Anatomy of an Epidemic: Book review

Note from Mel: Just as I hoped, Ptery agreed to post his review of this important book here. A version of this book review has been submitted to the weekly newspaper Real Change in Seattle. I’ve read this book too, & will be posting my own reactions to it within the next few days. I should mention that I’m the person who “dodged the magic bullets” who Ptery mentions a ways into it.

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker
(New York: Crown Publishers, 2010).
416 pages. ISBN 978-0-307-45241-2.

An epidemic of gargantuan proportions has been afoot for some time, according to Robert Whitaker, author of Anatomy of an Epidemic. I have felt it so myself, but who listens to previous customers of the great professional class of biological psychiatrists?

The epidemic

Whitaker originally came to this research in 1998 as a journalist reporting on clinical testing of new drugs, when he became aware of studies in which schizophrenia patients were withdrawn from their anti-psychotic medications. He was appalled, believing that anti-psychotic medications were as necessary for schizophrenia as insulin was for diabetics — which is what the psychiatric profession wanted us all to believe. But he came across the results of two World Health Organization studies, both of which showed better outcomes for sufferers of schizophrenia in Third World countries like India, Nigeria, and Colombia than in the Western world (U.S. and European). The kicker is that only 16% of those sufferers were maintained continuously on anti-psychotic medications, compared with 61% of the patients in developed countries. This began a long research for Whitaker, leading to his earlier book, Mad in America (2001), and Anatomy of an Epidemic (2010), both of which confirm what many opponents of forced treatment have been saying for years without the benefit of “a white coat” or the aura of respectability (they were “just patients,” or they were “just members of a mind control cult called Scientology” — biopsychiatry’s largest opposition). Whitaker has shown that there is no “chemical imbalance” that is rebalanced by anti-psychotic medications, but that the medications cause harm to the nerves of the brain, which do not always recover, creating more illness over time than there had ever been. The result has been an epidemic rise in the population of disabled mentally ill, from 355,000 adults in state and county mental hospitals in 1995 to over 4 million on SSI or SSDI for mental illness — 1 in 76 American adults.

Anatomy of an Epidemic goes far beyond how those suffering from schizophrenia are treated, but covers all major classes of mental illness. The epidemic is most evident in the history of depression and bipolar disorder. Bipolar disorder especially used to be very rare, occurring in only 1 in 13,000 people in 1955, but now occurring in 1 in 40 people. Whitaker points to antidepressants as the culprit, giving those who suffer from depression debilitating outcomes, where as before many people recovered from depression on their own. In one study discussed by Whitaker of 87,290 patients from 1997 to 2001 who were diagnosed with depression or anxiety, those treated with antidepressants converted to bipolar illness at three times the rate of those who didn’t take antidepressants.

The epidemic has also spread to children all the way down to toddler ages. In children, ADHD has been the beginning diagnosis, leading to high outcomes of bipolar and poor outcomes further on as the children grow into adulthood if they are placed on stimulants that are supposed to address their issues. From 1987, when the practice of prescribing psychiatric medications to children gained traction, to 2007, the number of American children getting SSI or SSDI checks for disability because of mental illness increased by 35 times, from 16,200 in 1987 to 561,569 in 2007. This is in spite of medications that the psychiatric profession has assured us are supposed to help people — not disable them.

So, finally after 60 years of misinformation and withholding of truth from psychiatrists, a book of rational upstanding merit has hit the media. Anatomy of an Epidemic also documents how psychiatrists and their allies the pharmaceutical companies have managed such a scheme. It has been the most important book for me to read in over twenty years as I struggled to tell others about the possibility of real disability from taking psychiatric drugs. Those who did the research chose alternatives to drugs. I also have friends who are on the medications because they have been on them too long to stop. They are still in pain and it saddens me, but I understand.

Getting off psychiatric medications

I also understand that there are some people who have been helped by psychiatric drugs, and I would not want them to go off them because it is better for them to be taking them. No one knows why they work, or what causes mental illness in the first place. Whitaker himself does not advise anyone to stop taking their meds. One reason is that withdrawal from medications is a process that will uncover the nerve damage from the medications and any previous problems that were unsolved will be more present. I will not hesitate to suggest to people to do their research and read Peter Breggin’s book Your Drug May Be Your Problem. Breggin provides food for thought about medications and life itself for someone contemplating trying life without drugs. Breggin gives sound information on how to safely transition off psychiatric medications. It is dangerous, but many people have done it successfully. BUT DO THE RESEARCH and HAVE A PLAN and BACK UP people you trust to go through this with you, including a sympathetic doctor. I understand that this can be hard. So many people are locked into their drugs with housing, SSI, SSDI and family relationships that make it even more complicated.

