BOOK REVIEW

Disability Insurance payments, to 2007, when the psychiatrist. In this book, Whitaker never Anatomy of an Epidemic: 1 in every 76 Americans was disabled by seriously considers the changes in government Magic Bullets, Psychiatric mental illness. As Whitaker notes, the rates of definitions of disability, diagnostic standards, disability because of mental illness more than family structures, alcohol and illicit drug use, Drugs, and the Astonishing doubled by this measure. He also observes a incarceration rates for the mentally ill, eco- Rise of Mental Illness dramatic increase in the prescriptions of psy- nomic inequality, a shift throughout medicine chiatric drugs over roughly the same period to prescribe, the prescribing of psychotropic in America of time. drugs by nonpsychiatrists, or any other pos- V (2010) New York: Crown He then asks an important question sible confounder. If I proposed to resolve the V Publishers. 416 pp. that of how these two observations are fascinating question Whitaker poses the re- relatedVbefore settling for a simple answer: lationship between psychiatric disability and the latter causes the former. Whitaker believes psychotropic prescriptionsVin the manner he Every psychiatrist encounters the antipsy- that, as psychiatrists prescribed more psycho- does, my study would be summarily rejected chiatry movement. It is encountered in the tropic drugs, they caused more Americans to for publication for never considering these skeptical colleague who wonders why you become mentally disabled. other possible confounders. The result is a wasted your medical degree, in the relative His thesis seems easy to dismiss, but book that is a well-narrated collection of in- who asks if you still perform lobotomies on Whitaker is a fluent writer who synthesizes terpretations that advance a singular argu- everyone, and in the patient who insists that interviews, depositions, case reports, cohort ment. Whitaker lingers over observational they would never take a psychiatric medica- studies, randomized controlled trials, and studies but crudely summarizes a complex, tion but wants alprazolam. The stigma sur- basic science studies into a single story. As I well-controlled, government-funded studyV rounding the mentally ill and those who treat read the book, recommended to me by a psy- like the Clinical Trials of In- them endures. So why should you consider chiatry intern who was shaken by its claims, tervention Effectiveness study trialVin two reading a provocative book whose dust jacket I was unsettled. Whitaker criticizes the rigor sentences, to the effect that none of the drugs compares psychotropic drugs to a phrenology of key studies, summarizes concerns that the worked. chart? DSM increases psychiatric diagnoses, details This is a shame because you could After spending a week alternately want- the compromising relationships between aca- write a complex book on the dangers of ing to throw this book across the room in dis- demic and the pharmaceutical in- polypharmacy, on the benefits of stopping gust and excitedly researching the studies it dustry, and shows how the selective reporting and starting psychotropic medications grad- cites, I found three reasons. First, Whitaker of data skews perceptions of the efficacy and ually, on trying to decide who needs psycho- reviews decades of studies, explores novel safety of psychotropic drugs. tropic drugs and who does not, on the need mental health programs, and interviews many The trouble is that, while there is merit for well-designed long-term studies of the people with mental illness. Whitaker raises im- to many of these criticisms, Whitaker’s ar- consequences of using psychotropic drugs, portant questions about the misuse and over- gument is totalizing. He does not simply on whether (and which) psychosocial inter- use of psychotropic drugs and introduced me criticize the use of alprazolam for anxiety, ventions are more or less helpful than psy- to the thought-provoking longitudinal studies something many psychiatrists second, but he chotropic drugs, and on the need to reform conducted by Ross Baldessarini and Martin criticizes the use of every psychotropic drug the relationships between psychiatrists and Harrow. Second, the book is being compared for every chronic mental illness. Each agent the . The data gath- to Rachel Carson’s Silent Spring, and Whitaker he considersVantipsychotic, , ered by Whitaker would inform that book, a hopes to spark an analogous reform move- , lithium, and stimulantsVare book that acknowledges the limits of psy- ment. Whitaker has spoken at multiple con- ultimately ‘‘pathological agents.’’ In his con- chiatric knowledge and the irreducible com- ferences, delivered a grand rounds presentation clusion, he acknowledges that medications plexity of people with mental illness. Instead, at the Massachusetts General Hospital Depart- can be used for ‘‘some people’’ but then Whitaker is just as crass a materialist as ment of Psychiatry, and founded a nonprofit demands that psychiatry ‘‘admit that the the psychiatrists he caricatures, settling for a organization called the Foundation for Excel- drugs, rather than fix chemical imbalances in simple but crude interpretation: those drugs lence in Mental Health Care. Whitaker is ad- the brain, perturb the normal functioning of messed you up. vancing his argument, and psychiatrists should neurotransmitter pathways’’ (p. 333). In this respond. Finally, his book is an object lesson statement, the expansive sweep of Whitaker’s in the hazards of interpretation. interpretation becomes clear: I know of no se- Whitaker begins by making two ob- rious psychiatrist who believes that psycho- Abraham M. Nussbaum, MD, MTS servations. He observes a startling rise in the tropic drugs ‘‘fix chemical imbalances in the Denver Health rates of psychiatric disability from 1987, when brains’’ of their patients. and Department of Psychiatry 1 in every 184 Americans was disabled by The problem is, as it so often is in University of Colorado mental illness as defined by receiving Supple- antipsychiatry literature, that the assumption School of Medicine mental Security Income or Social Security that the critical factor in any bad outcome is Denver, CO

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