In this astonishing and startling book, award-winning science and history writer Robert Whitaker investigates a medical mystery: Why has the number of disabled mentally ill in the United States tripled over the past two decades? Every day, 1,100 adults and children are added to the government disability rolls because they have become newly disabled by mental illness, with this epidemic spreading most rapidly among our nation’s children. What is going on?
Anatomy of an Epidemic challenges readers to think through that question themselves. First, Whitaker investigates what is known today about the biological causes of mental disorders. Do psychiatric medications fix “chemical imbalances” in the brain, or do they, in fact, create them? Researchers spent decades studying that question, and by the late 1980s, they had their answer. Readers will be startled—and dismayed—to discover what was reported in the scientific journals.
Then comes the scientific query at the heart of this book: During the past fifty years, when investigators looked at how psychiatric drugs affected long-term outcomes, what did they find? Did they discover that the drugs help people stay well? Function better? Enjoy good physical health? Or did they find that these medications, for some paradoxical reason, increase the likelihood that people will become chronically ill, less able to function well, more prone to physical illness?
This is the first book to look at the merits of psychiatric medications through the prism of long-term results. Are long-term recovery rates higher for medicated orunmedicated schizophrenia patients? Does taking an antidepressant decrease or increase the risk that a depressed person will become disabled by the disorder? Do bipolar patients fare better today than they did forty years ago, or much worse? When the National Institute of Mental Health (NIMH) studied the long-term outcomes of children with ADHD, did they determine that stimulants provide any benefit?
By the end of this review of the outcomes literature, readers are certain to have a haunting question of their own: Why have the results from these long-term studies—all of which point to the same startling conclusion—been kept from the public?
In this compelling history, Whitaker also tells the personal stories of children and adults swept up in this epidemic. Finally, he reports on innovative programs of psychiatric care in Europe and the United States that are producing good long-term outcomes. Our nation has been hit by an epidemic of disabling mental illness, and yet, as Anatomy of an Epidemic reveals, the medical blueprints for curbing that epidemic have already been drawn up.
Andrea Tone. Basic Books, 2008. The definitive history of America’s tranquilizer culture—from the Miltown sensation in the 1950s to Valium in the 1960s and 1970s to Xanax in the twenty-first century.
Andrea Tone is Canada Research Chair in the Social History of Medicine at McGill University. She is the author of numerous articles and books including Devices and Desires: A History of Contraceptives in America, named one of the Best Books of 2001 by the Washington Post, and which inspired the Emmy Award-winning PBS documentary on the birth control pill. Devices and Desires received wide acclaim. The New York Times described it as “marvelously eye-opening” and American Scientist praised it as “remarkable...richly textured...[and] engaging to read.” Her work has been featured on ABC, PBS, NPR, and the History Channel, and in the New York Times. She lives in Montreal.
"In this exciting book, Martin brilliantly sketches out a relationship between the frenetic pace of modern life and the way in which bipolar disorder is imagined and evoked. Martin describes the way the diagnosis comes to carry meaning for those who hold it and the cultural dimensions of the way in which the illness is understood and experienced."—Tanya Luhrmann, author of Of Two Minds: An Anthropologist Looks at American Psychiatry"Learned, imaginative, and insightful, Bipolar Expeditions explores experience, stigma, and performance using the varied tools of ethnography, history, and social theory. Martin's readers will return from that contested and new-found land called mania with a richer and more sophisticated understanding of a fundamental aspect of the human condition."—Charles Rosenberg, Harvard University"This is a gracefully written, lively, and wholly fascinating book. Martin offers a rich and multifaceted portrait of the role of bipolar illness—and of our notions about bipolar illness—in contemporary American society. The book is broad-ranging, both in its focus and in the theoretical perspectives it employs. I do not know of any other books that address bipolar illness in anything like this fashion."—Louis A. Sass, author of Madness and Modernism"Bipolar Expeditions is a wonderful book. It is compellingly written, elegantly structured, both deeply scholarly and intensely personal. Destined to become an instant classic, the book offers a strikingly original argument with the potential to change forever how the reader thinks about 'mental illness.' Martin is a master of popular culture. She is also in command of a vast psychiatricliterature."—Lorna A. Rhodes, University of Washington
David Healy. Johns Hopkins University Press. 2008. That conceptual entity — and thus lived reality — we call bipolar disease today is peculiarly a product of our world. It is a world in which reductionist notions of disease have come to dominate our way of thinking about sickness. It is a world of bureaucratic categories and psychopharmaceutical practice. It is a world created in part by the laboratory's accomplishments, but it is also a social world shaped in part by mass media and advertising, by corporate strategies and government policies. And, as is illustrated by highly visible contemporary debates over the problematic increase of bipolar diagnoses in children, it is shaped as well by the public contestation of such clinical judgments — decisions that are in theory individual, private, and objective.
