Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America

The gist of the book is that we still do not know quite how psychotropic medicines work, and the way they are prescribed is a result of an intentional “re-medicalization” of psychiatry by the APA, through DSM-III and up.

Mind-acting medicines have become a far too common first resort for diagnoses of dubious maladies, such as bi-polar disorder of a two-year-old. Granted, a single data point is merely an anecdote, but an avalanche of them is concerning. There is a pattern to this over-prescription of mystery drugs, a mechanism by which it ratchets upward, several roots of the problem which have propelled it to the current state, and a widespread, growing body of evidence that less drugs makes better recoveries.

This is not to say that there is not a valid role for psychotropic prescriptions; to the contrary. Some large fraction of the population in question are genuinely helped, and would be flat out of luck without them. The problem comes in when that fraction shrinks relative to the population which are served these drugs, with an arriving wave of people who have not been helped, but harmed by hasty prescription and poorly thought-out programming of primary and alternate courses of medicine (or whatever you call it when you say, Hm, the Zoloft seems not to work so wall — how about some Xanax?).

I get that people respond differently to different medications, and that much of the initial stage of addressing mental health issues is an exploratory process. The book is full of examples and portrays a general mechanism whereby rigor behind this process is honored in the breach in a wide segment of cases. A huge fact surfacing from beneath a troubled sea is the number and severity of people who have been harmed through exposure to psychotropic drugs; whose current very real mental medical issues may well have been caused by the hammer-for-mosquito approach of powerful drugs for transitory problems, or those amenable to simpler, less caustic solutions.

If there were no widespread valid use for psychotropic drugs, we very likely wouldn’t have them. I’m comfortable with that. By the same token, if there were no pattern of people, especially youth, being flattened and fried by these medicines out of ignorance and in some cases a pill-pushing mentality (the well-documented “magic bullet” mindset), then we wouldn’t see the popular backlash building.

A popular backlash proves nothing, as evidenced by the ridiculous anti-vaccine mob. Marching Morons are very real, and they may well carry the day. Everybody has their chosen moron — Al Gore thinks it’s me, I think it’s the Vaxxers, and I have no idea who the Vaxxers look down upon (aside from people who get their kids vaccinated). So I don;t take mere counter-scientific complaining from somebody’s audiobook as a prima facie case before me.

The book is buttressed with a rotating slew of case studies and historical documentation. The author relates political, personal, professional, and bureaucratic maneuvers evidenced across hundreds of years in the development of trains of thought which have risen and fallen, bringing us to where we are today. The DSM-series, for example, doesn’t get the way it is by accident, nor through rigorous application of scientific principles. This is the same book that says genitalia are no indicator of sex, or “gender”, to use a word quite inappropriately borrowed from linguistics. Rather, the DSM is an edited document like any other, and like a news show, it both reflects and drives the current state of thinking in the psychiatric community.

One thing that the APA diagnosed was it own lack of prestige relative to other medical fields for some time in the last century. It wrote itself a prescription, the DSM-III, for psychotropic drugs. The third edition streamlined and standardized diagnostic criteria for mental maladies, and did not focus them. A great increase was seen on those strands which connected particular symptoms to the issuing of powerful mind meds. The release of the DSM-III, more than any other single event, drove the increase in prescriptions for psychotropic drugs. This doesn’t make it the Necronomicon — it just came with some consequences that were not entirely unintended, and which have proven difficult to get back in the bottle for a number of reasons.

It is not as though the profession is filled with hand-rubbing lizard-like figures gleeful to shove more pills down some unsuspecting throats. But a profession with great power also carries great responsibility. Part of that includes facing up to criticism, and entails a willingness to re-consider supposedly settled facts from time to time. Each family of psychotropic drug was brought to prominence as a side effect. Not one family of these medicines has come about as a result of understanding the problem, and then striving to engineer a solution. At a minimum, and even if nothing else were of concern, this shaky foundation should constitute sufficient call to continually re-examine the current state of knowledge in this field.

In my own analogy, I liken the state of science to mixing fuel additives to tune the performance of a car which we strongly suspect is carbureted. If it’s fuel-injected, it’s probably central-point. Oh, and the fuel additives are concocted from kitchen supplies — we were originally trying to pickle eggs.


This is an eye-opening book. If you have grown suspicious that medicating two-year-olds for supposed bi-polar disorder is wrong, and that the boom in mental illness is not what it’s reported to be, then you have felt the skeleton of an ugly, primitive beast. Author Robert Whitaker puts the flesh on those bones, and reveals the whole shaggy shambling monster for what it is. Via the mental health racket, we are a society at war with itself, doing great damage and claiming great victories.


