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