Read Anatomy of an Epidemic Online
Authors: Robert Whitaker
Anatomy of an Epidemic (46 page)
Said Healy: “The thought-control aspect of things in psychiatry today is like old-style Eastern European social control.”
The third aspect to the storytelling process that has led to our societal delusion about the merits of psychiatric drugs is easy to document. Imagine what our beliefs would be today if, over the past twenty years, we had opened our newspapers and read about the following findings, which represent but a sampling of the outcome studies we reviewed earlier in the book:
1990
: In a large, national depression study, the eighteen-month stay-well rate was highest for those treated with psychotherapy (30 percent) and lowest for those treated with an antidepressant (19 percent). (NIMH)
1992
: Schizophrenia outcomes are much better in poor countries like India and Nigeria, where only 16 percent of patients are regularly maintained on antipsychotics, than in the United States and other rich countries, where continual drug usage is the standard of care. (World Health Organization)
1995
: In a six-year study of 547 depressed patients, those who were treated for the disorder were nearly seven times more likely to become incapacitated than those who weren’t, and three times more likely to suffer a “cessation” of their “principal social role.” (NIMH)
1998
: Antipsychotic drugs cause morphological changes in the brain that are associated with a worsening of schizophrenia symptoms. (University of Pennsylvania)
1998
: In a World Health Organization study of the merits of screening for depression, those diagnosed and treated with psychiatric medications fared worse—in terms of their depressive symptoms and their general health—over a one-year period than those who weren’t exposed to the drugs. (WHO)
1999
: When long-term benzodiazepine users withdraw from the drugs, they become “more alert, more relaxed, and less anxious.” (University of Pennsylvania)
2000
: Epidemiological studies show that long-term outcomes for bipolar patients today are dramatically worse than they were in the pre-drug era, with this deterioration in modern outcomes likely due to the harmful effects of antidepressants and antipsychotics. (Eli Lilly; Harvard Medical School)
2001
: In a study of 1,281 Canadians who went on short-term disability for depression, 19 percent of those who took an antidepressant ended up on long-term disability, versus 9 percent of those who didn’t take the medication. (Canadian investigators)
2001
: In the pre-drug era, bipolar patients did not suffer cognitive decline over the long term, but today they end up
almost as cognitively impaired as schizophrenia patients. (Sheppard Pratt Health System in Baltimore)
2004
: Long-term benzodiazepine users suffer cognitive deficits “moderate to large” in magnitude. (Australian scientists)
2005
: Angel dust, amphetamines, and other drugs that induce psychosis all increase D
2
HIGH receptors in the brain; antipsychotics cause this same change in the brain. (University of Toronto)
2005
: In a five-year study of 9,508 depressed patients, those who took an antidepressant were, on average, symptomatic nineteen weeks a year, versus eleven weeks for those who didn’t take any medication. (University of Calgary)
2007
: In a fifteen-year study, 40 percent of schizophrenia patients off antipsychotics recovered, versus 5 percent of the medicated patients. (University of Illinois)
2007
: Long-term users of benzodiazepines end up “markedly ill to extremely ill” and regularly suffer from symptoms of depression and anxiety. (French scientists)
2007
: In a large study of children diagnosed with ADHD, by the end of the third year “medication use was a significant marker not of beneficial outcome, but of deterioration.” The medicated children were also more likely to engage in delinquent behavior; they ended up slightly shorter, too. (NIMH)
2008
: In a national study of bipolar patients, the major predictor of a poor outcome was exposure to an antidepressant. Those who took an antidepressant were nearly four times as likely to become rapid cyclers, which is associated with poor long-term outcome. (NIMH)
A check of newspaper archives reveals that the psychiatric establishment has thoroughly succeeded in keeping this information from the public. I searched for accounts of these studies in the
New York Times
archives and in the LexisNexis database, which covers most
U.S. newspapers, and I couldn’t find a
single
instance where the results were accurately reported.
*
Newspapers, of course, would have been happy to publish these study results. However, medical news is typically generated in this way: The scientific journals, the NIH, medical schools, and pharmaceutical companies issue press releases touting certain findings as important, and reporters then sift through the releases to identify the ones they deem worthy of writing about. If no press releases are issued, or there is no other effort by the medical community to publicize the findings, then no stories appear. We can even document this blackout process at work in the NIMH’s handling of Martin Harrow’s outcomes study. In 2007, the year he published his results in the
Journal of Nervous and Mental Disease
, the NIMH issued eighty-nine press releases, many on inconsequential matters. But it did not issue one on Harrow’s findings, even though his was arguably the best study of the long-term outcomes of schizophrenia patients that had
ever
been done in the United States.
83
It’s fair to say that if the results had been the reverse, the NIMH would have sounded the press-release gong and newspapers across the country would have touted the findings.
Although reports about most of the studies listed above simply never appeared in newspapers, there were a couple of instances when psychiatrists were forced to say something to reporters about one of the studies, and each time they spun the results. For example, when the NIMH announced the three-year results from its MTA study of ADHD treatments, it did not inform the public that stimulant usage during the third year was a “marker of deterioration.” Instead, it put out a press release with this headline:
IMPROVEMENT
FOLLOWING ADHD TREATMENT SUSTAINED FOR MOST CHILDREN
. That headline told of drugs that had been
beneficial
, and while the text of the release did state that “continuing medication was no longer associated with better outcomes by the third year,” it also included a canned quote from lead author Peter Jensen stating that there was still plenty of reason to keep children on Ritalin. “Our results suggest that medication can make a long-term difference for some children if it’s continued with optimal intensity, and not started or added too late in a child’s clinical course.”
