January 7, 2002

FYI

MAD IN AMERICA (Perseus Press), a new book by Robert Whitaker, a prize winning science journalist, is sure to cause a stir. Whitaker holds psychiatry’s feet to the fire by examining the evidence in the professional psychiatric literature, FDA documents, published treatment outcome studies–including the World Health Organization, and patients’ testimonies.

This book shatters illusions by sheding light on the artful marketing of a succession of inhumane, toxic, even debilitating treatments that have been promoted as “breakthrough” successes, even cures.

For example, in their hay day, surgical lobotomies were hailed as “miracle brain surgery” that won its inventor, neurosurgeon Egas Moniz, a Noble Prize. First generation, neuroleptic drugs (which were introduced just as lobotomies lost their luster) were described at that time, as “chemical lobotomies” because, like surgical lobotomies the drugs induced debilitating mental and motor dysfunction. First, and second generation neuroleptic drugs continue to induce severe, disabling side effects, but their promotion has been artfully refashioned as “chemical balance” agents.

Psychiatry continues to lack any objectifiable scientific tools for diagnosing psychiatric disorders, the field is open to unverifiable interpretations. Currently it is claimed, but not proven, that people with mental disorders, including schizophrenia, depression, and even ADHD, have a “chemical imbalance” in the brain–while no one knows what a “chemical balance” of the brain should be. It is further claimed–without evidence– that the drugs restore the brain’s “chemical imbalance” by some sort of “balancing act” that improves patients’ condition and their ability to recover.

Whitaker challenges those unsubstantiated claims with sustained evidence of treatment outcome from the scientific literature and data from the World Health Organization. The data demonstrates that recovery for an American schizophrenia patient is LESS likely than for such a patient in an underdeveloped country where psychotropic drugs are in short supply.

The pre-publication reviews (below) call the book, “An absorbing, sometimes harrowing history of the medical treatment of the mentally ill in the US, from its roots in England–think Bedlam–to the present, and a scorching indictment of the status quo.” “Sure packs a wallop.” [Kirkus] “the mad in America have suffered as essentially nonconsensual experimental subjects.” [Booklist] “as fascinating as it is ultimately horrifying.” [Mother Jones]

Patients and families may find the book useful as a road map for gathering evidence needed to support legal action–either to prevent harm from forced treatment, or to claim neurological damage sustained from the drugs.

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Kirkus Reviews:

"An absorbing, sometimes harrowing history of the medical treatment of the mentally ill in the US, from its roots in England–think Bedlam–to the present, and a scorching indictment of the status quo.

Whitaker, a science reporter (who has written) for the Boston Globe, does a bang-up job of showing how treatment of the mad has reflected society's changing political views and philosophical values. He recounts how the 18th-century European view that the mentally ill were beasts to be subdued and tamed led to fearfully harsh treatment, whereas in the early 19th century, the Quaker perspective that the mentally ill were fellow human beings deserving of empathy, resulted in humane therapy emphasizing gentle kindness and the comforts of a good home. In the 20th century, the eugenics movement in the U.S., which saw the mentally ill as hereditary defectives without rights, led to brain-damaging therapies–insulin coma, metrazol-induced seizure, electroshock, and prefrontal lobotomy–that were applied without the consent of patients and robbed them of the part of the mind that made them human. In the 1950s, chlorpromazine was introduced as a chemical lobotomy, useful for making disruptive patients sluggish and manageable. However, Whitaker points out, under the influence of pharmaceutical-industry marketing efforts, it and other neuroleptics came to be seen as safe and effective antischizophrenic drugs, a view that no only benefited drug companies financially but gave psychiatry the status of a scientific discipline and provided states a rationale for discharging medicated patients from overcrowded public mental hosptials. Whitaker argues that far from being effective, neuroleptics induce pathological conditions by causing irreversible brain damage. He cites World Health Organization studies showing that in countries where doctors do not keep their schizophrenic patients on neuroleptics–India, Niger, Colombia–recovery rates are dramatically higher than in the U.S. And according to the author, the hubris of the American medical community makes change unlikely. Sure packs a wallop." ~~~~~~~

Booklist

“American psychiatry has excelled throughout the nation’s history, but doctors and drug manufacturers have profited far more than psychiatric patients. When the World Health Organization compared schizophrenics’ recovery rates in the U.S. and in nations too poor to afford the latest psychopharmaceuticals, it found that a Third World patient was exponentially likelier than an American one to regain sanity. Whitaker’s articulate dissection of “mad medicine” in the U.S. explains why that dismaying contrast obtains. Assuming that insanity arises from identifiable physical causes, American psychiatry theorized about those causes and sought to find physical therapies and, later, drugs that attacked those causes. Accordingly, from being shocked with cold water and repeatedly nearly drowned, to suffering chemically and electronically induced grand mal seizures, to having the frontal lobes of their brains chopped off, to being drugged into parkinsonism (the preferred modus nowadways), the mad in America have suffered as essentially nonconsensual experimental subjects. Since World War II, drug companies have made continued testing increasingly worthwhile, despite the lack of encouraging results. This horrifying history is all the more discomfiting because another mode of treatment was successfully used from the late eighteeenth century until the 1870s. Called moral treatment by its Quaker champions, it involved treating the mad with kindness and sympathetic companionship rather than drugs and machines. But it cost too much, and it wasn’t professional.”

–Ray Olson ~~~~~~~~~~~~~~~~~~~~~

Mother Jones

“In Mad in America Robert Whitaker laments that medical outcomes for schizophrenics in the United States “are now no better than they were in the first decades of the twentieth century, when the therapy of the day was to wrap the insane in wet sheets.” If Whitaker, a Pulitzer-nominated medical journalist from the Boston Globe, fails to examine all the social complexities behind this disturbing fact, he makes a convincing case for attributing it to the reliance on neuroleptic drugs like Thorazine and its offspring.

In 1954, when Thorazine went on the market, our mental-health system was still infused with eugenic notions of disease, under which the mentally ill were considered “defectives” to be isolated and, above all, prevented from reproducing. Insulin-induced coma, lobotomy, and electroshock were still accepted treatments for schizophrenia, and Thorazine was initially praised for producing “an effect similar to frontal lobotomy.” In the years that followed, Whitaker writes, the pharmaceutical industry, the government, and the medical profession colluded to spin neuroleptic drugs into popular treatments–despite a lack of evidence of their efficacy and abundant evidence that they “made people chronically ill, more prone to violence and criminal behavior, and more socially withdrawn.” Mad in America is a passionate, compellingly researched polemic, as fascinating as it is ultimately horrifying.”

–Ben Ehrenreich