I finished listening to Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker, narrated by Ken Kliban on my Audible app.

Try Audible and get it free: https://www.audible.com/pd/B003MXR26W?source_code=AFAORWS04241590G4

 

 

 


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24 thoughts on “Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America”

  1. I don’t know what happened but it seems everyone has mental issues and needs medication now. I worry that the meds take away the ability for people to cope. I am not sure but I think the physical nature of most jobs kept people sane. Exercise is a good way to relieve stress. Now people are in front of screens and keyboards which adds stress.

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  2. 10 Cents:
    I don’t know what happened but it seems everyone has mental issues and needs medication now. I worry that the meds take away the ability for people to cope. I am not sure but I think the physical nature of most jobs kept people sane. Exercise is a good way to relieve stress. Now people are in front of screens and keyboards which adds stress.

    Yup.  You’re tracking.

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  3. Haakon Dahl:

    10 Cents:
    I don’t know what happened but it seems everyone has mental issues and needs medication now. I worry that the meds take away the ability for people to cope. I am not sure but I think the physical nature of most jobs kept people sane. Exercise is a good way to relieve stress. Now people are in front of screens and keyboards which adds stress.

    Yup.  You’re tracking.

    Do you think some of this has to do with the “Blizzard of Snowflakes” recently?

    The Greatest Generation conquered Europe before breakfast.

    The New Generation can’t get out of bed because someone might use a wrong word. “I need a Xanax.”

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  4. I will say this and be done because I don’t think I will change any minds:

    Having lived 25 years in community mental health, I know there are many people untreated who need help. Mental Illness can be horrible. I have seen medications help many many people. You may want to say I am part of the problem, biased, hell, even taking payments from the Drug companies. That is fine.

    If you want to look for changing the rules to sell drugs, Blood Pressure is where it is at. They have redefined high blood pressure down so much that 50% of Americans have it. When the panel making that decision includes people who’s companies sell high blood pressure medicine that says something.

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  5. Bryan, I agree that we are drowning in the “working wounded”, many of whom would benefit from a good reset.

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  6. Bryan G. Stephens:
    I will say this and be done because I don’t think I will change any minds:

    Having lived 25 years in community mental health, I know there are many people untreated who need help. Mental Illness can be horrible. I have seen medications help many many people. You may want to say I am part of the problem, biased, hell, even taking payments from the Drug companies. That is fine.

    If you want to look for changing the rules to sell drugs, Blood Pressure is where it is at. They have redefined high blood pressure down so much that 50% of Americans have it. When the panel making that decision includes people who’s companies sell high blood pressure medicine that says something.

    Bryan, it would be wrong to say no one needs help but I do worry that there is over diagnosing. There are many degrees and ways to bring health.

    How many people are cured in your opinions?

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  7. 10 Cents:

    Bryan G. Stephens:
    I will say this and be done because I don’t think I will change any minds:

    Having lived 25 years in community mental health, I know there are many people untreated who need help. Mental Illness can be horrible. I have seen medications help many many people. You may want to say I am part of the problem, biased, hell, even taking payments from the Drug companies. That is fine.

    If you want to look for changing the rules to sell drugs, Blood Pressure is where it is at. They have redefined high blood pressure down so much that 50% of Americans have it. When the panel making that decision includes people who’s companies sell high blood pressure medicine that says something.

    Bryan, it would be wrong to say no one needs help but I do worry that there is over diagnosing. There are many degrees and ways to bring health.

    How many people are cured in your opinions?

    Cured of what? Severe and Persistent mental Illness is not cured, it is managed, like any other chronic illness.

    And from a therapy side, there is always some work we can do. We are never fully integrated, but always working on better integrating. The whole “life is a journey” thing.

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  8. Bryan G. Stephens:

    10 Cents:

    Bryan G. Stephens:
    I will say this and be done because I don’t think I will change any minds:

    Having lived 25 years in community mental health, I know there are many people untreated who need help. Mental Illness can be horrible. I have seen medications help many many people. You may want to say I am part of the problem, biased, hell, even taking payments from the Drug companies. That is fine.

    If you want to look for changing the rules to sell drugs, Blood Pressure is where it is at. They have redefined high blood pressure down so much that 50% of Americans have it. When the panel making that decision includes people who’s companies sell high blood pressure medicine that says something.

    Bryan, it would be wrong to say no one needs help but I do worry that there is over diagnosing. There are many degrees and ways to bring health.

