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Bipolar Disorder

Hypotheses, Scientific Evidence and On Being Compared to an AIDS Denier

Exploring a medical puzzle

In today’s Boston Globe (April 14), Dr. Dennis Rosen, a pediatric lung and sleep specialist at Children’s Hospital in Boston, reviews my new book, Anatomy of an Epidemic. He also posted this review on his Psychology Today blog.

I am actually quite grateful for it, even though it’s a negative review. I expected that defenders of the medical faith would be critical of the book, but even so, it helps to stir a conversation that I hope will become a larger one in our society about the long-term effects of psychiatric medications.

As Dr. Rosen notes, the book does raise a hypothesis. Since Prozac’s arrival on the scene in 1987, the number of adults on government disability due to mental illness has tripled, leaping from 1.25 million in 1987 to 4 million today. The number of children receiving a government disability payment due to mental illness has risen from 16,200 in 1987 to 561,569 in 2007. So my hypothesis is this: Could our drug-based paradigm of care, in some unforeseen way, be fueling this epidemic of disabling mental illness?

To answer that question, I reviewed 50 years of outcomes literature for four major adult disorders: schizophrenia, anxiety, depression and bipolar illness. I did the same for three childhood disorders: depression, ADHD, and juvenile bipolar illness. I looked to see in particular whether psychiatric medications have altered the long-term course of the disorders for the better or for the worse, and also whether psychiatric medications could, at times, stir new and more severe psychiatric symptoms in patients. In other words, I looked to see whether this paradigm of care increased the risk that a person would become chronically ill, and ill too with disabling symptoms.

My intent, with this book, is to present the long-term data to readers, as it has regularly been kept hidden from the public. They can then evaluate for themselves whether they think that the data shows that our drug-based paradigm of care is, in fact, fueling our society’s epidemic of disabling mental illness. The first physician in the U.K. to review Anatomy of an Epidemic, Druin Burch, wrote this for the New Scientist:

“Up close, [Whitaker’s] arguments are worryingly sane and consistently based on evidence. They amount to a provocative yet reasonable thesis, one whose astonishing intellectual punch is delivered with the gripping vitality of a novel. Whitaker manages to be damning while remaining stubbornly optimistic in this enthralling and frighteningly persuasive book.”

Dr. Rosen came to the opposite conclusion. He writes: “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.” Fair enough. As I said, my hope with this book is to have readers decide for themselves whether the data supports the hypothesis, and, in that way, perhaps the book will stir a larger discussion on why our society is seeing such a rise in the number of people on government disability due to mental illness (and on the overall merits of our drug-based paradigm of care.)

But then Dr. Rosen closes his piece by subtly comparing me to an AIDS denier! Now I have to say, I think this is a bit over the top. All I do in this book is follow the evidence trail. It is a book that seeks an “evidence-based” explication for the epidemic, and as such, it applies a mainstream medical method to depicting the long-term merits of psychiatric medications. I embrace the very value that American medicine declares should drive its use of therapies, and any honest review of the book should acknowledge that.

Now to the more important point. I do think Dr. Rosen and those who say that the book fails to make its case then need to answer such questions as these:

a) What do they think is causing the astonishing rise in the number of disabled mentally ill in this country today?

b) Why does depression run a more chronic course today than it did in the pre-antidepressant era?

c) Why have bipolar outcomes deteriorated so notably in modern times? Why has the employment rate for people with this disorder declined from 85% in the pre-lithium era to around 35% today? Why do people with bipolar today show evidence of long-term cognitive decline, when they didn’t used to?

d) In Martin Harrow’s long-term study of schizophrenia outcomes, which was funded by the NIMH, the 15-year recovery rate for those off medication was 40 percent, versus 5 percent for those on medication. Why weren’t the results from that study announced to the press and published in newspapers nationwide?

Such are just a few of the many questions raised by Anatomy of an Epidemic. At the very least, I think these are questions that our society needs to address.

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