National Empowerment Center
Whitaker’s previous book on mental health, Mad in America, Whitaker asked
the reader to inspect the historical record of psychiatric practice and decide
if that practice conforms to the standards of science. His approach was to use
the basic elements of scientific reasoning to assess the effectiveness of a
variety of methods, including water bath therapy, restraint therapy, lobotomy,
electro-convulsive therapy and psychopharmacology. It was clear that none of the
evidence supporting the use of these methods was convincing to Whitaker, and
with good reason. In Mad in America the history of treatment for the
mentally ill takes on the appearance of a series of fanciful quests more akin to
the flights of Don Quixote than to the process of science. Anyone who has worked
in the mental health field can relate to an observer’s dismay at the
fad-oriented rise and fall of preferred treatments. Psychiatry and psychology
have advocated at length to be considered as fields of science. Sadly, the use
of the scientific method has not always accompanied these endeavors and Whitaker
had every right to pose the hard questions.
In his new book, Anatomy of an Epidemic, Whitaker has returned to this inquiry. This time he focuses on the recent history of psychiatry, in particular the field of psychopharmacology. Whitaker asks the same question: where is the science? He wades into the existing research data and picks through the details, asking the data to fit a logical standard. Not surprisingly, much of it does not.
Although Whitaker’s book can be seen as an attack on the use of psychiatric medicines, that isn’t really the purpose of the book. The inherent purpose is to ask some piercing questions related to the use of medications in mental health treatment. The chief concern relates to the massive rise in mental illness since the dawn of the pharmaceutical era. Whitaker poses the question that if medications are as effective as claimed, why are the mentally ill not getting better and why, as a society, are we seeing a dramatic increase in the numbers of mentally ill? Whitaker ruminates on possible explanations for these phenomena but ultimately can offer no definitive answer. This is reasonable and scientific, because we don’t really understand enough to provide an encompassing conclusion. Whitaker’s role is that of the challenger. How important is it to us to find the answer? It’s going to take a priority effort by society to achieve this.
What is clear from Whitaker’s book is that something very fishy is going on in the field of psychiatry and psychopharmacology. Pharmaceutical companies are making enormous profits off psychiatric drugs, and as the numbers of mentally ill increase so do the sales of drugs. Many psychiatrists have been personally involved in working with pharmaceutical companies to promote drugs and have individually benefited from these relationships. That drugs are being brought to market with questionable research supporting their effectiveness probably wouldn’t surprise anyone. That it could be happening on an industry-wide scale is a frightening concept that deserves detailed investigation. The critique offered by Whitaker is disturbing. As a society we have learned to implicitly trust our doctors. It now seems possible that such trust is undeserved. Certainly the advance proposals of the Diagnostic and Statistical Manual of the American Psychiatric Association for the next edition of the psychodiagnostic bible, the DSM-5, are quite alarming. The trend seems to be to expand diagnostic criteria for many disorders and add new diagnoses, the outcome of which could easily be a further increase in the numbers of mentally ill (and the numbers of potential drug consumers).
At this point, the field appears to be a juggernaut out of control. Whitaker has done a good job at turning on the light and revealing the elephant in the room. What steps we take next are up to us.
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