It is in this multidimensional sense that the subject of David Healy's biography exists outside the bodies and emotions of any particular man, woman, or child. But these aggregated social, cultural, and institutional realities can and do intrude into very real bodies and minds. Healy never lets us forget the men, women, and children who feel emotional pain and incapacity no matter how much such disquieting experience is modified by drugs and ideology, by business plans and bureaucratic rationalities, by professional strategies and rewards. His subject is both timeless and timely, situated in social and cultural space, yet anchored implacably in the idiosyncratic circumstantiality of particular lives.Charles E. Rosenberg, From the Foreword
David, Healy. 1999. Harvard University Press.
When we stop at the pharmacy to pick up our Prozac, are we simply buying a drug? Or are we buying into a disease as well? The first complete account of the phenomenon of antidepressants, this authoritative, highly readable book relates how depression, a disease only recently deemed too rare to merit study, has become one of the most common disorders of our day—and a booming business to boot.
The Antidepressant Era chronicles the history of psychopharmacology from its inception with the discovery of chlorpromazine in 1951 to current battles over whether these powerful chemical compounds should replace psychotherapy. An expert in both the history and the science of neurochemistry and psychopharmacology, David Healy offers a close-up perspective on early research and clinical trials, the stumbling and successes that have made Prozac and Zoloft household names. The complex story he tells, against a backdrop of changing ideas about medicine, details the origins of the pharmaceutical industry, the pressures for regulation of drug companies, and the emergence of the idea of a depressive disease. This historical and neurochemical analysis leads to a clear look at what antidepressants reveal about both the workings of the brain and the sociology of drug marketing.
Most arresting is Healy's insight into the marketing of antidepressants and the medicalization of the neuroses. Demonstrating that pharmaceutical companies are as much in the business of selling psychiatric diagnoses as of selling psychotropic drugs, he raises disturbing questions about how much of medical science is governed by financial interest.
Ethan Watters. Simon and Schuster. 2010. It is well known that American culture is a dominant force at home and abroad; our exportation of everything from movies to junk food is a well-documented phenomenon. But is it possible America's most troubling impact on the globalizing world has yet to be accounted for? In Crazy Like Us, Ethan Watters reveals that the most devastating consequence of the spread of American culture has not been our golden arches or our bomb craters but our bulldozing of the human psyche itself: We are in the process of homogenizing the way the world goes mad.
America has been the world leader in generating new mental health treatments and modern theories of the human psyche. We export our psychopharmaceuticals packaged with the certainty that our biomedical knowledge will relieve the suffering and stigma of mental illness. We categorize disorders, thereby defining mental illness and health, and then parade these seemingly scientific certainties in front of the world. The blowback from these efforts is just now coming to light: It turns out that we have not only been changing the way the world talks about and treats mental illness — we have been changing the mental illnesses themselves.
For millennia, local beliefs in different cultures have shaped the experience of mental illness into endless varieties. Crazy Like Us documents how American interventions have discounted and worked to change those indigenous beliefs, often at a dizzying rate. Over the last decades, mental illnesses popularized in America have been spreading across the globe with the speed of contagious diseases. Watters travels from China to Tanzania to bring home the unsettling conclusion that the virusis us: As we introduce Americanized ways of treating mental illnesses, we are in fact spreading the diseases.
In post-tsunami Sri Lanka, Watters reports on the Western trauma counselors who, in their rush to help, inadvertently trampled local expressions of grief, suffering, and healing. In Hong Kong, he retraces the last steps of the teenager whose death sparked an epidemic of the American version of anorexia nervosa. Watters reveals the truth about a multi-million-dollar campaign by one of the world's biggest drug companies to change the Japanese experience of depression — literally marketing the disease along with the drug.
But this book is not just about the damage we've caused in faraway places. Looking at our impact on the psyches of people in other cultures is a gut check, a way of forcing ourselves to take a fresh look at our own beliefs about mental health and healing. When we examine our assumptions from a farther shore, we begin to understand how our own culture constantly shapes and sometimes creates the mental illnesses of our time. By setting aside our role as the world's therapist, we may come to accept that we have as much to learn from other cultures' beliefs about the mind as we have to teach.