    How many people are cured in your opinions?

    Cured of what? Severe and Persistent mental Illness is not cured, it is managed, like any other chronic illness.

    And from a therapy side, there is always some work we can do. We are never fully integrated, but always working on better integrating. The whole “life is a journey” thing.

    Bryan, I don’t know what the right analogy is but are you saying it is more of a “gas station” than a “repair shop”.

    I am speaking from ignorance but I see people not getting better. They still have a lot of ups and downs. It would be nice to see them more independent and more solid.

    In your experience, do people ever get off the drugs or is it more like they need to keep taking them to manage their care till they die?

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  9. For those who prefer print, here are the paperback and Kindle editions of Anatomy of an Epidemic.

    In 2006, I read Artificial Happiness by Ronald M. Dworkin, which concentrates mostly on the widespread prescription of antidepressants, often by general practitioners, to people who are not clinically depressed but basically, just unhappy.  This is an important topic (especially given the side effects of these medications, not to mention the consequences of tens of millions of people including youth and adolescents being medicated as opposed to doing something about the causes of their unhappiness), but I do not recommend the book.  Here’s a pull quote from my review.

    These are serious questions, and deserve serious investigation and a book-length treatment of the contemporary scene and trends. This is not, however, that book. The author is an M.D. anæsthesiologist with a Ph.D. in political philosophy from Johns Hopkins University, and a senior fellow at the Hudson Institute—impressive credentials. Notwithstanding them, the present work reads like something written by somebody who learned Marxism from a comic book. Individuals, entire professions, and groups as heterogeneous as clergy of organised religions are portrayed like cardboard cutouts—with stick figures drawn on them—in crayon. Each group the author identifies is seen as acting monolithically toward a specific goal, which is always nefarious in some way, advancing an agenda based solely on its own interest. The possibility that a family doctor might prescribe antidepressants for an unhappy patient in the belief that he or she is solving a problem for the patient is scarcely considered. No, the doctor is part of a grand conspiracy of “primary care physicians” advancing an agenda to usurp the “turf” (a term he uses incessantly) of first psychiatrists, and finally organised religion.

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  10. 10 Cents:

    Bryan G. Stephens:

    10 Cents:

    Bryan G. Stephens:
    I will say this and be done because I don’t think I will change any minds:

    Having lived 25 years in community mental health, I know there are many people untreated who need help. Mental Illness can be horrible. I have seen medications help many many people. You may want to say I am part of the problem, biased, hell, even taking payments from the Drug companies. That is fine.

    If you want to look for changing the rules to sell drugs, Blood Pressure is where it is at. They have redefined high blood pressure down so much that 50% of Americans have it. When the panel making that decision includes people who’s companies sell high blood pressure medicine that says something.

    Bryan, it would be wrong to say no one needs help but I do worry that there is over diagnosing. There are many degrees and ways to bring health.

    How many people are cured in your opinions?

    Cured of what? Severe and Persistent mental Illness is not cured, it is managed, like any other chronic illness.

    And from a therapy side, there is always some work we can do. We are never fully integrated, but always working on better integrating. The whole “life is a journey” thing.

    Bryan, I don’t know what the right analogy is but are you saying it is more of a “gas station” than a “repair shop”.

    I am speaking from ignorance but I see people not getting better. They still have a lot of ups and downs. It would be nice to see them more independent and more solid.

    In your experience, do people ever get off the drugs or is it more like they need to keep taking them to manage their care till they die?

    I am comfortable with the idea that somethings get cured, some things get treated, and some things get the upper hand.  Obviously, the goal is to move each thing from worse categories to better.

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  11. 10 Cents:

    Bryan G. Stephens:

    10 Cents:

    Bryan G. Stephens:
    I will say this and be done because I don’t think I will change any minds:

    Having lived 25 years in community mental health, I know there are many people untreated who need help. Mental Illness can be horrible. I have seen medications help many many people. You may want to say I am part of the problem, biased, hell, even taking payments from the Drug companies. That is fine.

    If you want to look for changing the rules to sell drugs, Blood Pressure is where it is at. They have redefined high blood pressure down so much that 50% of Americans have it. When the panel making that decision includes people who’s companies sell high blood pressure medicine that says something.

    Bryan, it would be wrong to say no one needs help but I do worry that there is over diagnosing. There are many degrees and ways to bring health.

    How many people are cured in your opinions?

    Cured of what? Severe and Persistent mental Illness is not cured, it is managed, like any other chronic illness.