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If we want to get another look at this spinning process, we can turn to a 1998
New York Times
article that briefly told of the WHO study on schizophrenia outcomes in rich and poor countries. After interviewing psychiatrists about the study, the
Times
reporter wrote that “schizophrenics generally responded better to treatment in less developed countries than in more technologically developed countries.”
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Responded better to treatment
—readers could only assume that schizophrenia patients in India and Nigeria responded better to antipsychotic
s
than patients in the United States and other rich countries did. They had no way to know that “treatment” for 84 percent of the schizophrenia patients in the poor countries consisted of being off the drugs.
In July 2009, I also searched the NIMH and NAMI websites for some mention of the studies listed above, and I found zilch. For instance, the NIMH website did not discuss the remarkable decline in bipolar outcomes in modern times, even though Carlos Zarate, who coauthored the 2000 article that documented this decline, was head of the NIMH’s mood and anxiety disorders research unit in 2009. Similarly, NAMI’s website didn’t provide any information about Harrow’s study, even though it provides reason for parents of schizophrenic children to be
optimistic
. Forty percent of those off medications recovered over the long term! But that finding directly contradicted the message that NAMI has promoted to the public for decades, and NAMI’s website is sticking to that message. Antipsychotics, it informs the public, “correct an imbalance in the chemicals that enable brain cells to communicate with each other.”
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Finally, the entire outcomes history documented in this book is missing from the 2008 edition of the APA’s
Textbook of Psychiatry
,
which means that medical students training to be psychiatrists are kept in the dark about this history.
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The book does not discuss “supersensitivity psychosis.” It does not mention that antidepressants may be depressogenic agents over the long term. It does not report that bipolar outcomes are much worse today than they were forty years ago. There is no discussion of rising disability rates. There is no talk about the cognitive impairment that is seen in longtime users of psychotropic drugs. The textbook authors are clearly familiar with many of the sixteen studies listed above, but, if they do mention them, they don’t discuss the relevant facts about medication usage. The long-running study by Harrow, the textbook states, reveals that there are some schizophrenia patients who “are able to function without the benefit of continuous antipsychotic treatment.” The authors of that sentence didn’t mention the stunning difference in recovery rates for the unmedicated and medicated groups; instead they crafted a sentence that told of the
benefit of continuous antipsychotic treatment
. In a similar vein, while the textbook briefly discusses the WHO study on the better outcomes of schizophrenia patients in poor countries like India and Nigeria, it does not mention that patients in those countries weren’t regularly maintained on antipsychotics. In a section on benzodiazepines, the authors acknowledge that there are concerns about their addictive properties, but then state that long-term outcomes for those who stay on benzodiazepines are generally good, as most patients “maintain their therapeutic gains.”
There is a story that psychiatry doesn’t dare tell, which shows that our societal delusion about the benefits of psychiatric drugs isn’t entirely an innocent one. In order to sell our society on the soundness of this form of care, psychiatry has had to grossly exaggerate the value of its new drugs, silence critics, and keep the story of poor long-term outcomes hidden. That is a willful, conscious process, and the very fact that psychiatry has had to employ such storytelling methods reveals a great deal about the merits of this paradigm of care, much more than a single study ever could.
*
At the end of 1989, Eli Lilly obtained approval to market fluoxetine in Germany, but with a label that warned of the elevated risk of suicide.
*
In fact, eighty-four patients treated with risperidone had suffered a “serious adverse event,” which the FDA defined as a life-threatening event or one that required hospitalization.
*
There were newspaper reviews of my book
Mad in America
that mentioned the WHO study of better schizophrenia outcomes in poor countries where patients were not regularly maintained on the drugs, and since then, this information has become somewhat known. In addition, I mentioned Martin Harrow’s fifteen-year schizophrenia study in a talk I gave at Holy Cross College in February 2009, and that led to a February 8, 2009, article in the
Worcester Telegram and Gazette
(Mass.) that discussed Harrow’s work. That was the first time that news of his study had appeared in any American newspaper.
Tallying Up the Profits
“Receiving $750 checks for chatting with some
doctors during a lunch break was such easy money
that it left me giddy.”
—
PSYCHIATRIST DANIEL CARLAT (2007)
1
The walk from Jenna’s group home in Montpelier, Vermont, to the town’s Main Street is only two blocks long, and yet, on the late spring morning I visited, it took us twenty minutes to travel that distance, for Jenna had to stop every few steps and catch her balance, with her aide, Chris, constantly putting his hand up behind her in case she fell.
*
Jenna had first taken an antidepressant twelve years earlier, when she was fifteen years old, and now she was on a daily cocktail of eight drugs, including one for drug-induced Parkinsonian symptoms. As we sat outside a café, Jenna told me her story, although at times—because of her problems with motor control—it was difficult to understand her. Her tremors are so severe that when she dunked her pastry, the coffee spilled and she had trouble bringing the pastry to her lips.
“I’m sooooooo messed up,” she says.
I had gone to the interview thinking that Jenna had been diagnosed with tardive dyskinesia, an antipsychotic side effect that can disable people. But it wasn’t clear whether her motor impairments were due to that particular type of drug-induced dysfunction or to a more idiosyncratic drug-related process, and by the time the interview was over, Jenna had raised a new issue for me to think about. She told of how psychiatrists and other mental health workers had always resisted seeing any of her physical or emotional difficulties as drug-caused, but instead had regularly blamed everything on her illness, and, from her point of view, that was a thinking process dictated by monetary interests. If you wanted to understand the care she’d received, you had to understand that she was valuable to the pharmaceutical companies as a “consumer” of their medications. “Nobody,” Chris explains, “has addressed the fact that the drugs may be causing her problems.”
