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Books_FNL with art 8/20/10 4:02 PM Page 14 Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America By Robert Whitaker; Crown rowing numbers of authors have criticized the drug industry's influence on psychiatry, but Robert Whitaker's Anatomy of an Epidemic stands out for its research, historical perspective, and more than anything else, its readability. Most books in this genre to date have questioned whether anti-depressants and mood stabilizers are effective enough to justify their unpleasant side effects. Whitaker goes one step further by citing studies, unmentioned by the psychiatric industry, that show medications are actually making patients worse in the long term—and costing taxpayers billions of dollars. As Whitaker points out, every day 1,100 new people join the government disability rolls for reasons of mental illness, adding to the more than 4 million already there. Whitaker makes three convincing arguments: Science has never conclusively proven that mental illness is a symptom of chemical imbalances in the brain; studies show medications actually introduce such imbalances once taken; and long-term studies show patients growing worse, not better, from medication regimens. Whitaker, a journalist by trade, allows his deep reporting to make the case, but what I found even more fascinating was his ability to thread a narrative around psychiatry's huge paradigm shift toward pharmaceutical silver bullets. This odyssey begins with science's accidental discovery of drugs that seemed to ease the symptoms of mental illness, through the psychiatric industry's internal struggle with the Freudian couch, to the forging of the unholy alliance with drug manufacturers that defines the landscape we know today. Through this history, we discover the fallibility of an industry in which we have granted an incredible amount of faith. "As a society, we put our trust in the medical profession to develop the best possible clinical care for diseases and ailments of all types," Whitaker writes. "We expect that the profession will be honest with us as it goes about this task. And yet, as we look for ways to stem the epidemic of disabling mental illness that has erupted in this country, we cannot trust psychiatry, as a profession, to fulfill that responsibility." The story begins after World War II when science was making incredible breakthroughs with the discovery of antibiotics. It was an age in which the inventor of the frontal lobotomy, Egaz Moniz, won the Nobel Prize for medicine. Suddenly doctors were able to produce G 14 N AT I O N A L N U R S E real antidotes, and money followed, with companies such as Merck, Rhone-Poulenc, and Wallace Laboratories employing massive budgets for research. During this period of exhaustive chemical experimentation, scientists noticed curious side effects that seemed to affect patient demeanor. Some chemicals seemed to calm the agitated; others appeared to sooth the anxious or enliven the depressed. And it was from these side effects that scientists drew conclusions as to how the brain functions: Thorazine, for example, restricts dopamine; thus it stood to reason that schizophrenia is a symptom of excess dopamine. "Researchers would identify the mechanism of action for a class of drugs, how the drugs either lowered or raised levels of a brain neurotransmitter, and soon the public would be told that people treated with those medications suffered from the opposite problem," Whitaker writes. As the author points out, however, this approach failed to prove that these imbalances were, in fact, the root causes of mental illness. Respected psychiatrists, for example, have convincingly debunked the theory that high dopamine levels cause schizophrenia. What has been proven, on the other hand, is that medications irrevocably alter the brain's chemistry upon their introduction, forcing it to undergo "compensatory adaptations" that steer it in an abnormal manner. "Rather than fix chemical imbalances in the brain, the drugs create them," Whitaker writes. The biological compensations often produce positive results— especially in the first six weeks, the standard length of a drug study—but almost inevitably, the responses diminish as the medications make "substantial and long-lasting alterations in neural function." Whitaker cites abundant evidence, through studies suppressed by psychiatry or formulated through his own analysis of public health data, that reveals the damaging effects of medications over the long haul, including addiction, brain deterioration, and often, compounded symptoms. Whitaker also shows that the industry was aware of these long-term effects, but failed to act. "Could [psychiatry] really now confess to the public, or even admit to itself, that the very class of drugs said to have 'revolutionized' the care of the mentally ill was in fact making patients chronically ill?" Whitaker writes. Hardly. In fact, as scientists were just beginning to discover some of the downsides to medication, the psychiatric industry was about to launch a new revolution as partners in the burgeoning pharmaceutical trade. In the late 1960s and early 1970s, psychiatry faced threats on several fronts. Psychiatrists like Thomas Szasz were questioning the medical model on moral grounds. Talk therapy was growing in popularity, stealing patients. In response, the industry remade itself by, counterintuitively, W W W. N A T I O N A L N U R S E S U N I T E D . O R G J U LY | A U G U S T 2 0 1 0