    And from a therapy side, there is always some work we can do. We are never fully integrated, but always working on better integrating. The whole “life is a journey” thing.

    Bryan, I don’t know what the right analogy is but are you saying it is more of a “gas station” than a “repair shop”.

    I am speaking from ignorance but I see people not getting better. They still have a lot of ups and downs. It would be nice to see them more independent and more solid.

    In your experience, do people ever get off the drugs or is it more like they need to keep taking them to manage their care till they die?

    People with bi polar or schizophrenia are going to be on meds for the rest of their lives to manage it. It is chronic.

    I also think they should seek therapy to help address those sx.

    Major Depression can see a remission as high as 80% with drugs and talk therapy. That is remission. That is not a cure.

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  12. On anti-depressants, I have seen many people benefit from ongoing use. It is not just getting to the mood “happy” but better quality of life. They do best, when they couple it with therapy. In America, people want the pill, not the work of therapy. Therapy is work.

    Trying to be “happy” all the time is a fool’s errand. We should pursue meaning instead. No pill will give you that.

    We are always going to have ups and downs.

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  13. Bryan G. Stephens:

    10 Cents:

    Bryan G. Stephens:

    10 Cents:

    Bryan G. Stephens:
    I will say this and be done because I don’t think I will change any minds:

    Having lived 25 years in community mental health, I know there are many people untreated who need help. Mental Illness can be horrible. I have seen medications help many many people. You may want to say I am part of the problem, biased, hell, even taking payments from the Drug companies. That is fine.

    If you want to look for changing the rules to sell drugs, Blood Pressure is where it is at. They have redefined high blood pressure down so much that 50% of Americans have it. When the panel making that decision includes people who’s companies sell high blood pressure medicine that says something.

    Bryan, it would be wrong to say no one needs help but I do worry that there is over diagnosing. There are many degrees and ways to bring health.

    How many people are cured in your opinions?

    Cured of what? Severe and Persistent mental Illness is not cured, it is managed, like any other chronic illness.

    And from a therapy side, there is always some work we can do. We are never fully integrated, but always working on better integrating. The whole “life is a journey” thing.

    Bryan, I don’t know what the right analogy is but are you saying it is more of a “gas station” than a “repair shop”.

    I am speaking from ignorance but I see people not getting better. They still have a lot of ups and downs. It would be nice to see them more independent and more solid.

    In your experience, do people ever get off the drugs or is it more like they need to keep taking them to manage their care till they die?

    People with bi polar or schizophrenia are going to be on meds for the rest of their lives to manage it. It is chronic.

    I also think they should seek therapy to help address those sx.

    Major Depression can see a remission as high as 80% with drugs and talk therapy. That is remission. That is not a cure.

    What are the percentages in the general population for these?

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  14. 10 Cents:

    Bryan G. Stephens:

    10 Cents:

    Bryan G. Stephens:

    10 Cents:

    Bryan G. Stephens:
    I will say this and be done because I don’t think I will change any minds:

    Having lived 25 years in community mental health, I know there are many people untreated who need help. Mental Illness can be horrible. I have seen medications help many many people. You may want to say I am part of the problem, biased, hell, even taking payments from the Drug companies. That is fine.

    If you want to look for changing the rules to sell drugs, Blood Pressure is where it is at. They have redefined high blood pressure down so much that 50% of Americans have it. When the panel making that decision includes people who’s companies sell high blood pressure medicine that says something.

    Bryan, it would be wrong to say no one needs help but I do worry that there is over diagnosing. There are many degrees and ways to bring health.

    How many people are cured in your opinions?

    Cured of what? Severe and Persistent mental Illness is not cured, it is managed, like any other chronic illness.

    And from a therapy side, there is always some work we can do. We are never fully integrated, but always working on better integrating. The whole “life is a journey” thing.

    Bryan, I don’t know what the right analogy is but are you saying it is more of a “gas station” than a “repair shop”.

    I am speaking from ignorance but I see people not getting better. They still have a lot of ups and downs. It would be nice to see them more independent and more solid.

    In your experience, do people ever get off the drugs or is it more like they need to keep taking them to manage their care till they die?

    People with bi polar or schizophrenia are going to be on meds for the rest of their lives to manage it. It is chronic.

    I also think they should seek therapy to help address those sx.

    Major Depression can see a remission as high as 80% with drugs and talk therapy. That is remission. That is not a cure.

    What are the percentages in the general population for these?