The reality is that no one knows what causes mental illness. All this talk of a biochemical cause has been a nice looking charade for people to look like they are scientific and keep their jobs. [not to mention gaining professional prestige and making lots of money.] They’ve done an amazing marketing job on the American public; unfortunately they have misled us all in a way that is worse than criminal. Prozac was known to cause suicidal thoughts and impulses in the first trials of that drug. But did they [Eli Lilly, Prozac’s manufacturer] tell anyone? Did they put it on the label? Did they hold it from production? No. They did none of these things. It was the reporting of incidents and several lawsuits that finally led to a label being put on the bottle. Many places in Europe the drug is banned. Whitaker’s book fills in a lot of the gaps in information that people so desperately need that the press has not delivered — having gone straight to the “experts” for their information.

A Finnish solution: Open Dialogue

Besides the research with many graphs showing the numbers and history of pharmopsychiatry, the most exciting thing to me about Anatomy of an Epidemic is Whitaker’s ponderings of what to do and who’s doing what. Particularly, the Finns in Western Lapland (which once had an incidence of schizophrenia twice and even three times higher than in the rest of Finland and Europe), use need-adapted treatment and Open Dialogue and have shown a sound record of success with psychosis and schizophrenia. In this method, the recovery rate for patients is astonishing. Only 20% of first-time psychotic patients are treated continuously with anti-psychotic medication, and only about one-third are exposed to anti-psychotic medications at all. Yet 80% — most not treated at all with medications — are back at school or in jobs within two to five years. The Open Dialogue method works by creating a team of three who work collaboratively as a team with the patient and his or her family and support system. Meetings, usually in the patient’s home, are conducted openly, with every person, including the patient, included as a full participant in the conversation, and all treatment decisions are made jointly between the patient and treatment providers. There is no forced treatment, most patients never receive medications, and only around 20% end up using medications continuously. Since 1993, not even one first-episode psychotic patient in Western Lapland has gone on to be chronically hospitalized — a very different outcome than had been common there before, or what is still common in the U.S.

The Finnish psychiatrists and psychologists in Western Lapland also have the idea that the illness is social rather than biological or even psychological. “Psychosis does not live in the head,” Whitaker quotes Tapio Salo, a psychologist at Keropudas Hospital in Tornia, Finland. “It lives in the in-between of family members, and in the in-between of people. It is in the relationship, and the one who is psychotic makes the bad condition visible. He or she ‘wears the symptoms’ and has the burden to carry them.”

This is novel language for me, who has felt that this kind of communication is essential to healing but didn’t have a name for it. Knowing who you are, what you need and having people to share your reality with is crucial to mental health. Having used a talking stick (a Native American communication tool) at home when things got out of hand with my nephew, I can attest to this firsthand. (See my story below). And it follows along with what systems theory says about how things work: that the relationships within any system are much more important to look than just its “parts.” An individual person is just one part of a system of social and physical relationships.

The Finnish doctors talk about repairing the social fabric the “sick” person is in. It makes so much sense to me that Open Dialogue therapy as used in Tornio works. Why don’t we get unafraid of being seen as “crazy” and speak up? Why don’t we get unafraid of “crazy” people and listen up as well? They’ve done it in Finland and since the 1980s have reduced the incidence of schizophrenia in Western Lapland down from 25 a year to 2 a year as measured from new cases. I could see collaborative methods like Open Dialogue working with all sorts of problems. Creating this space, we could face a lot more than we can alone and in this process we could do restorative justice, heal our children, change the school system, and change how we all look at what’s important.

I highly recommend Anatomy of an Epidemic to anyone associated with psychiatry as a patient, family member, friend, city planners and care providers because the truth must be made known and the large construct of lies that underlie bio-psychiatry and the the psychopharmaceutical marketplace needs to stop. If you want the short version before buying it, watch Whitaker’s on BookTV here: http://cs.pn/magicbullets. (Whitaker also has links to all the studies referred to in his book at his website: http://www.madinamerica.com/.)

A personal story

But before you go and hate all these doctors, think about what kind of culture we live in. I for one have had to struggle with my own illness and treatment that was supposed to help. In the late 1980s, I had several problems that I understand today, but didn’t at the time. It all culminated in me starting to drink — alcohol was my lead-in drug. It led to LSD really fast, and then to me getting lost in the streets of San Francisco, losing four days of sleep and food. Of course I was crackers. I needed sleep and food. I got it in the hospital, but I also got a cocktail of heavy drugs. I only survived not becoming a statistic through having become aware of what Haldol (an “antipsychotic”) was and what others have suffered before me by the hands of psychiatry. I had a short stay in the hospital because I started tonguing the meds (and secretly spitting them out) as soon as I was able to figure out where I was. I think it was day three, when I finally got enough sleep that I was able to look at the map of San Francisco that was on the wall, and it all came back to me. I was oriented again times three. (This is medical provider talk meaning that the patient can state who he/she is, where he/she is, when he/she is — day, year, etc.) So, very shortly I got my support team together and advocated myself right out of there.