Alan V. Horwtiz and Jerome C. Wakefield, Oxford University Press. 2009. Depression has become the single most commonly treated mental disorder, amid claims that one out of ten Americans suffer from this disorder every year and 25% succumb at some point in their lives. Warnings that depressive disorder is a leading cause of worldwide disability have been accompanied by a massive upsurge in the consumption of antidepressant medication, widespread screening for depression in clinics and schools, and a push to diagnose depression early, on the basis of just a few symptoms, in order to prevent more severe conditions from developing.
In The Loss of Sadness, Allan V. Horwitz and Jerome C. Wakefield argue that, while depressive disorder certainly exists and can be a devastating condition warranting medical attention, the apparent epidemic in fact reflects the way the psychiatric profession has understood and reclassified normal human sadness as largely an abnormal experience. With the 1980 publication of the landmark third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), mental health professionals began diagnosing depression based on symptoms—such as depressed mood, loss of appetite, and fatigue—that lasted for at least two weeks. This system is fundamentally flawed, the authors maintain, because it fails to take into account the context in which the symptoms occur. They stress the importance of distinguishing between abnormal reactions due to internal dysfunction and normal sadness brought on by external circumstances. Under the current DSM classification system, however, this distinction is impossible to make, so the expected emotional distress caused by upsetting events-for example, the loss of a job or the end ofa relationship- could lead to a mistaken diagnosis of depressive disorder. Indeed, it is this very mistake that lies at the root of the presumed epidemic of major depression in our midst.
In telling the story behind this phenomenon, the authors draw on the 2,500-year history of writing about depression, including studies in both the medical and social sciences, to demonstrate why the DSM's diagnosis is so flawed. They also explore why it has achieved almost unshakable currency despite its limitations. Framed within an evolutionary account of human health and disease, The Loss of Sadness presents a fascinating dissection of depression as both a normal and disordered human emotion and a sweeping critique of current psychiatric diagnostic practices. The result is a potent challenge to the diagnostic revolution that began almost thirty years ago in psychiatry and a provocative analysis of one of the most significant mental health issues today.
Revolution was in the air in the 1960s. Civil rights protests demanded attention on the airwaves and in the streets. Anger gave way to revolt, and revolt provided the elusive promise of actual change. But a very different civil rights history evolved at the Ionia State Hospital for the Criminally Insane in Ionia, Michigan. Here, far from the national glare of sit-ins, boycotts, or riots, African American men suddenly appeared in the asylum’s previously white, locked wards. Some of these men came to the attention of the state after participating in civil rights demonstrations, while others were sent by the military, the penal system, or the police. Though many of the men hailed from Detroit, ambulances and paddy wagons brought men from other urban centers as well. Once at Ionia, psychiatrists classified these men under a single diagnosis: schizophrenia.
In The Protest Psychosis, psychiatrist and cultural critic Jonathan Metzl tells the shocking story of how schizophrenia became the diagnostic term overwhelmingly applied to African American men at the Ionia State Hospital, and how events at Ionia mirrored national conversations that increasingly linked blackness, madness, and civil rights. Expertly sifting through a vast array of cultural documents—from scientific literature, to music lyrics, to riveting, tragic hospital charts—Metzl shows how associations between schizophrenia and blackness emerged during the 1960s and 1970s in ways that directly reflected national political events. As he demonstrates, far from resulting from the racist intentions of individual doctors or the symptoms of specific patients, racialized schizophrenia grew from a much widerset of cultural shifts that defined the thoughts, actions, and even the politics of black men as being inherently insane.
Ultimately, The Protest Psychosis provides a cautionary tale of how anxieties about race continue to impact doctor-patient interactions, even during our current, seemingly post-race era of genetics, pharmacokinetics, and brain scans.
When he began a new research project on antidepressants and placebos (a "meta-analysis" of a large number of published studies), practicing psychotherapist and research psychologist Kirsch (How Expectancies Shape Experience) was surprised to uncover evidence that inadequate supervision by the FDA had allowed pharmaceutical companies to cherry-pick test results for publication and submission to the feds, suppressing unwanted outcomes; further, apparent evidence of active drugs' effectiveness when compared to placebos could often be attributed to patients correctly guessing which group they were in based on the side effects (or the lack thereof) they had come to expect in conjunction with anti-depressants. When his results were published in early 2008, Kirsch was surprised to find himself and his research the subject of front page newspaper stories, TV and radio coverage, and a vigorous debate in the medical community that continues to this day. Writing with a broad audience in mind, Kirsch expands on this important topic in a lively style with clear, cogent explanations of the science involved, and many examples of the differences between solid and flawed research. The result is a fascinating book with broad implications for science policy.
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