A Silent Spring for psychiatry

By Leslie Campbell, June 2011

Is our drug-based paradigm for treating mental illness working?

On the first really nice spring evening this year, 300 people sat in St John the Divine Church Hall listening with rapt attention to a presentation by Robert Whitaker.

In April of this year, Whitaker received the prestigious Investigative Reporters and Editors Award for his book Anatomy of an Epidemic, and he came to Victoria to talk about what’s in that book. In a nutshell, Whitaker says long term studies show that outcomes among aggregates of people with various mental illnesses—depression, bipolar, schizophrenia—are significantly better when they avoid the very drugs we are told are their salvation.

It’s a radical message, but Whitaker is a consummate researcher and has been studying in this field for over a decade. A former Boston Globe reporter, his first book on the subject was Mad in America, published in 2002. Among other things, it drew attention to the fact that long-term outcome studies of antipsychotics regularly showed these drugs increased the likelihood people diagnosed with schizophrenia would become chronically ill. 

Whitaker doesn’t condemn all drug use; he believes that pharmaceuticals can help some people with mental illness. But he thinks the blanket embrace of potent drugs that disrupt normal brain chemistry could be making some people chronically ill.

 

AT HIS LECTURE (watch a video of the lecture here: http://www.focusonline.ca/?q=node/18), he first established the astonishing increase in mental illness in the US (and likely in Canada) since the introduction of psychopharmaceuticals in the 1960s. In 1955, only one in 468 people suffered a mental illness; by 2008 it was one in 76. And between 1987—the year Prozac came on stream—and 2007, the number of Americans on disability rolls for mental health reasons, tripled.

The increase in cost is also astounding. Whitaker told us that in 1987, the US collectively spent $800 million on psychiatric drugs. By 2008 it was $40 billion.

He noted that 40 years ago, bipolar (then known as manic-depression) was a rare disorder affecting one in 5000 people; now it affects one in 50—a 100-fold increase. Children are another growth area: In 1987, there were 16,000 US children categorized as mentally disabled. Twenty years later, that number had risen to 600,000. 

This startling growth in mental illness led Whitaker to ask two central questions: First, how do medications shape long-term outcomes for people in terms of such things as employment, social interaction, physical health, functionality, and symptoms? Second, is it possible that we’re creating mental illness? After all, the drugs are modifying the brain, putting stress on it. In effect, Whitaker explained, they put an accelerator on (for seratonin uptake, for example), so the brain responds by putting on the brake, trying to maintain its normal function. The same compensatory model applies for other drugs (though sometimes in the reverse). This could make it tough to go off the drugs without a relapse, or stress the brain in other ways.

Early researchers like Giovanni Fava (editor-in-chief of the journal  Psychotherapy and Psychosomatics) raised the spectre that antidepressant drugs might be beneficial in the short term, but worsen the progression of depression in the long term by increasing biochemical vulnerability to the disease. Use of antidepressant drugs, wrote Fava, may “propel the illness to a more malignant and treatment-unresponsive course.”

Studies on long-term outcomes from around the world, said Whitaker, all showed that the highest rates of staying well, with minimal symptoms, occur among patients who receive only non-drug therapy (e.g. psychotherapy or even just exercise). Modern epidemiological studies indicate antidepressants help about 30 percent of people to get well—and of those only half stay well indefinitely. That means the drugs only work long term for about 15 percent of people with depression. In a 1999 psychiatric textbook, it was admitted that the drugs didn’t help most people in the long run.

Despite such observations, depression went from what was described in the 1960s by leading medical experts as a self-limiting, episodic disorder, with spontaneous recovery without treatment being the norm after a few months, to a more chronic, drug-managed illness. 

Whitaker related other studies: A 10-year retrospective Dutch study of depressed patients found that 76 percent of those who did not take any drugs recovered and never relapsed. Another five-year study in Alberta of 9500 people found that the drug-taking group were depressed on average 19 weeks a year, while those who did not take antidepressants were only depressed for 11 weeks. And a World Health Organization study in 15 cities around the world also showed that non-medicated patients enjoyed much better health than those who took antidepressants. 

Studies of long-term outcomes around drug-based therapy for schizophrenia, bipolar, and ADHD have also shown similar results, said Whitaker. Moreover, he argued, antidepressants function as a “gateway” to bipolar: “In the first year of antidepressant use, eight percent convert to bipolar.”

But such findings are rarely reported in the media.

 

A FEW DAYS AFTER HIS PRESENTATION, I emailed Whitaker and asked him for his explanation of why so many of us have never heard about the poor long-term outcomes associated with drug therapy for mental illness—and why his award-winning book has received so little coverage.

He believes it comes back to the well-entrenched “story” that these drugs fix chemical imbalances in the brain—even though there is actually no hard evidence for this. The story is propped up by the financial clout of Big Pharma—$40 billion annually is spent in the US on psychotropic drugs—and the prestige of the psychiatric community. Whitaker states, “When psychiatrists at top academic medical [institutions] are quoted, the public doesn’t think, ‘Oh, these people are paid spokespeople for drug companies’ (which in essence they are, since they get paid to be speakers, advisors, consultants, etc). The public sees them as the societal figures who know best, and so of course trust them.”

More surprisingly, Whitaker also points to some established organizations that have also been co-opted by the pharmaceutical industry. “In the United States,” wrote Whitaker in his email, “the National Alliance on Mental Illness provides the moral authority, as this organization is the voice of ‘parents,’ and of course parents would want to know the truth and what is best for their children, right? Again, the public doesn’t appreciate the ideology that has fuelled that group from the beginning, which is that it wanted to embrace a ‘biological’ story that would put the ‘mother-causes-schizophrenia’ Freudian story to rest. The public also doesn’t understand that pharma worked to co-opt that group from the moment it arrived on the scene, and has done so very successfully (with grants, etc.).”

Whitaker also credits the large amounts of money US corporate media make on “direct-to-consumer” advertising with stifling more thorough discussion of the pharmaceutical story. (In Canada such advertising is illegal, but media companies like Canwest have lobbied to change that.)

Last, but not least, Whitaker told me that in the US, the very existence of Scientology and its anti-drug stand has made it difficult to get his message out: “[It] makes reporters and academics extremely reluctant to write critically of the mainstream ideology, lest they be accused of being Scientologists.” Hints of an association with the religion are used by critics to smear the messenger and steer debate away from the evidence.

These forces, Whitaker feels, have combined to maintain “the story” that drugs are effectively combating mental illness. 

Let’s hope that Whitaker’s Anatomy of an Epidemic—referred to by some as the Silent Spring of psychiatry—will lead to an open dialogue about the use of psychopharmaceuticals.

 

THIS MONTH, continuing the drug theme, we have a feature report by Rob Wipond—who by the way is a finalist in the Western Magazine Awards for his column in Focus. Rob’s investigation turned up a startling fact: Almost 50 percent of residents in BC’s long-term care facilities are being given antipsychotics. 

For the record: Leslie Campbell is not a Scientologist (and neither is Mr Whitaker nor Rob Wipond). The studies Whitaker relies on are available on his website: www.robertwhitaker.org. If you’d like to be on an email list for future related events and info, please contact rob (at) robwipond (dot) com.