http://www.boston.com/ae/books/articles/2010/04/14/tying_the_rise_in_mental_illness_to_drugs_used_in_its_treatment/

ANATOMY OF AN EPIDEMIC: Magic Bullets,
Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America By
Robert Whitaker

Crown, 416 pp., $26

In “Anatomy of an Epidemic’’
Whitaker presents his theory that the dramatic increase in mental illness in the
United States since World War II is the direct result of the medicines
psychiatrists have been prescribing to treat it, and that this itself stems from

an unholy alliance between the pharmaceutical industry and corrupt physicians.
However, although extensively researched and drawing upon hundreds of sources,
the gaps in his theory remain too large for him to succeed in making a
convincing argument.

Whitaker cites studies showing better outcomes for
patients with depression or schizophrenia who have come off their medications
than for those who have stayed on them, but doesn’t consider the possibility
that this may be because those with milder disease recovered and no longer
needed medications, while those who were sicker to begin with simply could not
do without them.

He also includes the stories of individual patients, all
of whom fared poorly on psychiatric medications and did better after coming off
them. One was of a young woman from Seattle prescribed an antidepressant at age
11 to treat her bed-wetting, who then became agitated and spiraled into
full-blown psychosis. When Whitaker met her at age 21 she was living in a group
home for the severely mentally ill, mute, and withdrawn. Her story is
heartbreaking, and the implication is that her deterioration was triggered by
the medications she was given.

But how can one be certain of this?
Perhaps she was destined for mental illness through a combination of her genes
and the environment in the same way that some children develop cancer,
irrespective of any medications they may be taking. Perhaps without the
medications given to treat her psychosis her course would have been even worse.
Many children are treated with tricyclics for bed-wetting and the vast majority
do fine. A single case does not prove the rule, and here lies the basic problem
of this book. As Whitaker himself points out, there simply are not enough data

from well-designed, trustworthy studies. And without this information, it is
impossible to conclude anything meaningful about cause and effect.

Though
there remain unanswered questions about the efficacy of some psychiatric
medications in some patients and their long-term consequences, there is no
denying that they have brought about a huge improvement in quality of life for
millions. While it is reasonable for Whitaker to raise his concerns, it is
critical to remember that hypothesis is no substitute for data.

Ignoring
this can lead to disastrous consequences, such as occurred in South Africa at
the turn of this century. Thabo Mbeki, then president of that country, refused

to accept that AIDS was caused by the HIV virus, believing instead that it was a
side effect of malnutrition and the medications used to treat AIDS itself. In
the absence of an effective treatment and prevention program, it is estimated
that 365,000 South Africans died prematurely of AIDS between the years 2000-05
(currently, 18.1 percent of South African adults have HIV/AIDS).

Those
who would seize the opportunity to cast psychiatry as a discipline into the
rubbish heap without consideration for the benefits it has brought to so many
would do well to remember how Mbeki’s inability to distinguish between theory
and fact exacted such an enormous toll in human life and
suffering.

Dr. Dennis Rosen is a pediatric lung and sleep specialist
at Children’s Hospital Boston and an instructor in pediatrics at Harvard Medical
School.
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