    Schizophrenia is fortunately rare. We see maybe .3 to .7% of the population, with no effects from socio-economic status. Interestingly, being born in the winter months or higher latitudes seem to correlate with higher rates.

    Major Depression is much more common, and may be as high at 5-6% for adults.

    Rates of bipolar are around 3-4%.

    The thing is, that what we really are diagnosis are syndromes, not diseases. We look at a cluster of symptoms and label it an illness. As time goes on, what gets called what, changes. Autism rates have gone up, in part, because Autism has been redefined. 25 years ago doctors talked about “agitated depression” that today is more likely to be called “bi-polar, mixed”. (BTW bi polar depression is a lot more resistant to medication, and that population is more at risk of suicide).

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  15. Bryan G. Stephens:

    10 Cents:

    Bryan G. Stephens:

    10 Cents:

    Bryan G. Stephens:

    10 Cents:

    Bryan G. Stephens:
    I will say this and be done because I don’t think I will change any minds:

    Having lived 25 years in community mental health, I know there are many people untreated who need help. Mental Illness can be horrible. I have seen medications help many many people. You may want to say I am part of the problem, biased, hell, even taking payments from the Drug companies. That is fine.

    If you want to look for changing the rules to sell drugs, Blood Pressure is where it is at. They have redefined high blood pressure down so much that 50% of Americans have it. When the panel making that decision includes people who’s companies sell high blood pressure medicine that says something.

    Bryan, it would be wrong to say no one needs help but I do worry that there is over diagnosing. There are many degrees and ways to bring health.

    How many people are cured in your opinions?

    Cured of what? Severe and Persistent mental Illness is not cured, it is managed, like any other chronic illness.

    And from a therapy side, there is always some work we can do. We are never fully integrated, but always working on better integrating. The whole “life is a journey” thing.

    Bryan, I don’t know what the right analogy is but are you saying it is more of a “gas station” than a “repair shop”.

    I am speaking from ignorance but I see people not getting better. They still have a lot of ups and downs. It would be nice to see them more independent and more solid.

    In your experience, do people ever get off the drugs or is it more like they need to keep taking them to manage their care till they die?

    People with bi polar or schizophrenia are going to be on meds for the rest of their lives to manage it. It is chronic.

    I also think they should seek therapy to help address those sx.

    Major Depression can see a remission as high as 80% with drugs and talk therapy. That is remission. That is not a cure.

    What are the percentages in the general population for these?

    Schizophrenia is fortunately rare. We see maybe .3 to .7% of the population, with no effects from socio-economic status. Interestingly, being born in the winter months or higher latitudes seem to correlate with higher rates.

    Major Depression is much more common, and may be as high at 5-6% for adults.

    Rates of bipolar are around 3-4%.

    The thing is, that what we really are diagnosis are syndromes, not diseases. We look at a cluster of symptoms and label it an illness. As time goes on, what gets called what, changes. Autism rates have gone up, in part, because Autism has been redefined. 25 years ago doctors talked about “agitated depression” that today is more likely to be called “bi-polar, mixed”. (BTW bi polar depression is a lot more resistant to medication, and that population is more at risk of suicide).

    [spoiler title="Kidding"] I wanted to the know the percentages of the Ratburger population who are suffering. Don’t mention names. Just post avatar pictures so no one will know who you are talking about. [/spoiler]

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  16. I have seen both autism and depression successfully treated with medications.   In some cases, I am familiar with patients undergoing some mystery metabolic change that sent them spiraling into chaos, with several months of trial-and-error needed to develop a new treatment regime.

    It takes patient family support and diligent healthcare professionals to help some patients navigate really frustrating conditions.   Perseverance is required.

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  17. Very quickly, I will add that another book that’s come across my radar screen is Saving Normal by Allen Frances, M.D.   I haven’t read it thoroughly so please don’t mistake this as a recommendation, however, he does address what he believes to be the over-diagnosis of psychiatric disorders and subsequent over-medication of same.

    Since I am snowed in today (another 3″ of global warming fell on us last night) it will give me a chance to revisit it.

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  18. Susan in Seattle:
    Very quickly, I will add that another book that’s come across my radar screen is Saving Normal by Allen Frances, M.D.   I haven’t read it thoroughly so please don’t mistake this as a recommendation, however, he does address what he believes to be the over-diagnosis of psychiatric disorders and subsequent over-medication of same.

    Since I am snowed in today (another 3″ of global warming fell on us last night) it will give me a chance to revisit it.

    I knew Bryan was trying to get us all under his care. Thanks, Susan.

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