction and theoretical orientation to commit to. The model that won out was a medical one. A Medical Model means diagnosing and then treatment. Treatment in medicine of course includes well medicine.

Some important historical milestones include the 1938 Food and Drug Cosmetics Act. Whitaker explains on pp. 55-56,

The law required drug firms to prove to the Food and Drug Administration that their products were safe (they still did not have to prove that their drugs were helpful), and in its wake, the FDA began decreeing that certain medicines could be purchased only with a doctor's prescription.

Also in 1946, Congress passed the National Mental Health Act, which meant that the government could sponsor research in the mental health field, providing grants. The National Institute of Mental Health (NIMH) was established three years later to oversee the reforms via government regulation.

In accordance with the medical model for mental health, in 1952 the Diagnostic Statistical Manual (DSM) for mental disorders was published. The DSM and its subsequent revisions became the staple for diagnosing in the mental health arena.
  

Whitaker makes particular note of several medications. In 1954 the FDA gave its stamp of approval to a drug called Thorazine. It was initially billed as a tranquilizer but through a metamorphosis which included government and media became a disease-fighting pill rather than just a tonic. Shortly after Thorazine's introduction a new "happy" pill called Miltown was also introduced with promises of Nirvana (the propaganda for this pill included a Salvador Dali exhibition for which he was paid quite well). Chapter 4 in Anatomy of an Epidemic gives details about these two drugs. Miltown was a predecessor for more modern drugs such as Prozac. Thorazine was given all sorts of credit for success in decreasing the amount and time of hospitalizations for individuals diagnosed with schizophrenia. But Whitaker on pp. 92-94 uses hard facts to refute that notion. Here are some highlights. Prior to the introduction of Thorazine, of people admitted for a first schizophrenic episode in the 1940s and 1950s, 75% were recovered enough in the first three years to return to the community, the majority within the first year. Returning to the community meant back to family and even work. California records from 1956 after Thorazine's introduction found that 85% who were not prescribed medication were discharged within eighteen months; those treated with the drug had a lower (74%) rate of discharge. So why does Thorazine get credit as some breakthrough drug for schizophrenia patients being discharged from hospitals at an increased rate? Whitaker explains on p. 93,

The 1965 Medicare and Medicaid legislation 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 naturally began shipping their chronic patients to nursing homes. That was when the census in state mental hospitals began to noticeably drop rather than in 1955, where Thorazine was introduced.

Whitaker also does a great job discussing the absolute explosions of diagnoses of ADHD and Bipolar disorder. This is a disturbing pattern that has long been an irritant for me. While I believe that there can be some benefits from medications, I have felt strongly for some time that we are over-diagnosing and over-medicating. Whitaker's take-down of Prozac is particularly well done.
  

This has been a great resource for me as a mental health professional in discussing medications with my clients. It is eye opening and informative. I highly recommend Anatomy of an Epidemic to anyone concerned about mental health medication and the effects it has had on our society.

© 2013 Sarah Emily Jordan