It took years for me to overcome the stigma from what happened to me and finding words for who I am, what I need in order to form healthy relationships. Even though I knew the system was screwy, I had a rough time with what I did. I did take too many drugs, I got lost, and I felt a lot of shame about that. That was over 25 years ago and I’ve recovered and I understand what happened from a deep level. I can now talk about how it started for me: being a kid from an alcoholic family who also happened to be a transman. I started drinking when I hit adolescence, but before I could even face my rare “queer” identity, I was sexually molested by my therapist. Now if anyone understands how that can affect a kid, well, of course it felt weird, but also I was getting attention for being special and getting attention period. It also gave me the idea that I was really an adult. Other than giving me a few tools on how not to drink, he didn’t “cure” me, but instead gave me a sexual addiction to carry with me for a number of years. I went off to college to try and figure out my vocation and didn’t succeed.

When I returned from college, I was assaulted again, but after this time I went on to a woman’s festival in Michigan. During the four-day event, a woman was taken off the land to a psychiatric facility. There was uproar and I became politicized from it. It could have been me freaking out, but was lucky I had someone to talk to about what happened with me. So in short order, I learned about class, race, mental-ism, able-ism. Then I went on a journey to Big Mountain in Arizona, a portion of the Dine Nation’s reservation lands, and there learned about what community was. In all that journeying, I became closer to coming out as trans, but alas, what led up to hospitalization was getting back to the city where everyone is supposed to watch their own back, get a job, with no one to feed or house them if they fail. In this condition, so many things hit the fan at once. At the point of my forced hospitalization, I understood something at a gut level that took another 25 years to sort out and articulate.

I spent those years as an activist. I also found my partner who suffers periodically from depression who says she’s “dodged the magic bullets” of psychiatric medications, instead learning to take care of herself successfully in other ways. Together we raised my nephew who came to us at age 9, diagnosed “severely emotionally disturbed” and on the antidepressant Imipramine — at least the fourth drug that he’d been tried on (the others being Ritalin, Dexedrine, and Thorazine). We took him off it over the course of 6 months where he finally stabilized without it and started to work on his violent behavior. He’s been completely drug free since age 9-1/2, and is now a strapping good-hearted 22-year-old who’s just finishing up Job Corps.

Being trans was the last piece that put my life on track. I now have an inkling of who I am what I need and have found happiness in being able to communicate this to others. I have also taken off from this culture to research what needs to change before I can come back and work. I am without a house to live in, but I am not homeless. I look back in on a culture that is not facing up to facts and certainly not comfortable with facing the despair that many who are leaders of this new movement towards sustainability have felt.

Mental health & sustainability

Finally, to share what is most importance to me about this book: The kind of collaboration demonstrated in Open Dialogue offers a way to heal in a wider sense. Open Dialogue fits into the 4th step of The Natural Step, a sustainability framework put forth by a medical doctor in Sweden (Dr. Karl-Henrik Robèrt) who cut through all the confusing arguments around what needed to be done about the environment. He saw a direct correlation to the rising rates of cancer that was killing his patients.
Simply, the four steps of the Natural Step are:

1. Reduce the amount of materials that are brought up from under the earth in to the level the natural system can make it non-toxic again.
2. Reduce the amount of man made materials to levels the natural system can t transform back into none-toxic again.
3. Reduce the destruction to natural systems so they can do the work of detoxifying these substances.
4. Meet human needs worldwide.

The fourth step — meeting human needs worldwide — is the one most confusing to sustainability folks, and I’ve given it a great deal of thought over the years since I learned of this framework. I see Americans suffering form a spiritual poverty and great alienation from their environment, while third world countries suffer from hunger and a dearth of material needs. Given the World Health Organization reports of higher cure rates in Third World nations points to a possibly more intact society, whereas in developed nations like the U.S. there is more alienation, broken families and a rare occurrence of extended families with rich supports intact. The ideal of the independent person has been very destructive to the social fabric.

Open Dialogue and similar collaborative methods offer a means of healing. It’s important as we move through this economic/ecological crisis that we find a way to mend the social fabric. As the casualties of our mental health system pile up and people are unable to take care of themselves, we will not be able to sustain all the costs. This is one of the reasons that the downtown shelters run by officials that cost so much are having so many problems. They are bearing some of the cost of psychiatry’s methods.

Where I am in Tent City 4, we’re taking care of each other and keeping our heads on straight. We do so by coming together and working it out collectively. All the people here are learning that we can take care of each other, where the system failed us. We don’t ask for much, just a job and an apartment, but we’re keeping our heads together in the meantime and living in tents and organizing so that we stay safe. This is revolutionary for people. The amazing thing is, is that it works. To run 16 shelters in the area costs SHARE about $725,000 per year to run, while around 500 beds are provided. I have faith in humans to fix all the stuff going on by talking about it.

As the epidemic of mental illness rises to a crisis point, so does the pathway to a sustainable future narrow. As more people become aware of the ecological crisis, we’ll need some kind of safe communication space to work out our despair and grief. Again, this is prohibitive work on a public scale. Much change needs to happen soon if society wants to continue.

It’s all connected. It’s time for us to start talking to each other rather than relying on the experts. We all see how it is going — we need to gather together and think together. There is such a thing as collective intelligence, and I think the Finns are on to something big. There is such a thing as opening our hearts in safe space and working it out, rather than waiting for our “superiors” or “experts” to tell us what to do. We have eyes and something special between our ears. I believe we can do it. Let’s get it done.